1 / 29

Dr Heather O Dickinson My web page Department of Child Health University of Newcastle

Dr Heather O Dickinson My web page Department of Child Health University of Newcastle. Audit of cancer registrations notified by National Health Service Central Register in England & Wales .

lelia
Download Presentation

Dr Heather O Dickinson My web page Department of Child Health University of Newcastle

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Dr Heather O DickinsonMy web pageDepartment of Child HealthUniversity of Newcastle Audit of cancer registrations notified by National Health Service Central Register in England & Wales

  2. I work on the epidemiology of children’s cancer, mainly on cohort studies in relation to exposures around birth: • population mixing • infections • father’s preconceptional irradiation Heather Dickinson

  3. Learning objectives - understand: • importance of ascertainment of cases from multiple sources • importance of diagnostic review • age - cohort effects • Performance objectives - able to: • use capture-recapture methods • organise a diagnostic review

  4. Cancer registration system in England & Wales 12 regional cancer registries National Health Service Central Register (NHSCR)

  5. Cancers notified by NHSCR Notified by NHSCR Expected 100 80 60 No. of cancers 40 20 0 1971 1975 1980 1985 1990 1993 Year of diagnosis

  6. Objective For NHSCR cancer registrations, 1971-89, to assess: • Accuracy of diagnoses Were site and type codes correct? • Completeness of ascertainment Did they tell us about ALL the people who got cancer?

  7. Accuracy of diagnostic codes from NHSCR

  8. Identify hospital of diagnosis Request biopsy, pathology or post-mortem report Material found and satisfactory? No Yes No Yes Hospital ID no. known? Request clinical records Yes No Clinical records obtained? Review complete Review cancer or death registration

  9. Pathology review of NHSCR cancer registrations

  10. Diagnostic groups We grouped the cancers into diagnostic groups: • we used 13 standard groups for children’s cancer Kramarova et al., 1996 • we added 3 groups for adult cancer

  11. Level of agreement between diagnostic codes of NHSCR and review

  12. Reasons for disagreement

  13. Reasons for disagreement We were interested in whether the accuracy of diagnosis depended on: • age • how recently the original diagnosis was made

  14. The Cumbrian birth cohort 100,000 Total no. in cohort 0-14 yrs 15-24 yrs over 25 yrs 50,000 0 1971 1975 1980 1985 1989 Year

  15. NHSCR and review diagnoses in different groups 12 8 % of cases 4 0 0-14 15-24 over 25 Age (in years) at diagnosis p for heterogeneity = 0.03

  16. NHSCR and review diagnoses in different groups 12 8 % of cases 4 0 1971-74 1975-79 1980-84 1985-89 Time period of diagnosis p for trend = 0.07

  17. Completeness of ascertainment by NHSCRDid NHSCR tell us about all the people in our cohort who got cancer?

  18. Completeness of ascertainment by NHSCR *N = No. of cancers not notified by NHSCR

  19. Completeness of ascertainment by NHSCR • 720 cases notified by NHSCR • 694 confirmed as malignant • 740 malignancies notified from all sources Ascertainment = 694/740 = 94%

  20. Completeness of ascertainment by NHSCR 12 8 % of cases missed 4 0 0-14 15-24 over 25 Age (in yrs) at diagnosis p for heterogeneity = 0.02

  21. Completeness of ascertainment by NHSCR 8 6 4 % of cases missed 2 0 1971-74 1975-79 1980-84 1985-89 Time period of diagnosis p for trend = 0.83

  22. Completeness of ascertainment by NHSCR Other cases? • Not notified by NHSCR AND • Not notified by any other source

  23. Cases not notified by NHSCR or other sources Over 25 years Notified by NHSCR? Yes No Notified Yes 215 11 by other No 86 ? sources?

  24. Cases not notified by NHSCR or other sources 15 - 24 years Notified by NHSCR? Yes No Notified Yes 194 15 by other No 24 ? sources?

  25. Cases not notified by NHSCR or other sources 0 - 14 years Notified by NHSCR? Yes No Notified Yes 175 0 by other No 86 ? sources?

  26. Cancers missed by NHSCR Notified by Age other sources? TOTAL (in years) n YES NO (%) at diagnosis 0-14 20.0 20 (10%) 0.0 15-24 (7%) 16.9 15 1.9 over 25 14.4 11 (5%) 4.4 ALL AGES (7%) 46 6.3 51.3

  27. Summary: completeness of ascertainment by NHSCR • NHSCR definitely missed 46 (6%) out of 740 casesnotified by all sources. • NHSCR probably missed more cases which were not notified to us by any source.

  28. Summary: completeness of ascertainment by NHSCR • NHSCR missed 10% of cases in the youngest age group. • NHSCR probably missed at least 10% of cases in other age groups too.

  29. Conclusions • Ascertainment from multiple sources & • Diagnostic review are essential for epidemiological studies of cancer

More Related