A new method to evaluate the completeness of case ascertainment by a cancer registry

BACKGROUND: Epidemiologic research into cancer and subsequent decision making to reduce the cancer burden in the population are dependent on the quality of available data. The more reliable the data, the more confident we can be that the decisions made would have the desired effect in the population. The North American Association of Central Cancer Registries (NAACCR) certifies population-based cancer registries, ensuring uniformity of data quality. An important assessment of registry quality is provided by the index of completeness of cancer case ascertainment. NAACCR currently computes this index assuming that the ratio of cancer incidence rates to cancer mortality rates is constant across geographic areas within cancer site, gender, and race groups. NAACCR does not incorporate the variability of this index into the certification process. METHODS: We propose an improved method for calculating this index based on a statistical model developed at the National Cancer Institute to predict expected incidence using demographic and lifestyle data. We calculate the variance of our index using statistical approximation. RESULTS: We use the incidence model to predict the number of new incident cases in each registry area, based on all available registry data. Then we adjust the registry-specific expected numbers for reporting delay and data corrections. The proposed completeness index is the ratio of the observed number to the adjusted prediction for each registry. We calculate the variance of the new index and propose a simple method of incorporating this variability into the certification process. CONCLUSIONS: Better modeling reduces the number of registries with unrealistically high completeness indices. We provide a fuller picture of registry performance by incorporating variability into the certification process.     

Study of completeness of registration at the Estonian cancer registry.

Every cancer registry should be able to quantify the level of completeness of registration. The current study describes a routine quality control procedure in the Estonian Cancer Registry (ECR) for assessing the completeness of registration. The registry's database was compared with the databases of the Tartu University Lung Clinic and the Maarjam?isa Hospital of the Tartu University Clinics, and active retrieval to obtain missing cancer cases diagnosed in 1998 was carried out. The overall completeness of case ascertainment based on this study was 90.8%. As a result of this procedure, 67 cases of malignant neoplasms (1.1% of the total number of incident cancer cases for 1998) and 11 cases of other reportable neoplasms were detected and recorded at the ECR. Cancers of the lung, thyroid gland and prostate were most frequently under-notified. For these sites, the number of cancer cases for 1998 for Estonia as a whole increased 2.6%, 11.8% and 2.2%, respectively. To conclude, the existence of electronic databases is a positive development, but cancer registrars still need to employ labour-intensive methods to validate diagnostic codes and to decide whether to include in the ECR cases found by active retrieval. Based on the findings of our study, which is the first one of its kind in Estonia, the completeness of cancer reporting varied by cancer site, and it appeared to be a substantial concern for several sites.     

肿瘤恶病质发病机制和临床诊疗的研究进展

肿瘤恶病质是恶性肿瘤并发的多因素复杂综合征,50％～80％的晚期恶性肿瘤患者会发生恶病质,严重降低其生活质量,缩短其生存时间,影响疗效。作为一种与肿瘤相关的代谢紊乱综合症,其发病机制复杂,涉及多器官系统的改变,因而对其分期和严重程度的精确评估也十分困难。现阶段针对恶病质的治疗手段非常有限,对一些非药物的干预和抗恶病质药物的使用尚存争议,目前临床上提倡利用个体化、多学科、多手段的综合治疗模式来延缓肿瘤恶病质的进程。本文将对其发病机制、分期评估以及干预治疗三个方面的研究进展进行综述。     

Quality analysis of population-based information on cancer stage at diagnosis across Europe,with presentation of stage-specific cancer survival estimates: A EUROCARE-5 study

BackgroundCancer registries (CRs) are fundamental for estimating cancer burden, evaluating screening and monitoring health service performance. Stage at diagnosis—an essential information item collected by CRs—has been made available, for the first time, by CRs participating in EUROCARE-5. We analysed the quality of this information and estimated stage-specific survival across Europe for CRs with good data quality.Data and methodsSixty-two CRs sent stage (as TNM, condensed TNM or extent of disease) for 15 cancers diagnosed in 2000–2007. We assessed the quality, partly by comparing stage according to the three systems. We also developed procedures to reconstruct stage (categories: local, regional, metastatic and unknown) using information from all three systems, thus minimising the amount of missing information.ResultsModerate-to-excellent stage concordance was found for practically all 24 CRs, for which it was possible to compare at least two staging systems. However, since stage was often incorrectly assigned, and information on the presence/absence of metastases was often lacking, data on only 7/15 cancers from 34/62 CRs (15 countries) were of sufficient quality for further analysis. Cases diagnosed ≥70 years had more advanced (or lacking) stage– and worse stage-specific survival than those <70 years.ConclusionsMany European CRs collect and record reasonably accurate stage information. Others have difficulties. Both the completeness of primary data and the accuracy of stage coding need to be improved in order for CRs to fulfil their expanding roles in cancer control. We propose our stage reconstruction/checking procedures as a means of fully exploiting the stage information provided by EUROCARE CRs. More advanced (or lacking) stage at diagnosis plus poorer stage-specific survival in the elderly are worrying.     

