Evaluation of bias in familial risk estimates: A study of common cancers using Swedish population-based registers
Evaluation of bias in familial risk estimates: A study of common cancers using Swedish population-based registers
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DOI：
10.1093/jnci/djn290
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发表时间：
2008-09-17
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影响因子：
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通讯作者：
Czene, Kamila
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作者：
Leu, Monica;Reilly, Marie;Czene, Kamila
背景如果在登记开始之前疾病发生时，基于人口的登记不能确定亲属受影响，则可能导致家族性癌症估计的偏倚（即家族史的“左截断”）。（在患有癌症的父母的后代中）结直肠癌、肺癌、乳腺癌，前列腺癌和黑色素瘤的相对风险与模拟人群进行了比较。该研究队列（约700万人）基于1961-2002年期间与瑞典癌症登记处相关联的瑞典多代登记处。使用R-软件包PopLab模拟具有完整家族信息的相似相关个体人群（约700万），并用于估计观察到的家族史的敏感性。结果结直肠癌、肺癌、乳腺癌、前列腺癌和黑色素瘤的表观家族危险度分别为1.99（95%置信区间[CI] = 1.85 - 2.14），2.05（95% CI = 1.86 - 2.26），1.84（95% CI = 1.76 - 1.92），2.33（95% CI = 2.19 - 2.48）和2.68（95% CI = 2.35 - 3.07），相应的绝对发生率分别为3.69、2.59、16.05、10.38和2.96/10000人-年，在父母被诊断患有相同癌症的后代中。除黑色素瘤外，所有研究癌症的校正年龄组特异性和总体家族风险估计值均接近这些表观风险（均约为2.0）。对于黑色素瘤，校正估计值3.18（95% CI = 2.73 - 3.64）略大于表观估计值，未纳入表观估计值的置信区间。当感兴趣的暴露是在年轻时受影响的父母时，这种偏差更加明显;黑色素瘤的表观估计值从4.07（95% CI = 3.21至5.16）至5.67（95%CI = 4.51 ~ 6.83）。瑞典多代队列的风险估计通常不会出现左截断偏倚。
Background Bias in estimates of familial cancer may result if population-based registers fail to identify relatives as affected when disease occurs before the start-up of registration (ie, "left-truncation" of family history).Methods Apparent familial relative risks (among offspring of parents with cancer) of colorectal, lung, breast, and prostate cancers and melanoma in a Swedish cohort were compared with relative risks in a simulated population. The study cohort (approximately 7 million individuals) was based on the Swedish MultiGenerational Register linked to the Swedish Cancer Register for the period 1961-2002. A similar population of related individuals (approximately 7 million) with complete family information was simulated by using the R-package PopLab and used to estimate the sensitivity of the observed family history. This sensitivity was then used to calculate corrected age group-specific and overall risks, which were compared with the apparent familial risks of cancer in the cohort.Result The apparent familial risks for colorectal, lung, breast, and prostate cancers and melanoma were 1.99 (95% confidence interval [CI] = 1.85 to 2.14), 2.05 (95% CI = 1.86 to 2.26), 1.84 (95% CI = 1.76 to 1.92), 2.33 (95% CI = 2.19 to 2.48), and 2.68 (95% CI = 2.35 to 3.07), with corresponding absolute rates of 3.69, 2.59, 16.05, 10.38, and 2.96 per 10 000 person-years, among offspring of parents diagnosed with the same cancer. Corrected age group-specific and overall estimates of the familial risks were close to these apparent risks for all studied cancers (all approximately 2.0), except for melanoma. For melanoma, the corrected estimate of 3.18 (95% CI = 2.73 to 3.64) was somewhat larger than the apparent estimate and was not included in the confidence interval for the apparent estimate. When the exposure of interest was a parent affected at a younger age, this bias was more pronounced; the apparent estimate for melanoma changed from 4.07 (95% CI = 3.21 to 5.16) to 5.67 (95% CI = 4.51 to 6.83) after correction.Conclusions For common cancers, risk estimates from the Swedish MultiGenerational cohort do not generally appear to be biased by left-truncation.