RE: Source of cancer data

[Jack_Earley@RL.GOV]

I guess the question really becomes which is more relevant, incidence or

mortality? Having cancer is unfortunate, but if it's benign, it's not a big

deal. And what purpose would it serve to include such cancers? If it's not

benign, but generally curable, or occurs so late in life that it's hardly

distinguishable from other "natural" causes of death, it's more unfortunate,

but still not incredibly significant. IMO, mortality data are the common

denominator and should therefore be most useful (and I suspect that

"physician error" is not a confounding factor that would invalidate Dr.

Cohen's work--in fact, since it no doubt occurs randomly across the

population, it should have a null effect).



Jack Earley

Radiological Engineer





-----Original Message-----

From: Otto G. Raabe [mailto:ograabe@UCDAVIS.EDU]

Sent: Wednesday, December 19, 2001 11:40 AM

To: BERNARD L COHEN

Cc: Jacobus, John (OD/ORS); John Williams; internet RADSAFE

Subject: Re: Source of cancer data





At 12:45 PM 12/19/01 -0500, BERNARD L COHEN wrote:

>	--Are you saying essentially that more care is taken to get a

>proper diagnosis at incidence than after death? I can understand that if

>experts agree on it.

>	Is there anything compelling physicians to report incidence? Is

>there evidence that all, or nearly all incidence is reported? By

>law, they are required to report cause of death.

************************************************************************

December 19, 2001



I am suggesting that there are two factors that make cancer incidence data

more accurate than mortality data: 



(1) During diagnosis and treatment there is usually accurate information

about the specific type of cancer, but there may be a disconnect between

that diagnosis and what is reported on the death certificate because the

physician required to fill out the death certificate may not have time to

review the total medical record and may not know about the earlier

diagnosis. Also, the direct cause of death may be ancillary to lung cancer.



(2) Those patients who are cured of a given type of cancer or who are not

cured but succumb to some other disease may not show up as having had that

cancer (e.g., lung cancer) on the death certificate. For example, someone

who has had lung cancer, had surgery, and dies in a car accident will not

be shown to have had lung cancer on their death certificate. If they die of

pneumonia that is some how related to an underlying case of lung cancer,

the certificate may still only be coded for pneumonia.



Otto



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