2. Overview of Incidence Data at the Virginia Cancer Registry 2000-2004 Carolyn Halbert M.A.,.M.P.H. Statistical Analysis Coordinator Virginia Cancer Registry October 3, 2007

3. Oh No, Not Data! Data is not as scary as you may think and can do so much to help get your job done!

4. Components of the Surveillance System Clinics, free standing centers LaboratoriesPhysicians Central Registry Fed. Surveillance Pgm. (CDC NPCR) Local, Regional, State, & National Partners (PH, NAACCR, ACS) Hospitals Public health authorities

5. Data Requests Institutional Review Board Requests Media requests AcademicIndustry Not for profit You!

6. What can data do for you? Strategic planning Strategic planning -are there enough radiology cases to justify a new radiologist -are there enough radiology cases to justify a new radiologist Grants? Grants? Certificates of Need ? Certificates of Need ?

7. Data Caution Statement conservative account of the disease in Virginia. conservative account of the disease in Virginia. out-of-state data lag time out-of-state data lag time Underreporting Underreporting rates may be higher in more urbanized areas where case ascertainment is more complete. rates may be higher in more urbanized areas where case ascertainment is more complete. case reporting may be more complete for certain racial groups, cancer sites, or diagnosis stages. case reporting may be more complete for certain racial groups, cancer sites, or diagnosis stages. Our goal is to be able to provide you with valid and reliable data with which to understand cancer in Virginia and to make informed policy decisions. Our goal is to be able to provide you with valid and reliable data with which to understand cancer in Virginia and to make informed policy decisions.

8. Suppression Issues Rival hospital data Rival hospital data Counts under 11 for geographic areas smaller than the state Counts under 11 for geographic areas smaller than the state Counts under 6 for state level data Counts under 6 for state level data Rates based on counts <15 Rates based on counts <15 Rates are per 100,000 and age-adjusted to the 2000 U.S.Census (Industry standard) Rates are per 100,000 and age-adjusted to the 2000 U.S.Census (Industry standard)

9. Counts vs. Rates What is the difference Burden of care-use counts Use rates for comparisons across areas but rates can sometimes be misleading

10. Now let’s look at the DATA This is only a small sample of our data or how we can look at data

11. Top 5 Cancers among Females in Virginia (Count and Percent), 2000 – 2004 Breast23,90732.6% Lung & Bronchus 9,76013.3% Colon & Rectum 8,49611.6% Corpus & Uterus, NOS 4,1025.6% Non-Hodgkin Lymphoma 25583.5%

12. Top 5 Cancers among Males in Virginia (Count and Percent), 2000 – 2004 Prostate24,44330.9% Lung & Bronchus 12,76316.1% Colon & Rectum 8,49610.9% Urinary Bladder 4,6465.9% Melanoma33054.2%

13. Cancer Site by Gender Rates are per 100,000 Age Adjusted to 2000 US Census (19 year age group) standard

14. Pediatric Cancers By Gender Rates are per 100,000 Age Adjusted to 2000 US Census (19 year age group) standard

15. Pediatric Cancers by Top Sites and Gender Rates are per 100,000 Age Adjusted to 2000 US Census (19 year age group) standard

16. Health Regions: A Closer Look Rates are per 100,000 Age Adjusted to 2000 US Census (19 year age group) standard Ries LAG, Melbert D, Krapcho M, Mariotto A, Miller BA, Feuer EJ, Clegg L, Horner MJ, Howlader N, Eisner MP, Reichman M, Edwards BK (eds). SEER Cancer Statistics Review, 1975-2004, NCI Bethesda, MD, http://seer.cancer.gov/csr/1975_2004/, based on November 2006 SEER data submission, posted to the SEER web site, 2007.

17. Drilling Down a Bit More

18. Who Gets Prostate Cancer? Rates are per 100,000 Age Adjusted to 2000 US Census (19 year age group) standard

19. Who Gets Breast Cancer? Rates are per 100,000 Age Adjusted to 2000 US Census (19 year age group) standard. Other includes Asian, Pacific Islander, American Indian, Alaskan Native, other and unknown

20. Who gets Lung Cancer? Rates are per 100,000 Age Adjusted to 2000 US Census (19 year age group) standard. Other includes Asian, Pacific Islander, American Indian, Alaskan Native, other and unknown

21. Who Gets Colon Cancer? Rates are per 100,000 Age Adjusted to 2000 US Census (19 year age group) standard. Other includes Asian, Pacific Islander, American Indian, Alaskan Native, other and unknown

22. Cancer Incidence Rates by Age by Selected Site, VA, 2000-2004

23. Stage at Diagnosis by Race, All Sites 2000-2004

24. Age-Specific Cancer Mortality Rates Selected sites VA, 2000-2004 Source: VDH Division of Health Statistics

25. Now let’s look over the years

26. Rates are per 100,000 Age Adjusted to 2000 US Census (19 year age group) standard. Other includes Asian, Pacific Islander, American Indian, Alaskan Native, other and unknown Trends : All Sites

27. Trends : Breast and Cervical Rates are per 100,000 Age Adjusted to 2000 US Census (19 year age group) standard

28. Trends: Colon & Rectum

29. Rates are per 100,000 Age Adjusted to 2000 US Census (19 year age group) standard Trends: Melanoma

30. Data on the web http://www.vahealth.org/cdpc/cancer/02 data.asp

31. We still have a long road ahead..

32. Cancer Risk Factors Behavioral risk factors: tobacco use, physical inactivity, overweight, diet and alcohol use, lack of preventive screening Behavioral risk factors: tobacco use, physical inactivity, overweight, diet and alcohol use, lack of preventive screening Other risk factors: environmental carcinogens, occupational factors, family history, environmental pollution, ultraviolet radiation, and socioeconomic status have all been linked to cancer. Other risk factors: environmental carcinogens, occupational factors, family history, environmental pollution, ultraviolet radiation, and socioeconomic status have all been linked to cancer. Viruses (HPV, Hepatitis) Viruses (HPV, Hepatitis)

33. Respondents to Virginia Behavioral Risk Factor Surveillance System (BRFSS) 2000-2002 Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, [

34. Data Analysis for Case Ascertainment Table 2: Sources of Data by Population* # cases % cases by region Non-Appalachian Source MD Office 3971.01% Appalachian Source MD Office 1022.65% Non-Appalachian Source DCO 5171.33% Appalachian Source DCO 922.39% Physician offices and DCO’s are greater sources of data in Appalachia than in non- Appalachia by population percent *Cancer Surveillance in Appalachian Virginia: Evaluating Data Quality and Enhancing Case Finding Carolyn Halbert M.A., M.P.H., Jim Martin Ph.D., Virginia Cancer Registry Virginia Department of Health Poster Presentation NAACCR 2007

35. Final Thoughts The data are truly useful to a variety of people. The data are truly useful to a variety of people. The data are used to answer many kinds of questions: scientific research, public health policy, and disease surveillance. The data are used to answer many kinds of questions: scientific research, public health policy, and disease surveillance. Our results are only as good as your data. We value working with you. Our results are only as good as your data. We value working with you. Almost at 3 years of certification Almost at 3 years of certification Data collection and use are improving and growing…especially thanks to your efforts Data collection and use are improving and growing…especially thanks to your efforts

36. Thank you Cancer Registrars!

37. Our Partners

38. Questions?? Carolyn.Halbert@vdh.virginia.gov Carolyn.Halbert@vdh.virginia.gov Carolyn.Halbert@vdh.virginia.gov 804 864 7861 804 864 7861