The American Cancer Society (ACS) estimates that more than 8 million Americans alive today have a history of cancer, of whom 5 million were diagnosed 5 or more years ago. Most of these 5 million can be considered cured, while others still have evidence of cancer. In 1995, about 1,252,000 new cancer cases were diagnosed. This estimate does not include basal and squamous cell skin cancers and in situ carcinomas except bladder. The annual incidence of these skin cancers is estimated to be more than 800,000 cases. There has been a steady rise in cancer mortality in the United States in the last half-century. In 1995, about 547,000 people died of cancer--more than 1,500 people a day. One out of every five deaths in the United States is from cancer.
The American Cancer Society (ACS) estimates that more than 8 millionAmericans alive today have a history of cancer, of whom 5 millionwere diagnosed 5 or more years ago. Most of these 5 million canbe considered cured, while others still have evidence of cancer.In 1995, about 1,252,000 new cancer cases were diagnosed. Thisestimate does not include basal and squamous cell skin cancersand in situ carcinomas except bladder. The annual incidence ofthese skin cancers is estimated to be more than 800,000 cases.There has been a steady rise in cancer mortality in the UnitedStates in the last half-century. In 1995, about 547,000 peopledied of cancer--more than 1,500 people a day. One out of everyfive deaths in the United States is from cancer.
A National Prevention Strategy: Cancer Surveillance
The National Program of Cancer Registries (NPCR) serves as a fundamentaltool in surveillance efforts that will provide the needed factualbasis for appropriate policy decisions and allocation of scarceresources. Cancer surveillance refers to the ongoing, timely,and systematic collection and analyses of cancer incidence andmortality data crucial to the planning, implementation, and evaluationof public health practices.
The final link in the surveillance chain is the application ofthe data to prevention and control programs by evaluating programeffectiveness and planning for the future. Statewide cancer incidenceand mortality data can be used to identify trends, patterns, andvariations for directing cancer control efforts; conducting research;and designing programs to reach medically underserved populations.
"The goal of this program is to reduce cancer mortality aspart of a national disease prevention strategy," said USHealth and Human Services Secretary Donna E. Shalala. "Weknow that the burden of cancer for Americans varies widely bygeographic location and by ethnicity. A national system of cancerregistries can help us understand the disease better and use ourresources to the best effect in prevention and treatment."
How Will the Data Be Used?
The Cancer Registries Amendment Act
In October 1992, Congress established a National Program of CancerRegistries (Public Law 102-515, The Cancer Registries AmendmentAct). This legislation authorizes the Centers for Disease Controland Prevention (CDC) to provide funds to states and territoriesto enhance existing cancer registries; to plan and implement registrieswhere they do not exist; to develop model legislation and regulationsfor states to enhance viability of registry operations; to setstandards for completeness, timeliness, and quality; and to providetraining.
With fiscal year 1995 funds of $17.6 million, 42 states and theDistrict of Columbia are currently receiving CDC support for cancerregistries: 34 for enhancement of established registries and 9for developing registries where they do not currently exist.
Previous Status of State Registries
Prior to the NPCR, 10 states had no existing registry and 40 stateshad registries operating at some leve, but many lacked the financialsupport and the personnel to gather complete, timely, and accuratedata on 100% of their population or to ensure minimum standardsof quality. A number of states also lacked legal support for theiroperations, further hindering their ability to collect necessaryinformation.
Comprehensive, timely, and accurate data about cancer incidenceand stage at diagnosis are needed to provide useful feedback forevaluating progress toward cancer control in all 50 states andterritories. Such data have not been uniformly available at stateand local levels, although numerous cancer control programs havebeen initiated for breast, cervical, and skin cancers, among others.The data will also aid state health departments in conductingpopulation-based epidemiologic research.
DCPC will convene an annual meeting of funded registry statesfor information sharing, problem solving, and training. Site visitswill be scheduled as needed to assess program progress and mutuallyresolve problems. DCPC will also assist states and national organizationsin using cancer surveillance activities data to describe stateor national disease burdens, to evaluate cancer control activities,and to identify populations at high-risk of certain cancers. DCPCroutinely collaborates with federal, state, and private organizationson the design, implementation, and analysis of surveillance researchrelated to cancer.
How Does the NPCR Complement Existing Cancer Registries?
NPCPR-funded central registries will complement existing registries,such as the National Cancer Institute's Surveillance, Epidemiology,and End Results (SEER) program. The SEER program gathers in-depthdata on a sample of the population in five states (Connecticut,
Hawaii, Iowa, New Mexico, Utah) and six metropolitan areas (Atlanta,Detroit, Los Angeles, San Francisco/Oakland, San Jose/Monterey,Seattle), covering about 14% of the US population. It monitorstrends in incidence, treatment, survival time, and the extentof disease.
The NPCR, when fully operational in all funded states, will collectincidence data on 93% of the US population, including the firstcourse of treatment and stage at diagnosis. The information canbe used to evaluate existing cancer screening programs and toanalyze cancer occurrence regionally, since cancer risk and environmentalexposures often cross state lines. The NPCR will provide informationto permit additional analyses on cancer as it relates to race/ethnicity.
The CDC works closely with other federal agencies and with nationalorganizations, such as the NAACCR, the American College of Surgeons,the National Cancer Registrars' Association, the American CancerSociety, and other professional organizations to ensure coordinationof efforts.