Antecedent Therapy Versus Detection Bias as Causes of Neoplastic Multimorbidity
Abstract
Neoplastic multimorbidity occurs when a patient is found to have a second primary cancer after the occurrence of a first. The phenomenon may be the result of aging, chance, or other specific causes, but in recent years, the radio- or chemotherapy administered for the first cancer has regularly been suspected as a possible cause of the second. A commonly disregarded alternative explanation, however, is that the second cancers were clinically "silent" discoveries found because of increased diagnostic detection procedures in patients known to have a first cancer. Such patients are more likely to receive intensive surveillance and technologic testing than the general population often used as a control group. In 43 recent reports of neoplastic multimorbidity, however, only five mentioned the problem of detection bias, and only one tried to eliminate it by using a suitable analytic comparison. Unless adequate analytic precautions are taken, antineoplastic therapy may be falsely accused of being carcinogenic.
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Among 43 case-control and cohort studies published from 1990 to 1994 that investigated the risk of second cancers in patients with a history of cancer, medical surveillance bias was mentioned in only 5 articles.
“Among 43 case-control and cohort studies published from 1990 to 1994 that investigated the risk of second cancers in patients with a history of cancer, medical surveillance bias was mentioned in only 5 articles [ 66 ].”
From Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): Explanation and Elaboration (2007) · cites this paper as [66]
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Vandenbroucke, J. P., von Elm, E., Altman, D. G., Gøtzsche, P. C., Mulrow, C. D., Pocock, S. J., Poole, C., Schlesselman, J. J., Egger, M., & Initiative, F. T. S. (2007) · PLoS Medicine · doi:10.1371/journal.pmed.0040297 · Cited by 8,613 · see citing works
“Among 43 case-control and cohort studies published from 1990 to 1994 that investigated the risk of second cancers in patients with a history of cancer, medical surveillance bias was mentioned in only 5 articles [66].”
Vandenbroucke, J. P., Elm, E. V., Altman, D. G., Gøtzsche, P. C., Mulrow, C. D., Pocock, S. J., Poole, C., Schlesselman, J. J., Egger, M., & initiative, F. T. S. (2007) · Annals of Internal Medicine · doi:10.7326/0003-4819-147-8-200710160-00010-w1 · Cited by 3,543 · see citing works
Vandenbroucke, J. P., von Elm, E., Altman, D. G., Gøtzsche, P. C., Mulrow, C. D., Pocock, S. J., Poole, C., Schlesselman, J. J., & Egger, M. (2014) · International Journal of Surgery · doi:10.1016/j.ijsu.2014.07.014 · Cited by 2,969 · see citing works
Vandenbroucke, J. P., von Elm, E., Altman, D. G., Gøtzsche, P. C., Mulrow, C. D., Pocock, S. J., Poole, C., Schlesselman, J. J., & Egger, M. (2007) · Epidemiology · doi:10.1097/ede.0b013e3181577511 · Cited by 2,779 · see citing works
- Authors
- Craig, S. L., & Feinstein, A. R.
- Affiliations
- Yale New Haven Hospital (US)
- Corresponding author
- Feinstein, Alvan R.
- Venue
- American Journal of Clinical Oncology
- Published
- 1999-02
- Volume
- 22
- Issue
- 1
- Pages
- 51-56
- ISSN
- 0277-3732 (ISSN-L)
- OpenAlex
- W2046746860
- Cited by
- 21
- References
- 0
- Citations by year
- 2025: 1 · 2024: 1 · 2022: 1 · 2021: 1 · 2019: 1 · 2017: 1 · 2016: 1 · 2014: 2
- FWCI
- 0.81
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Clinical Oncology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Multiple and Secondary Primary Cancers
- Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
- Health Sciences › Medicine › Oncology › Cutaneous Melanoma Detection and Management
- Keywords
- secondary malignancies, detection bias, antineoplastic therapy, radiotherapy, cancer surveillance, diagnostic testing, carcinogenicity
- MeSH terms
- Humans, Morbidity, Neoplasms, Bias, Neoplasms, Second Primary
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