The effect of performing corrections on reported uterine cancer mortality data in the city of São Paulo

Abstract

Reports of uterine cancer deaths that do not specify the subsite of the tumor threaten the quality of the epidemiologic appraisal of corpus and cervix uteri cancer mortality. The present study assessed the impact of correcting the estimated corpus and cervix uteri cancer mortality in the city of São Paulo, Brazil. The epidemiologic assessment of death rates comprised the estimation of magnitudes, trends , and area-level distribution based on three strategies: i) using uncorrected death certificate information; ii) correcting estimates of corpus and cervix uteri mortality by fully reallocating unspecified deaths to either one of these categories, and iii) partially correcting specified estimates by maintaining as unspecified a fraction of deaths certified as due to cancer of "uterus not otherwise specified". The proportion of uterine cancer deaths without subsite specification decreased from 42.9% in 1984 to 20.8% in 2003. Partial and full corrections resulted in considerable increases of cervix (31.3 and 48.8%, respectively) and corpus uteri (34.4 and 55.2%) cancer mortality. Partial correction did not change trends for subsite-specific uterine cancer mortality, whereas full correction did, thus representing an early indication of decrease for cervical neoplasms and stability for tumors of the corpus uteri in this population. Ecologic correlations between mortality and socioeconomic indices were unchanged for both strategies of correcting estimates. Reallocating unspecified uterine cancer mortality in contexts with a high proportion of these deaths has a considerable impact on the epidemiologic profile of mortality and provides more reliable estimates of cervix and corpus uteri cancer death rates and trends.

Disparities in cervical and breast cancer mortality in Brazil

“…However, a fall in mortality from this cancer had been detected in several states even before these initiative commenced. Decreases in cervical cancer deaths had been recorded in the municipality of Sao Paulo between 1980 and 1999, 8 between 1984 and 2003 2 and between 1987 and 1998 in the municipalities of Campinas, Piracicaba and Sao Joao da Boa Vista, 18 all in the state of Sao Paulo. Similar declines were identified in Paraná 5 and in Minas Gerais between 1980 and 2005.…”

Trends in socioeconomic inequalities in cancer mortality in Barcelona: 1992–2003

“…However, epidemiological assessment of cervical cancer mortality is subjected to uncertainty due to a large proportion of uterine cancer being notified as "not otherwise specified"; and hence with no distinction between cancers originated in the cervix or in the corpus uteri [51]. …”

“…In the case of cervical cancer, where the screening is opportunistic, the situation is different and the inequalities for this kind of cancer are highest, although the evidence in Barcelona shows that the relative inequality may have presented a slight decrease. However, epidemiological assessment of cervical cancer mortality is subjected to uncertainty due to a large proportion of uterine cancer being notified as "not otherwise specified"; and hence with no distinction between cancers originated in the cervix or in the corpus uteri [ 51 ].…”

Correção da magnitude da mortalidade por câncer do colo do útero no Brasil, 1996-2005

“…1,2,4,14,16,17 The objective of the present study was to develop a methodology for correction of reported cervical cancer deaths in Brazil by combining two approaches: correction of SIM-related issues and those specifi cally related to death certifi cates reporting as primary cancer site "uterus, NOS. "…”