Transcript Reporting Delay Among NPCR States

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
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Model for Cancer
Control
Plan Interventions
Measure &
Evaluate
Cancer Burden
•
•
Act
Implement Interventions
•
Prevention
•
Screening
Treatment &
rehabilitation
Palliative Care
The Cancer Continuum
Diagnosis /
Stage
Death
Survival
Prevention
Treatment &
Early
Detection
Rehabilitation
Palliative
Care
Cancer Control in
Action

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
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
SEER
SEER/NPCR
(2000+)
AK HI
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 data
Increase 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/
United States Cancer Statistics: 2004
Census Region and Division
Seattle-Puget
Sound
WA
OR
PACIFIC
ID
WY
San FranciscoOakland
San JoséMonterey
SD
WEST
NORTH
CENTRAL
MOUNTAIN
NV
MI
WI
IA
NE
CO
KS
MO
IL
MIDDLE
ATLANTIC
PA
OH
IN
WV
KY
Los Angeles
AZ
NM
OK
WEST
AR
TX
AK
WEST
SOUTH
CENTRAL
LA
AL
VA
NC
TN
MS
NEW
ENGLAND
NY
Detroit
EAST
NORTH
CENTRAL
UT
CA
NORTHEAST
ND
MIDWEST
MN
MT
ME
Atlanta
EAST
SOUTH
CENTRAL
SC
SOUTH
ATLANTIC
GA
Division
State
FL
HI
SOUTH
State contributing
mortality data
State contributing
incidence and
mortality data
Female Breast Cancer (Invasive)
SEER Incidence and U.S. Death Rates
Incidence
160
140
Rate Per 100,000
120
100
80
60
Death
40
20
0
'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
*Rates are per 100,000 and are age-adjusted to the 2000 U.S. standard population.
Source: SEER Cancer Statistics Review, 1975-2004
Year
The Cancer Continuum
Diagnosis /
Stage
Early
Detection
Female Breast Cancer Cases
Diagnosed at Early Stage
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
1995–1997
Percentage
of Cases
< 39.1
39.1–48.1
48.2–55.9
56 & over
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
Death
Survival
Treatment &
Rehabilitation
Palliative
Care
Linkage between the Registries and
State Vital Statistics Offices
Cancer Registry
Incident
Cases
Vital Statistics
All
Deaths
… to update vital status
Incident
Cases
Deaths
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
100
90
Relative survival (%)
80
70
60
50
2000-01
1996-99
40
1991-95
1986-90
30
20
10
0
0
1
2
3
4
Years since diagnosis
5
Relative Survival and Population “Cure”
Mean survival of
fatal cases
“cured” patients
Cure for more Colorectal Cancers, UK
45
40
Colon
Cure (%)
35
1986-90
Rectum
1981-85
30
1976-80
25
1971-75
20
Women Men
15
0
10
0.0
0.5
1.0
1.5
2.0
Mean survival of "fatal" cases (years)
Source: M. Coleman
2.5
The “Eyes” and “Hands”
of Cancer Control
Diagnosis
Death
Survival
Prevention
Treatment &
Early
Detection
Rehabilitation
Palliative
Care
Model for Cancer
Control
Plan Interventions
Measure &
Evaluate
Cancer Burden
•
Incidence
Stage at
diagnosis
•
Deaths
Survival
Act
Implement Interventions
•
Prevention
•
Screening
Treatment &
rehabilitation
Palliative Care
Important Collaborations between
Cancer Registries and Vital
Records
Hannah Weir
[email protected]
(770) 488-3006