the national program of cancer registries: enhancing cancer incidence data … hannah k. weir, phd...
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The National Program of Cancer Registries: Enhancing Cancer
Incidence Data …
Hannah K. Weir, PhD
Division of Cancer Prevention and Control
Centers for Disease Control and Prevention
…with Vital Records Data for Cancer Control
Cancer Control: an approach to reducing cancer incidence, morbidity and mortality through prevention, early detection, treatment, rehabilitation and palliation.
CDC’s Cancer Prevention and Control Programs
omprehensiveomprehensiveCCancerancerCC
ontrolontrolCC
Model for Cancer Control
Measure &Evaluate
Cancer Burden
Plan Interventions
• Prevention
• Screening
• Treatment & rehabilitation
• Palliative Care
ActImplement Interventions
The Cancer Continuum
Prevention Early
Detection
Diagnosis / Stage
Treatment &
Rehabilitation
Palliative Care
Death
Survival
If Cancer Control Planners are the “hands” of CC Plan and implement the interventions)
Vital Records and Cancer Registries are the “eyes” of CC Measure and evaluate cancer burden
Cancer Control in Action
Surveillance, Epidemiology, and End Results Program (SEER)
1971 National Cancer Act 1973+, 5 States, 4 Metro
Areas, 10% population coverage
1991 added 2 more Metro Areas, 14% population coverage
2001, added 4 more states,
26% population coverage
AK HI
SEER
SEER/NPCR (2000+)
National Program of Cancer Registries (NPCR) 1992 Cancer
Registries Amendment Act 1995 – 1998
45 states, 3 territories, District of Columbia
96% population coverage
SEER
NPCR
NPCR/SEER
AK HI
What do the ‘eyes” see in the cancer continuum ?
Vital Records - Cancer Deaths
Death
Cancer Registries - New Occurrences of Cancer
Diagnosis
Prevention
United States Cancer Statistics Combined NPCR and SEER
incidence dataIncrease in population coverage
1999 .. 78% 2002 .. 93%
2000 .. 84% 2003 .. 96%
2001 .. 92% 2004 .. 98% 100% cancer death data State, regional, and national
incidence and mortality data for whites, blacks, Asians/Pacific Islanders (A/PI), American Indian/Alaska Native (AI/AN), Hispanics, and children
www.cdc.gov/cancer/npcr/
NORTHEAST
Division
State
State contributing mortality data
State contributing incidence and mortality data
WEST
Seattle-Puget Sound
San Francisco-Oakland
San José-Monterey
Los Angeles AZ
AK
WY
OR
HI
ID
MT
UT
NV
CO
WA
NM
CA
PACIFIC
MOUNTAIN PA
ME
NY
MIDDLE ATLANTIC
NEW ENGLAND
SOUTH
Atlanta
TXGA
TN
AL
KY
AROK
MS
FL
LA
VA
NC
SC
EAST SOUTH CENTRAL
SOUTH ATLANTICWEST
SOUTH CENTRAL
WV
Detroit
OH
ND
KS
IANE
MO
MN
WIMI
IN
WEST NORTH CENTRAL
EAST NORTH CENTRAL
SD
IL
United States Cancer Statistics: 2004 Census Region and Division
MIDWEST
Female Breast Cancer (Invasive)SEER Incidence and U.S. Death Rates
0
20
40
60
80
100
120
140
160
'75 '76 '77 '78 '79 '80 '81 '82 '83 '84 '85 '86 '87 '88 '89 '90 '91 '92 '93 '94 '95 '96 '97 '98 '99 '00 '01 '02 '03 '04
Year
Rate
Per 1
00,00
0
Incidence
Death
*Rates are per 100,000 and are age-adjusted to the 2000 U.S. standard population.Source: SEER Cancer Statistics Review, 1975-2004
The Cancer Continuum
Early
Detection
Diagnosis / Stage
Female Breast Cancer Cases Diagnosed at Early Stage
Percentageof Cases
1985–1987
< 39.1
39.1–48.1
48.2–55.9
56 & over
1995–1997
Female Breast Cancer Cases Diagnosed at Early Stage
< 39.1
39.1–48.1
48.2–55.9
56 & over
Percentageof Cases
Institute of Medicine Reports “ We all want to believe that when
people get cancer, they will receive medical care of the highest quality. Even as new scientific breakthroughs are announced, though, many cancer patients may be getting the wrong care, too little care, or too much care, in the form of unnecessary procedures.” (IOM 1999)
“NPCR …has great potential to facilitate national, population-based assessments of the quality of cancer care …”
(IOM 2000)
The Cancer Continuum
Diagnosis
Treatment &
Rehabilitation
Palliative Care
Death
Survival
Linkage between the Registries and State Vital Statistics Offices
IncidentCases
All Deaths
Cancer Registry Vital Statistics
Deaths
… to update vital status
IncidentCases
Blanket NPCR-NDI Application
2006 – application approved to obtain vital status information on cancer patients who move our of state between the time of their diagnosis and their death
Clinical Research vs. Public Health
Clinical trials highest achievable survival
Public health average survival achieved
1 2 3 4 50
10
20
30
40
50
60
70
80
90
100
0
1996-99
1991-951986-90
2000-01
Rel
ativ
e su
rviv
al (
%)
Years since diagnosis
Relative Relative Survival and Population “Cure” and Population “Cure”
“cured” patients
Mean survival of fatal cases
Cure for more Colorectal Cancers, UK
Source: M. Coleman
The “Eyes” and “Hands” of Cancer Control
Prevention Early
Detection
Diagnosis
Treatment &
Rehabilitation
Palliative Care
Death
Survival
Model for Cancer Control
Measure &Evaluate
Cancer Burden
Incidence
Stage at diagnosis
Deaths
Survival
Plan Interventions
• Prevention
• Screening
• Treatment & rehabilitation
• Palliative Care
ActImplement Interventions
Important Collaborations between Cancer Registries and Vital Records
Hannah Weir
(770) 488-3006