Holleczek B, Brenner H
Dr. sc. hum. Bernd Holleczek, Saarland Cancer Registry, Präsident Baltz Straße 5, 66119 Saarbrücken, Germany, E-mail:
Methods Inf Med. 2016;55(2):182-92. doi: 10.3414/ME15-01-0004. Epub 2015 Dec 18.
Population-based cancer registries (CRs) are powerful tools for measuring cancer burden and progress against cancer. The study's objective was to investigate the effects of under-reporting at lifetime, death certificate notifications, and trace-back on the incidence a newly established population-based CR may record during its initial 15 years of operation.
Using cancer data of nine CRs of the SEER programme we performed model calculations to investigate temporal trends of the recorded incidence that might be expected if registration started in 1995 with gradually increasing proportions of cancers reported to the CR. It was assumed that the CR obtains all death certificates providing cancer as the underlying cause of death. Different scenarios with regard to the development of the proportions of cancers reported to the CR and the use of trace-back were evaluated.
Our model calculations demonstrated that the inclusion of cancers notified from death certificates which were diagnosed prior to the start of registration and which attribute to the incidence estimates of the year of death ('prevalent' cases) may compensate under-reporting typically observed right after the start of a CR. The recorded incidence may even be overestimated during the first years of registration, if large amounts of prevalent cancers are notified from death certificates (e.g. overestimation of lung cancer incidence by 8% and 21% in the first year of registration, if the proportions of cases reported were 50% and 70% in that year, overestimation of myeloma incidence still exceeding 5% after eight years of registration, if the proportion of cases reported to the CR had reached 97.5% after six years). Trace-back may effectively reduce the recorded surplus cancer cases.
During the initial years of registration, the inclusion of prevalent cancers from death certificates may compensate the higher amount of underreporting right after the start of a CR. Accurate incidence estimates may nevertheless be observed for highly fatal cancers if substantial proportions of cancer cases are missed at lifetime, however apparent incidence trends observed in the initial years of registration need to be interpreted with caution.
基于人群的癌症登记处（CRs）是衡量癌症负担及抗癌进展的有力工具。本研究的目的是调查漏报在终生、死亡证明通知以及追溯方面对一个新建立的基于人群的CR在其运营的最初15年期间可能记录的发病率的影响。
利用监测、流行病学和最终结果（SEER）计划中9个CR的癌症数据，我们进行了模型计算，以研究如果登记始于1995年且报告给CR的癌症比例逐渐增加时可能预期的记录发病率的时间趋势。假设CR获取所有将癌症列为根本死因的死亡证明。评估了关于报告给CR的癌症比例发展以及追溯使用的不同情景。
我们的模型计算表明，纳入登记开始前诊断且归因于死亡年份发病率估计值的死亡证明中通知的癌症（“现患”病例），可能弥补CR开始后通常观察到的漏报情况。如果从死亡证明中通知大量现患癌症，登记最初几年记录的发病率甚至可能被高估（例如，在登记第一年，如果当年报告病例的比例分别为50%和70%，肺癌发病率高估8%和21%；如果在六年内报告给CR的病例比例达到97.5%，登记八年后骨髓瘤发病率高估仍超过5%）。追溯可有效减少记录的多余癌症病例。
在登记的最初几年，纳入死亡证明中的现患癌症可能弥补CR开始后较高的漏报量。然而，如果在终生阶段大量癌症病例被遗漏，对于高致命性癌症仍可观察到准确的发病率估计值，不过在登记最初几年观察到的明显发病率趋势需谨慎解释。
