Access the full text.
Sign up today, get DeepDyve free for 14 days.
References for this paper are not available at this time. We will be adding them shortly, thank you for your patience.
"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.
American Journal of Public Health – American Public Health Association
Published: Oct 1, 1992
You can share this free article with as many people as you like with the url below! We hope you enjoy this feature!
Read and print from thousands of top scholarly journals.
Already have an account? Log in
Bookmark this article. You can see your Bookmarks on your DeepDyve Library.
To save an article, log in first, or sign up for a DeepDyve account if you don’t already have one.
Copy and paste the desired citation format or use the link below to download a file formatted for EndNote
Access the full text.
Sign up today, get DeepDyve free for 14 days.
All DeepDyve websites use cookies to improve your online experience. They were placed on your computer when you launched this website. You can change your cookie settings through your browser.