Appropriateness of the standard mortality/incidence ratio in evaluation of completeness of population-based cancer registry data

Background: The magnitude of differences in mortality incidence (M:I) ratios derived from the national mortality source and those derived from cancer registry (CR) databases may be used to determine associated factors. Methods: All information on cancer incidence cases and mortality cases from January 1, 2003 to December 31, 2007 were retrieved from 5 population-based cancer registries in four regions of Thailand. Two sources of mortality were used: death cases within the cancer registries and mortality statistics obtained from the Ministry of Public Health (MOPH). Plots of percentage M:I ratios from cancer registry databases and from national mortality sources against 1 minus 5 years relative survival (1-5yrRS) were used to visualize the correlation between the two mortality sources. A Poisson regression model was used to determine the influence of cancer sites and registries on the M:I ratio/[1-5yrRS]. Results: There was high variability between the standard M:I ratio derived from national mortality compared with 1-5 year RS. The factors affecting M:I ratios are sources of mortality data and misclassification of topographic site as the cause of death. Conclusions: Use of the M:I ratio is not recommended to evaluate completeness of cancer registry data when the quality of mortality data is poor.     

Survival and age at diagnosis of breast cancer in a population-based cancer registry

From the population covered by the Lombardy Cancer Registry, Italy, 1991 female breast cancer patients diagnosed from 1976 to 1981 were followed up until May 1987. Relative survival was 69% at 5 years and 58% at 10 years; median survival was 8.8 years. Ages 40–49 showed the best survival; ages 25–34 were 20% lower. From age 50 onwards, survival decreased progressively, with the exception of age group 65–74. We suggest that the best prognosis for ages 40–49, followed by the survival fall in subsequent ages, could be related to an anticipation of diagnosis in ages near menopause. The death hazard function showed a bimodal pattern, with a first peak in the first years after diagnosis, and a second one between the seventh and eight years. The death hazard rate decreased by about 1% per year at each subsequent calendar year of diagnosis. When such an estimated calendar effect was taken in account, there were no considerable survival differences among Western countries covered by population-based cancer registries.     

Agreement of diagnosis and its date for hematologic malignancies and solid tumors between medicare claims and cancer registry data

PURPOSE: Claims data may be a suitable source studying associations between drugs and cancer. However, linkage between cancer registry and claims data including pharmacy-dispensing information is not always available. We examined the accuracy of claims-based definitions of incident cancers and their date of diagnosis. METHODS: Four claims-based definitions were developed to identify incident leukemia, lymphoma, lung, colorectal, stomach, and breast cancer. We identified a cohort of subjects aged >or=65 (1997-2000) from Pennsylvania Medicare and drug benefit program data linked with the state cancer registry. We calculated sensitivity, specificity, and positive predictive values of the claims-based definitions using registry as the gold standard. We further assessed the agreement between diagnosis dates from two data sources. RESULTS: All definitions had very high specificity (>or=98%), while sensitivity varied between 40% and 90%. Test characteristics did not vary systematically by age groups. The date of first diagnosis according to Medicare data tended to be later than the date recorded in the registry data except for breast cancer. The differences in dates of first diagnosis were within 14 days for 75% to 88% of the cases. Bias due to outcome misclassification of our claims-based definition of cancer was minimal in our example of a cohort study. CONCLUSIONS: Claims data can identify incident hematologic malignancies and solid tumors with very high specificity with sufficient agreement in the date of first diagnosis. The impact of bias due to outcome misclassification and thus the usefulness of claims-based cancer definitions as cancer outcome markers in etiologic studies need to be assessed for each study setting.     

