[Date Prev][Date Next][Thread Prev][Thread Next][Date Index][Thread Index]
Re: lung cancers, primary vs secondary
Dr. Field, do you happen to have any approximation of the cost to have an autopsy
done on. say, a deceased relative? I vaguely recall around $500 many years ago, but
really have no idea.
Thanks in advance,
Maury Siskel maury@webtexas.com
=============================
epirad@mchsi.com wrote:
> 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?
> > >
> >
> >
> >
> > ************************************************************************
> > You are currently subscribed to the Radsafe mailing list. To unsubscribe,
> > send an e-mail to Majordomo@list.vanderbilt.edu Put the text "unsubscribe
> > radsafe" (no quote marks) in the body of the e-mail, with no subject line.
> > You can view the Radsafe archives at http://www.vanderbilt.edu/radsafe/
> >
>
> ************************************************************************
> You are currently subscribed to the Radsafe mailing list. To unsubscribe,
> send an e-mail to Majordomo@list.vanderbilt.edu Put the text "unsubscribe
> radsafe" (no quote marks) in the body of the e-mail, with no subject line.
> You can view the Radsafe archives at http://www.vanderbilt.edu/radsafe/
--
It is the soldier, who salutes the flag, who serves under the flag,
and whose coffin is draped by the flag, who allows the protester to
burn the flag. Charles M. Province
************************************************************************
You are currently subscribed to the Radsafe mailing list. To unsubscribe,
send an e-mail to Majordomo@list.vanderbilt.edu Put the text "unsubscribe
radsafe" (no quote marks) in the body of the e-mail, with no subject line.
You can view the Radsafe archives at http://www.vanderbilt.edu/radsafe/