Transcript Public Reporting of HMO Performance: Impact on Smoking

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
Tennessee
April 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?



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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


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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 Comparisons
Incidence Rates for Males, All Races Combined, 2005

Comparison of
incidence rates in
Tennessee with
U.S. incidence
rates
 Top 10
cancers
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Rates are ageadjusted
Similar
comparisons could
be made between
county and state
rates
http://www.cdc.gov/uscs
USCS: State vs. National Comparisons
Incidence Rates for Females, All Races Combined,
2005

Comparison of
incidence rates in
Tennessee with
U.S. incidence
rates
 Top 10
cancers


Rates are ageadjusted
Similar
comparisons could
be made between
county and state
rates
http://www.cdc.gov/uscs
USCS: State Rankings
Incidence Rates for Female Breast Cancer, 2005

Ranking of incidence
rates (including U.S.)
from highest to
lowest
 Available for 27
cancer sites by
sex
 All races
combined


Rates are ageadjusted
Similar comparisons
could be made for TN
counties
http://www.cdc.gov/uscs
State Cancer Facts
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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 Facts
Incidence 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

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Rates are ageadjusted
Similar
comparisons
could be made at
the county level
http://apps.nccd.cdc.gov/StateCancerFacts/
State Cancer Facts
Incidence 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 ageadjusted
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
45
40
35
30
25
20
15
10
5
0
Unknown
In Situ
Local
Regional
Stage at Diagnosis
Burden of Cancer in Tennessee 2007
http://health.state.tn.us/Downloads/TNBurdenofCancer08.pdf
Distant
Evaluating Effectiveness of Screening:
Female Breast Cancer Cases Diagnosed at Early
Stage before Mammography Widely Accepted
Michigan, 1985–1987
Percentage
of 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
Percentage
of Cases
< 39.1
39.1–48.1
48.2–55.9
56 & over
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
Examples: Identification of disparities

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
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.
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 Eheman
[email protected]
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.