Cancer registry databases: an overview of techniques of statistical analysis and impact on cancer epidemiology

Evaluating the Educational Value of Cancer Registries - a Systematic Review and Thematic Analysis

Cancer registries encompass a broad array of functions that underpin cancer control efforts. Despite education being fundamental to improving patient outcomes, little is known regarding the educational value of cancer registries. This review will evaluate the educational value of cancer registries for key stakeholders as reported within published literature and identify opportunities for enhancing their educational value. Four databases (Ovid Medline, Embase, CINAHL and Web of Science) were searched using a predefined search strategy in keeping with the PRISMA statement. Data was extracted and synthesised in narrative format. Themes and frequency of discussion of educational content were explored using thematic content analysis. From 952 titles, ten eligible studies were identified, highlighting six stakeholder groups. Educational outcomes were identified relating to clinicians (6/10), researchers (5/10), patients (4/10), public health organisations (3/10), medical students (1/10) and the public (1/10). Cancer registries were found to educationally benefit key stakeholders despite educational value not being a key focus of any study. Deliberate efforts to harness the educational value of cancer registries should be considered to enable data-driven quality improvement, with the vast amount of data promising ample educational benefit.

Linking the Center for International Blood and Marrow Transplant Research Registry to the California Cancer Registry and California Hospital Patient Discharge Data

Advances in hematopoietic cell transplantation (HCT) have substantially improved patient survival, increasing the importance of studying outcomes and long-term adverse effects in the rapidly growing population of HCT survivors. Large-scale registry data from the Center for International Blood and Marrow Transplant Research (CIBMTR) are a valuable resource for studying mortality and late effects after HCT, providing detailed data reported by HCT centers on transplantation-related factors and key outcomes. This study was conducted to evaluate the robustness of CIBMTR outcome data and assess health-related outcomes and healthcare utilization among HCT recipients. We linked data from the CIBMTR for California residents with data from the population-based California Cancer Registry (CCR) and hospitalization information from the California Patient Discharge Database (PDD). In this retrospective cohort study, probabilistic and deterministic record linkage used key patient identifiers, such as Social Security number, ZIP code, sex, birth date, hematologic malignancy type and diagnosis date, and HCT type and date. Among 22,733 patients registered with the CIBMTR who underwent autologous or allogeneic HCT for hematologic malignancy between 1991 and 2016, 89.0% were matched to the CCR and/or PDD (n = 17,707 [77.9%] for both, n = 1179 [5.2%] for the CCR only, and n = 1342 [5.9%] for the PDD only). Unmatched patients were slightly more likely to have undergone a first autologous HCT than an allogeneic HCT (12.6% versus 9.0%), to have a larger number of missing linkage identifiers, and to have undergone HCT prior to 2010. Among the patients reported to the CIBMTR who matched to the CCR, 85.7% demonstrated concordance of both hematologic malignancy type and diagnosis date across data sources. This linkage presents unparalleled opportunities to advance our understanding of HCT practices and patient outcomes.

Epidemiological Trends and Attributable Risk Burden of Cervical Cancer: An Observational Study from 1990 to 2019

BACKGROUND

Cervical cancer, especially in underdeveloped areas, poses a great threat to human health. In view of this, we stratified the age and social demographic index (SDI) based on the epidemiological development trend and attributable risk of cervical cancer in countries and regions around the world.

METHODS

According to the data statistics of the global burden of disease database (GBD) in the past 30 years, we adopted the annual percentage change (EAPCs) to evaluate the incidence trend of cervical cancer, that is, incidence rate, mortality, and disability adjusted life expectancy (DALY). Meanwhile, we investigated the potential influence of SDI on cervical cancer's epidemiological trends and relevant risk factors for cervical cancer-related mortality.

RESULTS

In terms of incidence rate and mortality, the high SDI areas were significantly lower than those of low SDI areas. The incidence and mortality in women aged 20 to 39 were relatively stable, whereas an upward trend existed in patients aged 40 to 59. The global cervical cancer incidence rate increased from 335642 in 1990 to 565541 in 2019 (an increase of 68.50%, with an average annual growth rate of 2.28%), while the age-standardized incidence rate (ASIR) showed a slight downward trend of 14.91/100000 people (95% uncertainty interval [UI], 13.37-17.55) in 1990 to 13.35/100,000 persons (95% UI, 11.37-15.03) in 2019. The number of annual deaths at a global level increased constantly and there were 184,527 (95% UI, 164,836-218,942) deaths in 1990 and 280,479 (95% UI, 238,864-313,930) deaths in 2019, with an increase of 52.00%(average annual growth rate: 1.73%). The annual age-standardized disability adjusted annual life rate showed a downward trend (decline range: 0.95%, 95% confidence interval [CI], from -1.00% to - 0.89%). In addition, smoking and unsafe sex were the main attributable hazard factors in most GBD regions.

CONCLUSIONS

In the past three decades, the increase in the global burden of cervical cancer is mainly concentrated in underdeveloped regions (concentrated in low SDI). On the contrary, in countries with high sustainable development index, the burden of cervical cancer tends to be reduced. Alarmingly, ASIR in areas with low SDI is on the rise, which suggests that policy makers should pay attention to the allocation of public health resources and focus on the prevention and treatment of cervical cancer in underdeveloped areas, so as to reduce its incidence rate, mortality, and prognosis.

