Impact of reporting delay and reporting error on cancer incidence rates and trends.
BACKGROUND
Cancer incidence rates and trends are a measure of the cancer burden in the general population. We studied the impact of reporting delay and reporting error on incidence rates and trends for cancers of the female breast, colorectal, lung/bronchus, prostate, and melanoma.


METHODS
Based on statistical models, we obtained reporting-adjusted (i.e., adjusted for both reporting delay and reporting error) case counts for each diagnosis year beginning in 1981 using reporting information for patients diagnosed with cancer in 1981-1998 from nine cancer registries that participate in the Surveillance, Epidemiology, and End Results (SEER) program. Joinpoint linear regression was used for trend analysis. All statistical tests are two-sided.


RESULTS
Initial incidence case counts (i.e., after the standard 2-year delay) accounted for only 88%-97% of the estimated final counts; it would take 4-17 years for 99% or more of the cancer cases to be reported. The percent change between reporting-adjusted and unadjusted cancer incidence rates for the 1998 diagnosis year ranged from 3% for colorectal cancers to 14% for melanoma in whites and for prostate cancer in black males. Reporting-adjusted current incidence trends for breast cancer and lung/bronchus cancer in white females showed statistically significant increases (estimated annual percent change [EAPC] = 0.6%, 95% confidence interval [CI] = 0.1% to 1.2%) and 1.2%, 95% CI = 0.7% to 1.6%, respectively), whereas trends for these cancers using unadjusted incidence rates were not statistically significantly different from zero (EAPC = 0.4%, 95% CI = -0.1% to 0.9% and 0.5%, 95% CI = -0.1% to 1.1%, respectively). Reporting-adjusted melanoma incidence rates for white males showed a statistically significant increase since 1981 (EAPC = 4.1%, 95% CI = 3.8% to 4.4%) in contrast to the unadjusted incidence rate, which was most consistent with a flat or downward trend (EAPC = -4.2%, 95% CI = -11.1% to 3.3%) after 1996.


CONCLUSIONS
Reporting-adjusted cancer incidence rates are valuable in precisely determining current cancer incidence rates and trends and in monitoring the timeliness of data collection. Ignoring reporting delay and reporting error may produce downwardly biased cancer incidence trends, particularly in the most recent diagnosis years.
Clegg
Limin X
LX
Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD 20892, USA. lin_clegg@nih.gov
Feuer
Eric J
EJ
Midthune
Douglas N
DN
Fay
Michael P
MP
Hankey
Benjamin F
BF
D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D001943:Breast Neoplasms / Q000453:epidemiology* / Q000208:ethnology; D001984:Bronchial Neoplasms / Q000453:epidemiology* / Q000208:ethnology; D015179:Colorectal Neoplasms / Q000453:epidemiology* / Q000208:ethnology; D005260:Female; D006801:Humans; D015994:Incidence; D016014:Linear Models; D008175:Lung Neoplasms / Q000453:epidemiology* / Q000208:ethnology; D008297:Male; D008545:Melanoma / Q000453:epidemiology* / Q000208:ethnology; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000453:epidemiology* / Q000208:ethnology; D018426:SEER Program; D017678:Sex Distribution; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data