MOLLY SCHWENN, MD CANCER REGISTRY MAINE CDC, DHHS OCTOBER 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) 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

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) Pancreas Colon Kidney Endometrium (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 Data Source: Maine Cancer Registry, NPCR-CSS submission

Cancer INCIDENCE Maine Cancer Registry, October 2013 AGE-ADJUSTED INCIDENCE OF CERVICAL CANCER AMONG FEMALES, MAINE Data Source: Maine Cancer Registry, NPCR-CSS submission

Cancer INCIDENCE Maine Cancer Registry, October 2013 AGE-ADJUSTED INCIDENCE OF BREAST CANCER AMONG FEMALES, MAINE Data Source: Maine Cancer Registry, 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, (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 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 Data source: Maine and U.S. Mortality: National Center for Health Statistics, All Causes of Death, Public-Use with State, Total U.S. ( ) Note: Rates are age-adjusted to the US 2000 standard population Only malignant cases were used

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

Cancer Mortality Maine Cancer Registry, October 2013 AGE-ADJUSTED CANCER MORTALITY TREND: ALL MALIGNANT CANCERS, MAINE National Center for Health Statistics, All Causes of Death, Public-Use With State, Total U.S. ( )

Cancer Mortality Maine Cancer Registry, October 2013 AGE-ADJUSTED CANCER MORTALITY TREND: TOP CAUSES OF CANCER AMONG MALES, MAINE Data Source: National Center for Health Statistics, All Causes of Death, Public-Use With State, Total U.S. ( )

Cancer Mortality Maine Cancer Registry, October 2013 AGE-ADJUSTED CANCER MORTALITY TREND: TOP CAUSES OF CANCER AMONG FEMALES, MAINE Data Source: National Center for Health Statistics, All Causes of Death, Public-Use With State, total U.S. ( )

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

Percentage of Maine adults who receive appropriate cancer screening

Contact Info Molly Schwenn, MD Maine Cancer Registry, Maine CDC, DHHS Phone: (207)

Surveillance Resources on the Web Mortality  Detailed mortality data on CDC Wonder: Cancer  CDC:  NCI:  NAACCR: (“FastStats” and “Quick Cancer Stats & Maps”) BRFSS  CDC BRFSS website: