Estimating bias in causes of death ascertainment in the Finnish Randomized Study of Screening for Prostate Cancer

详细信息    查看全文

• 作者：Tuomas P. Kilpelä ; inen ; M.D. ; Ph.D.^a ; ^{tuomas.kilpelainen@hus.fi} ; Tuukka Mä ; kinen ; M.D. ; Ph.D.^b ; Pekka J. Karhunen^c (professor) ; Jussi Aro ; M.D. ; Ph.D.^a ; Jorma Lahtela^d (professor) ; Kimmo Taari^a (professor) ; Kirsi Talala ; Ph.D.^e ; Teuvo L.J. Tammela^f (professor) ; Anssi Auvinen^g (professor)
• 关键词：CoD ; cause of death ; SA ; screening arm ; CA ; control arm ; PCa ; prostate cancer ; CI ; confidence interval ; HR ; hazard ratio ; ERSPC ; European Randomized Study of Screening for Prostate Cancer ; PLCO ; prostate ; lung ; colorectal and ovarian cancer screening trial ; PSA ; prostate-specific antigen
• 刊名：Cancer Epidemiology
• 出版年：2016
• 出版时间：December 2016
• 年：2016
• 卷：45
• 期：Complete
• 页码：1-5
• 全文大小：388 K
• 卷排序：45

文摘

Precise cause of death (CoD) ascertainment is crucial in any cancer screening trial to avoid bias from misclassification due to excessive recording of diagnosed cancer as a CoD in death certificates instead of non-cancer disease that actually caused death. We estimated whether there was bias in CoD determination between screening (SA) and control arms (CA) in a population-based prostate cancer (PCa) screening trial.MethodsOur trial is the largest component of the European Randomized Study of Screening for Prostate Cancer with more than 80,000 men. Randomly selected deaths in men with PCa (N = 442/2568 cases, 17.2%) were reviewed by an independent CoD committee. Median follow-up was 16.8 years in both arms.ResultsOverdiagnosis of PCa was present in the SA as the risk ratio for PCa incidence was 1.19 (95% confidence interval (CI) 1.14–1.24). The hazard ratio (HR) for PCa mortality was 0.94 (95%CI 0.82–1.08) in favor of the SA. Agreement with official CoD registry was 94.6% (κ = 0.88) in the SA and 95.4% (κ = 0.91) in the CA. Altogether 14 PCa deaths were estimated as false-positive in both arms and exclusion of these resulted in HR 0.92 (95% CI 0.80–1.06).ConclusionsA small differential misclassification bias in ascertainment of CoD was present, most likely due to attribution bias (overdiagnosis in the SA). Maximum precision in CoD ascertainment can only be achieved with independent review of all deaths in the diseased population. However, this is cumbersome and expensive and may provide little benefit compared to random sampling.