On changes in the recorded mortality from cancer and their possible interpretation / by Major Greenwood, jun., and Frances Wood.

  • Greenwood, Major, 1880-1949.
Date:
1914
Catalogue details

Licence: In copyright

Credit: On changes in the recorded mortality from cancer and their possible interpretation / by Major Greenwood, jun., and Frances Wood. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    We now turn to the rates for different sites and begin with the experience of England and Wales, 1897-1911. The data used were read off from the diagrams on pp. Ixix and Ixx of the Registrar- General’s Annual Report for 1910. The sites selected for analysis were, in males, intestine, tongue, rectum, stomach, liver; in females, intestine, rectum, breast, stomach, uterus and liver. Lines have been fitted to index numbers derived both from corrected and uncorrected rates, except in the instance of the liver, which we only included as a possible criterion of changes in diagnosis. Tables VIa and VIb and Diagrams IVa, IVb, Va and Vb were constructed on the same principles as before. Beginning with the males (corrected figures) we notice that the stomach-rate has increased less than that of the tongue, which is represented by a line of sensibly the same gradient as the rectum; the rate of intestinal cancer has advanced faster than any of the others. Among females, we find a similar rate of increase both for the breast and the stomach, a slightly greater rate of change in the rectum and a markedly steeper gradient for the line of intestinal cancer. The slope of the uterine rates is actually negative. The position of intestinal cancer can easily be explained on the hypothesis of improved diagnosis, but the other results seem to us quite inconsistent with this supposition. Cancer of the tongue in males and of the breast in females, typically accessible sites, have increased faster than cancer of the stomach, the difference in the case of the tongue being quite appreciable. Cancer of the rectum, again, has not advanced very much, if at all, faster than that of the accessible sites. It is a point not without significance that cancer of the rectum has in both sexes increased faster than cancer of the stomach, although the former has always been presumably easier to diagnose than the latter. The decrease in uterine cancer cannot be passed over in silence. Bashford and Murray’s figures seem to suggest that diagnosis of uterine cancer is subject to as much alteration on the findings of an autopsy as malignant disease of other sites, so that with an assumed constant incidence and improved diagnosis we ought to have had an increase in cancer of this site too. Are we to suppose either (1) that diagnosis in the particular instance of cancer of the uterus has deteriorated or (2) that owing to operative improvements the true death-rate from the disease has diminished, the incidence remaining the same ? We can of course discard (1), but (2) is impossible to answer. There is no doubt that more persons, at least in London, now resort to hospitals than before, and it is generally believed that both the technique and