MOLLY SCHWENN, MDCANCER REGISTRYMAINE CDC, DHHSOCTOBER 25, 2013

Population-based Cancer Surveillance: State

Perspective

Public Health Surveillance

“Public health surveillance is the ongoing, systematic collection, analysis, interpretation, and dissemination of data regarding a health-related event for use in public health action to reduce morbidity and mortality and to improve health.”

Centers for Disease Control and Prevention. Updated guidelines for evaluating public health surveillance systems: recommendations from the guidelines working group. MMWR 2001;50(No. RR-13).

State-Based Surveillance Systems

Most states have and use these major systems for Chronic Disease/Cancer Surveillance:

Mortality Data from Vital Statistics System State Cancer Registry Hospital Discharge Data System BRFSS (Behavioral Risk Factor Surveillance System) YRBS (Youth Risk Behavior Survey, in Maine =

Maine Integrated Youth Health Survey)

State Cancer Registry

MCR receives/collects detailed, high-quality information on all newly diagnosed cancers

All states have rigorous standards set in place by the North American Association of Central Cancer Registries (NAACCR) Tumor registrars go through rigorous training &

certification NAACCR annually reviews data for accuracy,

completeness, and timeliness and certifies state registries:

Maine Cancer Registry has received gold (highest level) certification for the past 10 years (2004 – 2013)

State Cancer Registry (cont.)

In addition to required reports of cancer, MCR actively seeks and uses other data sources to enhance case ascertainment and data quality Pathology Lab reports, state death files, other state

registries

Newer efforts include conducting linkages e.g. to National Death Index, claims data

Working toward receiving all electronic reporting, including Meaningful Use 2 option for providers

Incidence

Incidence Data Newly diagnosed cases of cancer among Maine

residents

Rates are calculated per 100,000 population and age-adjusted to the year 2000 U.S. standard population

U.S. comparison data is derived from the Surveillance, Epidemiology and End Results (SEER) Program of the National Cancer Institute (Whites, All Races)

Maine Cancer Registry, October 2013

Maine’s Highest Incidence Cancers

Lung *** significantly higher than US white (M & F)

ColorectalProstateBreast All sites combined ***(M & F)Other tobacco-related cancers ***(M)Other rates significantly higher than US white pop. Bladder (M & F) Leukemia (M) Esophagus (M) MCR, 2010

Tobacco-Related Cancers

LUNG

Laryngeal Oral cavity and pharynx Esophageal Stomach Pancreas Kidney and renal pelvis Bladder Cervix Acute myeloid leukemia (AML)

Age as a “Risk Factor”

56% of cancers in Maine are diagnosed at or after age 65 (MCR, 2010 data)

As the Maine population ages, our burden of cancer not only seems higher, it is higher

Age is especially a factor for cancers where repeated exposure over a long duration plays a role e.g. lung cancer where peak in rate is between 75 and 79 years. For other tobacco- related cancers, peak 80 – 84 years. Other cancers frequent in the elderly include colorectal, leukemias and related bone marrow disorders,

Obesity-Related Cancers

Adenocarcinoma of the Esophagus *** (M)PancreasColonKidneyEndometrium (uterus)Breast - postmenopausal

Source: 2007 report from American Institute of Cancer Research and World Cancer Research Fund

Cancer INCIDENCE

Maine Cancer Registry, October 2013

AGE-ADJUSTED INCIDENCE OF COLORECTAL CANCER, MAINE 1995-2010

Data Source: Maine Cancer Registry, 1995-2010 NPCR-CSS submission

Cancer INCIDENCE

Maine Cancer Registry, October 2013

AGE-ADJUSTED INCIDENCE OF CERVICAL CANCER AMONG FEMALES, MAINE 1995-2010

Data Source: Maine Cancer Registry, 1995-2010 NPCR-CSS submission

Cancer INCIDENCE

Maine Cancer Registry, October 2013

AGE-ADJUSTED INCIDENCE OF BREAST CANCER AMONG FEMALES, MAINE 1995-2010

Data Source: Maine Cancer Registry, 1995-2010 NPCR-CSS submission

Cancer incidence by County

Maine Cancer Registry, October 2013

Mortality

Mortality Data Deaths associated with cancer among Maine residents Based on death certificates Collected and maintained by Maine CDC Processed through standard national algorithms to

determine the underlying and contributing causes of death

Rates are calculated per 100,000 population and age-adjusted to the year 2000 U.S. standard population

Quality of information on the death certificate can vary

Maine Cancer Registry, October 2013

Death Rates for Selected Chronic Diseases, 1999-2009 (Maine)

0

50

100

150

200

250

300

'99 '00 '01 '02 '03 '04 '05 '06 '07 '08 '09

Year

Ag

e-A

dju

sted

Dea

th R

ate Cancer Heart Disease CLRD Stroke Diabetes

CLRD = Chronic Lower Respiratory DiseaseRates per 100,000 population, age-adjusted to the 2000 U.S. standard population.Cancer data are calculated using NCHS mortality data and SEER*Stat Version 7.0.5. Data for other causes are from Maine Mortality Data, Office of Data, Research, and Vital Statistics.

