On a fundamental problem in the analysis of cancer registry dataIn epidemiology research with cancer registry data, it is often of primary
interest to make inference on cancer death, not overall survival. Since cause
of death is not easy to collect or is not necessarily reliable in cancer
registries, some special methodologies have been introduced and widely used by
using the concepts of the relative survival ratio and the net survival. In
making inference of those measures, external life tables of the general
population are utilized to adjust the impact of non-cancer death on overall
survival. The validity of this adjustment relies on the assumption that
mortality in the external life table approximates non-cancer mortality of
cancer patients. However, the population used to calculate a life table may
include cancer death and cancer patients. Sensitivity analysis proposed by
Talbäck and Dickman to address it requires additional information which is
often not easily available. We propose a method to make inference on the net
survival accounting for potential presence of cancer patients and cancer death
in the life table for the general population. The idea of adjustment is to
consider correspondence of cancer mortality in the life table and that in the
cancer registry. We realize a novel method to adjust cancer mortality in the
cancer registry without any additional information to the standard analyses of
cancer registries. Our simulation study revealed that the proposed method
successfully removed the bias. We illustrate the proposed method with the
cancer registry data in England.
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