Is the apparent rise in cancer mortality in the elderly real? analysis of changes in certification and coding of cause of death in England and Wales, 1970–1990

Grulich, Andrew E.; Swerdlow, Anthony; Silva, I dos Santos; Beral, V

doi:10.1002/ijc.2910630203

Cited by 52 publications

(33 citation statements)

References 13 publications

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“…7,14,15 However, previous studies have indicated several sources of potential error, particularly in assigning the cause of death in elderly prostate cancer patients with considerable comorbidity. 5,10,[16][17][18] In fact, more than half of the deaths in patients with prostate cancer are due to causes other than prostate cancer. 19 In England and Wales, nearly a half of the noted increase in prostate cancer mortality from 1970 to 1990 for men 75-84 years old was accounted for by inaccuracies in death certification.…”

Section: Discussionmentioning

confidence: 99%

“…19 In England and Wales, nearly a half of the noted increase in prostate cancer mortality from 1970 to 1990 for men 75-84 years old was accounted for by inaccuracies in death certification. 17 Trends in prostate cancer mortality have also been shown to follow the rise and fall of newly detected cases, suggesting misattribution of the cause of death among prostate cancer patients. 20 However, little information is available for death-cause attribution in this era of the widespread use of PSA.…”

Section: Discussionmentioning

confidence: 99%

“…16 This is in contrast to the results of earlier studies assessing concordance between medical records and death certificates, suggesting that death records are too unreliable for the assessment of prostate cancer mortality. 17,18,21 However, the quality of death-cause registration is likely to vary across different regions and countries. The Swedish experience for mammography screening, for example, has shown that death certificates may provide a solid basis for assessing mortality in large population-based studies, which is in line with our findings for prostate cancer.…”

Section: Discussionmentioning

confidence: 99%

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Assessment of causes of death in a prostate cancer screening trial

Mäkinen

Karhunen

Aro

et al. 2007

Intl Journal of Cancer

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Accurate assessment of the causes of death is crucial for a conclusive evaluation of the ongoing prostate cancer screening trials. Here, we report the validity of the official causes of death as compared with an independent expert review in the Finnish prostate cancer screening trial. Because nearly 80,000 men were involved, death-cause evaluation was restricted to men diagnosed for prostate cancer. Medical charts were retrieved and the cause of death was assigned by an expert review panel for all deaths among men with prostate cancer during the study period, 1996-2003. The panel decision was compared with both death certificates and the official causes of death as assigned by Statistics Finland. Of a total of 315 deaths, the review panel attributed 127 (41%) to prostate cancer and 184 (59%) to other causes, the corresponding figures in death certificates being 124 (40%) and 187 (60%). Four cases were excluded because of insufficient information. The death-certificate data were in agreement with the panel's assessment in 305 out of 311 cases (overall agreement 97.7%, j 5 0.95). The overall agreement between the official causes of death and the panel's decision was 97.4% (304/311, j 5 0.95). The sensitivity of the certificates in identifying prostate cancer deaths was 96.1% (panel as golden standard). Correspondingly, specificity was 98.9%. The official causes of death thus provide an accurate means for evaluating disease-specific mortality in a large population-based prostatecancer screening trial in Finland. ' 2007 Wiley-Liss, Inc.Key words: prostate cancer; prostate-specific antigen; mass screening; cause of death; mortality; randomized trials Prostate cancer mortality is declining in some parts of the world, e.g., in the United States.1 Widespread debate has prevailed as to the extent to which the decrease may be a consequence of prostate-specific antigen (PSA)-based screening. The only valid means of settling the issue is through large randomized screening trials. Such trials are currently under way in both the United States (Prostate, Lung, Colorectal and Ovary screening trial, PLCO) and Europe (European Randomized Study of Prostate Cancer Screening, ERSPC), and the first mortality results are expected within a few years.2 Nevertheless the value of these ongoing trials has been questioned by suggesting that it would be almost impossible to demonstrate (or rule out) the value of PSA screening on account of possible misdiagnosis of the cause of death in elderly men with multiple comorbidities.3 Accurate assessment of the underlying cause of death is thus crucial for a conclusive evaluation of the possible benefits of prostate cancer screening. For several chronic conditions, a panel of experts has been regarded as the preferred strategy to establish cause-specific mortality for research purposes. [4][5][6] However, the use of death certificates has also been advocated to avoid labor-intensive and costly death reviews in large epidemiological studies. 7The Finnish prostate cancer screening trial is a part of ...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Assessment of causes of death in a prostate cancer screening trial

