a Department of Research , Cancer Registry of Norway , Oslo , Norway.
b Department of Health Management and Health Economics , University of Oslo , Oslo , Norway.
Acta Oncol. 2018 Dec;57(12):1663-1670. doi: 10.1080/0284186X.2018.1497296. Epub 2018 Aug 31.
Accurate information about treatment is needed to evaluate cervical cancer prevention efforts. We studied completeness and validity of reporting cervical treatments in the Cancer Registry of Norway (CRN).
We identified 47,423 (92%) high-grade cervical dysplasia patients with and 3983 (8%) without recorded treatment in the CRN in 1998-2013. We linked the latter group to the nationwide registry of hospital discharges in 1998-2015. Of patients still without treatment records, we randomly selected 375 for review of their medical history. Factors predicting incomplete treatment records were assessed by multiple imputation and logistic regression.
Registry linkage revealed that 10% (401/3983) of patients received treatment, usually conization, within one year of their initial high-grade dysplasia diagnosis. Of those, 11% (n = 44) were missing due to unreporting and 89% (n = 357) due to misclassification at the CRN. Of all cases in medical review, patients under active surveillance contributed almost 60% (223/375). Other reasons of being without recorded treatment were uncertain dysplasia diagnosis, invasive cancer or death. Coding error occurred in 19% (73/375) of randomly selected cases. CRN undercounted receipt of treatment by 38% (n = 1526) among patients without recorded treatment which translates into 97% overall completeness of treatment data. Incomplete treatment records were particularly associated with public laboratories, patients aged 40-54 years, and the latest study years.
CRN holds accurate information on cervical treatments. Completeness and particularly validity can be further improved through the establishment of new internal routines and regular linkage to hospital discharges.
为了评估宫颈癌防治工作的效果，需要准确的治疗信息。本研究旨在评估挪威癌症登记处（CRN）报告宫颈癌治疗情况的完整性和准确性。
我们在 1998-2013 年期间于 CRN 中识别出 47423 例（92%）高级别宫颈上皮内瘤变（CIN）患者伴有治疗记录和 3983 例（8%）无治疗记录的患者。我们将后者与 1998-2015 年全国性的住院患者登记数据库进行了链接。对于仍无治疗记录的患者，我们随机抽取了 375 例进行病历回顾。通过多重插补和逻辑回归分析评估了导致治疗记录不完整的因素。
登记处链接显示，10%（401/3983）的患者在初次高级别 CIN 诊断后的一年内接受了治疗，通常为子宫颈锥形切除术。其中 11%（n=44）由于未报告而缺失，89%（n=357）由于 CRN 中的错误分类而缺失。在所有接受病历回顾的患者中，主动监测的患者约占 60%（223/375）。其他无记录治疗的原因包括不确定的上皮内瘤变诊断、浸润性癌或死亡。随机选择的 375 例病例中，有 19%（73/375）存在编码错误。CRN 漏报了 38%（n=1526）无记录治疗患者的治疗情况，这意味着治疗数据的总体完整性为 97%。不完整的治疗记录与公共实验室、年龄在 40-54 岁之间的患者以及最新研究年份之间存在显著相关性。
CRN 掌握了关于宫颈癌治疗的准确信息。通过建立新的内部程序并定期与住院患者登记数据库进行链接，可以进一步提高治疗数据的完整性和准确性。
