>...a lot of cancer went
>undiagnosed, or people died younger from something else. My
>great-grandfather died of "urinary blockage" that was almost certainly
>prostate cancer. His son was diagnosed with prostate cancer, but died
>of something else (at 92) before the cancer could get him.
>For me it is the former 1-in-8 rate that is doubtful. That *also* makes
>the conclusion of greatly increasing cancer incidence suspect, but from
>the *other* end.
In confirmation of his suspicions, the following:
British Medical Journal 1998;317:1033 ( 17 October )
Cancer diagnosis is often missed
Janice Hopkins Tanne, New York
Lethal cancers were not diagnosed or were misdiagnosed before death in 44%
of cases, according to a 10 year retrospective study of postmortem
examinations at a US academic medical centre.
This discrepancy calls into serious question all public health statistics
based on death certificate information, as well as clinical decisions,
according to Dr George Lundberg, a pathologist and editor of JAMA.
Dr Elizabeth Burton and colleagues reviewed data on all 1105 men and women
in whom postmortem examinations were carried out between 1986 and 1995 at
the Medical Center of Louisiana in New Orleans (JAMA 1998;280:1245-8). The
medical centre's rate of postmortem examination was unusually high (42%)
thanks to cooperation with the local coroner.
Because diagnoses from death certificates are unreliable, Dr Burton
gathered clinical diagnoses from surgical pathology reports, cytology
reports, and patient charts. She found 250 malignant tumours in 225
patients. Of the 250 cancers, 111 were misdiagnosed or undiagnosed before
death (103 undiagnosed, 8 misdiagnosed). Only 34 of the tumours were
clinically suspected. The undiagnosed cancer was the cause of death in 57%
The most common undiagnosed cancers affected the respiratory tract,
gastrointestinal tract, and genitourinary tract. Although southern
Louisiana does not have an unusually high incidence of cancer, it has a
high death rate from cancer. The medical centre, which is also a trauma
centre, serves an indigent black population in whom substance misuse,
comorbid illness, and lack of regular medical care are common. Many
patients in whom postmortem examinations were conducted in this study died
soon after admission with advanced disease.
"Low tech autopsy trumps high tech medicine in getting the right answer,"
Dr Lundberg said. In the United States the rate of postmortem examinations
for patients dying in hospital has dropped from about 50% in the 1950s to
perhaps 5% or zero in community hospitals and nursing homes. From the
1960s, hospital pathologists lost interest in postmortem examinations as
they began to profit from laboratory tests paid for by Medicare health
insurance for elderly people, according to Dr Lundberg.
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