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Enhancing DATA SYSTEMS to Improve the Quality of CANCER Care
APPENDIX D
Information on Cancer Registries, by State
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TABLE D-1 State Cancer Registries—Indicators of Data Quality
General Information
Data Quality Indicators
Year Casefindingg Began Using:
Statea
Year of Initial Operation
Year Population-Based Datab Available
Death Certificate Only(%)c
Estimate of Completeness (%)d
Included in U.S. Combined Rates?e
Certified in 1999?f
M.D. Offices
Ambulatory Surgical Centers
Arizona
1981
1995
2.2
86.0
1992
1992
California
1946
1988
1.2
100.4
1988
1988
Colorado
1968
1988
1.8
102.2
1995
1988
Connecticut
1935
1935
1.5
108.9
No
No
Delaware
1972
1972
5.7
92.9
1998
No
Florida
1981
1981
NA
99.7
No
1995
Hawaii
1960
1960
0.4
112.8
1960
1978
Idaho
1969
1970
1.7
101.1
1980
1988
Illinois
1985
1986
5.4
93.0
No
1994
Indiana
1987
1987
NA
NA
No
No
Iowa
1973
1973
1.2
101.9
No
1988
Kentucky
1991
1991
3.2
90.6
No
1995
Louisiana
1974
1988
1.6
94.4
1995
1988
Maine
1983
1983
NA
89.5
1995
1995
Maryland
1982
1982
NA
NA
1996
1996
Massachusetts
1980
1982
NA
91.0
No
1982
Michigan
1985
1985
1.2
99.4
No
No
Minnesota
1988
1988
1.0
98.8
No
No
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Montana
1979
1979
NA
83.5
No
No
Nebraska
1987
1987
0.3
92.0
1990
No
Nevada
1979
1979
2.0
NA
No
1990
New Hampshire
1986
1987
NA
89.4
1986
1987
New Jersey
1978
1979
2.7
99.0
1978
1988
New Mexico
1966
1973
2.0
94.9
1973
1973
New York
1940
1976
4.8
93.3
No
No
North Carolina
1987
1990
NA
89.0
1990
1995
Pennsylvania
1982
1985
NA
97.2
No
No
Rhode Island
1986
1986
2.1
101.3
1986
1986
Tennessee
1986
1989
NA
NA
No
No
Texas
1949
1992
6.5
92.9
No
No
Utah
1966
1966
0.2
98.7
1973
1994
Virginia
1970
1990
NA
81.5
1998
1998
Washington
1991
1992
3.5
103.4
1992
1992
West Virginia
1993
1993
2.1
92.5
No
1993
Wisconsin
1976
1978
3.7
103.8
1992
1992
Wyoming
1962
1962
0.4
91.0
1962
1997
a Thirty-six state registries responded to NAACCR's Call for Data. The nonparticipating registries include: Alaska, Alabama, Arkansas, Georgia, Kansas, Mississippi, Missouri, North Dakota, Ohio, Oklahoma, Oregon, South Carolina, South Dakota, and Vermont.
b A population-based registry is defined as one that “includes information about all cases of a specific disease in a geographically defined area that relates to a specific population.” [From: Wallace RB (ed). Maxcy, Rosenau, Last-Public Health and Preventive Medicine, 14th ed. Stamford, CT: Appleton and Lange, 1998.]
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c Standards for Cancer Registries, Vol. III, p. 41. Based on the experience of the SEER Program, 1% –1.5% death-certificate-only (DCO) cases are expected and acceptable. Values between 0% and 1% or 1.5% and 3% require analysis and explanation. If 0% are DCO, death clearance has not been performed. A high percentage of DCO cases may be the result of underreporting from other sources, incomplete investigation (or follow back) of the DCO cases due to limited resources, or both. In addition, when a population-based registry first begins death clearance, the percentage of DCO cases tends to be higher because some DCO cases were diagnosed prior to the operation of the registry and therefore are not linked to the registry database.
dVol. I: Incidence, p. I-7. The adjusted NAACCR estimate of completeness was calculated using the following equation:
Adjusted % Completeness = (Observed Cs–Ds) × 100%
Expected Cs
where observed Cs_= number of cancer cases for all sites in the registry, Ds = number of duplicate records (calculated using the NAACCR estimate of duplicates, based on the registry's results from completing the Protocol for Assessing Duplicate Cases), and Expected Cs = estimated number of cancer for all sites if completeness is 100%. [See Vol. I: Incidence, pp. 7–8 for a detailed derivation of this equation and its variables.]
