摘要：
The accuracy of cancer mortality data varies across different cancers.
Mortality records and death certificates may not always reflect
the true cause of death for various reasons (e.g., misdiagnosis,
improper recording on the death certificate, miscoding of the cause
of death recorded on the death certificate). Mesothelioma, a rare
tumor which is caused by exposure to asbestos, is a special case.
Until 1999 when the 10th revision of the International Classification
of Diseases (ICD-10) introduced a specific mesothelioma code, mesothelioma
deaths were coded to other causes (e.g., cancer of the pleura, cancer
of other or ill-specified sites). Even after the introduction of
this mesothelioma code, researchers have shown that estimates of
mesothelioma mortality based on death certificates are still biased
downward. This article reviews available literature with quantitative
information on mesothelioma underascertainment, in particular on
different rates of underestimation for pleural and peritoneal mesotheliomas,
and suggests two approaches to estimating downward bias in absolute
risk estimates due to mesothelioma underascertainment. The choice
of approach used depends on whether the information on the proportion
of peritoneal mesotheliomas is available. Both approaches are demonstrated
and evaluated using a cohort of asbestos workers from Libby, MT.
The methods developed in this article may be used in analyses of
other asbestos cohorts and in methodologies to predict future mesothelioma
burden in populations. Similar approaches can be used to assess
the impact of underascertainment of other cancers on risk estimates
of other chemicals.
