1. Gary M. Levin, BA, CTR Florida Cancer Data System NAACCR 2008 Annual Conference 2007 Multiple Primary Rules: Impact on Tumor Counts

2. Presentation Overview Florida Multiple Primary 2007 Automated Procedure Estimated Impact on Florida Tumor Counts Estimated Impact on Non-Florida Tumor Counts Conclusions Future 2

3. Special Thanks 3 To All Who Contributed To The MP2007 Algorithm Mayra Alvarez, RHIT, CTR Meg Herna, BA, CTR Jill MacKinnon, PhD, CTR Sarah Manson, BS, RHIT, CTR Mehrdad Nadji, MD Wendy Scharber, RHIT, CTR Brad Wohler, MS MP2007 Algorithm is CTR Driven

4. MP2007 Automated Procedures Design 4

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6. MP2007 Automated Procedures Methodology Primary Site Pairs Histology Pairs Laterality Check Timing Rules Specialized Coded Rules for Deviation in Model 6

7. MP2007 Automated Procedures Methodology – Site Pairs 7 C160 1 C1611 C160 C1621 C160 C1631 C160 C1641 C160 C1651 C160 C1661 C160 C1681 C160 C1691 C160 C2682 C160 C2692 C161 C2682 C161 C2692 C162 C2682 C162 C2692 C163 C2682 C163 C2692 C164 C2682 Direct application of MP/H Rules Reasonable Extension of MP/H Rules (specific and general site) C030 C470S* C030 C490S* C031 C470S* C031 C490S* C039 C470S* C039 C490S* Correctly link Sarcoma cases C155 C1603 C159 C1603 Correctly link GE Junction cases C340 C3903 C341 C3903 C342 C3903 C343 C3903 C348 C3903 C349 C3903 Experience has shown are likely the same: - data sources - Level of automation - Review of results Slide Courtesy of Wendy Scharber

8. MP2007 Automated Procedures Methodology – Histology Pairs 8 First Version Needs further evaluation from: Registrars Pathologists Currently under review by Tumor Linkage Workgroup 8010 8011 8010 8012 8010 8020 8010 8140 8010 8380 8050 8260 9380 9441 Slide Courtesy of Wendy Scharber

9. MP2007 Control Table 9 Primary SitesHistologyInvasive/ Insitu Timing Diagnosis TimingSchemaLaterality Check Schema IDClass Used in Timing C000-C148,C300-C3298000-8799,8992-9139,9141- 9999 601825Head and Neck Y10-2 C149-C179,C190-C299,C330- C339,C350-C439,C450- C499,C510-C609,C620- C648,C650-C658,C660- C668,C690-C699,C702- C709,C721-C724,C726- C727,C730-C750,C754-C999 8000-8799,8992-9139,9141- 9509,9515-9999 60365Other Sites Y20-2 C180-C1898000-8799,8992-9139,9141- 9999 60365Colon Y30-2 C340-C3498000-8799,8992-9139,9141- 9999 601095Lung Y40-2 C440-C4498720-878060 Melanoma Y50-2 C440-C4498000-8719,8781-8799,8992- 9139,9141-9999 60365Skin - Other Y60-2 C500-C50985309999999991825BreastInflamatory N70-2 C500-C5098000-8529,8531-8799,8992- 9139,9141-9999 601825Breast Y80-2 C6198030-857660999999999Prostate-Epithelial N90-2 C6198580-8799,8992-9139,9141- 9999 60365Prostate - Other N100-2 C6198000-802960999999999Prostate - General N110-2 C6498000-8799,8992-9139,9141- 9999 601095Kidney Y120-2 C6498960999999999 Kidney - Wilms N130-2 C692,C6999510-9514999999999 Retinoblastoma N140-2 C700,C701,C710- C719,C720,C725,C728,C729, C751-C753 8000-8799,8992-9139,9141- 9999 999999999 Brain N150-2 C000-C8099140999999999 Kaposi Sarcoma N160-2 C659,C669-C6898000-8799,8992-9139,9141- 9999 601095Urinary System Y170-2 C000-C8098800-8959,8961-899160365Sarcoma Y180-2 Slide Courtesy of Wendy Scharber

