In this issue of JAMA Oncology, Acuna et al1 examine the association between solid-organ transplantation and cancer mortality in a population-based setting. By relying on robust methodology and linked data from the Canadian Organ Replacement Register, the Ontario Cancer Registry, and the Office of the Registrar General of Ontario, they were able to circumvent common limitations of past population-level analyses on the same topic.2,3 For one, the cause of death was reliably obtained for all transplant recipients. A past study may have underestimated cancer as a cause of death given the high number of cases with unknown cause of death.3 Second, the ability to ascertain for the type of cancer death allows us to differentiate between (1) recurrence and death from a pretransplant neoplasm and (2) death from a de novo malignant neoplasm. This is an important distinction because many liver and lung transplant recipients ultimately die of the same disease that was the indication for transplantation. Third, competing risk methodology is elegantly used to conclude that the risk of cancer death is not restricted to long-term survivors and increases steadily over time.
Schmid M, Chun FK, Trinh Q. Targeted Cancer Screening After Solid-Organ Transplantation. JAMA Oncol. 2016;2(4):470. doi:10.1001/jamaoncol.2015.5172