Defining The Cancer Burden Defining The Cancer Burden for Cancer Control for Cancer Control Presented by Presented by Thomas C. Tucker, PhD, MPH Thomas C. Tucker, PhD, MPH Associate Professor Associate Professor Department of Epidemiology Department of Epidemiology College of Public Health College of Public Health University of Kentucky University of Kentucky Associate Director for Cancer Control Associate Director for Cancer Control Markey Cancer Center Markey Cancer Center University of Kentucky University of Kentucky Director of the Kentucky Cancer Registry Director of the Kentucky Cancer Registry CCC Workshop - Atlanta, Georgia - August 7, 2012
Defining The Cancer Burden for Cancer Control. Presented by Thomas C. Tucker, PhD, MPH Associate Professor Department of Epidemiology College of Public Health University of Kentucky Associate Director for Cancer Control Markey Cancer Center University of Kentucky - PowerPoint PPT Presentation
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Defining The Cancer Burden for Defining The Cancer Burden for Cancer ControlCancer Control
Presented byPresented by
Thomas C. Tucker, PhD, MPHThomas C. Tucker, PhD, MPH
Associate ProfessorAssociate ProfessorDepartment of Epidemiology Department of Epidemiology
College of Public HealthCollege of Public HealthUniversity of KentuckyUniversity of Kentucky
Associate Director for Cancer ControlAssociate Director for Cancer ControlMarkey Cancer CenterMarkey Cancer CenterUniversity of KentuckyUniversity of Kentucky
Director of the Kentucky Cancer RegistryDirector of the Kentucky Cancer Registry
CCC Workshop - Atlanta, Georgia - August 7, 2012
Topics to be covered• What is Cancer Control & why is data important?• How do we measures the cancer burden?• What are the major sources of data that can be
used to describe the burden of cancer?• Some specific limitations associated with using
central cancer registry data for cancer control.• What are the major cancer control sites?• What is the logic model for using these major
sources of data to define the burden of cancer? • Combining sources of data to define the burden of
cancer for the major cancer control sites in specific geographic areas?
• An example of how this process has worked.
What is “Cancer Control”?
The use of evidence based prevention, early detection, treatment, and continuing care intervention strategies to reduce cancer incidence, morbidity and mortality in defined populations.
Phases of Cancer Control
Early Detectio
nPreventio
nDiagnosi
sTreatment
Continuing Care
Data and Cancer Control
What is striking about the definition of cancer control are it’s implications for the use of data at all phases of the cancer control continuum. Muir, et al. have said that “data are an essential part of any rational program of cancer control”. In fact, it is difficult to imagine any effective cancer control efforts that do not rely on some type of data collection and analysis. In essence, data represent the eyes of our cancer control program. Without these eyes, it would not be possible to see our cancer control problems and it would not be possible to see the impact of our cancer control activities.
What are the common sources of data that can be used for defining the
cancer burden?
• Demographic data (Census U.S)• Risk factor data (BRFSS)• Incidence data (KCR)• Mortality data (State Vital Records)
Demographic (Census) data
• Covers the entire population
• Provides details on important factors that influence the burden of cancer in a population
• Is only done once every 10 years in the U.S.
• Is difficult to determine the number of people in a population by race and ethnicity.
Behavioral Risk Factor Surveillance System
• Largest telephone survey in the world• Tracks many important health risks• Complex sample design• Difficult to generalize the information to
small populations
Incidence Data
• Closer in time to causal events• Represents both occurrence and risk of
getting disease• Difficult to get all of the cases• Complex coding rules• Screening effect
Mortality Data
• Very complete data• Represents the ultimate negative health
outcome• Far away in time from causal factors• Care must be taken to use consolidated
death records
Difficulties Associated with Using Central Cancer Registry Data for Cancer Prevention and Control
• The screening effect• Difficulties associated with the occurrence of
cancer in very small populations
Screening Effect
• What happens to the female breast cancer incidence rate in a population when more women have mammography screening?
