Lihua Liu, PhD., Assistant Professor, Los Angeles Cancer Surveillance Program (NAACCR Committee Member)

With its large and diverse population, the Los Angeles Cancer Surveillance Program has always emphasized the importance of monitoring cancer trends and patterns among racial/ethnic populations. After demonstrating the substantially varied cancer risk patterns across Asian ethnic subgroups, researchers at the University of Southern California have begun to focus on understanding possible cancer disparities among the heterogeneous Latino subpopulations. Using data from the California Cancer Registry for 1995-2011, the researchers documented differences in colorectal cancer incidence characteristics and risk estimates among Latino subgroups defined by country of origin. The findings highlight the impact of generations of population admixture across Latin America and varying degrees of acculturation among Latinos in California on colorectal cancer risk disparities, which deserves further investigation. This study underscores the importance of considering the heterogeneity within the Latino population, and the need to improve the collection of detailed ethnic and birthplace information to facilitate cancer research and control strategies.

Read Full Article (The abstract below is an article originally posted on Springer Link)

Abstract

Holly J. Kulhawick, CTR, Supervisor, Cancer Registry, Renown Health

Casefinding is an ongoing struggle for most hospital registries that translates into headaches for their associated Central Registries. Most commercial Registry Software providers now offer automation of casefinding using the ICD-9/10 Disease Index as an upload file. Alternatively, some products provide automated upload of positive pathology reports, and there are even companies that have come up with automated crosslinks from Radiation Oncology software products to the Cancer Registry Database, which allows for a direct import of treatment information. All of these options increase the efficiency and accuracy of the Hospital Cancer Registry and improve data quality for their associated Central Registry.

There is hesitation amongst many members of our community to avail themselves of these options. As a group we need to help bridge the gap and make use of all means of providing better quality, more timely data. We’ve all heard that the time lapse between treatment and data collection is too long to make the data of real use to many Oncologists. If we can find ways to perform casefinding closer to real time, that can be a huge step towards providing our physicians and researchers quality data that meets their needs. At Renown, we have focused on concurrent abstracting of our top sites. Coupling that initiative with automated casefinding and treatment data collection have allowed us to provide data that is within two weeks of real time to our physicians and administration.

Registrars shouldn’t fear this particular change. We’ve discovered that time spent in initiating this process has been minimal, but the benefits are immense. We are able to find new patients in time to get their cases assigned to the appropriate Tumor Board immediately after diagnosis, to provide our Nurse Navigators with lists of new patients, and we can use Registry data for popular Oncology Dashboard items like time from diagnostic biopsy to treatment, etc. within a time frame that allows Oncology managers to make adjustments if they note a slow down before patient care is impacted.

Read Full Article (The snippet below is from an article originally posted on Advance Healthcare Network)

Many cancer registries are short staffed. Given that fact, it makes little sense to avoid automation, but a recent informal poll of Certified Tumor Registrars (CTRs) at the 2015 National Cancer Registrars Association’s annual conference indicated that few registries are availing themselves of this technology. I heard a lot of interesting comments to the effect that automating casefinding, now available from most software vendors, produced too much additional work in duplicate records.

Last fall, against sage advice, I automated casefinding at my hospital. This involved meeting with our cancer registry software vendor and working with the report writers on the hospital’s IT staff. The goal included converting ICD-9 Disease Index files into a format that matched the North American Association of Central Cancer Registries (NAACCR) file layouts using a template provided by the hospital’s cancer registry software company. The process took about a month because of the IT department’s competing priorities and involved changing field sizes and converting one of the race fields to match the software. The time and effort to create this new program have yielded significant positive outcomes for the registry. The first upload of 300+ cases (one week’s worth) took five minutes. Not only did the new program run all 300 cases past existing suspense and completed abstracts, it noted differences in the matching criteria and flagged the cases with inconsistencies. I had long suspected that one of my speediest abstractors had a transposition issue and this new process confirmed it. … Read more

Armen Ghazarian, MPH, Cancer Research Training Award Fellow, National Cancer Institute

The incidence of testicular cancer, the most commonly occurring cancer among young men in the United States, has long been higher among white men than men of racial/ethnic groups. A National Cancer Institute study team used NAACCR Cancer in North America (CiNA) data to examine trends in testicular cancer incidence by race/ethnicity and by geographic area. We found that while testicular cancer incidence remains highest among white men, rates are increasing most rapidly among Hispanic men in all regions of the US, except the South. Reasons for the increase among Hispanics are unknown, but could possibly be related to place of birth, changing environmental exposures, genetic susceptibility or length of residence in the United States according to Armen Ghazarian, one of the authors of the study.

