[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-370145-105":59,"doc-detail-370145-en":134},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":127,"head_meta":129,"extra_data":131,"updated_unix":133},105,"en","importance-of-reference-group-selection-in-the-evaluation-of-cancer-incidence","Importance of reference group selection in the evaluation of cancer incidence","","Elevated cancer incidence has been reported among World Trade Center (WTC)-exposed responders, with incidence rate ratios varying across follow-up periods. This study evaluates how different reference populations shape relative cancer incidence and temporal change-point patterns. Data from 65,691 participants in the WTC Combined Rescue/Recovery Cohort (2002–2015) were analyzed using Poisson regression controlling for age, race/ethnicity, and calendar year. Reference choices (NYC, NYS, US) altered effect sizes, significance, and timing by cancer site, with a significant prostate change-point only versus a US reference group.",{"@graph":69,"@context":126},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/importance-of-reference-group-selection-in-the-evaluation-of-cancer-incidence/370145/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/importance-of-reference-group-selection-in-the-evaluation-of-cancer-incidence/370145.png","ImageObject",300,407,{"name":92,"@type":93},"Jiven","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-29","2026-09-23",true,{"@type":102,"interactionType":103,"userInteractionCount":34},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118,122],{"name":109,"@type":110,"acceptedAnswer":111},"Why does the choice of reference population matter in evaluating cancer incidence?","Question",{"text":112,"@type":113},"Different baseline incidence patterns in reference groups can bias estimated incidence rate ratios and affect which temporal change-points are detected.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"What reference populations were compared in this study?",{"text":117,"@type":113},"The analysis compared three reference populations: New York City (NYC), New York State (NYS), and a US population.",{"name":119,"@type":110,"acceptedAnswer":120},"Which cancers showed higher or lower incidence rate ratios in WTC-exposed responders?",{"text":121,"@type":113},"Prostate and thyroid cancer incidence rate ratios were significantly greater, while colon and lung cancer incidence rate ratios were significantly lower compared with the reference groups.",{"name":123,"@type":110,"acceptedAnswer":124},"Did the study find temporal change-points, and for which cancer?",{"text":125,"@type":113},"A significant change-point was found only for prostate cancer, and only when comparisons were made to a US population reference group.","https://schema.org",{"og:url":83,"og:type":128,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":130,"canonical":83},"index,follow",{"doc_id":132,"site_id":62},370145,1790913058,{"code":4,"msg":5,"data":135},{"doc_id":132,"user_id":136,"nickname":92,"user_avatar":137,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":138,"file_id":139,"file_url":140,"file_type":141,"file_size":142,"view_count":34,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":52,"language":143,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":144,"faqs":145,"seo_title":146,"seo_description":67,"update_tm":147,"read_time":148},1099513958607,"https://ap-avatar.wpscdn.com/avatar/100002390cf8733938c?x-image-process=image/resize,m_fixed,w_180,h_180&k=1778829742770036399","[www. nature.com/scientificreports](www. nature.com/scientificreports)  \nOPEN  \nImportance of reference groupselection in the evaluation of cancer incidence  \nAlexandra K. Mueller1,2,10, Brandon Vaeth1,2,10, Andrew C. Todd4, Christopher R. Dasaro4, Jiehui Li5, Baozhen Qiao6, Paolo Boffetta7,8, David J. Prezant1,2,3, Charles B. Hall3, David G. Goldfarb1,2,3,11 &  \nRachel Zeig-Owens1,2,3,9,11􀀍  \nElevated cancer incidence has been reported among World Trade Center (WTC)-exposed responders, with some incidence rate ratios (IRRs) varying over time. This study describes the influence that different reference populations have on relative cancer incidence and temporal trends. Participants from the WTC Combined Rescue/Recovery Cohort (n = 65,691) were observed between 1/1/2002 and 12/31/2015 using data obtained from 13 state cancer registries. Poisson regression was used to estimate IRRs controlling for age, race/ethnicity, and calendar year. IRRs and change-points were estimated using three reference populations (New York City (NYC), New York State (NYS), and a US population) . IRRs for each cancer site varied in magnitude. Prostate and thyroid cancer IRRs were significantly greater in WTC-exposed responders, while colon and lung cancer IRRs were significantly lower compared with NYC, NYS, and US population reference groups. The range of IRRs varied by reference population. Mixed findings were observed for other cancers, as results were dependent on the reference group used. A significant change-point was found only for prostate cancer, and only when compared to a US population. Our findings suggest that reference population selection will influence the IRR, timing, and statistical significance of change-point estimation, varying with followup length.  \nKeywords Cancer incidence, Reference population, World Trade Center disaster  \nWorkers who performed rescue and recovery work at the World Trade Center (WTC) site following the 9/11/2001 (9/11) attacks have been found to have a higher incidence of certain cancers than the general population1–4. Rates of specific cancers, such as prostate and thyroid, were greater among those with higher level WTC-exposure intensity1,2. However, associations between WTC exposure and cancer may vary over time, and reported estimates only reflect the average risk over the follow-up period. We have previously reported that the incidence of cutaneous melanoma and prostate cancer indeed varied over time when using New York State (NYS) as a reference population3,4. This could be due to biologic reasons such as latency periods5 caused by specific carcinogens or systematic differences in screening practices that differ from the reference population. Assessing change-points in models analyzing cancer incidence allows for better understanding of induction/ latency periods, which may vary by cancer type6.  \nA lesser-studied influence on relative cancer incidence is the selection of an appropriate reference population, as differing baseline incidence in reference groups may bias estimated incidence rate ratios due to unmeasured  \n1Bureau of Health Services, World Trade Center Health Program, Fire Department of the City of NewYork, Brooklyn, NY, USA. 2Division of Pulmonary Medicine, Department of Medicine, Montefiore Medical Center, Bronx, NY, USA.  \n3Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA. 4World Trade Center Health Program General Responder DataCenter, Department of Environmental Medicine and Climate Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA. 5New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, NY, USA. 6New York State Department of Health, Bureau of Cancer Epidemiology, Albany, NY, USA. 7Stony Brook Cancer Center, Stony Brook University, Stony Brook, NY, USA. 8Department of Medical and Surgical Sciences, University of Bologna, Bologna, EmiliaRomagna, Italy. 9MetroTech C","cbCaim3cFbQtIjWJ","https://ap.wps.com/l/cbCaim3cFbQtIjWJ","pdf",1788997,"English","# Overview and study aim\n## Study population and follow-up\n## Statistical approach\n## Results by cancer site\n## Interpretation and implications for change-points","[{\"question\":\"Why does the choice of reference population matter in evaluating cancer incidence?\",\"answer\":\"Different baseline incidence patterns in reference groups can bias estimated incidence rate ratios and affect which temporal change-points are detected.\"},{\"question\":\"What reference populations were compared in this study?\",\"answer\":\"The analysis compared three reference populations: New York City (NYC), New York State (NYS), and a US population.\"},{\"question\":\"Which cancers showed higher or lower incidence rate ratios in WTC-exposed responders?\",\"answer\":\"Prostate and thyroid cancer incidence rate ratios were significantly greater, while colon and lung cancer incidence rate ratios were significantly lower compared with the reference groups.\"},{\"question\":\"Did the study find temporal change-points, and for which cancer?\",\"answer\":\"A significant change-point was found only for prostate cancer, and only when comparisons were made to a US population reference group.\"}]","Importance of reference group selection in the evaluation of cancer incidence | PDF",1790187052,25]