Death Rates for Leading Cancers and All Cancer Combined, Maine and U.S., 2008

020406080

100120140160180200

All CancersCombined

Prostate(Male)

Breast(Female)

Lung &Bronchus

(both sexes)

Colon &Rectum (both

sexes)

Death

Rate

per

100,0

00

Maine

U.S. (Whites Only)

U.S. (All Races)

Data source: Maine and U.S. Mortality: National Center for Health Statistics, All Causes of Death, Public-Use with State, Total U.S. (1969-2008)

Note: Rates are age-adjusted to the US 2000 standard populationOnly malignant cases were used

Highest Mortality Cancers in Maine

All sites combined *** (M & F)Lung *** (Females, close for Males)Other Tobacco-related ***(M)ProstateColorectalBreastBladder ***(M) Esophagus *** (M)Myeloma ***(F) MCR,

2010

Cancer Mortality

Maine Cancer Registry, October 2013

 AGE-ADJUSTED CANCER MORTALITY TREND: ALL MALIGNANT CANCERS, MAINE 1969-2010

National Center for Health Statistics, All Causes of Death, Public-Use With State, Total U.S. (1969-2010)

Cancer Mortality

Maine Cancer Registry, October 2013

AGE-ADJUSTED CANCER MORTALITY TREND: TOP CAUSES OF CANCER AMONG MALES, MAINE 1969-2010

Data Source: National Center for Health Statistics, All Causes of Death, Public-Use With State, Total U.S. (1969-2010)

Cancer Mortality

Maine Cancer Registry, October 2013

AGE-ADJUSTED CANCER MORTALITY TREND: TOP CAUSES OF CANCER AMONG FEMALES, MAINE 1969-2010

Data Source: National Center for Health Statistics, All Causes of Death, Public-Use With State, total U.S. (1969-2010)

Cancer Mortality by County

Maine Cancer Registry, October 2013

Cancer Incidence & Mortality

Maine Cancer Registry, October 2013

State-Based Surveillance Systems

Most all states have and use these major systems for Chronic Disease Surveillance: Mortality Data from Vital Statistics Systems State Cancer Registries BRFSS (Behavioral Risk Factor Surveillance

System) )

Behavioral Risk Factor Surveillance System

All states conduct the BRFSS using standard methods State-based and implemented survey coordinated by CDC

Historically a random-digit-dial land-line phone survey

Implemented multi-modal survey beginning 2011 Incorporating cell phone surveys

Non-institutionalized adults 18+ years of ageComplex sample survey to provide weighted data

representative of the statewide adult populationSelf-reported data

Behavioral Risk Factor Surveillance System

2011 and future BRFSS data will not be comparable to 2010 and prior data due to change in methodology.

88.8 89.1 86.3 85.0

82.9 84.7 84.7 84.3

47.3

59.264.2

72.6 74.3

85.1 83.6

0

10

20

30

40

50

60

70

80

90

100

'00 '01 '02 '03 '04 '05 '06 '07 '08 '09 '10

Year

Pe

rce

nta

ge

of

Ad

ult

s

Pap test w/in past 3 years (women)

Mammogram w/in past 2 years (women 50+)

Ever had Colonoscopy/ Sigmoidoscopy (50+)

Percentage of Maine adults who receive appropriate cancer screening

Contact Info

Molly Schwenn, MD

Maine Cancer Registry, Maine CDC, DHHS Phone: (207) 287-5196Email: molly.schwenn@maine.gov

Surveillance Resources on the Web

Mortality Detailed mortality data on CDC Wonder:

http://wonder.cdc.gov/

Cancer CDC: http://apps.nccd.cdc.gov/uscs/Index.aspx NCI: http://cancer.gov/statistics NAACCR: http://www.naaccr.org/ (“FastStats” and

“Quick Cancer Stats & Maps”)

BRFSS CDC BRFSS website: http://www.cdc.gov/brfss/