Journal of the National Cancer Institute Advance Access originally published online on March 24, 2009
JNCI Journal of the National Cancer Institute 2009 101(7):533-536; doi:10.1093/jnci/djn517
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© The Author 2009. Published by Oxford University Press.
BRIEF COMMUNICATION |
The Impact of Underreported Veterans Affairs Data on National Cancer Statistics: Analysis Using Population-Based SEER Registries
Affiliation of authors: Cancer Statistic Branch, Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
Correspondence to: Nadia Howlader, MS, Cancer Surveillance Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, 6116 Executive Blvd Suite 504, Bethesda, MD 20892-8315 (e-mail: howladern{at}mail.nih.gov).
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.
| CONTEXT AND CAVEATS Prior knowledge A recent policy change by the US. Department of Veterans Affairs (VA) has resulted in the underreporting of incident cancer cases to some cancer registries. Study design Estimated numbers of missing VA cancer patients in 2005 were used to correct cancer incidence rates and trends in the Surveillance, Epidemiology, and End Results Program. Contributions Due to the underreporting, overall cancer burden was underestimated by 1.6% for males and 0.05% for females. Changes in long-term incidence were modest and occurred mainly among black males. Implications The reduced reporting of VA patients to central cancer registries led to an underestimation of cancer incidence that modestly changed long-term trends. Limitations The variance in the estimated adjustment factors was not determined. From the Editors
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Manuscript received July 23, 2008; revised December 10, 2008; accepted December 30, 2008.
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