H.Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA.
Cancer Epidemiol Biomarkers Prev. 2012 Mar;21(3):474-81. doi: 10.1158/1055-9965.EPI-11-1087. Epub 2012 Jan 11.
The recent decrease in myeloid leukemia incidence may be directly attributed to changes in the population-based cancer registries 2001 guidelines, which required the capture of only one malignancy in the myeloid lineage per person and the simultaneous adoption of myelodysplastic syndrome registration in the United States.
We constructed four claims-based algorithms to assess myeloid leukemia incidence, applied the algorithms to the 1999-2008 Surveillance Epidemiology and End Results (SEER)-Medicare database, and assessed algorithm validity using SEER-registered cases.
Each had moderate sensitivities (75%-94%) and high specificities (>99.0%), with the 2+BCBM algorithm showing the highest specificity. On the basis of the 2+BCBM algorithm, SEER registered only 50% of the acute myelogenous leukemia cases and a third of the chronic myelogenous leukemia (CML) cases. The annual incidence of myeloid leukemia in 2005 was 26 per 100,000 persons 66 years or older, much higher than the 15 per 100,000 reported by SEER using the same sample.
Our findings suggest underreporting of myeloid leukemias in SEER by a magnitude of 50% to 70% as well as validate and support the use of the 2+BCBM claims algorithm in identifying myeloid leukemia cases. Use of this algorithm identified a high number of uncaptured myeloid leukemia cases, particularly CML cases.
Our results call for the commitment of more resources for centralized cancer registries so that they may improve myeloid leukemia case ascertainment, which would empower policy makers with ability to properly allocate limited health care resources.
髓系白血病发病率的近期下降可能直接归因于基于人群的癌症登记处 2001 年指南的变化，该指南要求每人仅捕获髓系谱系中的一种恶性肿瘤，同时在美国采用骨髓增生异常综合征登记。
我们构建了四个基于索赔的算法来评估髓系白血病的发病率，将这些算法应用于 1999 年至 2008 年监测、流行病学和最终结果（SEER）-医疗保险数据库，并使用 SEER 登记的病例评估算法的有效性。
每种算法的敏感性（75%-94%）均较高，特异性（>99.0%）较高，2+BCBM 算法的特异性最高。基于 2+BCBM 算法，SEER 仅登记了 50%的急性髓细胞性白血病病例和三分之一的慢性髓细胞性白血病（CML）病例。2005 年，66 岁及以上人群中每 100,000 人中有 26 例髓系白血病，远高于 SEER 同期报告的每 100,000 人 15 例。
我们的研究结果表明，SEER 对髓系白血病的报告不足 50%至 70%，并验证和支持使用 2+BCBM 索赔算法来识别髓系白血病病例。该算法的使用确定了大量未捕获的髓系白血病病例，尤其是 CML 病例。
我们的研究结果呼吁为中央癌症登记处投入更多资源，以便它们能够提高髓系白血病病例的确定能力，从而使决策者有能力合理分配有限的医疗保健资源。
