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National cancer survey data have indicated an unprecedented decline in the rate of Hodgkin's disease among white Americans over the age of 40. The authors have hypothesized that this difference may not represent an actual decrease in the incidence of the disease, but changes in diagnostic accuracy over the past two decades. The Repository Center for Lymphoma Studies provides a unique resource for evaluating changes in diagnostic accuracy over time. The repository contains both original diagnoses and expert reevaluations for a large number of lymphoma specimens. In reviewing the data, it was found that the accuracy of diagnosis of Hodgkin's disease has improved over time, as might be expected. One consequence of this fact, however, is that Hodgkin's disease was overdiagnosed in the past. Therefore, improved accuracy of diagnosis alone would result in an apparent decrease in the incidence of Hodgkin's disease. Furthermore, the accuracy of diagnosis was found to decrease with the patient's age, and thus improvements in diagnosis are likely to be more noticeable in the incidence figures for older people. A reevaluation of the incidence rates, taking estimated diagnostic errors into account, suggests that the changes in the incidence among older patients may, in fact, be the result of diagnostic errors. However, the review estimated that the increase in Hodgkin's disease among younger people, particularly Hodgkin's disease of the nodular sclerosis type, may actually be greater than previously estimated. The authors provide a detailed breakdown of the incidence of Hodgkin's disease according to different age groups and different disease subtypes. They suggest that the available data are consistent with an unknown infectious cause of Hodgkin's disease, and indicate that the most significant trend in the incidence of Hodgkin's disease is an increase among teenagers and young adults. (Consumer Summary produced by Reliance Medical Information, Inc.)