The durability of previous examinations for cancer: Danish nationwide cohort study

Background: Patients previously examined for cancer with a negative result may present in general practice with ongoing or new symptoms or signs suggestive of cancer. Aim: To explore the potential existence of a relatively safe period for cancer occurrence after receiving negative examination results for specific types of cancer, including lung (CT thorax), upper gastrointestinal (gastroscopy), colorectal (colonoscopy), bladder (cystoscopy), and breast (clinical mammography). Design: and Setting: Register-based time-to-event analyses were conducted, starting on January 1 st ,2017, involving all 3.3 million Danish citizens aged 30-85 years who had not previously been diagnosed with the specific types of cancer. Method: The population was categorized based on the time since their most recent examination. Using one-year follow-up, we calculated the age- and sex-adjusted hazard ratios of being diagnosed with the related cancer, with non-examined individuals as reference. Negative examination results were defined as the absence of a cancer diagnosis within six months following the examination. Results: : Previous negative examination results were common, also among those diagnosed with cancer during follow-up. Individuals with a negative colonoscopy had nearly half the risk of being diagnosed with colorectal cancer. However, already one year after a clinical mammography and two years after a CT thorax the risk of diagnosing the related cancers was significantly higher among those with a previous negative result compared to non-examined individuals. Conclusion: This study did not identify a post-examination period in which the cancer risk, compared to non-examined individuals, was sufficiently low to confidently rule out any of the investigated cancers.