To the Editor.—
It was good to see a lead article in JAMA1 highlighting the value of routine necropsy not only for teaching purposes, but also for the data on the occurrence of incidental disease that such examinations can provide. I was surprised, however, that the authors did not bemoan the falling autopsy rate that is reducing the epidemiologic value of such data. Extrapolation of their figures suggests that the autopsy will be dead at Yale University as early as 1990!There are several reasons why the prevalence rates for "surprise" cases of lung cancer at autopsy are not comparable to the incidence rates from a tumor registry. The proportion of cases that are undiagnosed prior to autopsy is somewhat arbitrary since it depends on the thoroughness of the diagnostic effort in life. There might well be more "surprises" in smaller, service-oriented hospitals than in larger, academic ones. Moreover,
Rhoads GG. The Epidemiologic Necropsy. JAMA. 1987;258(22):3254. doi:10.1001/jama.1987.03400220053020
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