JAMA Oncology
"Because cancer can occur in young people and creates significant disability prior to death, the social impact as measured by disability-adjusted life-years (DALYs) is staggering."
....In
oncology, diagnostic accuracy is a critical issue for developing cancer
treatment strategies. Cancer registries are linked to surgical
pathology assessments. While some cancers may be amenable to accurate
diagnosis through clinical evaluation or simple diagnostic testing, most
cancers can be difficult to specify in the absence of tissue diagnosis.
The GBD investigators provide estimates of years of life lost for
different cancers, some of which showed little change in ranking over
the study years (eg, lung, colon, breast, esophagus, ovarian, uterine,
melanoma), whereas others had marked variation in rank order (eg,
pancreatic, bladder, gall bladder, Hodgkin lymphoma, myeloma). These
variations in the latter group could reflect differences in cancer
prevalence, biology, and/or treatment but may alternatively relate to
diagnostic inaccuracy, because all of the cancers with variations in
rank order require higher-quality imaging studies and/or pathology
assessment for definitive diagnosis. Histologically different cancers
that present in adjacent anatomic locations and/or with similar signs
and symptoms could easily be confused. Without histologic evidence
confirming malignant tissue diagnosis, mortality causation assessment
tools cannot reliably differentiate between primary liver cancer, gall
bladder cancer, pancreatic cancer, and cancer metastatic to liver, all
of which have similar clinical presentations. Because accurate tissue
diagnosis is fundamental to cancer registry methodology but is not
required in GBD analysis, the GBD approach developed by IHME seems
unlikely to achieve the diagnostic precision of a pure cancer
registry–based method. These findings highlight the importance for
strengthening global pathology and imaging services in conjunction with
expanding cancer registration data systems throughout the world, which
could benefit both GLOBOCAN and GBD estimates........
