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MEMORIAL SLOAN-KETTERING CANCER CENTER

1275 YORK AVENUE, NEW YORK, NEW YORK 10021 arnt .
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January 4, 1980

Joshua Lederberg

President
The Rockefeller University
New York City 10021

Dear Doctor Lederberg:

| looked over Sam Epstein's commentary in the Wall Street
Journal, which was in response to an editorial by Harry Schwartz.

Whether the 1940, 1950, 1960 or 1970 United States population
is used as a standard for age-adjustment, which would enable comparison
of summary mortality statistics over time, the distorting effect by
choice of standard should be minimal. An important issue, however, is
that age-standardization may obscure significant differences in age-
specific patterns. Furthermore, total cancer mértality statistics may
obscure important site-specific differences over time and these may
vary by sex, race, ethnicity, social class, geography, occupation, etc.

The trend of increasing number of cancer deaths in the United
States over the past 40 years must be interpreted in the context of:

a) increasing numbers in the population at risk and the
proportion of older persons in the population;

b) improving diagnostic technology and completeness of
reporting;

c) improving methods of treatment resulting in decreasing
mortality; and

d) changing incidence due to carcinogenic exposures of
varying potency, intensity and duration.

MEMORIAL HOSPITAL FOR CANCER AND ALLIED DISEASES
SLOAN-KETTERING INSTITUTE FOR CANCER RESEARCH

SLOAN-KETTERING DIVISION, GRADUATE SCHOOL OF MEDICAL SCIENCES, CORNELL UNIVERSITY
Joshua Lederberg
January 4, 1980
page two

During the period 930-1970, the population at risk increased
74% and almost twice as many people reached 65 or older. Devesa and
Schneiderman (American J. Epidemiology 106:1-5, 1977) concluded that
after adjusting for these population characteristics, the "real!
increase in age-specific mortality over a period of 40 years was
9.5%, and during the period 1960-1970, 2.8% or 0.28% per year.

Although Dr. Epstein is correct in pointing out the increases
among black males, these pertain largely to the tobacco-dependent
sites and prostatic cancer.

_ | am uncertain whether the magnitude of "real'’ increase
during the period 1969-1976 has been as high as 5.5%. This would
reflect an acceleration in the annual rates, when compared with 1960-
1970. | am checking into this, however, and will send you material
from the National Cancer Institute when it arrives.

Sincerely yours, Vy
David Schottenfeld, M.D.
Chief of Epidemiology and

Preventive Medicine
Professor of Public Health

DS: jz
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