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Western Washington Cancer Surveillance System |
The Cancer Surveillance System (CSS) is part of the Division of Public Health Sciences (PHS) of the Fred Hutchinson Cancer Research Center in Seattle, Washington, USA. Funding is provided by the Surveillance, Epidemiology, and End Results (SEER) program of the National Cancer Institute (NCI) and Washington State Department of Health.
Since 1974, the CSS has operated under contract with the SEER program to provide incidence, treatment, and follow-up data on all newly-diagnosed malignancies (except non-melanotic skin cancers) occurring in residents of 13 counties of northwest Washington State. There has been voluntary participation by hospitals, radiation units, surgical centers and the majority of the pathology laboratories in the reporting of cancer incidence.
In March 1990, the Washington State Legislature passed a law that established a system to accurately monitor the incidence of cancer within the state for the purposes of understanding, controlling, and reducing the occurrence of cancer in this state. In order to accomplish this, the Legislature required that cancer cases would be reported to the Department of Health (DOH), thus establishing a state-wide cancer registry. The DOH designated the CSS as the contractor responsible for coordinating the collection of cancer information in its reporting area and assigned the Eastern Washington Statewide Cancer Registry as the contractor for the eastern Washington area and the 6 counties in southwest Washington.
Malignant melanoma incidence rates in Western Washington state have increased from 6 per 100,000 per year for both men and women in 1974 to 16 per 100,000 per year for females and 19 per 100,000 per year for males in 1991. The age-specific incidence rates for melanoma begin to rise over this period shortly after adolescence and reach their peak in those over 75 years of age. A decline in mortality in the younger age groups in recent years has been observed, and could be a result of early evaluation and treatment.
A shift toward treatment of melanoma on an outpatient basis over the past 30 years has caused concern that the recent increase in incidence of malignant melanomas may be higher than reported. A study at the Fred Hutchinson Cancer Research Center concludes that there has indeed been a growing amount of underreporting of cutaneous melanoma from 1974-1984: "In western Washington state, the incidence of melanoma of the skin had been underestimated in the registry rates by approximately 2% in 1974 and approximately 21% in 1984" (Karagas et al., 1991). The CSS has undertaken procedures to insure more complete reporting of melanoma patients in the future.
Cases are collected from hospitals; outpatient surgical centers; pathologists', radiotherapists' and dermatologists' offices; and Washington State resident death certificates. CSS Data Collection Staff members abstract over 95% of the cases; the remainder are abstracted by hospital tumor registry personnel. All casefinding and quality control procedures are also carried out by CSS staff members as well as SEER representatives. All registry data are kept in strict confidence in accordance with the latest NCI guides for compliance of the Federal Privacy Act of 1974.
The CSS reporting area has a population of over 3 million, about 70% of the state's population. The population racial breakdown is as follows: 88% White, 5.5% Asian, 4% Black, 1.5% Native American, and 1% other. Crossing racial categories, Hispanics comprise 3% of the state's population. Approximately 76% of the people in the CSS reporting area reside in two Primary Metropolitan Statistical Areas (PMSAs), The Seattle-Everett area (King and Snohomish counties) and the Tacoma area (Pierce County). The other counties covered are Whatcom, Skagit, San Juan, Island, Clallam, Jefferson, Grays Harbor, Mason, Thurston, and Kitsap. Incidence data since January 1, 1974 are available for the 13-county area from the CSS. Data on over 18,300 (1991) cases a year are submitted to the SEER program.
The data collected at diagnosis cover patient and demographic identification, including address, birth date, birthplace, sex, race, marital status, and occupation. Each record indicates the source institution, the date of admittance, and the follow-up physician. In addition, there is information on the tumor itself, therapy, and date of last follow-up and/or death certificate.
The CSS data are used by both local health care institutions and state researchers. Area hospitals and the local medical communities receive monthly follow-up summaries, listings, and letters. They also receive patient listings on a quarterly basis. The following information can be accessed by all cooperating reporting institutions and physicians: 1) listings and tabulations of cases by site, admit or diagnosis date, stage, therapy, and numerous other factors; 2) survival studies using various criteria; 3) patients' residence studies (zip code, census tract); 4) patient treatment and referral patterns (for certificates of need); and 5) American College of Surgeons surveys and studies. The Fred Hutchinson Cancer Research Center epidemiologists and biostatisticians are available to the local medical community for consultation on study design development and the use of the CSS. Such local studies with CSS data include: incidence patterns, cancer correlation with environmental factors, case-control studies, patterns of care, and factors affecting survival. The Division of Public Health Sciences also utilizes the CSS data for other epidemiologic and biostatistical studies.
Data are updated on an annual basis for patients who have become lost to follow-up through normal clinical follow-up methods. State and federal agencies which are linked to the CSS master patient index provide current information. Twice a year the CSS provides SEER/NCI with incidence and survival data (non-identified data). CSS also contributes to large studies involving two or more SEER areas. Non-identified data are released to graduate students in epidemiology and biostatistics as well as to investigators in other parts of the U.S. and the world. The CSS also responds with non-identified data to queries from the Cancer Information Service and news media.
Available Reports:
Contact Information:
Dr. David B. Thomas, Director
Cancer Surveillance System (CSS)
Fred Hutchinson Cancer Research Center
1124 Columbia Street, MP-826
Seattle WA 98104Phone: (206) 667-5134 -- (206) 667-4709
Fax: (206) 667-5530
E-mail: mpotts@cclink.fhrc.org
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