Underreporting of Myeloid Malignancies by United States Cancer Registries
A partir des données des registres américains du cancer, cette étude évalue l'ampleur de la sous-déclaration dans l'incidence des leucémies myéloïdes
Background: The recent decrease in myeloid leukemias (ML) incidence may be directly attributed to changes in the population-based cancer registries' 2001 guidelines, which required the capture of only 1 malignancy in the myeloid lineage per person and the simultaneous adoption of myelodysplastic syndrome registration in the United States. Methods: To address these potential limitations, we constructed 4 claims-based algorithms to assess ML incidence, applied the algorithms to the 1999-2008 Surveillance Epidemiology and End Results (SEER)-Medicare database, and assessed algorithm validity using SEER-registered cases. Each algorithm required 1 or more ML claims and accounted for recommended diagnostic services during the year prior to the first claim: 1+, 2+, 2+blood counts (BC) and 2+BCBM (bone marrow) (ordered by sensitivity). Results: Each had moderate sensitivities (75% to 94%) and high specificities (above 99.0%), with the 2+BCBM algorithm demonstrating the highest specificity. Based on the 2+BCBM algorithm, SEER registered only 50% of the AML cases and a third of the CML cases. The annual incidence of ML in 2005 was 26 per 100,000 persons 66 years or older, much higher than the 15 per 100,000 reported by SEER using the same sample. Conclusion: Our findings suggest underreporting of myeloid leukemias in SEER by a magnitude of 50-70%, as well as validate and support the use of the 2+BCBM claims algorithm in identifying ML cases. Moreover, use of this conservative and highly specific algorithm identified a high number of uncaptured ML cases, particularly CML cases.