are known, such as tobacco smoke, but others remain elusive. However, the study of the distribution of cancer within the population has led to important developments in cancer prevention and control. The identification of factors associated with an increased risk of cancer (e.g., smoking and lung cancer) allows health professionals and public health experts to target areas for interventions and future research.

In studying cancer in relationship to different population groups, one focuses on those forms that are most prevalent in each group and that are associated with the highest rate of mortality. This means that the same forms of cancer may not be of equal importance for all groups. Because there are so many different forms of cancer and because changes in the prevalence of the disease occur slowly, it is neither practical nor necessary to report routinely on all possible forms of cancer. In addition, because of the complexity of classifying groups, because of the different ways of identifying people within groups at the numerator (i.e., the number of specific cases counted) or denominator (i.e., the number of individuals in a defined group) levels, and because small groups with only a few cases of individuals with cancer will result in unreliable rates, one must be aware of the limitations of data analysis and avoid drawing conclusions beyond what is justified by the quality of the data.

Assessing the Burden of Cancer Among U.S. Population Groups

The responsibility within NIH for assessing the burden of cancer among various groups lies with the NCI, and specifically with the Surveillance, Epidemiology and End Results (SEER) program. The goals of the SEER program are as follows (National Cancer Institute, 1998c):


    Determine the incidence of cancer in selected geographic areas of the United States with respect to demographic and social characteristics of the population and provide information relevant to the generalizability of the rates to the total U.S. population.


    Using data from the National Center for Health Statistics, provide cancer mortality rates for the total U.S. as well as by county and state.


    Monitor trends in cancer incidence and mortality associated with specific forms of cancer with respect to geographic area and demographic, social, ethnic, and biological characteristics of the population.


    Monitor trends in cancer patient survival with respect to specific forms of cancer, extent of disease, demographic and socioeconomic variables of prognostic importance, and patterns of care.


    Identify factors related to the length and quality of patient survival through special studies of treatment patterns and other aspects of medical care.

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