Weir Hannah K, Sherman Recinda, Yu Mandi, Gershman Susan, Hofer Brenda M, Wu Manxia, Green Don
Centers for Disease Control and Prevention, Atlanta, Georgia.
North American Association of Central Cancer Registries, Springfield, Illinois.
J Registry Manag. 2020 Fall;47(3):150-160.
The number of cancer cases in the United States continues to grow as the number of older adults increases. Accurate, reliable and detailed incidence data are needed to respond effectively to the growing human costs of cancer in an aging population. The purpose of this study was to examine the characteristics of incident cases and evaluate the impact of death-certificate-only (DCO) cases on cancer incidence rates in older adults.
Using data from 47 cancer registries and detailed population estimates from the Surveillance, Epidemiology and End Results (SEER) Program, we examined reporting sources, methods of diagnosis, tumor characteristics, and calculated age-specific incidence rates with and without DCO cases in adults aged 65 through ≥95 years, diagnosed 2011 through 2015, by sex and race/ethnicity.
The percentage of cases (all cancers combined) reported from a hospital decreased from 90.6% (ages 65-69 years) to 69.1% (ages ≥95 years) while the percentage of DCO cases increased from 1.1% to 19.6%. Excluding DCO cases, positive diagnostic confirmation decreased as age increased from 96.8% (ages 65-69 years) to 69.2% (ages ≥95 years). Compared to incidence rates that included DCO cases, rates in adults aged ≥95 years that excluded DCO cases were 41.5% lower in Black men with prostate cancer and 29.2% lower in Hispanic women with lung cancer.
Loss of reported tumor specificity with age is consistent with fewer hospital reports. However, the majority of cancers diagnosed in older patients, including those aged ≥95 years, were positively confirmed and were reported with known site, histology, and stage information. The high percentage of DCO cases among patients aged ≥85 years suggests the need to explore additional sources of follow-back to help possibly identify an earlier incidence report. Interstate data exchange following National Death Index linkages may help registries identify and remove erroneous DCO cases from their databases.
随着美国老年人口数量的增加，癌症病例数持续上升。为了有效应对老龄化人口中癌症日益增长的人力成本，需要准确、可靠且详细的发病率数据。本研究的目的是检查新发病例的特征，并评估仅依据死亡证明（DCO）的病例对老年人癌症发病率的影响。
利用来自47个癌症登记处的数据以及监测、流行病学和最终结果（SEER）计划的详细人口估计数据，我们按性别和种族/族裔，研究了2011年至2015年期间年龄在65岁至95岁及以上、被诊断患有癌症的成年人的报告来源、诊断方法、肿瘤特征，并计算了包含和不包含DCO病例的特定年龄发病率。
从医院报告的病例百分比（所有癌症合计）从90.6%（65 - 69岁）降至69.1%（95岁及以上），而DCO病例的百分比从1.1%增至19.6%。排除DCO病例后，随着年龄增长，阳性诊断确认率从96.8%（65 - 69岁）降至69.2%（95岁及以上）。与包含DCO病例的发病率相比，95岁及以上成年人中排除DCO病例的发病率，前列腺癌黑人男性降低了41.5%，肺癌西班牙裔女性降低了29.2%。
随着年龄增长报告的肿瘤特异性丧失与医院报告减少一致。然而，在老年患者中诊断出的大多数癌症，包括95岁及以上的患者，都得到了阳性确认，并报告了已知的部位、组织学和分期信息。85岁及以上患者中DCO病例的高比例表明需要探索额外的随访来源，以帮助可能识别更早的发病率报告。国家死亡指数关联后的州际数据交换可能有助于登记处从其数据库中识别并删除错误的DCO病例。
