Cancer Tracking: The State of the Nation James S. Marks, M.D., M.P.H. Director Chronic Disease Prevention and Health Promotion

“If the United States is to reduce the human and financial costs of chronic diseases with effective public health prevention efforts, the first step is to establish a tracking capacity for chronic diseases and environmental exposures.” Source: Transition Report to the New Administration: Strengthening our Public Health Defense Against Environmental Threats. January 2001, The PEW ENVIROMENTAL HEALTH COMMISSION

“The PEW Environmental Health Commission at John Hopkins School of Public Health called on Congress and the White House to protect Americans from chronic diseases- the No. 1 cause of death in the U.S.- by tracking where and when these health problems occur and possible links to environmental factors.” Source: Protect Public From Chronic Disease, PEW Commission Urges Disease, Environmental Exposures Must Be Tracked to Save Lives, January 2001, The PEW ENVIROMENTAL HEALTH COMMISSION

Why cancer tracking is critical. Why strong cancer registries are needed in every state. The present and future of cancer registries.

Why Cancer tracking is critical.

State Cancer Registries PURPOSE: Is progress occurring? Are specific populations at higher risk? Are cancer prevention and control efforts having the expected effect? Where and how would resources be best used? Evaluate clusters, quality of care and new interventions.

Why strong cancer registries are needed in every state.

CDC’s National Program of Cancer Registries Providing national leadership by helping states and territories: Fund all 45 states not wholly funded by SEER Recommend standards for data completeness, timeliness, and quality Modernize and computerize reporting and data-processing Develop laws and regulations that promote quality registries

*North American Association of Central Cancer Registries Certification of data from cancers diagnosed 1995, 1996, 1998, 2000 NAACCR*-Certified State Cancer Registries DC

Female Breast Cancer Cases Diagnosed at Early Stage Michigan, 1985–1987 Percentage of Cases < – – & over

Female Breast Cancer Cases Diagnosed at Early Stage Michigan, 1995–1997 Percentage of Cases < – – & over

KENTUCKY: Uninsured cancer patients have lower three-year survival rates for colorectal, breast, prostate and lung cancer compared with insured patients The Archives of Internal Medicine, October 12, 2003

Patterns of Care Study Two studies examining four cancer sites: breast, prostate, colon and ovarian. Compares quality of treatment data reported to NPCR registries with data from medical records Population-based samples estimate proportion of patients who receive recommended standard of care

Breast, Colon and Prostate Cancer Data Quality & Patterns of Care Study Eight registries involved: New York Rhode Island South Carolina District of Columbia Illinois Louisiana Colorado California

Ovarian Cancer Treatment Patterns and Outcomes Study Three registries involved: Maryland New York California

What is the Present and Future of Cancer Registries Trust for America’s Health- “Improving Cancer Tracking Today Saves Lives Tomorrow: Do States Make the Grade?” is an interim report in establishing systems and great growth in the quality of data. The future is to use cancer registries for issues of cancer prevention, detection and care. To serve as a model, as implied in the first Trust For America’s Health report, “America’s Environmental Health Gap: Why the Country Needs a Nationwide Health Tracking Network” for the tracking of critical chronic disease health problems of our time.

The Cancer Weapon America Needs Most “Although not as glamorous, cancer tabulation can be more important in the fight against cancer than performing an intricate operation or an elegant experiment. A network of cancer registries can be our most potent new weapon against the disease. “ Source:Healey JH. The cancer weapon America needs most. Reader’s Digest June 1992;140(842):69–72.

The Cancer Weapon America Needs Most “People do not naturally rally round a cause like cancer record-keeping because no one can point to victims who will suffer without it. Rather, it is our larger understanding of cancer that suffers. And thus, we are all victims. “ Source:Healey JH. The cancer weapon America needs most. Reader’s Digest June 1992;140(842):69–72.