Use of positive predictive value to evaluate the Armed Forces Health Surveillance Division brain cancer incidence rules, active component department of the Air Force pediatric dependent population, January 1, 2010-December 31, 2020.

The Armed Forces Health Surveillance Division (AFHSD) uses a surveillance case definition to identify malignant brain tumors among U.S. active service members. This case definition was applied to the dependent pediatric population of the active component of the Department of the Air Force, which identified 179 malignant brain cancer cases. Those identified pediatric cases were reviewed using multiple data sources. The positive predictive value (PPV) of the AFHSD case definition was found to be 64.5% (95% confidence interval [CI], 55.9-72.5%). In 2019, Webber et al. reported a PPV of 84.3% for brain and other nervous system cancers among U.S. active component officers. The current pediatric study's lower PPV suggests the case definition may be less effective for pediatric populations, indicating a need for refining surveillance methods for dependent populations. The AFHSD case definition was less effective at identifying malignant brain tumors in the active component Air Force pediatric dependent population, with a lower PPV compared to previous studies of the active component Air Force adult population. In addition, several cases were missed by the AFHSD rules. The PPV of the AFHSD case definition was lower when applied to the Air Force pediatric dependent population (64.5%; 95% CI, 55.9-72.5%) compared to the previously published PPV in the adult population (84.3%). There were an additional 16 cases of malignant brain tumors missed by initial screening utilizing AFHSD incidence rules.