The Impact of Underreported Veterans Affairs Data on National Cancer Statistics: Analysis Using Population-Based SEER Registries

Cancer Statistic Branch, Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, 6116 Executive Blvd Suite 504, Bethesda, MD 20892-8315, USA.
Journal of the National Cancer Institute (Impact Factor: 12.58). 05/2009; 101(7):533-6. DOI: 10.1093/jnci/djn517
Source: PubMed


Reduced cancer reporting by the US Department of Veterans Affairs (VA) hospitals in 2007 (for patients diagnosed through 2005)
impacted the most recent US cancer surveillance data. To quantify the impact of the reduced VA reporting on cancer incidence
and trends produced by the Surveillance, Epidemiology, and End Results Program, we estimated numbers of missing VA patients
in 2005 by sex, age, race, selected cancer sites, and registry and calculated adjustment factors to correct for the 2005 incidence
rates and trends. Based on our adjustment factors, we estimated that as a result of the underreporting, the overall cancer
burden was underestimated by 1.6% for males and 0.05% for females. For males, the percentage of patients missing ranged from
2.5% for liver cancer to 0.4% for melanoma of the skin. For age-adjusted male overall cancer incidence rates, the adjustment
factors were 1.015, 1.012, and 1.035 for all races, white males, and black males, respectively. Modest changes in long-term
incidence trends were observed, particularly in black males.

Download full-text


Available from: David G Stinchcomb, Feb 25, 2015
  • Source
    • "Recent advances in the understanding of mesothelioma pathophysiology may impact therapy and survival [14] [15]. Despite these advances, reported survival is poor according to the SEER database and improving only slowly over time [16]. Factors reported to be important in mesothelioma development are age at first exposure, latency, a personal and family history of cancers [17], and genetic predisposition [14,18–20]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Survival for mesothelioma has been shown to be poor, with marginal improvement over time. Recent advances in the understanding of pathophysiology and treatment of mesothelioma may impact therapy to improve survival that may not be evident from available clinical trials that are often small and not randomized. Therapies may affect survival differently based on mesothelioma location (pleural vs peritoneal). Data are conflicting regarding the effect of asbestos exposure on mesothelioma location. We examined survival in a large cohort of mesothelioma subjects analyzed by tumor location and presence and mode of asbestos exposure. Data were analyzed from cases (n = 380) diagnosed with mesothelioma from 1992 to 2012. Cases were either drawn from treatment referrals, independent medical evaluation for medical legal purposes, or volunteers who were diagnosed with mesothelioma. Subjects completed an occupational medical questionnaire, personal interview with the examining physician, and physician review of the medical record. This study reports better survival for mesothelioma than historical reports. Survival for peritoneal mesothelioma was longer than that for pleural mesothelioma (hazard ratio = 0.36, 95% confidence interval = 0.24-0.54, P < .001) after adjusting for gender and age at diagnosis. Non-occupational cases were more likely to be 1) diagnosed with peritoneal mesothelioma, 2) female, 3) exposed, and 4) diagnosed at a younger age and to have a 5) shorter latency compared to occupational cases (P < .001). Peritoneal mesothelioma was more likely associated with non-occupational exposure, thus emphasizing the importance of exposure history in enhancing early diagnosis and treatment impact. Copyright © 2014 Neoplasia Press, Inc. Published by Elsevier Inc. All rights reserved.
    Full-text · Article · Feb 2015 · Translational oncology
  • Source
    • "Cancer registries are used worldwide to collect and analyze demographic, diagnostic, and survival data. Some registries are fraught with poor quality and infrastructure ; however, there is no standardized system for the collection and reporting of descriptive statistics worldwide [2] [3]. Comprehensive reviews of descriptive epidemiologic statistics, such as this one, are warranted to better understand the totality of the currently available data and to optimize the utility of such data in the future. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The compilation of comprehensive, worldwide epidemiologic data can inform hypotheses on cancer etiology and guide future drug development. These statistics are reported by a multitude of sources using varying methods; thus, compiling a complete database of these statistics is a challenge. To this end, this paper examined the usefulness of a novel, multisource approach-extracting data from the peer-reviewed literature, online reports, and query systems from cancer registries and health agencies and directly contacting cancer registry personnel-for building a comprehensive, multinational epidemiologic cancer database. The major B-cell malignancies were chosen as the cancer subtype to test this approach largely because their epidemiology has not been well characterized in the peer-reviewed literature. We found that a multisource approach yields a more comprehensive epidemiologic database than what would have been possible with the use of literature searches alone. In addition, our paper revealed that cancer registries vary considerably in their methodology, comprehensiveness, and ability to gather information on specific B-cell malignancy subtypes. Collectively, this paper demonstrates the feasibility and value of a multisource approach to gathering epidemiologic data.
    Full-text · Article · Dec 2012
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The American Cancer Society, the Centers for Disease Control and Prevention (CDC), the National Cancer Institute (NCI), and the North American Association of Central Cancer Registries (NAACCR) collaborate annually to provide updated information regarding cancer occurrence and trends in the United States. This year's report includes trends in colorectal cancer (CRC) incidence and death rates and highlights the use of microsimulation modeling as a tool for interpreting past trends and projecting future trends to assist in cancer control planning and policy decisions. Information regarding invasive cancers was obtained from the NCI, CDC, and NAACCR; and information on deaths was obtained from the CDC's National Center for Health Statistics. Annual percentage changes in the age-standardized incidence and death rates (based on the year 2000 US population standard) for all cancers combined and for the top 15 cancers were estimated by joinpoint analysis of long-term trends (1975-2006) and for short-term fixed-interval trends (1997-2006). All statistical tests were 2-sided. Both incidence and death rates from all cancers combined significantly declined (P < .05) in the most recent time period for men and women overall and for most racial and ethnic populations. These decreases were driven largely by declines in both incidence and death rates for the 3 most common cancers in men (ie, lung and prostate cancers and CRC) and for 2 of the 3 leading cancers in women (ie, breast cancer and CRC). The long-term trends for lung cancer mortality in women had smaller and smaller increases until 2003, when there was a change to a nonsignificant decline. Microsimulation modeling demonstrates that declines in CRC death rates are consistent with a relatively large contribution from screening and with a smaller but demonstrable impact of risk factor reductions and improved treatments. These declines are projected to continue if risk factor modification, screening, and treatment remain at current rates, but they could be accelerated further with favorable trends in risk factors and higher utilization of screening and optimal treatment. Although the decrease in overall cancer incidence and death rates is encouraging, rising incidence and mortality for some cancers are of concern.
    Full-text · Article · Feb 2010 · Cancer
Show more