Cancer statistics: a comparison between World Health Organization (WHO) and Global Burden of Disease (GBD)

This study aims to define comparability of 2016 statistics between Global Health Estimates (GHE) and Global Health Data Exchange (GHDx) registries for disability-adjusted life years (DALYs) and mortality of the 25 most frequent worldwide malignancies. An excellent correlation can be found between the two registries for both cancer DALYs (r = 0.988) and mortality (r = 0.993). Cancer-related DALYs are substantially equivalent (mean bias, -1.9%; P = 0.603), while cancer mortality is modestly but significantly overestimated in GDHx (mean bias, 9.1%; P = 0.004). These results suggest that cancer DALYs estimate appear almost overlapping between GHE and GHDx registries, while cancer mortality is slightly overestimated in GDHx.

Updates on larynx cancer epidemiology

Objective

Laryngeal cancer is an important oncologic entity, whose prognosis depends on establishing appropriate preventive and diagnostic measures, especially in populations at higher risk.

Methods

Epidemiologic information including worldwide incidence, prevalence, burden of health loss (disability-adjusted life year; DALYs) and mortality of larynx cancer was obtained from the Global Health Data Exchange (GHDx) database.

Results

The current incidence, prevalence and mortality of laryngeal cancer are estimated at 2.76 cases/year per 100,000 inhabitants, 14.33 cases/year per 100,000 inhabitants and 1.66 deaths/year per 100,000 inhabitants, respectively, averaging 3.28 million DALYs each year. Incidence and prevalence have increased by 12% and 24%, respectively during the past 3 decades, whilst mortality has declined by around 5%. The epidemiologic burden of this malignancy is approximately 5-fold higher in males and increases in parallel with ageing, peaking after 65 years of age. Both incidence and mortality rates are higher in Europe and lower in Africa, but the ratio between deaths and incidence is the highest in Africa. Incidence has gradually declined in Europe during the past 3 decades, whilst it has increased in South-East Asia and Western Pacific. Cigarette smoking and alcohol abuse contribute for about 90% of overall worldwide mortality for laryngeal cancer.

Conclusions

Laryngeal cancer still poses a high clinical and societal burden, with an escalating temporal trend not expected to reverse soon.

Surveillance, Epidemiology, and End Results (SEER) and SEER-Medicare Databases: Use in Clinical Research for Improving Colorectal Cancer Outcomes

The Surveillance, Epidemiology, and End Results (SEER) program is a clinical database, funded by the National Cancer Institute (NCI), which was created to collect cancer incidence, prevalence, and survival data from U.S. cancer registries. By capturing approximately 30% of the U.S. population, it serves as a powerful resource for researchers focused on understanding the natural history of colorectal cancer and improvement in patient care. The linked SEER-Medicare database is a robust database allowing investigators to perform studies focusing on health disparities, quality of care, and cost of treatment in oncologic disease. Since its infancy in the early 1970s, the database has been utilized for thousands of studies resulting in novel publications that have shaped our management of colorectal cancer among other malignancies.

Bayesian adjustment for trend of colorectal cancer incidence in misclassified registering across Iranian provinces

Misclassification error is a common problem of cancer registries in developing countries that leads to biased cancer rates. The purpose of this research is to use Bayesian method for correcting misclassification in registered cancer incidence of eighteen provinces in Iran. Incidence data of patients with colorectal cancer were extracted from Iranian annual of national cancer registration reports from 2005 to 2008. A province with proper medical facilities can always be compared to its neighbors. Almost 28% of the misclassification was estimated between the province of East Azarbaijan and West Azarbaijan, 56% between Fars and Hormozgan, 43% between Isfahan and Charmahal and Bakhtyari, 46% between Isfahan and Lorestan, 58% between Razavi Khorasan and North Khorasan, 50% between Razavi Khorasan and South Khorasan, 74% between Razavi Khorasan and Sistan and Balochestan, 43% between Mazandaran and Golestan, 37% between Tehran and Qazvin, 45% between Tehran and Markazi, 42% between Tehran and Qom, 47% between Tehran and Zanjan. Correcting the regional misclassification and obtaining the correct rates of cancer incidence in different regions is necessary for making cancer control and prevention programs and in healthcare resource allocation.

The Canadian Forces Cancer and Mortality Study II: a longitudinal record-linkage study protocol

BACKGROUND

Military service exposes personnel to unusual situations with unclear health-related implications, and to identify both immediate and delayed risks, part of health surveillance includes examination of mortality and cancer rates that extends beyond periods of military service. The main aim of the Canadian Forces Cancer and Mortality Study II (CFCAMS II) is to describe the mortality and cancer experience of Canadian Armed Forces personnel (serving and released; about 230 000 people), with the further aim of informing health promotion and prevention programs for serving personnel and services for veterans after they leave the military.

