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Underreporting of myeloid malignancies by United States cancer registries
Benjamin M Craig1, Dana E Rollison, Alan F List
1H.Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA. benjamin.craig@moffitt.org
Insights
Cancer registries may underreport myeloid leukemias by 50-70%. A new claims-based algorithm, 2+BCBM, accurately identifies more myeloid leukemia cases, including chronic myelogenous leukemia (CML).
Area of Science:
- Hematology
- Cancer Epidemiology
- Health Services Research
Background:
- Population-based cancer registries (SEER) guidelines changed in 2001, potentially affecting myeloid leukemia incidence reporting.
- The adoption of myelodysplastic syndrome registration may have influenced myeloid leukemia capture rates.
Purpose of the Study:
- To develop and validate claims-based algorithms for assessing myeloid leukemia incidence.
- To compare the incidence of myeloid leukemia identified by claims data versus SEER data.
Main Methods:
- Four claims-based algorithms were constructed to identify myeloid leukemia cases.
- Algorithms were applied to the 1999-2008 SEER-Medicare database.
- Algorithm validity was assessed using SEER-registered cases.
Main Results:
- The 2+BCBM algorithm demonstrated high specificity (>99.0%) and moderate sensitivity (75%-94%).
- SEER data captured only 50% of acute myelogenous leukemia and 33% of chronic myelogenous leukemia (CML) cases identified by the 2+BCBM algorithm.
- Myeloid leukemia incidence in 2005 was estimated at 26 per 100,000 persons aged 66+, significantly higher than SEER's reported 15 per 100,000.
Conclusions:
- SEER data underreports myeloid leukemias by 50-70%.
- The 2+BCBM claims algorithm is validated for identifying myeloid leukemia cases, including uncaptured CML cases.
- Improved case ascertainment in cancer registries is needed for accurate resource allocation.
Background:
The recent decrease in myeloid leukemia incidence may be directly attributed to changes in the population-based cancer registries 2001 guidelines, which required the capture of only one malignancy in the myeloid lineage per person and the simultaneous adoption of myelodysplastic syndrome registration in the United States.
Methods:
We constructed four claims-based algorithms to assess myeloid leukemia incidence, applied the algorithms to the 1999-2008 Surveillance Epidemiology and End Results (SEER)-Medicare database, and assessed algorithm validity using SEER-registered cases.
Results:
Each had moderate sensitivities (75%-94%) and high specificities (>99.0%), with the 2+BCBM algorithm showing the highest specificity. On the basis of the 2+BCBM algorithm, SEER registered only 50% of the acute myelogenous leukemia cases and a third of the chronic myelogenous leukemia (CML) cases. The annual incidence of myeloid leukemia in 2005 was 26 per 100,000 persons 66 years or older, much higher than the 15 per 100,000 reported by SEER using the same sample.
Conclusion:
Our findings suggest underreporting of myeloid leukemias in SEER by a magnitude of 50% to 70% as well as validate and support the use of the 2+BCBM claims algorithm in identifying myeloid leukemia cases. Use of this algorithm identified a high number of uncaptured myeloid leukemia cases, particularly CML cases.
Impact:
Our results call for the commitment of more resources for centralized cancer registries so that they may improve myeloid leukemia case ascertainment, which would empower policy makers with ability to properly allocate limited health care resources.
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