Read Full Article (The abstract below is an article originally posted on the Wiley Online Library)

Abstract

Rebecca Cassady, RHIA, CTR, Director, Desert Sierra Cancer Surveillance Program (NAACCR Committee Member)

This article regarding the increase of contralateral prophylactic mastectomies (CPM) in male breast cancer patients is significant as it may change the clinical practice for male breast cancer patients. Male breast cancers represent 1% of the breast cancer incidence in relation to all breast cancers. They are usually diagnosed at a later stage which can affect survival. Men considering CPM procedures will need to have the additional discussions with their provider, surgeons, support personnel, financial counselors and family members. It is important to provide all aspects of clinical care for male breast cancer patients to ensure the best outcome of their diagnosis and good quality of life.

Read Full Article (The abstract below is an article originally posted on the JAMA Network)

Abstract

Francis P. Boscoe, Ph.D, Research Scientist, New York State Cancer Registry (NAACCR at-large Board Member)

This week, a team of researchers published a study using central cancer registry data which found that U.S. counties where 40% of the women met mammography screening guidelines in 2000 had age-adjusted incidence rates of about 200 per 100,000 and ten-year mortality rates of about 50 per 100,000. Counties where 80% of the women met mammography screening guidelines in 2000 (twice as many) had age-adjusted incidence rates of about 350 per 100,000 (almost twice as many) and ten-year mortality rates of about 50 per 100,000 (exactly the same). While they took this as further evidence against the unqualified utility of mammography, they were careful not to overstate the point. Instead, they helpfully concluded:

“As is the case with screening in general, the balance of benefits and harms is likely to be most favorable when screening is directed to those at high risk, provided neither too frequently nor too rarely, and sometimes followed by watchful waiting instead of immediate active treatment”.

Given the very different risk profiles associated with breast cancer subtypes, might we be moving toward a time when screening recommendations are based on more than just age?

“If you haven’t gotten this message already, you should heed it now: The benefits of screening for breast cancer are limited. We should be doing fewer screening mammograms, not more.” …

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Read Full Article (The abstract below is from an article from JAMA Internal Medicine)

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Abstract

Click image to enlarge

Importance: Screening mammography rates vary considerably by location in the United States, providing a natural opportunity to investigate the associations of screening with breast cancer incidence and mortality, which are subjects of debate.

Objective: To examine the associations between rates of modern screening mammography and the incidence of breast cancer, mortality from breast cancer, and tumor size.

Design, Setting, and Participants: An ecological study of 16 million women 40 years or older who resided in 547 counties reporting to the Surveillance, Epidemiology, and End Results cancer registries during the year 2000. Of these women, 53 207 were diagnosed with breast cancer that year and followed up for the next 10 years. The study covered the period January 1, 2000, to December 31, 2010, and the analysis was performed between April 2013 and March 2015.

Exposures: Extent of screening in each county, assessed as the percentage of included women who received a screening mammogram in the prior 2 years.

Main Outcomes and Measures: Breast cancer incidence in 2000 and incidence-based breast cancer mortality during the 10-year follow-up. Incidence and mortality were calculated for each county and age adjusted to the US population.

Results: Across US counties, there was a positive correlation between the extent of screening and breast cancer incidence (weighted r = 0.54; P < .001) but not with breast cancer mortality (weighted r = 0.00; P = .98). An absolute increase of 10 percentage points in the extent of screening was accompanied by 16% more breast cancer diagnoses (relative rate [RR], 1.16; 95% CI, 1.13-1.19) but no significant change in breast cancer deaths (RR, 1.01; 95% CI, 0.96-1.06). In an analysis stratified by tumor size, we found that more screening was strongly associated with an increased incidence of small breast cancers (≤2 cm) but not with a decreased incidence of larger breast cancers (>2 cm). An increase of 10 percentage points in screening was associated with a 25% increase in the incidence of small breast cancers (RR, 1.25; 95% CI, 1.18-1.32) and a 7% increase in the incidence of larger breast cancers (RR, 1.07; 95% CI, 1.02-1.12).

Conclusions and Relevance: When analyzed at the county level, the clearest result of mammography screening is the diagnosis of additional small cancers. Furthermore, there is no concomitant decline in the detection of larger cancers, which might explain the absence of any significant difference in the overall rate of death from the disease. Together, these findings suggest widespread overdiagnosis.

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The opinions expressed in this article are those of the authors and may not represent the official positions of NAACCR.