Mäkinen

Karhunen

Aro

et al. 2007

Intl Journal of Cancer

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“…This is not a site where the mortality data are likely to have been affected appreciably by changes in diagnostic technology or criteria. Breast cancer mortality data at older ages are particularly susceptible to artefacts of death certification and of coding selection of underlying cause of death (Grulich et al, 1995), but again this does not appear likely to explain most of the increase. Screening in recent years may have resulted in the detection of incident cases that would not otherwise have been known, or that would have been diagnosed later, but it is unlikely to have increased apparent mortality, and indeed in the long term should lead to a decrease in mortality.…”

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confidence: 99%

“…It should also be noted that data on trends at middle and younger ages are likely to be more reliable than those for older ages (Grulich et al, 1995), although the high rates of cancer at older ages make these important to consider too from a public health and health care perspective.…”

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confidence: 99%

Trends in cancer incidence and mortality in Scotland: description and possible explanations

Swerdlow

Silva²,

Reid³

et al. 1998

Br J Cancer

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Summary Secular and cohort trends in mortality from cancer in Scotland during 1953-93, and incidence during 1960-90, were analysed using individual records from the national mortality and registration files. For certain cancer sites, the secular analyses of mortality were extended back to 1911 by use of published data. Mortality from cancer at older ages in Scotland has increased over the last 40 years. In each sex, this trend has been dominated by the effects of smoking: all-cancer rates and rates of lung cancer, now the most common fatal cancer in men and in women in Scotland, reached a peak in the cohort of men born at the turn of the century and the cohort of women born in the 1920s. For much of the period, the Scottish all-age rates of lung cancer were the highest reported in the world; they are now decreasing on a secular basis in men, but are still increasing in women. There have also been large increases at older ages in the incidence and mortality rates for cancer of the prostate in recent years, bladder cancer, nervous system cancer, non-Hodgkin's lymphoma, myeloma and leukaemia; for each there is likely to be a considerable artefactual element to the increase, with differing degrees of possibility that there may in addition be an element of real increase. Substantial decreases in mortality at all ages have occurred for stomach and colorectal cancers and substantial increases at all ages for pleural cancer and melanoma. Rates of mortality from breast cancer, the most common cancer in women in Scotland, have generally increased over the past 80 years; a temporary cessation in this upward trend occurred in the years during and after the Second World War, and recently rates have turned downward, probably at least in part because of better treatment. Mortality from ovarian cancer, the second most common reproductive-related female tumour in Scotland, has also increased at older ages. At younger ages, mortality from cancer in Scotland has decreased, especially in men, whereas incidence has not. This divergence, which has been a consequence of better treatment, has occurred especially for cancers of the testis and ovary, Hodgkin's disease and leukaemia. There have been increases at young adult ages, however, in both mortality from and incidence of oral and pharyngeal, oesophageal and laryngeal cancers in men, and melanoma and nonHodgkin's lymphoma in each sex. Cervical cancer rates at young ages also increased, but this trend has reversed for incidence in the most recent birth cohorts. Incidence rates have also increased for testicular cancer in young adults and leukaemia in children. With the possible exceptions of non-Hodgkin's lymphoma and childhood leukaemia, the increasing rates are likely largely to reflect real rises in incidence, and they highlight the need for investigation of the causes of these cancers, and, when causes are known, for preventive action. Keywords: cancer trends; incidence; mortality; Scotland Trends in cancer incidence and mortality are of interest both for epidemiology and for cli...

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