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Sean Altekruse DVM, MPH, PhD, DACVPM (Epidemiology) National Cancer Institute

Cancer incidence, survival and mortality trends in the United States USPHS Scientific and Training Symposium Veterinary Category Day June 20, 2012. Sean Altekruse DVM, MPH, PhD, DACVPM (Epidemiology) National Cancer Institute Division of Cancer Control and Population Sciences

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Sean Altekruse DVM, MPH, PhD, DACVPM (Epidemiology) National Cancer Institute

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  1. Cancer incidence, survival and mortality trends in the United StatesUSPHS Scientific and Training SymposiumVeterinary Category DayJune 20, 2012 Sean Altekruse DVM, MPH, PhD, DACVPM (Epidemiology) National Cancer Institute Division of Cancer Control and Population Sciences Surveillance Research Program Data Analysis and Interpretation Branch

  2. Veterinarians, Cancer Surveillance Community • Anil Chaturvedi DVM, PhD (NCI, DCEG Infectious Etiologies) • AmedinJemal DVM, PhD (ACS, V.P., Cancer Surveillance) • Sean Altekruse DVM, PhD (NCI, DCCPS, SRP) • Sally Bushhouse DVM, PhD (MN CSS) • ChandKhanna DVM, PhD (NCI, CCR) • Carol McClure DVM, PhD (PEI, CTC) • Others

  3. Surveillance, Epidemiology & End Results • What is SEER? • Types of data • Learn more about SEER

  4. What is SEER? Key part of Nation’s Cancer Control Infrastructure • Established by the 1971 National Cancer Act to -- - Provide baseline data on cancer burden - Focus research toward important opportunities - Assess prevention effectiveness

  5. Measuring Our Nation’s Progress Against Cancer • SEER data informs Nation’s cancer health policy & practice • Used by legislators, clinicians, scientists, health officials, advocacy groups, press & public (e.g. patients & families) • Over 4000 articles based on SEER cited in PubMed

  6. NCI SEER Program • Network of registries covering ~28% of US population • Public use data - cancer incidence, prevalence, survival • Person, site, histology, behavior, stage, treatment, vital status • Cancer as a model for chronic disease surveillance

  7. SEER Data Quality • Data quality continuously monitored • Quality improvement is integral to the SEER Program • Routinely update variables, documentation and training

  8. Evolution of SEER • SEER 9 covering years 1975+ • San Francisco-Oakland, Connecticut, Detroit, Hawaii, Iowa, New Mexico, Seattle, Utah, Atlanta • SEER 13 covering years 1992+ • SEER 9 plus San Jose-Monterey, Los Angeles, Rural Georgia, Alaska Natives • SEER 18 covering years 2000+ • SEER 13 plus Kentucky, Louisiana, New Jersey, Greater California and Georgia

  9. U.S. Map with 20 SEER Registries

  10. Population Coverage by Race/Ethnicity (2009 estimate) OriginalSEER FirstExpansion SecondExpansion Percentage of U.S. population 1973 on 1992 on 2000 on 60% 50% 40% 30% 20% 10% 0% White Black AI/AN API Hispanic AI/AN: American Indian and Alaska NativeAPI: Asian and Pacific Islander

  11. Where Are SEER Statistics Reported? • Cancer Statistics Review–Recent cancer statistics • Annual Report to the Nation–Multiagency collaboration • Fact Sheets–Summary of key statistics by cancer site • Analytic Software: HD*Calc, SEER*Stat, JoinPoint • Fast Stats–Web-based tables and graphs • State Cancer Profiles (Web-based) • Cancer Trends Progress Report (Web-based)

  12. Statistics from SEER Data • Rate per 100,000 population • Crude, Age-adjusted, Delay-adjusted • Trends (logistic regression) • Annual percent change • Average annual percent change • Survival • Prevalence, cancer survivors • Lifetime risk • Person- and Average-years of life lost

  13. Age-Adjusted, Delay-Adjusted Incidence Rates All Cancer Sites by Sex Males Both Sexes Observed Delay Adjusted Females

  14. Delay-Adjusted Incidence Trends All Cancer Sites by Sex AAPC -0.8* -0.9* Males -0.3* -0.5* Both Sexes 0.7 0.4 Observed Delay Adjusted Observed Delay Adjusted * AAPC is statistically different from 0 (p<.05) Females

