title: Cancer map patterns: are they random or not?
abstract: BACKGROUND
  Maps depicting the geographic variation in cancer incidence, mortality or treatment can be useful tools for developing cancer control and prevention programs, as well as for generating etiologic hypotheses. An important question with every cancer map is whether the geographic pattern seen is due to random fluctuations, as by pure chance there are always some areas with more cases than expected, or whether the map reflects true underlying geographic variation in screening, treatment practices, or etiologic risk factors.
  
  
  METHODS
  Nine different tests for spatial randomness are evaluated in very practical settings by applying them to cancer maps for different types of data at different scales of spatial resolution: breast, prostate, and thyroid cancer incidence; breast cancer treatment and prostate cancer stage in Connecticut; and nasopharynx and prostate cancer mortality in the U.S.
  
  
  RESULTS
  Tango's MEET, Oden's Ipop, and the spatial scan statistic performed well across all the data sets. Besag-Newell's R, Cuzick-Edwards k-NN, and Turnbull's CEPP often perform well, but the results are highly dependent on the parameter chosen. Moran's I performs poorly for most data sets, whereas Swartz Entropy Test and Whittemore's Test perform well for some data sets but not for other.
  
  
  CONCLUSIONS
  When publishing cancer maps we recommend evaluating the spatial patterns observed using Tango's MEET, a global clustering test, and the spatial scan statistic, a cluster detection test.
authors.affiliation: Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Massachusetts 02215, USA. Martin_Kulldorff@hms.harvard.edu
authors.forename: Martin
authors.initials: M
authors.lastname: Kulldorff
authors.forename: Changhong
authors.initials: C
authors.lastname: Song
authors.forename: David
authors.initials: D
authors.lastname: Gregorio
authors.forename: Holly
authors.initials: H
authors.lastname: Samociuk
authors.forename: Laurie
authors.initials: L
authors.lastname: DeChello
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003237:Connecticut / Q000453:epidemiology; D040362:Geographic Information Systems; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015233:Models, Statistical; D009369:Neoplasms / Q000453:epidemiology*; D011897:Random Allocation; D019371:Topography, Medical