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>> This is a report that has lots of information that shows us
that cancer is a complicated disease with...and it also I think provides a lot
of information related to all the efforts that are going on to actually improve
and reduce the cancer burden in the U.S. and I think it also characterizes a lot
of the work that's going on in the research community and the clinical community
and in those that are working to try to educate and inform individuals about what they can do
to reduce their own risk or have access to care.
[ Pause ]
Um, we're seeing declines in the large...the major cancer, lung cancer for men
but it's just plateaued for women, we're seeing declines in breast cancer in women,
prostate cancer for men and we're also seeing declines in colorectal cancer as well
as a number of other sites so we actually look at the details,
what does it mean that the rates are going down in terms of mortality it means
that we are hopefully reducing risk, we're finding effective ways to prep for those
that screening to find it early and then to move into the treatments that work.
For others we may be looking at improved treatment
for which we don't have some early detection,
or we may not actually understand all the risks factors.
So the mortality is giving us a summary of all the things going on, the progress to date.
In terms of incidents or new cases that might actually give us some indication
of the introduction of screening rates, it may help us look at sort of sometimes screening,
the incidents of new cases portend of what would be coming in terms of mortality.
So incidents are a lot harder to interpret because it may have some short term increase
if we have introduced a new screening, finding it early
but at the same time it actually gives us a picture of a lot
of the cancer control initiatives and activities, what's happening in the nation.
[ Pause ]
This time we decided to look at colorectal cancer because it's the second leading cause
of cancer deaths in the U.S., it's the third leading cancer diagnosed in men and in women
so a very important cancer and it's actually somewhat complex in terms of what we know
about what maybe related to risk factors, we have screening but different types of screening
that might help us find it early and effective treatment
and we have some you know newer treatments that are being used.
So we wanted to look at colorectal because of it's importance so we decided
that we would take...we'll use some work that is going
on among grantees are employing a technique of micro simulation, a way model these factors
to help us understand their relative contribution
to both explaining the patterns we have and actually giving some idea
of how we might predict in the future or what could be accomplished.
[ Pause ]
This paper actually is highly read and cited by the research community is even used
as a reference document every year, we bring together the latest data so it's kind
of people wait for it, it's a summary of all those many pieces of information
for the public I think it tries to give some of the highlights
of what's happening and update that for them.
And in terms...I think there's another audience here that when we're going into the use
of these modeling efforts to help us synthesize, interpret, look at what might be happening now
and in the future we also see that as providing information in making policy decisions,
allocating resources, helping those who are in other important decision making roles
to get a better handle on how to deal with all of the information they have.
[ Pause ]
SEER is been around for 30 plus years, we focus on high quality data that's available,
we make our data files available as a research file and have...have over 2,000 people
who ask us for it every year and use our data and that's a little bit unique in the world.
So, we have high quality data that we use that we make available to a wide range of people
to use and we've always focused on data quality, education training standards and the use
of tools, including data systems tools and analytic tools
to help us disseminate this information and we share it with our partners
so over the last decade or so we spent a lot of our time and energy as making sure
that we're disseminating, sharing and making sort of what we have developed available.
[ Pause ]
We collect all cancers in SEER as defined, including some of the in situ's
which are early...early stage if you will cancer.
[ Pause ]
We clearly have worked over the years with the CDC program to combine the data
and over many years now we have been working with the North American Association
of Central Cancer Registries which is the professional organization
for population based cancer registries even includes Canada to pool the data
from the high quality registries and over time since the program at CDC was authorized
by Congress beginning in '92 but data flowing in beginning mostly with mostly '95
as that data became mature and of high quality we have been reporting in the report
to the nation data that go beyond the SEER program.
So we work with our surveillance partners to try to come up with common definitions
that are more consistent in all these reporting units, SEER program has often initiated some
of defining these standards so that we share our information, we share some of out analytic tools
with our partners so we spent probably the last 15 years very actively involved
in the broader surveillance community where SEER I think played an extremely important role
in defining the infrastructure, the technology, the tools and the data particularly
for how we can report on the cancer burden in the U.S., measure it over time
and the includes new cases, that's incidents which is unique to SEER, survival, following up,
sort of what do we know, how do we know it for the different cancer sites by extended disease
or stage and then we work with our other partners the CDC's,
National Center for Health Statistics which provide some mortality data for the total U.S.
and we get mortality data, we publish more cancer mortality data than they do
because we sort of understand the cancer issues.
So, we receive that from them and we publish it and report on it
and again I think this really reflects efforts to coordinate the public
and the private components of this very also kind
of complex infrastructure that we have in the U.S.
[ Pause ]
So a cancer registry is a group that collects data on a defined population according
to specific rules, aggregate those data and report on cancer from that data base.
The CDC program funds all the states that are not unique to SEER, that's the 96 percent
but we fund many metropolitan regions within states that that they fund notably Seattle
which has almost 70 percent of the population for the state of Washington.
We fund the Detroit metropolitan region which is I think about 39
or so percent of the state of Michigan.
We fund Atlanta which is about 36 percent of the state of Georgia so nested within a number
of the states that CDC's program funds,
SEER has been funding...there's a SEER registry probably preceded their funding
and so our data go to the state, the CDC does not pay twice for this effort,
our data and so that data is incorporated into the state data.
California is a little more complicated because we have a couple of metropolitan regions there
around the San Francisco Bay area, we have Los Angeles that got added in and then
when we had our latest expansion we just added the rest of California whereas CDC funds all
of California so the SEER piece is broken into three geographic pieces that relate
to when they came into our program and the amount of...years of data that we have for them.
[ Pause ]
The SEER program has its own data standards as identified in our acquisition
of this information and our standards we're looking for 98 [percent] completeness
of all the cancer cases with in these 22 months, some metrics on the actual data elements,
how complete those pieces of information were.
So that's the SEER program, we manage it, we get data in we it filed
in a year earlier we start looking are you on the way to completeness, we get...when data come
in we have a lot of computer programs and ways in which we edit, we provide feedback
to our registries, that's one point.
The other programs have other ways that they're engaged in that,
they have different prep standards for example and the CDC program requires
at least 90 percent coverage within 22-25 months so you know if we have at least 90 percent
of those cases we will pool it into the data base.