Accuracy Of Cancer Death Certificates And Its Effect On Cancer Mortality Statistics

Cancer mortality statistics have been part of many epidemiological

investigations including a variety of etiological

studies of cancer. Deaths from cancer have been used in geographic

studies, studies of time trends, correlation studies,

and therapy evaluation. They have also been used to identify

cases for retrospective evaluation of possible etiological factors.

Because of the varied uses of mortality data, it is important

that they be reliable and accurate.

In the past, a number of authors have pointed out the

inaccuracies of cancer death certificates'-3 by comparing the

specified underlying cause of death to autopsy diagnosis and

to more specific hospital and pathologic information. Most of

these studies have been of limited scope and dealt only with

a small series of cases. To date, the only large-scale studies

on the accuracy of cancer death certification are Dorn and

Horn's 1941 study4 based on the First National Cancer Survey;

Dorn and Cutler's 1958 study5 based on the Second National

Cancer Survey; the Pan American Health Association

study in 19676; and studies by the Atomic Bomb Casualty

Commission7' 8 in Japan. No national assessment of the accuracy

of cancer mortality data in the United States has been

undertaken in the last 20 years. The study to be reported

compares the underlying cause of death from cancer with the

hospital cancer diagnosis of persons in specific areas of the

United States. In order to be included in the analyses to be

presented, a patient must have had a medical record which

indicated that a diagnosis of one and only one cancer had

been made and must have died with cancer coded as the underlying

cause of death on the death certificate. Furthermore,

the patient must have been a resident of the areas involved

in the study.

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