On a fundamental problem in the analysis of cancer registry data

In epidemiology research with cancer registry data, it is often of primary interest to make inference on cancer death, not overall survival. Since cause of death is not easy to collect or is not necessarily reliable in cancer registries, some special methodologies have been introduced and widely used by using the concepts of the relative survival ratio and the net survival. In making inference of those measures, external life tables of the general population are utilized to adjust the impact of non-cancer death on overall survival. The validity of this adjustment relies on the assumption that mortality in the external life table approximates non-cancer mortality of cancer patients. However, the population used to calculate a life table may include cancer death and cancer patients. Sensitivity analysis proposed by Talb\"{a}ck and Dickman to address it requires additional information which is often not easily available. We propose a method to make inference on the net survival accounting for potential presence of cancer patients and cancer death in the life table for the general population. The idea of adjustment is to consider correspondence of cancer mortality in the life table and that in the cancer registry. We realize a novel method to adjust cancer mortality in the cancer registry without any additional information to the standard analyses of cancer registries. Our simulation study revealed that the proposed method successfully removed the bias. We illustrate the proposed method with the cancer registry data in England.