Evaluation of data quality at the Gambia national cancer registry

The Gambia National Cancer Registry (GNCR) is one of the few nationwide population‐based cancer registries in sub‐Saharan Africa. Most registries in sub‐Saharan Africa are limited to cities; therefore, the GNCR is important in providing estimates of cancer incidence in rural Africa. Our study assesses the quality of its data. The methods proposed by Bray and Parkin, and Parkin and Bray (Eur J Cancer 2009;45:747–64) were applied to the registry data from 1990 to 2009 to assess comparability, validity and completeness. The system used for classification and coding of neoplasms followed international standards. The percentage of cases morphologically verified was 18.1% for men and 33.1% for women, and that of death certificate only cases was 6.6 and 3.6%, respectively. Incidence rates in rural regions were lower than in the urban part of the country, except amongst young male adults. Comparison with other West African registries showed that the incidences of liver and uterine cervical cancer were comparable, but those of prostate and breast in The Gambia were relatively low. The overall completeness was estimated at 50.3% using the capture–recapture method. The GNCR applies international standard practices to data collection and handling, providing valuable data on cancer incidence in sub‐Saharan Africa. However, the data are incomplete in the rural and elderly populations probably because of health care access and use.     

Survival and progression in high grade tumour subset of G2 and G3 pT1 bladder transitional cell carcinoma

AIMS: The newer 1998 WHO/ISUP grading system for bladder transitional cell carcinoma combined grade 3 (G3) and high grade tumour subset of grade 2 (G2) of the older 1973 WHO grading system into one homogenous high grade group. We evaluated for possible differences in survival and progression between these 2 grades in pT1 bladder tumours. METHODS: From Jan 1(st) 1991-Dec 31(st) 2003, 105 (61 G2 and 44 G3) pT1 bladder tumours fulfilled the 1998 WHO/ISUP high grade criteria. Survival and progression of these tumours were assessed. RESULTS: Of the 44 patients with G3 tumours, 20 are alive versus 22 of the 61 patients with high grade tumour subset of G2 (P=0.04). Of the 44 patients with G3 tumours, 13 progressed versus 12 of the 61 patients with high grade tumour subset of G2 (P=0.02). In multivariate analysis, G3 was a significant predictor of tumour progression (P=0.05) and marginally non-significant predictor of poor patient survival (P=0.056). CONCLUSIONS: A notable difference in survival and progression between high grade tumour subset of G2 and G3 is observed.     

Cytopathological diagnosis in a cancer registry

BACKGROUND.

To assess the role of cytology in tumor diagnosis and to explore the potential of this technique to improve tumor registry quality, the authors investigated the role of cytology as a diagnostic tool in registry databases.

METHODS.

Through the Italian Network of Cancer Registry (AIRTum) archive, the authors retrieved tumors diagnosed during the years 1983–2002 from several registries, Varese, Torino, Ragusa, Ferrara, Genova, and the Tuscan Cancer Registry. The authors then analyzed the amount of morphological confirmation by topographic code, distinguishing cytological from histological diagnosis. The authors analyzed, only for the Tuscan Cancer Registry, the amount of morphological confirmation by both histological and cytological diagnosis and demonstrated the variation of cytological confirmation with stage of tumor.

RESULTS.

The better morphological modality for diagnosis was rarely cytology, particularly among lung and pleural tumors; when considered together with histological analysis, cytology examination was often reported in cervical uterine and breast tumors. The usefulness of cytology increases with tumor stage, particularly in sites where biopsy is performed with difficulty.

CONCLUSIONS.

Cytology may be useful to improve tumoral characterization in advanced stages or in sites inaccessible for histology; moreover, cytology is useful as an initial detector of pathology, prior to histology. A prospect of improvement in diagnostic cytopathology and the use of ancillary techniques, such as molecular biology, could help clinicians and could increase the accuracy of cancer registration. Cancer (Cancer Cytopathol) 2007. © 2007 American Cancer Society.     

Long‐term survival and conditional survival of cancer patients in Japan using population‐based cancer registry data

Although we usually report 5‐year cancer survival using population‐based cancer registry data, nowadays many cancer patients survive longer and need to be followed‐up for more than 5 years. Long‐term cancer survival figures are scarce in Japan. Here we report 10‐year cancer survival and conditional survival using an established statistical approach. We received data on 1 387 489 cancer cases from six prefectural population‐based cancer registries in Japan, diagnosed between 1993 and 2009 and followed‐up for at least 5 years. We estimated the 10‐year relative survival of patients who were followed‐up between 2002 and 2006 using period analysis. Using this 10‐year survival, we also calculated the conditional 5‐year survival for cancer survivors who lived for some years after diagnosis. We reported 10‐year survival and conditional survival of 23 types of cancer for 15–99‐year‐old patients and four types of cancer for children (0–14 years old) and adolescent and young adults (15–29 years old) patients by sex. Variation in 10‐year cancer survival by site was wide, from 5% for pancreatic cancer to 95% for female thyroid cancer. Approximately 70–80% of children and adolescent and young adult cancer patients survived for more than 10 years. Conditional 5‐year survival for most cancer sites increased according to years, whereas those for liver cancer and multiple myeloma did not increase. We reported 10‐year cancer survival and conditional survival using population‐based cancer registries in Japan. It is important for patients and clinicians to report these relevant figures using population‐based data.     

