Routine Measures of Cancer Burden

Definitions, Uses, And Caveats

Cancer incidence is the frequency of occurrence of new cases of cancer in a defined
population for a given period of time. It can be expressed as the absolute number of
cases, although computation of rates is required for comparative purposes, with the
denominator the person-time at risk from which the cases in the numerator arose. The
statistic is useful in providing clues to the underlying risk factors and in planning and
prioritizing resources for primary prevention, where the aim is to reduce incidence via
changes in cultural and personal patterns of behavior.

Population-based cancer registries collect and classify information on all new cases of
cancer in a defined population and provide statistics on occurrence for the purposes of
assessing and controlling the impact of cancer in the community. Registries may cover
entire national populations or selected regions. The comparability, completeness, and
accuracy of incidence data are essential in making reliable inferences regarding
geographical and temporal variations in incidence rates. The Cancer Incidence In Five
Continents (CI5) series, first published in 1962, is now in its eighth volume (Parkin et al.,
2002) and covers diagnoses of cancer 1993–97 in 186 registries in 57 countries.
Inclusion is a good marker of the quality of an individual registry, given that the editorial
process includes numerous assessments of data quality.

Mortality provides a measure of the impact of cancer and is expressed either as number
of deaths occurring or as a mortality rate: The number of deaths per 100 000 persons
per year. Mortality is a product of the incidence and the case fatality from a given
cancer. Death rates estimate the average risk to the population of dying from a specific
cancer, while fatality, the inverse of cancer survival (the time that elapsed between the
diagnosis of cancer and death from it), represents the probability that an individual with
cancer will die from it. Data derive from vital registration systems, where usually a
medical practitioner certifies the fact and cause of death. The International
Classification of Diseases (ICD) provides a standardized system of nomenclature and
coding, and a suggested format for the death certificate.

Mortality data are affected by both the degree of detail and the quality of the
information, that is, the accuracy of the recorded cause of death and the completeness
of registration. These are known to vary considerably between countries and over time.
Mortality data are, however, more comprehensively available than incidence: The WHO
mortality databank contains national cancer mortality data on over 70 countries, and for
many, over extended periods of time. This availability partly explains its common
application as a surrogate for incidence in both geographic and temporal studies of
cancer, although its use must be guarded where survival differences are suspected
between the groups being compared.

Prevalence is a more complex measure of cancer incidence, fatality, and other

influences operating in affected individuals prior to death or cure. Partial prevalence is a
useful measure for quantifying the resource requirements needed for treating and
supporting cancer patients, as it limits the number of patients to those diagnosed
during a fixed time in the past. Prevalence for cases diagnosed within a certain number
of years are of relevance to initial treatment (within 1 year), clinical follow-up (2–3
years) and possible cure (4–5 years). There are some exceptions, primarily that of
female breast cancer, for which the risk of death remains higher than the general
population for many more years.