10. MP2007 Automated Procedures Methodology – Specialized Code Urinary – M6 Rule Urinary – M8 Rule Other Sites – M5 Rule (Kaposi Sarcoma) Other Sites – M7 Rule (Ovary) 10

11. MP2007 Multiple Primaries Calculator 11

12. Data Background for Linkage Based on 3.2 Million Source Records from Florida Linked Diagnosis Year 1981 - Present Includes Non-Analytic Cases – Primarily Class 3 Linkage done using Source Records Analysis Focuses on Diagnosis Year 2000-2006 12

13. Linkage Parameters Pre-MP2007 Rules Estimated Impact – Florida No Timing Rules Analytic/Non-Analytic Considered Equal Unknown Diagnosis Year use Date of First Contact 13

14. Linkage Parameters MP2007 Rules Estimated Impact – Florida MP2007 Rules Non-Analytic Cases - Skip Timing Rules Unknown Diagnosis Year - Skip Timing Rules 14

15. Timing Rule of > 5 years Minimal change in counts Removing Same Sites Table Examples: Upper/Lower Lip, Upper/Lower Gum Cannot Assess impact Original abstracting would have merged cases Estimated Impact – Florida Head and Neck 15 SitePre-2007MP2007DifferencePercent Gum, Other Mouth 27502745-5-0.18 Floor of Mouth 1308131240.31

16. Estimated Impact – Florida Colon 16 Sub-sitePre-2007MP2007DifferencePercent Cecum1310413188840.64 Appendix83784580.96 Ascending Colon1220812306980.80 Hepatic Flexure33413355140.42 Transverse Colon52725306340.64 Splenic Flexure22182239210.95 Descending Colon38023851491.29 Sigmoid Colon16994171251310.77 Large Intestine, NOS59606019590.99 Rectosigmoid Junction66896494-195-2.92 Rectum1472514595-130-0.88 Timing Rule > 1 year – Small change in counts – Timing Rule – Extension of Florida Site Pairs for 2007 Did not assess Familial Polyposis

17. Timing Rule of > 3 years Small change in counts Timing Rules Extensions of Florida Site Pairs for 2007 Non-Small Cell Adenocarcinoma with Small Cell Carcinoma Cannot Assess Original abstracting would have merged cases Estimated Impact – Florida Lung 17 SitePre-2007MP2007DifferencePercent Lung and Bronchus118442116492-1950-1.65

18. No Changes in Timing Rule > 60 Days Small change in counts Extensions of Florida Site Pairs for 2007 Estimated Impact – Florida Melanoma 18 SitePre-2007MP2007DifferencePercent Melanoma of the Skin3705036928-122-0.33 Melanoma Issue Midline Laterality is considered a separate primary. The MP2007 Procedure does NOT handle this. To properly identify Midline, would require additional resources which are NOT available. To be able to properly count Midline Melanoma would require NAACCR to consider adding a separate laterality code dedicated to Midline.

19. Timing Rule of > 5 years Small change in counts Timing Rules Inflammatory carcinoma is one primary Did Not Assess Estimated Impact – Florida Breast 19 SitePre-2007MP2007DifferencePercent Breast11627411812718531.59

20. Timing Rule of > 3 years Minimal change in counts Timing Rules MP2007 Rules split Kidney and Renal Pelvis Incidence Site Group includes both Kidney and Renal Pelvis Difficult to assess impact Estimated Impact – Florida Kidney 20 SitePre-2007MP2007DifferencePercent Kidney and Renal Pelvis2111321152390.18

21. Timing Rule of > 3 years Changes in counts Rule M6 and M8 Removing Same Sites Table Multiple tumors on same side (M3, M4) MP 2007 Module does not include these rules at this time Estimated Impact – Florida Renal Pelvis, Ureter, Bladder etc. 21 SitePre-2007MP2007DifferencePercent Urinary Bladder3671636577-139-0.38 Ureter14511170-281-19.37 Other Urinary Organs459382-77-16.78

