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ARTICLES: Ahmedin Jemal, Ram C. Tiwari, Taylor Murray, Asma Ghafoor, Alicia Samuels, Elizabeth Ward, Eric J. Feuer, and Michael J. Thun Cancer Statistics, 2004 CA Cancer J Clin 2004; 54: 8-29 [Abstract] [Full text] [PDF]

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Re: US Ovarian Cancer Cases and Deaths 2004

Ahmedin Jemal   (5 August 2004)

Cancer Statistics 2004

M. Steven Piver   (7 June 2004)

Re: US Ovarian Cancer Cases and Deaths 2004 5 August 2004
Ahmedin Jemal, Program Director, Cancer Occurence, Department of Epidemiology and Surveillance Research American Cancer Society Send letter to journal: Re: Re: US Ovarian Cancer Cases and Deaths 2004 ahmedin.jemal{at}cancer.org Ahmedin Jemal	Dear Dr. Piver: Thank you your interest in our estimated US cancer cases and deaths and for seeking an explanation for the increase in the estimated number of ovarian cancer deaths in the U.S. from 14,300 in 2003 to 16,090 in 2004. We generally discourage the use of our estimates to track-year to year changes in cancer deaths because the numbers are model-based and can vary considerably from year to year, especially for less common cancers (see page 29 of our paper, CA Cancer J Clin 2004; 54:8-29). In addition to uncertainty arising from our model, the increase in the total number of ovarian cancer deaths may be in part attributed to increases in age-adjusted death rates for ovarian cancer in recent years and overall growth and aging of the population. Epidemiologists use a statistical method called “age-adjustment” to compare groups of people with different age compositions and/or population sizes over time or across region. The attached file shows age-adjusted death rates and total recorded ovarian cancer deaths from 1969 through 2001; the total number of deaths does not account for the aging and growth of the population. These data illustrate the influence of increasing death rates and population size on the 2004 estimated total number of ovarian cancer deaths in the U.S. Age-adjusted death rates (per 100,000 females) decreased from 9.5 in 1991 to 8.7 in 1998, without a corresponding decrease in the total number of cancer deaths. In fact, the total number of ovarian cancer deaths during these corresponding periods slightly increased from 13,028 to 13,390 due to the growth and aging of the population, despite the decrease in age-adjusted death rates. In contrast to the age-adjusted mortality trends before 1998, ovarian cancer death rates slightly increased from 8.7 in 1998 to 9.0 in 2001, with a corresponding increase in the total number of ovarian cancer deaths from 13,390 to 14,414. Therefore, the increase in our estimates from 2001 to 2004 largely reflects this recent increasing pattern in ovarian cancer death rates and total recorded cancer deaths. It is also noteworthy that we changed our statistical method for predicting the number of deaths in 2004. Based on the trends in observed number of deaths from 1998 to 2001, it appears that the number of ovarian cancer deaths published in 2003 may be an underestimate. Please let us know if you have any further questions about our estimates. With regards, Ahmedin Jemal
Cancer Statistics 2004 7 June 2004
M. Steven Piver, Senior Gynecologic Oncologist Sisters of Charity Hospital Send letter to journal: Re: Cancer Statistics 2004 mpiver{at}chsbuffalo.org M. Steven Piver	To The Editor: For the past 35 years I have been, in addition to researching ovarian cancer, treating women with this disease. Even longer, the Amerian Cancer Society annually has been providing us with the important US estimated total cases and deaths from ovarian cancer. Gnagy et al. suggested that the decline in the observed US rates of ovarian cancer incidence and mortality from 1970 -1995 was secondary to the increase of oral contraceptives over that time, with the known protective effects of oral contraceptives against the development of ovarian cancer.1 Adding support to this thesis was a significant decrease in the number of ovarian cancer cases occurring between 1996 (26,700) and 2000 (23,100) and a significant decrease in the number of ovarian cancer deaths from 1996 (14,800) to 14,000 in the year 2000, as reported in the journal CA.2 Notwithstanding the report in the January/February 2004 issue of CA of "a new method of predicting US and state level cancer mortality counts for the current calenar year,"3 this writer believes the alarming increase in the estimated ovarian cancer mortality of 11.0% from the 14,300 deaths in 2003 to the 16,090 deaths in 2004, as reported in the January/February 2004 issue of CA has to be explained to the public and to the oncology community in more detail than a possible change in the method of estimating the total cases and deaths from ovarian cancer in the United States. M. Steven Piver, MD Senior Gynecologic Oncologist Sisters of Chariy Hospital 2157 Main Street Buffalo, NY 14214 Email: mpiver@chsbuffalo.org References 1. Gnagy, S; Ming, EE; Devesa, SS, et al. Declining ovarian cancer rates in US women in relation to parity and oral contraceptive use. Epidemiology 2000;11:102-105. 2. Greenlee, RT; Murray, T; Bolden, S; Wingo, PA. Cancer statistics. CA Cancer J Clin 2000;50:7. 3. Tiwari, RC; Ghosa, K; Jemal, A, et al. A new method of predicting US and state level cancer mortality counts for the current calendar year. CA Cancer J Clin 2004;54:30-40.