β Scribed by John Waterhouse
No coin nor oath required. For personal study only.
FOR MANY YEARS the only quantitative information about the impact of cancer on a community was derived from mortality data, from hospital cases, or from an occasional autopsy series. The newly developing science of epidemiology, encompassing both the descriptive examination of mortality patterns and the analytical study of their interrelationships with environmental and etiologic factors, especially with respect to time, has derived much of its methodology from the mathematical theory of the spread of epidemics. In the interwar period, it was advancing in its own right, pari passu with developments in demography, some of which were of direct relevance to epidemiologic methods. Much of demography in fact now comes within its purview, and if epidemiology has not wholly engulfed demography, it is because a concern for the correlates of disease has dominated its range of interests, in which case demography has been relegated to a supportive but rather subordinate role.
Mortality data of good quality in respect to diagnosis, sex, age, residence, and sometimes occupation were available to provide suitable pabulum for descriptive epidemiology from developed countries for many years, and after World War II from a much larger number of countries, though of a more variable quality. Yet for etiologic studies in particular, mortality statistics are not as valuable as morbidity or incidence statistics. For cancer with a high fatality, such as lung or stomach cancer, the two kinds of rates are nearly equivalent, but for cancers with a better prognosis, incidence, depending as it does on the time of diagnosis, is of much greater significance. If incidence data are to be of epidemiologic value, however, they must be available, like mortality information, in a systematic way, virtually all cases in a given area must be included, and the same quality of data should continue to be available over a period of years.
The idea of keeping a register of cancer cases that occur in a specific area over a period of time has recurred in many places. Perhaps Hamburg, West Germany should receive the accolade for establishing the first cancer registry, which began in 1927, became inactive during the war, and was reestablished in 1954.
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