Invited Commentary: Predicting Incidence Rates of Rare Cancers-Adding Epidemiologic and Spatial Contexts

There are unique challenges to identifying causes of and developing strategies for prevention of rare cancers, driven by the difficulty in estimating incidence, prevalence, and survival due to small case numbers. Using a Poisson modeling approach, Salmerón et al. (Am J Epidemiol. 2022;191(3):487-498) built upon their previous work to estimate incidence rates of rare cancers in Europe using a Bayesian framework, establishing a uniform prior for a measure of variability for country-specific incidence rates. They offer a methodology with potential transferability to other settings with similar cancer surveillance infrastructure. However, the approach does not consider the spatiotemporal correlation of rare cancer case counts and other, potentially more appropriate nonnormal probability distributions. In this commentary, we discuss the implications of future work from cancer epidemiology and spatial epidemiology perspectives. We describe the possibility of developing prediction models tailored to each type of rare cancer; incorporating the spatial heterogeneity in at-risk populations, surveillance coverage, and risk factors in these predictions; and considering a modeling framework with which to address the inherent spatiotemporal components of these data. We note that extension of this methodology to estimate subcountry rates at provincial, state, or smaller geographic levels would be useful but would pose additional statistical challenges.