Cancer Case-Control Studies with Other Cancers as Controls

Theoretical considerations concerning the use of other cancer patients as controls in cancer case-control studies are reviewed. Selection bias may be a problem in that some other cancers may be caused by the exposure under study biasing the odds ratio towards unity. Such bias is noted to be greatest with low prevalence exposures associated with high attributable risks for other cancers. However, it may be possible to identify selection bias with other cancer controls using census or other general population data. In addition, using other cancers as controls has important advantages with regard to recall and interviewer bias, which may be of unknown magnitude and direction when using general population controls. A further disadvantage of general population controls is that separate selection of decreased controls should usually be made for deceased cases, whereas a mixture of live and deceased controls can be expected when selecting other cancer patients as controls. Since there are also logistical and cost advantages in using other cancer patients as controls, this study design is likely to be used increasingly in the future, particularly in cancer registry settings.