sean altekruse dvm, mph, phd, dacvpm (epidemiology) national cancer institute
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Cancer incidence, survival and mortality trends in the United States USPHS Scientific and Training Symposium Veterinary Category Day June 20, 2012. Sean Altekruse DVM, MPH, PhD, DACVPM (Epidemiology) National Cancer Institute Division of Cancer Control and Population Sciences - PowerPoint PPT PresentationTRANSCRIPT
Sean Altekruse DVM, MPH, PhD, DACVPM (Epidemiology)National Cancer Institute
Division of Cancer Control and Population SciencesSurveillance Research Program
Data Analysis and Interpretation Branch
Cancer incidence, survival and mortality trends in the United States
USPHS Scientific and Training SymposiumVeterinary Category Day
June 20, 2012
Veterinarians, Cancer Surveillance Community
Anil Chaturvedi DVM, PhD (NCI, DCEG Infectious Etiologies)
Amedin Jemal DVM, PhD (ACS, V.P., Cancer Surveillance)
Sean Altekruse DVM, PhD (NCI, DCCPS, SRP)
Sally Bushhouse DVM, PhD (MN CSS)
Chand Khanna DVM, PhD (NCI, CCR)
Carol McClure DVM, PhD (PEI, CTC)
Others
Surveillance, Epidemiology & End Results
What is SEER?
Types of data
Learn more about SEER
What is SEER?
Key part of Nation’s Cancer Control InfrastructureEstablished by the 1971 National Cancer Act to -- - Provide baseline data on cancer burden - Focus research toward important opportunities - Assess prevention effectiveness
SEER data informs Nation’s cancer health policy & practice
Used by legislators, clinicians, scientists, health officials, advocacy groups, press & public (e.g. patients & families)
Over 4000 articles based on SEER cited in PubMed
Measuring Our Nation’s Progress Against Cancer
Network of registries covering ~28% of US population
Public use data - cancer incidence, prevalence, survival
Person, site, histology, behavior, stage, treatment, vital status
Cancer as a model for chronic disease surveillance
NCI SEER Program
SEER Data Quality
Data quality continuously monitored
Quality improvement is integral to the SEER Program
Routinely update variables, documentation and training
Evolution of SEER
SEER 9 covering years 1975+ San Francisco-Oakland, Connecticut, Detroit,
Hawaii, Iowa, New Mexico, Seattle, Utah, Atlanta
SEER 13 covering years 1992+ SEER 9 plus San Jose-Monterey, Los Angeles,
Rural Georgia, Alaska Natives
SEER 18 covering years 2000+ SEER 13 plus Kentucky, Louisiana, New Jersey,
Greater California and Georgia
U.S. Map with 20 SEER Registries
Population Coverage by Race/Ethnicity (2009 estimate)
0%
10%
20%
30%
40%
50%
60%
White Black AI/AN API Hispanic
Percentage of U.S. population 1973 on 1992 on 2000 on
OriginalSEER
FirstExpansion
SecondExpansion
AI/AN: American Indian and Alaska NativeAPI: Asian and Pacific Islander
Cancer Statistics Review–Recent cancer statistics
Annual Report to the Nation–Multiagency collaboration
Fact Sheets–Summary of key statistics by cancer site
Analytic Software: HD*Calc, SEER*Stat, JoinPoint
Fast Stats–Web-based tables and graphs
State Cancer Profiles (Web-based)
Cancer Trends Progress Report (Web-based)
Where Are SEER Statistics Reported?
