The latest annual status report on cancer once again illustrates the burden of cancer in the United States through the lens of incidence and mortality rates for all sites combined, and for the top cancer sites, by gender, age, and racial/ethnic group. But for the first time, the report adds a new statistical dimension aimed at deepening understanding of the reasons behind the data.
The report from the National Cancer Institute, American Cancer Society, and Centers for Disease Control and Prevention, appears in this issue of the Journal. As an example of how surveillance research can be expanded, the report links the mortality and incidence rates for a single site (lung cancer) with data on a risk factor (tobacco smoking prevalence).
The report (page 675) is based on incidence data drawn from NCI's Surveillance, Epidemiology, and End Results Program and mortality data taken from the CDC's National Center for Health Statistics. Age-adjusted rates use annual population estimates from the U.S. Census Bureau. For the focus on lung cancer, however, the report uses additional data collected by CDC and state health and education departments through annual and periodic national surveys that queried about youth and adult smoking behaviors.
By using risk factor data, the researchers were better able to interpret the trends, according to NCI author Brenda Edwards, Ph.D. But this is just a small example of what can be done in surveillance research, she said. In the future, NCI plans to link data sources and collaborate with organizational partners to increase and broaden the incidence, survival, and mortality findings for which the SEER program is known.
A year-long evaluation of SEER by the Surveillance Implementation Group, a review group comprised of 42 scientists from within NCI, other federal agencies, and the extramural community, culminated in a series of 12 recommendations laid out in five priority areas.
"We took a hard look at many dimensions of surveillance research," said Edwards, who was a member of the review group.
The group's report aimed to build on SEER's strengths through better modeling and methods. It also sought greater coverage of the U.S. population, especially minority, ethnic and racial groups. This would be accomplished through cooperation with CDC's cancer registry program, the North American Association of Central Cancer Registries, and states, Edwards said. The report also calls for the collection and reporting of SEER-quality incidence, mortality, and survival data on additional population groups, such as rural African Americans, Hispanics from Caribbean countries, American Indian populations, and others.
Risk Factors
In addition, the report calls for NCI surveillance research to support the collection of data on a variety of risk factors, such as family history, screening, quality of life, and patterns of care. But the review group noted that while there is a growing need for collecting and analyzing data, no formal training in surveillance research currently exists at NCI. The report therefore urges the institute to implement a training strategy for cancer prevention and control scientists that identifies specific training needs related to surveillance sciences.
Finally, the review group called for NCI to annually produce and disseminate a national report card on the cancer burden that is widely accessible to the public and would be used to evaluate the nation's performance in confronting the increasing burden of cancer. The content of the report card would reflect the expanded national surveillance program and its emphasis on additional data on cancer patients, patterns of their care, and variations in risk factors and screening data.
These recommendations will generate concepts that require funding. Several initiatives drawn from this plan are expected to be launched by late 1999, others are slated to begin in 2000, according to Robert A. Hiatt, M.D., Ph.D., deputy director of NCI's Division of Cancer Control and Population Sciences. Efforts to implement most of the recommendations will begin over the next 2 years, he said.
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