Population-based Cancer Surveillance: State Perspective

1. Population-based Cancer Surveillance: State Perspective Molly schwenn, MD Cancer Registry Maine CDC, DHHS October 25, 2013

2. 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).

3. 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)

4. 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)

5. 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

6. 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

7. Maine’s Highest Incidence Cancers • Lung *** significantly higher than US white (M & F) • Colorectal • Prostate • Breast • 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

8. Tobacco-Related Cancers • LUNG • Laryngeal • Oral cavity and pharynx • Esophageal • Stomach • Pancreas • Kidney and renal pelvis • Bladder • Cervix • Acute myeloid leukemia (AML)

9. 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,

10. Obesity-Related Cancers • Adenocarcinoma of the Esophagus *** (M) • Pancreas • Colon • Kidney • Endometrium (uterus) • Breast - postmenopausal • Source: 2007 report from American Institute of Cancer Research and World Cancer Research Fund

11. Cancer INCIDENCE Age-adjusted Incidence of COLORECTAL Cancer, Maine 1995-2010 Data Source: Maine Cancer Registry, 1995-2010 NPCR-CSS submission Maine Cancer Registry, October 2013

12. Cancer INCIDENCE Age-adjusted Incidence of CERVICAL Cancer among FEMALES, Maine 1995-2010 Data Source: Maine Cancer Registry, 1995-2010 NPCR-CSS submission Maine Cancer Registry, October 2013

13. Cancer INCIDENCE Age-adjusted Incidence of BREAST Cancer among females, Maine 1995-2010 Data Source: Maine Cancer Registry, 1995-2010 NPCR-CSS submission Maine Cancer Registry, October 2013

14. Cancer incidence by County Maine Cancer Registry, October 2013

15. 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

16. Death Rates for Selected Chronic Diseases, 1999-2009 (Maine) CLRD = Chronic Lower Respiratory Disease Rates 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.

17. Death Rates for Leading Cancers and All Cancer Combined, Maine and U.S., 2008 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 population Only malignant cases were used

18. Highest Mortality Cancers in Maine • All sites combined *** (M & F) • Lung *** (Females, close for Males) • Other Tobacco-related ***(M) • Prostate • Colorectal • Breast • Bladder ***(M) • Esophagus *** (M) • Myeloma ***(F) MCR, 2010

19. Cancer Mortality 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) Maine Cancer Registry, October 2013

20. Cancer Mortality 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) Maine Cancer Registry, October 2013

21. Cancer Mortality 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) Maine Cancer Registry, October 2013

22. Cancer Mortality by County Maine Cancer Registry, October 2013

23. Cancer Incidence & Mortality Maine Cancer Registry, October 2013

24. 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) • )

25. 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 age • Complex sample survey to provide weighted data representative of the statewide adult population • Self-reported data

26. Behavioral Risk Factor Surveillance System • 2011 and future BRFSS data will not be comparable to 2010 and prior data due to change in methodology.

27. Percentage of Maine adults who receive appropriate cancer screening

28. Contact Info Molly Schwenn, MD Maine Cancer Registry, Maine CDC, DHHS Phone: (207) 287-5196 Email: molly.schwenn@maine.gov

29. 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/