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Re: lung cancers, primary vs secondary
The accuracy of death certificate information regarding primary versus
secondary lung cancer is always suspect unless additional information is
available to confirm the information on the death certificate. The greatest
inaccuracy likely occurs in misdiagnosed primary lung cancer in non smoking
females. The lung cancer may often be a secondary cancer from a hidden cancer
from elsewhere else in the body such as the breast.
More to the point, we have conclusively shown that the mortality data used by
Dr. Cohen is temporally incorrect in relation to the latency period for cancers
and radon testing periods in Dr. Cohen's data. Actual incidence lung cancer
data from a National Cancer Institute Cancer Registry is in very poor agreement
with Dr. Cohen's surrogate data for the time period of interest.
See also -
Am J Ind Med. 1992;22(4):469-80.
Use of death certificates in epidemiological studies, including occupational
hazards: discordance with clinical and autopsy findings.
Selikoff IJ.
Mount Sinai School of Medicine, City University of New York, New York 10029.
There has long been evidence of frequent inaccuracy of death certificates, with
significant discordance between such designations and clinical and autopsy
data. This exists for occupational diseases as well. The use of statistical
rates based on death certificates has been seriously questioned despite their
utility for total mortality. Programs to supplement death certificate data,
particularly in occupational disease studies, may be helpful, and are reviewed.
------------------------------
APMIS Suppl. 1994;45:1-42.
Comparison of autopsy, clinical and death certificate diagnosis with particular
reference to lung cancer. A review of the published data.
Lee PN.
P. N. Lee Statistics and Computing Ltd., Sutton, Surrey, UK.
Some clinicians and some epidemiologists appear to be under the illusion that
techniques available for the diagnosis of internal diseases such as lung cancer
have improved so much that autopsies are not necessary on the bodies of most
people who die. Partly for this reason, partly for economic reasons and partly
because clinicians fear litigation if autopsy shows that they treated patients
for the wrong disease, autopsy rates have been falling in most developed
countries. The object of the present review was to ascertain how much reliance
can reasonably be put on clinical diagnoses made and death certificates
completed in the absence of autopsy data. In the case of lung cancer, high
rates of false positive and false negative diagnoses are universally prevalent,
with biases influencing these rates, so that smokers are more likely to be
appropriately investigated for lung cancer, and false negatives are commoner in
non-smokers. All investigators who have compared clinical-based and autopsy-
based death certificates have concluded that higher autopsy rates are necessary
and the results of one study suggest that a high autopsy rate in a hospital
leads to improvements in the accuracy of clinical diagnoses. The extent to
which diagnoses on death certificates that are dependent solely on clinical
data are seriously inaccurate for internal diseases such as lung cancer should
engender caution in all who use mortality data to guide public health policies
and to identify and quantify environmental risks to healths.
-------------------
> A few days ago, someone said that my lung cancer data were no good
> because many of the deaths included were from cases where lung cancer was
> secondary, a metathesis from other cancers. I sent a query about this to
> NCHS and received the reply below.
>
> Bernard L. Cohen
> Physics Dept.
> University of Pittsburgh
> Pittsburgh, PA 15260
> Tel: (412)624-9245
> Fax: (412)624-9163
> e-mail: blc@pitt.edu
> web site: http://www.phyast.pitt.edu/~blc
>
> ---------- Forwarded message ----------
> Date: Mon, 23 Jun 2003 10:00:41 -0400
> From: "Kochanek, Kenneth D." <kdk2@cdc.gov>
> To: "'blc+@pitt.edu'" <blc@pitt.edu>
> Cc: "Kochanek, Kenneth D." <kdk2@cdc.gov>, "Ingram, Deborah D." <ddi1@cdc.gov>
> Subject: query
>
> In 2000, there were 155,521 lung cancer underlying cause deaths in the
> United States. The information about the cause of these deaths is coded
> from the death certificate. If the certifier reported "primary lung cancer"
> or "lung cancer," the death is coded as primary lung cancer and this is what
> constitutes the number of deaths listed above.
>
> Lung cancer deaths that are coded as secondary lung cancer are not included
> in the number of lung cancer underlying cause deaths above. These deaths
> are included in a separate code called "Secondary malignant neoplasm of
> lung." In 2000, there were 224 underlying cause deaths coded to this cause.
>
> If you have any further questions, please let me know.
>
> Ken Kochanek
> --------------------------------------------------------------
> Kenneth D. Kochanek
> Statistician
> Mortality Statistics Branch
> Division of Vital Statistics
> National Center for Health Statistics
> 3311 Toledo Road, Room 7318
> Hyattsville, Maryland 20782
> Tel: 301-458-4319
> Fax: 301-458-4034
> E-mail: kdk2@cdc.gov
> Mortality Web Page:
> http://www.cdc.gov/nchs/about/major/dvs/mortdata.htm
>
> -----Original Message-----
> From: BERNARD L COHEN [mailto:blc+@pitt.edu]
> Sent: Thursday, June 19, 2003 1:23 PM
> To: CDC Wonder Customer Support
> Subject: RE: query
>
>
> Yes, I mean mortality data.
>
> Bernard L. Cohen
> Physics Dept.
> University of Pittsburgh
> Pittsburgh, PA 15260
> Tel: (412)624-9245
> Fax: (412)624-9163
> e-mail: blc@pitt.edu
> web site: http://www.phyast.pitt.edu/~blc
>
> On Tue, 17 Jun 2003, CDC Wonder Customer Support wrote:
>
> > Are you referring to the Mortality dataset?
> >
> > -----Original Message-----
> > From: Bernard Cohen [mailto:blc+@pitt.edu]
> > Sent: Monday, June 16, 2003 10:41 AM
> > To: cwus@cdc.gov
> > Subject: query
> >
> >
> > In your data on lung cancer, in what fraction of the cases reported is
> > cancer of the lung primary, and in what fraction may it be secondary?
> >
>
>
>
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