Using Cancer Registry Data for Comprehensive Cancer Control

Christie Eheman, PhD, National Program of Cancer Registries,

Division of Cancer Prevention and Control

Passport for the Future- A Cancer Free TennesseeApril 24, 2009

Overview: Cancer Surveillance

Cancer is a reportable disease Collect standardized data on all cancers

diagnosed not a sample or a survey

Cancer is the only chronic disease for which we have population based incidence data in each state

National Program of Cancer Registries

Scope of CDC Cancer Surveillance

Cancer Surveillance System Data on approximately 1.2 million new

invasive cancer cases are submitted to CDC each year

Includes data on approximately 13 million invasive cancer cases diagnosed during 1995–2005

96% coverage of U.S. population with NPCR 100% NPCR and NCI-SEER combined

How is central cancer registry data used?

Surveillance reports: national, state and local incidence data for cancer by age, race, gender, geographic regions

National and regional data can be used to describe cancer patterns in special populations and investigate rare cancers

Guide planning, implementation, and evaluation of cancer control programs at a national, state, and local level

Identify and document disparities Advance clinical, epidemiologic, and health

services research

Annual Report to the Nation Update of death and incidence

cancer rates 2008 report

First time report documented decline in cancer incidence

Special focus on tobacco-related cancers

State and regional differences in lung cancer trends

Collaboration between CDC, NCI, North American Association of Central Cancer Registries (NAACCR), ACS

MMWR Surveillance Summary

Collaboration with OSH First time that CDC has

reported on tobacco-related cancers on more than 90% of the population

Findings emphasize need for ongoing surveillance

Identify populations at greatest risk

Evaluate effectiveness of targeted tobacco control programs and policies

State Cancer Profiles

Comprehensive Cancer Control Plans

Dynamic views of cancer statistics for prioritizing cancer control efforts

Nation State County

Collaboration between NCI and CDC

http://statecancerprofiles.cancer.gov/

United States Cancer Statistics National cancer

statistics Collaboration, CDC,

NCI, NAACCR State, regional, and

national data Rates for whites,

blacks, Asians/Pacific Islanders (A/PI), American Indians/Alaska Natives (AI/AN), Hispanics, and children

http://www.cdc.gov/uscs

State and County data

State cancer incidence reports Respond to state-level inquiries and

requests Comprehensive Cancer Control

Planning Identifying state and local disparities Evaluate success of public health

programs

State of Tennessee Comprehensive Cancer Control Plan 2009 – 2012

How is Comprehensive Cancer Control Accomplished?

Determine the cancer burden; Identify the needs of communities and/or

population-based groups Develop interventions and infrastructure to address

the needs; and Evaluate the impact of these interventions on the

health of the community/population Data on cancer incidence provides valuable data

each step of the way

What type of factors can be evaluated?

Incidence rates Comparison to other states and National

rates Rural versus urban differences Differences between counties – percent

of population below poverty level Risk factors – tobacco use; screening

Stage at diagnosis Screening effectiveness Disparities in diagnosis

Treatment

USCS: State vs. National ComparisonsIncidence Rates for Males, All Races Combined, 2005

http://www.cdc.gov/uscs

Comparison of incidence rates in Tennessee with U.S. incidence rates

Top 10 cancers

Rates are age-adjusted

Similar comparisons could be made between county and state rates

USCS: State vs. National ComparisonsIncidence Rates for Females, All Races Combined,

2005

http://www.cdc.gov/uscs

Comparison of incidence rates in Tennessee with U.S. incidence rates

Top 10 cancers

Rates are age-adjusted

Similar comparisons could be made between county and state rates

USCS: State RankingsIncidence Rates for Female Breast Cancer, 2005

http://www.cdc.gov/uscs

Ranking of incidence rates (including U.S.) from highest to lowest

Available for 27 cancer sites by sex

All races combined

Rates are age-adjusted

Similar comparisons could be made for TN counties

State Cancer Facts

Condensed version of USCS

State and national data only

State versus national comparisons for top 10 cancer rates

By sex By race and

ethnicity

http://apps.nccd.cdc.gov/StateCancerFacts/

State Cancer FactsIncidence Rates for Prostate Cancer by Race and Ethnicity,

2005

Comparison of incidence rates by race and ethnicity in Tennessee

Suppress data if rates not stable

Rates are age-adjusted

Similar comparisons could be made at the county level

http://apps.nccd.cdc.gov/StateCancerFacts/

State Cancer FactsIncidence Rates for Female Breast Cancer by Race and

Ethnicity, 2005

Comparison of incidence rates by race and ethnicity in Tennessee

Suppress data if rates not stable

Rates are age-adjusted

Similar comparisons could be made at the county level

http://apps.nccd.cdc.gov/StateCancerFacts/

Overall Cancer Incidence Rates by County, Tennessee, 1999-2003

Source: Tennessee Comprehensive Cancer Control Program. Burden of Cancer in Tennessee. Available at: http://health.state.tn.us/Downloads/TNBurdenofCancer08.pdf

Overall Cancer Mortality Rates by County, Tennessee, 1999-2003

Source: Tennessee Comprehensive Cancer Control Program. Burden of Cancer in Tennessee. Available at: http://health.state.tn.us/Downloads/TNBurdenofCancer08.pdf

Example:

State of Tennessee Comprehensive Cancer Control Plan 2009 – 2012

Goal: Reduce colorectal cancer mortality through screening and early detection

How do you monitor progress? Mortality Incidence – stage at diagnosis

Colorectal cancer: Tennessee, 1999-2003

0

5

10

15

20

25

30

35

40

45

Unknown In Situ Local Regional Distant

Stage at Diagnosis

Burden of Cancer in Tennessee 2007 http://health.state.tn.us/Downloads/TNBurdenofCancer08.pdf

Evaluating Effectiveness of Screening:Female Breast Cancer Cases Diagnosed at Early

Stage before Mammography Widely AcceptedMichigan, 1985–1987

Percentageof Cases

< 39.1

39.1–48.1

48.2–55.9

56 & over

Percentageof Cases

< 39.1

39.1–48.1

48.2–55.9

56 & over

Female Breast Cancer Cases Diagnosed at Early Stage - Mammography Widely Accepted

Michigan, 2000–2002

Female Breast Cancer Cases Diagnosed at Early Stage - Mammography Widely Accepted

Michigan, 2000–2002

Enhancement of registry data

Examples of possible linkages National Death Index

Survival • Disparities• Differences in stage at diagnosis• Treatment differences

Insurance claims Treatment data

Other Programs and Agencies Indian Health Service administrative

data

Voti L, Richardson LC, Reis I, Fleming LE, MacKinnon J, Coebergh JWW. The effect of race/ethnicity and insurance in the administration of standard therapy for local breast cancer in Florida. Breast Cancer Res Treatment 2006; 95: 89-95.

Florida

Registry data were linked to Healthcare Administration inpatient and outpatient data –1997-2000

Elderly, Hispanic and Black women, uninsured, and women on Medicaid were less likely to receive standard treatment

Proposed next steps - Enhance and expand breast cancer preventive and treatment services for patients and providers

Examples: Identification of disparities

Summary

Cancer registry data is a valuable resource Quantify cancer burden

Particular populations Geographic areas

Monitor changes in incidence or stage at diagnosis

Success of interventions Changes in environmental or behavioral

factors

Christie EhemanCEheman@cdc.gov

The findings and conclusions in this presentation have not been formally disseminated by Centers for Disease Control and Prevention/the Agency for Toxic Substances and Disease Registry and should not be construed to represent any agency determination or policy.