Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 14-Day Trial for You or Your Team.

Learn More →

Conclusions on cancer and low socioeconomic status questioned.

Conclusions on cancer and low socioeconomic status questioned. "This study demonstrates that... lower socioeconomic status (SES) women ... are at extremely high risk of having their breast and cervical cancers diagnosed at late stages." We interpret the word "risk" to mean incidence (or relative risk), and in this study the risk of cancer-or cancer at any particular stage-cannot be determined because only cancer patients were studied. An appropriate sample ofpersons without cancer (i.e., controls) or a population denominator is needed in order to estimate the risk or relative risk of acquiring late-stage cancer. An alternative statement to descnibe the conclusions from the Mandelblatt et al. data could read as follows: "Among women with breast or cervical cancer, lower SES women ... were more likely to have their cancers detected at late stages." The fact that an outcome (late stage) may be associated with variables in a registry data set does not mean that having those variables increases the risk of acquiring the outcome. As an example, Table 1 shows a hypothetical population of 20 000 women, with 600 having breast cancer. The incidence or risk of late-stage cancer is the same (0.01) by SES; however, if only cancer cases (n = 600) were analyzed, as in Mandelblatt's study, low SES would be associated with late-stage cancer (odds ratio 3.0). We consider such associations (measured by P values or ratios) to be just that, and not estimates of risk. We do not mean to suggest that women of lower SES do not have an elevated risk or incidence of late-stage cancer. Indeed, other studies have suggested they do have a higher risk of late-stage breast cancer2 and that control programs may achieve considerable benefits by focusing on them. We simply point out that no statement about risk (incidence or relative risk) can be made from the data presented in this article. Unfortunately, the authors chose not to use available census data to estimate the characteristics of the population denominator and cancer-bystage risk. E Rober fA. Gunn, MD, MPH Danid M. Sosin, MD Thomas A. Fawey, MD At the time this letter was written, the authors were with the Division of Field Epidemiology, Epidemiology Program Office, Centers for Disease Control, Atlanta, Ga. Requests for reprints should be sent to Robert A. Gunn, MD, MPH, Division of Field Epidemiology, Epidemiology Program Office, Centers for Disease Control, MS C-08, 1600 Clifton Rd, NE, Atlanta, GA 30333. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png American Journal of Public Health American Public Health Association

Conclusions on cancer and low socioeconomic status questioned.

Loading next page...
 
/lp/american-public-health-association/conclusions-on-cancer-and-low-socioeconomic-status-questioned-cNV44MWVms

References

References for this paper are not available at this time. We will be adding them shortly, thank you for your patience.

Publisher
American Public Health Association
Copyright
Copyright © by the American Public Health Association
ISSN
0090-0036
eISSN
1541-0048
Publisher site
See Article on Publisher Site

Abstract

"This study demonstrates that... lower socioeconomic status (SES) women ... are at extremely high risk of having their breast and cervical cancers diagnosed at late stages." We interpret the word "risk" to mean incidence (or relative risk), and in this study the risk of cancer-or cancer at any particular stage-cannot be determined because only cancer patients were studied. An appropriate sample ofpersons without cancer (i.e., controls) or a population denominator is needed in order to estimate the risk or relative risk of acquiring late-stage cancer. An alternative statement to descnibe the conclusions from the Mandelblatt et al. data could read as follows: "Among women with breast or cervical cancer, lower SES women ... were more likely to have their cancers detected at late stages." The fact that an outcome (late stage) may be associated with variables in a registry data set does not mean that having those variables increases the risk of acquiring the outcome. As an example, Table 1 shows a hypothetical population of 20 000 women, with 600 having breast cancer. The incidence or risk of late-stage cancer is the same (0.01) by SES; however, if only cancer cases (n = 600) were analyzed, as in Mandelblatt's study, low SES would be associated with late-stage cancer (odds ratio 3.0). We consider such associations (measured by P values or ratios) to be just that, and not estimates of risk. We do not mean to suggest that women of lower SES do not have an elevated risk or incidence of late-stage cancer. Indeed, other studies have suggested they do have a higher risk of late-stage breast cancer2 and that control programs may achieve considerable benefits by focusing on them. We simply point out that no statement about risk (incidence or relative risk) can be made from the data presented in this article. Unfortunately, the authors chose not to use available census data to estimate the characteristics of the population denominator and cancer-bystage risk. E Rober fA. Gunn, MD, MPH Danid M. Sosin, MD Thomas A. Fawey, MD At the time this letter was written, the authors were with the Division of Field Epidemiology, Epidemiology Program Office, Centers for Disease Control, Atlanta, Ga. Requests for reprints should be sent to Robert A. Gunn, MD, MPH, Division of Field Epidemiology, Epidemiology Program Office, Centers for Disease Control, MS C-08, 1600 Clifton Rd, NE, Atlanta, GA 30333.

Journal

American Journal of Public HealthAmerican Public Health Association

Published: Oct 1, 1992

There are no references for this article.