Statistics from SEER Data
Rate per 100,000 population
Crude, Age-adjusted, Delay-adjusted
Trends (logistic regression)
Annual percent change
Average annual percent change
Survival
Prevalence, cancer survivors
Lifetime risk
Person- and Average-years of life lost
Age-Adjusted, Delay-Adjusted Incidence Rates All Cancer Sites by Sex
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
300
350
400
450
500
550
600
650
700
Year
Rat
e pe
r 100
,000
~~
Both Sexes
Males
Females
Observed Delay Adjusted
Observed Delay Adjusted
-0.5*-0.3*
-0.9*-0.8*
0.40.7
AAPC
Observed Delay Adjusted
* AAPC is statistically different from 0 (p<.05)
Both Sexes
Males
Females
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
300
350
400
450
500
550
600
650
700
Year
Rat
e pe
r 100
,000
~~
Delay-Adjusted Incidence Trends All Cancer Sites by Sex
1975
1977
1979
1981
1983
1985
1987
1989
1991
1993
1995
1997
1999
2001
2003
2005
2007
2009
250
350
450
550
650
750
850
~~
Males
250
350
450
550
650
750
850
~~
Females
White Black Asian/Pacific Islander American Indian/Alaska Native Hispanic
All Sites, Incidence Rates & Joinpoint Trends 1975-2009, All Ages
-0.8*
-1.0*
-0.3
-1.6*-2.2*
AAPC
0.50.2*
0.8*
0.10.3*
AAPC
* The AAPC is statistically significant from 0 (p<0.05)
Top 15 Cancer Incidence Rates
StomachLiver & IBD
Oral Cavity and PharynxLeukemiaPancreas
ThyroidCorpus and Uterus, NOSKidney and Renal Pelvis
Non-Hodgkin LymphomaMelanoma of the Skin
Urinary BladderColon and Rectum
Lung and BronchusProstate
Breast
0 10 20 30 40 50 60 70 80
7.57.9
10.91212.113.213.4
15.519.320.8
36.347.2
60.265.7
67.7
Age-adjusted rate per 100,000 -- SEER 18, 2009
Recent Incidence Trends by Cancer Site*
Average Annual Percent Change 2000-2009
* 10 year AAPC statistically different from 0 (p<0.05), joinpoint model fit, SEER 9 delay-adjusted rates from 1975-2009
Hodgkin LymphomaBrain & Other Nervous System Urinary Bladder All Cancer Sites Breast (Female) Ovary Stomach Prostate Lung & Bronchus (Male) Colon & Rectum Cervix Uteri Larynx
-4 -2 0 2 4 6 8
-2.5-2.5-2.4
-1.8-1.7-1.6
-0.9
-0.70000000000000
1
-0.3-0.2-0.2-0.1
0.010.1
0.30.4
0.600000000000001
0.700000000000001
0.80.9
1.32.8
3.23.6
6.7Thyroid Liver & Bile Duct
Kidney & Renal Pelvis Melanoma of the Skin
Pancreas Corpus & Uterus, NOS
Testis Myeloma
Non-Hodgkin Lymphoma EsophagusLeukemia
Lung & Bronchus (Female)Oral Cavity & Pharynx
**
**
***
**
**
**
**
**
***
Delay- and Age-Adjusted Incidence Trends, Leading Cancer Sites
1975
1977
1979
1981
1983
1985
1987
1989
1991
1993
1995
1997
1999
2001
2003
2005
2007
2009
0
50
100
150
200
250
ProstateBreast (Female)Lung and BronchusColon and Rectum
Year of Diagnosis
Rat
e pe
r 100
,000
19751977
19791981
19831985
19871989
19911993
19951997
19992001
20032005
20072009
0
20
40
60
80
100
120
140
160
Delay-Adjusted Incidence Rates
Mortality
22.1
HP 2020 Goal 20.6 per 100K
2012 estimated number of women in the US 226,870 women diagnosed 39,510 women die
Breast (Female)Incidence and Mortality Age-Adjusted Trends
?
?
* The AAPC is statistically significant from 0 (p<.05)
-0.7
-1.9*
19751977
19791981
19831985
19871989
19911993
19951997
19992001
20032005
20072009
-40
10
60
110
160
210
260
Delay-Adjusted Incidence Rates
Mortality
2012 estimated number of men in the US 241,750 men diagnosed 28,170 men die
Prostate (Male)Incidence and Mortality Age-Adjusted Trends
?
?
* The AAPC is statistically significant from 0 (p<.05)
22
HP 2020 Goal 21.2 per 100K
-1.7*
-3.5*
19751977
19791981
19831985
19871989
19911993
19951997
19992001
20032005
20072009
0
20
40
60
80
100
120Delay-Adjusted Incidence Rates
Mortality
2011 estimated numbers in the US 116,470 diagnosed 87,750 die
Lung and Bronchus (Males)Incidence and Mortality Age-Adjusted Trends
?
?
* The AAPC is statistically significant from 0 (p<.05)
-1.8*
-2.3*
19751977
19791981
19831985
19871989
19911993
19951997
19992001
20032005
20072009
0
10
20
30
40
50
60
Delay-Adjusted Incidence Rates
Mortality
2012 estimated numbers in the US 109,690 diagnosed 72,590 die
Lung and Bronchus (Female)Incidence and Mortality Age-Adjusted Trends
?
?
* The AAPC is statistically significant from 0 (p<.05)
0.1
-0.6*
19751977
19791981
19831985
19871989
19911993
19951997
19992001
20032005
20072009
0
10
20
30
40
50
60
70
Delay-Adjusted Incidence Rates
Mortality
2012 estimated numbers in the US 143,460 diagnosed 51,690 die
Colon and RectumIncidence and Mortality Age-Adjusted Trends
?
