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To the Editor:—
Mortality rates for lung cancer are misleading due to factors which also lead to many errors in other mortality statistics.Most deaths in the United States are not followed by an autopsy. The death may occur in the home, or the family may refuse autopsy permission in the hospital. The diagnosis in these cases is at best an educated guess, and the fashions as well as the nomenclature change from one generation to the other. For example, deaths attributed to acute indigestion later become deaths from appendicitis. Grippe becomes influenza, and now "virus" infections, and "bronchogenic carcinoma" are popular.Even when an autopsy is done the diagnosis is not entirely accurate. If the autopsy is done at night or on a weekend or a holiday, it may be performed by a resident or even a medical student, and the pathologist only sees tissues the following day to
Skinner EF. Errors in Lung Cancer Mortality Statistics. JAMA. 1966;198(13):1374. doi:10.1001/jama.1966.03110260086034