Abstract
During the last decades, autopsy rates have dramatically decreased in many countries. The Cancer Registry Zurich, which exists since 1980, provides the opportunity to address to what extent the number of autopsies in cancer patients has changed over a longer period of time and how often autopsies provide a diagnosis of clinically undetected cancer. Data from the Cancer Registry Zurich consisting of 102,434 cancer cases among 89,933 deceased patients between 1980 and 2010 were analyzed by means of descriptive statistics. The autopsy rate declined from 60 % in 1980 to 7 % in 2010. The total number of autopsies performed decreased from 1179 in 1986 to 220 in 2010. Furthermore, there was also a decline in the rate of newly detected tumours based on autopsy information. In 1980, the rate of newly detected tumours through autopsy was 42 % compared with 2010, when the rate had declined to 17 %. A consequence of the reduced autopsy rate is the reduction of incidental findings at autopsy in cancer registration. However, this reduction has not negatively affected the total incidence of cancer. It seems that the state-of-the-art diagnostic tools used for tumour detection are sufficiently reliable, allowing the scientific community to trust the quality of data provided by cancer registries in spite of decreasing autopsy rates.
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References
Shojania KG, Burton EC, McDonald KM, Goldman L. The autopsy as an outcome and performance measure. Evidence report/technology assessment (summary). 2002;(58):1–5.
Start RD, Firth JA, Macgillivray F, Cross SS, Road BH (1995) Have declining clinical necropsy rates reduced the contribution of necropsy to medical research? J Clin Pathol 48(5):402–404
Xiao J, Krueger GRF, Buja LM, Covinsky M (2009) The impact of declining clinical autopsy: need for revised healthcare policy. Am J Med Sci 337(1):41–46
Burton EC, McDonald KM, Goldman L, Page P (2003) Changes in rates of autopsy-detected. JAMA 289(21):2849–2856
Grinberg LT, da Silva Ferraz LF, Galtarossa Xavier AC, Nascimento Saldiva PH, Mauad T (2008) Clinico-pathological discrepancies in the diagnoses of solid malignancies. Pathol Res Pract 204(12):867–873
Lundberg GD (1998) Low-tech autopsies in the era of high-tech medicine: continued value for quality assurance and patient safety. JAMA 280(14):1273–1274
Schwanda-Burger S, Moch H, Muntwyler J, Salomon F (2012) Diagnostic errors in the new millennium: a follow-up autopsy study. Mod Pathol 25(6):777–783
Pastores SM, Dulu A, Voigt L, Raoof N, Alicea M, Halpern NA (2007) Premortem clinical diagnoses and postmortem autopsy findings: discrepancies in critically ill cancer patients. Crit Care 11(2):R48
Gradistanac T, Wittekind C (2011) Autopsy as a tool for quality assurance: Leipzig. Der Pathologe 32(Suppl 2):287–291
Lindström P, Janzon L, Sternby NH (1997) Declining autopsy rate in Sweden: a study of causes and consequences in Malmö. Sweden. J Intern Med 242(2):157–165
Bode PK, Cathomas G, Vogt P, Moch H (2014) Klinische Autopsie. Praxis 103(2):65–71
Chariot P, Witt K, Pautot V, Porcher R, Thomas G, Zafrani ES, Lemaire F (2000) Declining autopsy rate in a French hospital: physicians’ attitudes to the autopsy and use of autopsy material in research publications. Arch Pathol Lab Med 124(5):739–745
Nemetz PN, Ludwig J, Kurland LT (1987) Assessing the autopsy. Am J Pathol 128(2):362–379
Statistik Stadt Zürich (2012) Statistisches Jahresbuch der Stadt Zürich, p. 72
Kircher T, Nelson J, Burdo H (1985) Descriptive epidemiology of the autopsy in Connecticut, 1979-1980. Arch Pathol Lab 109(10):904–909
Nemetz PN, Ballard DG, Beard CN, Ludwig J, Tangalos EG, Kokmen E, Weigel KM, Belau PG, Bourne WM, Kurland LT (1989) An anatomy of the autopsy, Olmstead County, 1935 through 1985. Mayo Clin Proc 64:1055–1064
Cameron HM, McGoogan E, Clarke J, Wilson BA (1977) Trends in hospital necropsy rates: Scotland 1961-74. Br Med J 1(6076):1577–1580
Gutzwiller F, Moch H, Probst-Hensch M. Institut für Sozial- und Präventivmedizin der Universität Zürich (2009, Hrsg.): Krebs im Kanton Zürich. Kurzbericht des Krebsregisters
Baade PD, Youlden DR, Krnjacki LJ (2009) International epidemiology of prostate cancer: geographical distribution and secular trends. Mol Nutr Food Res 53(2):171–184
Konety BR, Bird VY, Deorah S, Dahmoush L (2005) Comparison of the incidence of latent prostate cancer detected at autopsy before and after the prostate specific antigen era. J Urol 174(5):1785–1788
Scott RJ, Mutchnik DL, Laskowski TZ (1996) Carcinoma of the prostate in elderly men: incidence, growth characteristics and clinical significance. J Urol 101:602–607
Gaensbacher S, Waldhoer T, Berzlanovich A (2012) The slow death of autopsies: a retrospective analysis of the autopsy prevalence rate in Austria from 1990 to 2009. Eur J Epidemiol 27:577–580
Bamber AR, Quince TA, Barclay SI, Clark JD, Siklos PW, Wood DF (2014) Medical student attitudes to the autopsy and its utility in medical education: a brief qualitative study at one UK medical school. Anat Sci Educ 7(2):87–96
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UB performed the statistical analysis and drafted the manuscript. HM, SD and SR participated in the design of the study. SD and DK coordinated the study and were responsible for data collection and preparation. All authors proofread the manuscript critically and approved the final manuscript.
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Bieri, U., Moch, H., Dehler, S. et al. Changes in autopsy rates among cancer patients and their impact on cancer statistics from a public health point of view: a longitudinal study from 1980 to 2010 with data from Cancer Registry Zurich. Virchows Arch 466, 637–643 (2015). https://doi.org/10.1007/s00428-015-1734-7
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DOI: https://doi.org/10.1007/s00428-015-1734-7