?
* The AAPC is statistically significant from 0 (p<.05)
-2.4*
-2.8*
Size of SEER: Rare Cancers, Cancer Heterogeneity
• The four leading cancers (lung, colorectal, breast & prostate) account for most of the U.S. cancer burden
• >50 other cancers with considerable burden
• Many anatomic sub-sites, histologic subtypes
• SEER population of sufficient size to evaluate these cancers
• “Personalized” or “Targeted” medicine
Delay- and Age-Adjusted Incidence Trends,Cancer Sites Decreasing By 1% Per Year Or More*
1975
1977
1979
1981
1983
1985
1987
1989
1991
1993
1995
1997
1999
2001
2003
2005
2007
2009
0
5
10
15
20
25
Cervix UteriStomachLarynx
Year of Diagnosis
Rat
e pe
r 100
,000
* Breast, Prostate, Lung & Bronchus, and Colon & Rectum graphed separately
Long Term Incidence Trends For Cancer Sites That Are Increasing By 1% Per Year Or More*
1975
1977
1979
1981
1983
1985
1987
1989
1991
1993
1995
1997
1999
2001
2003
2005
2007
2009
0
5
10
15
20
25
Melanoma of the Skin
Pancreas
Kidney and Renal Pelvis
Thyroid
Liver & Bile Duct
Year of Diagnosis
Rat
e Pe
r 100
,000
All Site
s
Lung and Bronchus
Colon and Rect
um
Prosta
te (M
ale)
Breast (
Female
)0%
10%20%30%40%50%60%70%80%90%
100%Fi
ve Y
ear R
elati
ve S
urvi
val
Source: Surveillance, Epidemiology and End Results (SEER) 17 Registries, Diagnosis Year 2003
Healthy People 2020 Target, All Cancer 5-year Relative Survival: 72.8%
5-Year Survival Target: 72.8%
5-Year Relative Survival By Site and Race
Liver and Bile Duct
Lung and Bronchus
Esophagus
Ovary
Leukemia
Larynx
Oral Cavity and Pharynx
Colon and Rectum
Non-Hodgkin Lymphoma
Cervix Uteri
Kaposi Sarcoma
Urinary Bladder
Corpus and Uterus, NOS
Hodgkin Lymphoma
Breast
Melanoma of the Skin
Testis
Prostate
0 20 40 60 80 100
15
16
18
44
55
61
63
65
69
69
74
78
84
85
90
91
96
100
11
13
11
36
48
54
42
57
61
59
49
64
60
81
78
72
89
96
BlackWhite
Other Sites (5-Yr Survival) Thyroid (98%)Kidney (78%)Myeloma (41%)Nervous System (34%)Stomach (27%)Pancreas (6%)
All Site 2020 Target: 72.8%
Number of Cancer Survivors --United States, 1971 to 2009
1970 1975 1980 1985 1990 1995 2000 2005 20100
2,000,000
4,000,000
6,000,000
8,000,000
10,000,000
12,000,000
14,000,000
Year
Num
ber i
n m
illio
ns
Female Breast22%
Prostate20%
Colorectal9%
Gynecologic8%
Hematologic (HD, NHL, Leukemia, ALL,
Lyeloma)8%
Urinary Tract (Bladder, Kidney,
Renal Pelvis)7%
Melanoma7%
Thyroid4%
Lung3%
Other12%
By Cancer Site
By Time since diagnosis
12 Million U.S. Cancer Survivors, 2008
≤ 19 Years of Age1%
20-39 Years of Age4%
40-64 Years of Age35%
65+ Years of Age60%
By Current Age
0 to <5 35%
5 to <10 24%
10 to <1516%
15 to <209%
20 to <255% > 25
11%
Liver cancer Increasing incidence/mortality: White, Black, Hispanic men Neighborhood SES Changes in treatment, survival
Prostate cancer (southeastern U.S.) Race-specific early stage diagnosis -- urban v. rural
Cervical cancer Geospatial and racial/ethnic variation
Childhood cancer Stalling progress to reduce mortality?
Linkage to socioeconomic dataLinkage to specimensSocial Media
“Did you know?” -- YouTube
Recent, Current Efforts
Summary
What is SEER?
Types of data
Applications
Thank You!
Sean Altekruse DVM, MPH, PhD, DACVPM (Epidemiology)
(301) 402-5331