© 1997 by Oxford University Press
Journal Of The National Cancer Institute, Vol 89, 58-65, Copyright © 1997 by Oxford University Press
BW Brown, C Brauner and LB Levy
BACKGROUND: We have previously argued against the calculation of cancer-
specific death rates as philosophically undefined and biased. Deaths
attributed to cancer during a particular year occur in patients diagnosed
during an unknown distribution of past times, so cancer- specific death
rates cannot be used to assess changes in the impact of cancer on survival
of the population at specific periods of diagnosis. PURPOSE: Our goal was
to develop and analyze three measures of the impact of cancer on population
survival that do not use the attributed cause of death: 1) the age-adjusted
proportion of the population diagnosed with cancer in a particular year and
projected to be dead of any cause by a particular age; 2) the same measure
corrected for population mortality; and 3) the expected years of life lost
to a 20- year-old individual because of the possibility of a diagnosis of
cancer. METHODS: Data on all adults diagnosed with any cancer during the
period from January 1973 through December 1990 were obtained from the
Surveillance, Epidemiology, and End Results (SEER) Program of the National
Cancer Institute. The measures were calculated separately for various
combined sex and race groups. Three 2-year diagnosis periods spaced 5 years
apart were considered: 1975-1976, 1980-1981, and 1985- 1986. A statistical
model was used to extrapolate survival beyond observation; the same model
was used for patients diagnosed in the three time periods to minimize the
effect of possible model misspecification on changes. RESULTS: Cancer
incidence increased for three of the four sex-race groups; age-adjusted
changes from 1975 through 1976 to 1985 through 1986 were +11.5% for white
men, +6.9% for white women, +15.1% for black men, and -9.2% for black
women. Human immunodeficiency virus (HIV)-related cancers were responsible
for an increased cancer incidence at early ages in white men in the latest
time period studied. There was a decrease in the incidence of gynecologic
cancers at early ages; the decrease was greater among black women (-55.1%)
than among white women (-39.3%). Age- and incidence- adjusted 5-year
survival increased by 17.9% for white men, 2.3% for white women, and 7.4%
for black men and decreased by 14.1% for black women. When the data from
1985 through 1986 were compared with those from 1975 through 1976, the
expected number of years lost to a 20-year- old individual because of
cancer changed as follows for the various sex- race groups: +1.4% for white
men (-4.0% if HIV-related cancers were not included in the calculation),
+2.1% for white women, +12.2% for black men, and +8.8% for black women.
CONCLUSIONS: For white men and women, there has been an increase in both
the incidence of and survival following the diagnosis of cancer; the two
effects nearly cancel in our measures. The experience of black men and
women has worsened because of increasing incidence or decreased survival.
ARTICLES
Assessing changes in the impact of cancer on population survival without considering cause of death
Department of Biomathematics, University of Texas M.D. Anderson Cancer Center, Houston 77030, USA.
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