22. Timing Rule of > 1 year Small change in counts Timing Rules Removing Same Sites Table Cannot Assess impact Original abstracting would have merged cases Estimated Impact – Florida Other Sites 22 SitePre-2007MP2007DifferencePercent Intrahepatic Bile Duct10271017-10-0.97 Liver75897621320.42 Nose, Nasal Cavity and Middle Ear11541169151.30 Cervix Uteri6955695610.01 Larynx82628284220.27 Other Endocrine including Thymus953965121.26

23. Estimated Impact – Florida Totals 23 SitePre-2007MP2007DifferencePercent 1981 - Present2577278257915718790.07 2000 – 20067939477944454980.06 No Change in Counts

24. Linkage Parameters Pre-MP2007 Rules Estimated Impact – Non-Florida Used Florida’s Data Used Florida MP2007 Procedure for Estimate Changed Timing Rules to 60 Days where applicable Reinstated Pre-MP2007 Site Pairs Non-Analytic - Skip Timing Rules Unknown Diagnosis Year - Skip Timing Rules 24

25. Linkage Parameters MP2007 Rules Estimated Impact – Non-Florida MP2007 Rules Non-Analytic - Skip Timing Rules Unknown Diagnosis Year - Skip Timing Rules 25

26. Timing Rule of > 5 years – Small Change Estimated Impact – Non-Florida Head and Neck 26 SitePre-2007MP2007DifferencePercent Gum, Other Mouth 27732745-28-1.01 Floor of Mouth 13281312-16-1.20 Breast SitePre-2007MP2007DifferencePercent Breast119370118127-1243-1.04

27. Estimated Impact – Non-Florida Colon 27 Sub-sitePre-2007MP2007DifferencePercent Cecum1320113188-13-0.10 Appendix848845-3-0.35 Ascending Colon1232212306-16-0.13 Hepatic Flexure33583355-3-0.09 Transverse Colon53135306-7-0.13 Splenic Flexure2239 00.00 Descending Colon38533851-2-0.05 Sigmoid Colon1717017125-45-0.26 Large Intestine, NOS61216019-102-1.67 Rectosigmoid Junction65246494-30-0.46 Rectum1477914595-184-1.25 Timing Rule > 1 year – Small Change

28. Timing Rule of > 3 years – Small Change Estimated Impact – Non-Florida Lung 28 SitePre-2007MP2007DifferencePercent Lung and Bronchus117565116492-1073-0.91 Kidney SitePre-2007MP2007DifferencePercent Kidney and Renal Pelvis2155921152-407-1.89

29. Timing Rule of > 3 years - Change Estimated Impact – Non-Florida Renal Pelvis, Ureter, Bladder etc. 29 SitePre-2007MP2007DifferencePercent Urinary Bladder3686836577-291-0.79 Ureter12221170-52-4.26 Other Urinary Organs409382-27-6.60 Timing Rule > 60 Days – No Change SitePre-2007MP2007DifferencePercent Melanoma of the Skin36928 00.00 Melanoma

30. Timing Rule of > 1 year - Change Estimated Impact – Non-Florida Other Sites 30 SitePre-2007MP2007DifferencePercent Intrahepatic Bile Duct10441017-27-2.59 Liver77297621-108-1.40 Nose, Nasal Cavity and Middle Ear1165116940.34 Cervix Uteri70396956-83-1.18 Larynx83768284-92-1.10 Other Endocrine including Thymus974965-9-0.92

31. Estimated Impact – Non-Florida Totals 31 SitePre-2007MP2007DifferencePercent 1981 - Present26109252579157-31768-1.22 2000 – 2006799197794445-4752-0.59 Change in Counts

32. Conclusions 32 Small Percentage Change Due to New MP2007 Rules Need Further Analysis Need Detail Review of Unexpected Counts Need to Compare Incidence Rates WARNING “ Staring at Numerical Results Can be Dangerous to Your Health ”

33. Future NAACCR Tumor Linkage Workgroup Review Validation of Site Pairs Validation of Histology Pairs Evaluation of Florida MP2007 Algorithm NPCR Development of Generalized Algorithm for Use by All Registries. Plan to function similar to CS Add Scoring mechanism to weight the reliability of each linkage Continue to Analyze and Refine Algorithm/Procedure 33

34. Thank You 34 Questions