Abstract
BackgroundCommon cancer monitoring practice is seldom prospective and rather driven by public requests. This study aims to assess the performance of a recently developed prospective cancer monitoring method and the statistical tools used, in particular the sequential probability ratio test in regard to specificity, sensitivity, observation time and heterogeneity of size of the geographical unit.MethodsA simulation study based on a predefined selection of cancer types, geographical unit and time period was set up. Based on the population structure of Lower Saxony the mean number of cases of three diagnoses were randomly assigned to the geographical units during 2008–2012. A two-stage monitoring procedure was then executed considering the standardized incidence ratio and sequential probability ratio test. Scenarios were constructed differing by the simulation of clusters, significance level and test parameter indicating a risk to be elevated.ResultsPerformance strongly depended on the choice of the test parameter. If the expected numbers of cases were low, the significance level was not fully exhausted. Hence, the number of false positives was lower than the chosen significance level suggested, leading to a high specificity. Sensitivity increased with the expected number of cases and the amount of risk and decreased with the size of the geographical unit.ConclusionsThe procedure showed some desirable properties and is ready to use for a few settings but demands adjustments for others. Future work might consider refinements of the geographical structure.Inhomogeneous unit size could be addressed by a flexible choice of the test parameter related to the observation time.
Highlights
Common cancer monitoring practice is seldom prospective and rather driven by public requests
The Center for Disease Control and Prevention (CDC) defines a cancer cluster as a greater-than-expected number of cancer cases that occurs within a group of people in a geographic area over a period of time [1]
Results showed that heterogeneity of Regional monitoring unit (RMU) size restricts reliability of the procedure regarding observation time and sensitivity
Summary
Common cancer monitoring practice is seldom prospective and rather driven by public requests. This study aims to assess the performance of a recently developed prospective cancer monitoring method and the statistical tools used, in particular the sequential probability ratio test in regard to specificity, sensitivity, observation time and heterogeneity of size of the geographical unit. The Center for Disease Control and Prevention (CDC) defines a cancer cluster as a greater-than-expected number of cancer cases that occurs within a group of people in a geographic area over a period of time [1]. Recent cancer cluster detection practice is seldom prospective and rather initiated by requests by the public, The idea of an automatized search for spatially and temporally elevated cancer incidence has been debated in the past [5, 6]. While early detection is its main advantage pitfalls have been discussed such as the high number of false positive results
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