A population based study of variations in operation rates for breast cancer,of comorbidity and prognosis at diagnosis: Failure to operate for early breast cancer in older women

Background

Older women are less likely to have surgery for operable breast cancer. This population-based study examines operation rates by age and identifies groups which present with early or late disease.

Methods

37 000 cancer registrations for 2007 were combined with Hospital Episode Statistics comorbidity data for England. Operation rates were examined by age, ethnicity, deprivation, comorbidity, screen-detection, tumour size, grade and nodal status. Early and late presentation were correlated with Nottingham Prognostic Index (NPI) groups and tumour size.

Results

The proportion of women not having surgery increased from 7–10% at ages 35–69 to 82% from age 90. From age 70, the proportion not having surgery rose by an average of 3.1% per year of age. Women with a Charlson Comorbidity Index score of ≥1 (which increased with age), with tumours >50 mm or who were node positive, were less likely to have surgery. Although women aged 70–79 were more likely to have larger tumours, their tumours were also more likely to have an excellent or good NPI (p < 0.001). Good prognosis tumours were more likely to be screen-detected, and less likely in women aged 0–39, the deprived and certain ethnic groups (p < 0.02).

Conclusions

From age 70 there is an increasing failure to operate for breast cancer. Younger women and certain ethnic groups presented with more advanced tumours. Older women had larger tumours which were otherwise of good prognosis, and this would not account for the failure to operate which may in part be related to comorbidity in this age group.     

Survival analysis of cancer cases from Qidong cancer registry

Thispaperdescribesthesurvivalexperiencefrom15selectedsitesofcancersaccordingtodatafromapopulation--basedcancerregistryduringtheperiodof1982--1991forevaluationofcancersurvivalaswellasdifferentcancercontrolmeasures.MATERIALSANDMETHODSDataCollectionCanc...     

Clinical and epidemiologic variations of esophageal cancer in Tanzania

AIM: To estimate the incidence of esophageal cancer (EC) in Kilimanjaro in comparison to other regions in Tanzania.METHODS: We also examined the clinical, epidemiologic, and geographic distribution of the 1332 EC patients diagnosed and/or treated at Ocean Road Cancer Institute (ORCI) during the period 2006-2013. Medical records were used to abstract patient information on age, sex, residence, smoking status, alcohol consumption, tumor site, histopathologic type of tumor, date and place of diagnosis, and type and date of treatment at ORCI. Regional variation of EC patients was investigated at the level of the 26 administrative regions of Tanzania. Total, age- and sex-specific incidence rates were calculated.RESULTS: Male patients 55 years and older had higher incidence of EC than female and younger patients. Of histopathologically-confirmed cases, squamous-cell carcinoma represented 90.9% of histopathologic types of tumors. The administrative regions in the central and eastern parts of Tanzania had higher incidence rates than western regions, specifically administrative regions of Kilimanjaro, Dar es Salaam, and Tanga had the highest rates.CONCLUSION: Further research should focus on investigating possible etiologic factors for EC in regions with high incidence in Tanzania.     

Altered hyaluronan biosynthesis in cancer progression

Microenvironmental stimuli can influence the malignant phenotype of cancer cells. Notably, the altered biosynthesis of hyaluronan, a constituent of the extracellular microenvironment, has been implicated in the progress and metastasis of carcinomas. The discovery of hyaluronan synthase (HAS) genes, which encode the key enzymes in hyaluronan biosynthesis, has enabled great strides in understanding the mechanism underlying altered hyaluronan production in cancer and the involvement of this polysaccharide in tumor progression. Recent studies using HAS transgenic mice have provided evidence that overproduction of hyaluronan in mammary tumors accelerates tumor growth through the recruitment of stromal cells and vasculature, revealing further insight into how increased hyaluronan influences the malignant behaviors of cancer cells.     

2009—2015年甘肃省肿瘤登记地区子宫体癌发病与死亡特征分析

目的 分析甘肃省肿瘤登记地区2009—2015年子宫体癌发病和死亡流行状况及变化趋势,为甘肃省子宫体癌的防治提供依据.方法 审核整理2009—2015年甘肃省肿瘤登记地区子宫体癌发病(死亡)率、构成比、中国人口标化率(中标率)和世界人口标化率(世标率)等,分析年龄别发病及死亡情况,并通过Joinpoint回归模型计算年...