• What happens to the colorectal cancer incidence rate in a population when more people are screened using colonoscopy?
Difficulties associated with the occurrence of cancer in very small populations
• The difference between “The difference between “countscounts” (frequency) and “” (frequency) and “ratesrates” ” (Risk).(Risk).
• Community A:Community A: Population 1 million, Count =Population 1 million, Count = 1000 cases 1000 cases Crude Rate = 1000/1,000,000x100,000 =Crude Rate = 1000/1,000,000x100,000 = 100 per 100,000 Pop.100 per 100,000 Pop.
• Community B:Community B: Population 100,000, Count =Population 100,000, Count = 100 cases 100 cases Crude Rate = 100/100,000x100,000 =Crude Rate = 100/100,000x100,000 = 100 per 100,000 Pop.100 per 100,000 Pop.
• Community C:Community C: Population 1000, Count =Population 1000, Count = 2 cases2 cases Crude Rate = 2/1000x100,000 =Crude Rate = 2/1000x100,000 = 200 per 100,000 Pop.200 per 100,000 Pop.
Difficulties associated Difficulties associated with the occurrence the occurrence of cancer in very small populations (Cont.)of cancer in very small populations (Cont.)
• Sentinel surveillance techniques can be used when communities have small populations and low cases counts.
• Population scientists can help determine if the frequency of cancer is normal (endemic) or abnormal (epidemic).
• Cancer rates are considered to be unstable when case counts are less then 15..
Number of Cases
What are the major cancer control sites?
Most Common Cancer Control Sites58 % of Total Cancer Cases in the U.S.
Most Common Cancer Control Sites62 % of Total Cancer Cases in Kentucky
All genders, all races, 2001-2005
Most Common Cancer Control Sites59 % of Total Cancers Deaths in Kentucky
All genders, all races, 2001-2005
Demographic Characteristics Contribute to
Risk Factors Contribute to
Incidence and Late Stage DX Contribute to
Cancer Mortality
Combining Data from Multiple Sources
Logic Model
Methodology (Approach) Used in the Methodology (Approach) Used in the C-Change/NAACCR ProjectC-Change/NAACCR Project
• The association between the demographic, risk, incidence, stage at diagnosis and mortality variables were explored using bivariate regression models.
• Variables with R-Squared values .25 or greater were used to construct the initial index for each type of cancer.
• The index was created using a simple rank sum technique. States were ranked from the highest to lowest cancer burden and placed into five groups with red being the states with the highest burden of cancer and green being those states with the lowest cancer burden.
Highest Burden Lowest Burden
Lung CancerLung Cancer
Lung Cancer Rank for States 2008-09 State College Ed+ Current
Summery of top ten states with the highest burden for each type of cancer
LungKentucky
West Virginia
Mississippi
Tennessee
Oklahoma
Arkansas
Indiana
Alabama
Louisiana
Missouri
BreastMississippi
Arkansas
Oklahoma
Louisiana
West Virginia
Alabama
Texas
Kentucky
Nevada
Tennessee
ColorectalMississippi
Louisiana
West Virginia
Oklahoma
Kentucky
Alabama
Arkansas
Indiana
Illinois
Nebraska
CervicalArkansas
Louisiana
Oklahoma
West Virginia
Mississippi
Texas
Alabama
Kentucky
Nevada
Wyoming
Cancer Control in Kentucky
The Kentucky Cancer Registry develops a profile of the cancer burden for the major cancers in each of the states 15 Area Development Districts (ADD’s) and presents these data annually to the District Cancer Councils that have been established in each ADD
Model for Cancer Control(Cancer control can be defined as “activities designed to reduce morbidity and mortality from cancer”)
Kentucky Cancer Program
Select Target Population
Develop Intervention
Strategy
Evaluate the Impact of
Intervention
Implement Intervention
Plan
Identify Problem
Measure Plan Act Measure
Registry Data
Other Data
Health Care Providers
Community
Health Care Providers
Others
Registry Data
Other Data
Lung Cancer By Area Development District in KY 2004-08