Comparison between diagnoses on death certificates and autopsy reports in Trieste: gynaecological cancers

We have compared autopsy results with the diagnosis reported on 759 death certificates for gynaecological cancers. High levels of discrepancies were noted for all sites. Surprisingly, complete agreement between death certificates and autopsy reports was found for only 30% of cervical and corpus tumours and for 50% of ovarian tumours. This low level of agreement was due partly to the poor quality of death certificates of older women. No difference in accuracy was found over the 15-year period considered. The most obvious causes of the discrepancies were of two types. The first was erroneous interpretation of codes; confusion between 180 (cervix) and 182 (corpus) was very frequent. The second type was associated with clinical factors, such as confusion of anatomical site, adjacent organs or metastases being diagnosed as primary tumours. A relatively frequent cause of inaccuracy on death certificates was consideration of patients who had been cured of a cancer as having died of the disease.