METHODS

This protocol is for a retrospective cohort study of serving and released Canadian Armed Forces personnel who enrolled on or after Jan. 1, 1976 in the Regular Force or Class C of the Reserve Force. To create our cohort, we identified record-linkage methods as the most appropriate mechanism to study mortality and cancer in those with a history of Canadian military service. Statistics Canada will link the CFCAMS II cohort file to the Canadian Vital Statistics (Mortality) and Canadian Cancer Registry databases for outcomes up to Dec. 31, 2014. The linkage will be stored in their highly secure linkage environment. Statistical analyses will be broadly divided into mortality and cancer incidence.

RESULTS

We will quantify mortality and cancer morbidity incidence and survival using multiple established methods, as well as age-period-cohort regression models to describe the relation between military service and mortality and cancer outcomes.

INTERPRETATION

The findings will represent novel and sound evidence on the risks and protective factors of military life.

Advancing Cancer Control Through Research and Cancer Registry Collaborations in the Caribbean

BACKGROUND

Few national registries exist in the Caribbean, resulting in limited cancer statistics being available for the region. Therefore, estimates are frequently based on the extrapolation of mortality data submitted to the World Health Organization. Thus, regional cancer surveillance and research need promoting, and their synergy must be strengthened. However, differences between countries outweigh similarities, hampering registration and availability of data.

METHODS

The African-Caribbean Cancer Consortium (AC3) is a broad-based resource for education, training, and research on all aspects of cancer in populations of African descent. The AC3 focuses on capacity building in cancer registration in the Caribbean through special topics, training sessions, and biannual meetings. We review the results from selected AC3 workshops, including an inventory of established cancer registries in the Caribbean region, current cancer surveillance statistics, and a review of data quality. We then describe the potential for cancer research surveillance activities and the role of policymakers.

RESULTS

Twelve of 30 Caribbean nations have cancer registries. Four of these nations provide high-quality incidence data, thus covering 14.4% of the population; therefore, regional estimates are challenging. Existing research and registry collaborations must pave the way and are facilitated by organizations like the AC3.

CONCLUSIONS

Improved coverage for cancer registrations could help advance health policy through targeted research. Capacity building, resource optimization, collaboration, and communication between cancer surveillance and research teams are key to obtaining robust and complete data in the Caribbean.

Information Management in Cancer Registries: Evaluating the Needs for Cancer Data Collection and Cancer Research

Cancer registry data collection involves, at a minimum, collecting data on demographics, tumor characteristics, and treatment. A common, identified, and standardized set of data elements is needed to share data quickly and efficiently with consumers of this data. This project highlights the fact that, there is a need to develop common data elements; Surveys were developed for central cancer registries (CCRs) and cancer researchers (CRs) at NCI-designated Cancer Centers, in order to understand data needs. Survey questions were developed based on the project focus, an evaluation of the research registries and database responses, and systematic review of the literature. Questions covered the following topics: 1) Research, 2) Data collection, 3) Database/ repository, 4) Use of data, 5) Additional data items, 6) Data requests, 7) New data fields, and 8) Cancer registry data set. A review of the surveys indicates that all cancer registries' data are used for public health surveillance, and 96% of the registries indicate the data are also used for research. Data are available online in interactive tables from over 50% of CRs and 87% of CCRs. Some other survey responses indicate that CCR treatment data are not complete for example treatment data, however cancer researchers are interested in treatment variables from CCRs. Cancer registries have many data available for review, but need to examine what data are needed and used by different entities. Cancer Registries can further enhance usage through collaborations and partnerships to connect common interests in the data by making registries visible and accessible.

Data coverage of a cancer registry in southern Iran before and after implementation of a population-based reporting system: a 10-year trend study

Background

Cancer registries help to decrease the burden of cancers by collecting accurate and complete data. We aimed to measure the completeness of coverage of information recorded between 2000 and 2009 in a cancer registry program in Fars province, southern Iran.

Methods

The cancer registry program run by Shiraz University of Medical Sciences was investigated in two periods: pathology-based data from 2000 to 2007 and population-based data from 2007 to 2009. Completeness of yearly coverage was measured as the number of reported cases of cancer in each year divided by estimated cases based on 107.3 new cases per 100 000 individuals. The percentage of complete data registration (patient’s name, age, gender, address, phone number and father’s name) and correct cancer encoding was calculated for each year and compared to the maximum acceptable error rate for each item.

Results

A total of 29 277 non-duplicate cancer records were studied. Completeness of coverage varied from 22.68% in 2000 to 118.7% in 2008. Deficiencies in patients’ demographic data were highest for name in 2002 (0.09%), age in 2006 (2.36%), gender in 2001 (0.06%) and father’s name in 2001 (52.5%). Incomplete address (99.7%) and missing phone number (100%) were most frequent in 2000, and deficiencies in encoding information were highest in 2008 (6.36%).

Conclusions

The cancer registry program in Fars province (southern Iran) was considered satisfactory in terms of completeness of coverage and information about age. However, it was deficient in recording patients’ phone number and address, and father’s name. The error level for cancer encoding was unacceptably high. Enhancing hardware and software resources, education and motivation in all public and private sectors involved in the cancer registry program, and greater attention to epidemiological research are needed to increase the quality of the cancer registry program, including its completeness.