For registries that did not complete the Protocol for Assessing Duplicate Cases, the NAACCR adjusted estimate for completeness is omitted from the registry description.
e Indicates states which meet all the following criteria for inclusion in the U.S. combined rates (Vol. I: Incidence, pp. 6–8):
Data for all 5 years, 1991–1995, were submitted.
The registry completed the Protocol for Assessing Duplicate Cases, developed by the Data Evaluation and Publication Committee, and submitted the results. If a registry had an estimate of duplicates that exceeded one per 1,000 records or 0.1% given its required sample size, the registry was not eligible for inclusion in the combined rates.
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The registry ran the case records for 1991–1995 against the Call for Data metafile prepared for the EDITS software and made all corrections.
The completeness of case ascertainment was completed using the formula above. Every registry included in the combined rates had an adjusted completeness estimate of at least 90%. The computed completeness estimate for all registries included in the combined incidence rates for the United States was about 99%.
f See Table D-2 for certification criteria. Registries were certified in 1,000 based on cases reported as of 1996.
g This date indicates the first year that cancer cases were reported from various sources. In addition to physicians' offices and ambulatory surgical centers, which are included in this summary table, cancer cases were also reported from the following sources: hospitals, death certificates, nonhospital pathology labs, radiation therapy sites, interstate data exchange, and nursing homes/hospices. Complete data for these sources can be found in the monograph.
SOURCES: Chert VW, Wu XC, Andrews PA (eds.). 1999, Cancer in North America: 1991–1995. Volume One: Incidence. Sacramento, CA: NAACCR. Tucker TC, HL Howe and HK Weir. 1999. Certificationfor population-based registries. J Registry Manage Feb:24–27.
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TABLE D-2 North American Association of Central Cancer Registries (NAACCR) Criteria and Standards for Certification of Cancer Registries
Criteria
Measure
Rationale
Gold Standard
Silver Standard
Completeness of case ascertainment
1. Compare actual incidence rate to expected incidence rate, using SEER Incidence to U.S. mortality ratio method*
2. Death clearance: Match all cancer deaths with registry records, and follow back on unmatched cancer deaths
3. Number of duplicate records
Demonstrates the registry has identified a sufficient proportion of expected cases.
Provides a more accurate count of cancer incidence by looking at unmatched cancer deaths.
Duplicates should be consolidated to ensure that one case is not entered more than once from different institutions.
95% completeness
Complete death clearance
<1 duplicate per 1,000
90% completeness
Complete death clearance
<2 duplicates per 1,000
Completeness of information recorded
1. Sociodemographic Information (% missing)
2. Percentage of “death certificate only” (DCO) cases
Includes: age at diagnosis, sex, race, county of residence at diagnosis
DCO cases often lack information on key variables, which limits utility, so a minimal proportion of DCO cases is desired.
<2% missing (3% for race)
<3%
<3% missing (5% for race)
<5%
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Accuracy of data
EDITS metafile: an electronic editing procedure capable of identifying logical inconsistencies in case records
Ensures that information is consistent and accurate enough to be useful,
99% cases passing EDITS
97% cases passing EDITS
Timeliness
All information and corrections must be entered within 23 months from close of diagnosis year.
Timely submission of information
Data submitted
Data submitted
NOTE: For certification at either the gold or silver standard, a registry must meet all criteria for that particular level of certification.
* The incidence to mortality ratio method uses the ratio of SEER incidence (site, race, and sex-specific) to U.S. mortality, and applies that ratio to the site, race, and sex-specific mortality rates of the population served by the registry. The expected incidence rate is calculated by multiplying these rate ratios by the cancer-specific mortality rate for that population. The incidence to mortality rate ratio method provides a more accurate expected incidence rate because it allows for the possibility that different populations have lower incidence rates. In the past, expected incidence was calculated by applying incidence rates of one area with complete case ascertainment, to the area under evaluation; this method assumed that the cancer incidence rates were similar.
SOURCE: Tucker TC, HL Howe and HK Weir. Certification for Population-BasedCancer Registries. J Registry Management. Feb 1999:24–27.
Representative terms from entire chapter:
incidence rates