  15. All Sites, Incidence Rates & Joinpoint Trends 1975-2009, All Ages Males Females AAPC -0.8* -1.0* AAPC 0.2* -0.3 0.5 -2.2* 0.8* -1.6* 0.3* 0.1 White Black Asian/Pacific Islander American Indian/Alaska Native Hispanic * The AAPC is statistically significant from 0 (p<0.05)

  16. Top 15 Cancer Incidence Rates Age-adjusted rate per 100,000 -- SEER 18, 2009

  17. Recent Incidence Trends by Cancer Site* * * * * * * * * * * * * * * * * * * * * Average Annual Percent Change 2000-2009 * 10 year AAPC statistically different from 0 (p<0.05), joinpoint model fit, SEER 9 delay-adjusted rates from 1975-2009

  18. Delay- and Age-Adjusted Incidence Trends, Leading Cancer Sites

  19. Breast (Female)Incidence and Mortality Age-Adjusted Trends • 2012 estimated number of women in the US • 226,870 women diagnosed • 39,510 women die -0.7 ? ? -1.9* * The AAPC is statistically significant from 0 (p<.05)

  20. Prostate (Male)Incidence and Mortality Age-Adjusted Trends • 2012 estimated number of men in the US • 241,750 men diagnosed • 28,170 men die -1.7* ? ? -3.5* HP 2020 Goal 21.2 per 100K * The AAPC is statistically significant from 0 (p<.05)

  21. Lung and Bronchus (Males)Incidence and Mortality Age-Adjusted Trends • 2011 estimated numbers in the US • 116,470 diagnosed • 87,750 die -1.8* ? ? -2.3* * The AAPC is statistically significant from 0 (p<.05)

  22. Lung and Bronchus (Female)Incidence and Mortality Age-Adjusted Trends • 2012 estimated numbers in the US • 109,690 diagnosed • 72,590 die 0.1 ? ? -0.6* * The AAPC is statistically significant from 0 (p<.05)

  23. Colon and RectumIncidence and Mortality Age-Adjusted Trends • 2012 estimated numbers in the US • 143,460 diagnosed • 51,690 die -2.4* ? ? -2.8* * The AAPC is statistically significant from 0 (p<.05)

  24. Size of SEER: Rare Cancers, Cancer Heterogeneity • The four leading cancers (lung, colorectal, breast & prostate) account for most of the U.S. cancer burden • >50 other cancers with considerable burden • Many anatomic sub-sites, histologic subtypes • SEER population of sufficient size to evaluate these cancers • “Personalized” or “Targeted” medicine

  25. Delay- and Age-Adjusted Incidence Trends,Cancer Sites Decreasing By 1% Per Year Or More* * Breast, Prostate, Lung & Bronchus, and Colon & Rectum graphed separately

  26. Long Term Incidence Trends For Cancer Sites That Are Increasing By 1% Per Year Or More*

  27. Healthy People 2020 Target, All Cancer 5-year Relative Survival: 72.8% 5-Year Survival Target: 72.8% Five Year Relative Survival Source: Surveillance, Epidemiology and End Results (SEER) 17 Registries, Diagnosis Year 2003

  28. 5-Year Relative Survival By Site and Race All Site 2020 Target: 72.8% Other Sites (5-Yr Survival) Thyroid (98%) Kidney (78%) Myeloma (41%) Nervous System (34%) Stomach (27%) Pancreas (6%)

  29. Number of Cancer Survivors --United States, 1971 to 2009

  30. 12 Million U.S. Cancer Survivors, 2008 20 to <25 > 25 5% 11% 0 to <5 15 to <20 35% 9% 10 to <15 16% 5 to <10 24% By Time since diagnosis

  31. Liver cancer Increasing incidence/mortality: White, Black, Hispanic men Neighborhood SES Changes in treatment, survival Prostate cancer (southeastern U.S.) Race-specific early stage diagnosis -- urban v. rural Cervical cancer Geospatial and racial/ethnic variation Childhood cancer Stalling progress to reduce mortality? Linkage to socioeconomic data Linkage to specimens Social Media “Did you know?” -- YouTube Recent, Current Efforts

  32. Summary • What is SEER? • Types of data • Applications

  33. Thank You! Sean Altekruse DVM, MPH, PhD, DACVPM (Epidemiology) altekrusesf@mail.nih.gov (301) 402-5331

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