11 th Annual Arizona Tribal Collaborative Conference Building - - PowerPoint PPT Presentation

11th Annual Arizona Tribal Collaborative Conference “Building Bridges for Cancer Care and Collaboration” Arizona Cancer Data May 3, 2018

OVERVIEW ARIZONA DATA – AMERICAN INDIAN

• Introduction to the Arizona Cancer Registry
• How information collected
• Incidence
• Mortality
• Comparisons to national and local data
• Websites

• Authority to collect cancer information:

– 1988: A.R.S. §36-133 Statute – 1992: A.A.C. Title 9 Chapter 4 Rules

• Who we are?

– Population-based surveillance system that collects, manages, and analyzes information on the incidence and survival of Arizona residents diagnosed with cancer.

• Where do the cases come from?

– Hospitals, free-standing clinics, physicians, pathology laboratories, data exchanges, and death certificates.

Arizona Cancer Reporting

Introduction – State Reporting

• 3-way agreement

– New Mexico Tumor Registry (NMTR) / IHS / AZ – NMTR travels into Arizona for data collection

• Data linkages with CDC funded Breast &

Cervical Cancer Early Detection Programs

Arizona Cancer Reporting

Indian Facilities & Cancer Reporting

• Tribally-Operated 638 Facilities
• Completeness of data
• Misclassification of American Indians

Arizona Cancer Reporting

Challenges & Opportunities

National Programs

NAACCR – Certification of Data

Arizona Cancer Reporting

Physician Reporting – Melanoma Task Force

755 1321 1721 1952 2162 2507 1202 1208 1040 1050 1254 1243 500 1000 1500 2000 2500 3000 2010 2011 2012 2013 2014 2015

Case Count Diagnosis Year A Comparison of the Reporting Source* - Physician and Hospital Case Reports Invasive and In Situ Melanoma, 2010-2015 Physicians & Clinics Hospitals

*An average of 65 cases per year received from other states, death certificates, and pathology labs were excluded from the reports received analysis.

2010 2011 2012 2013 2014 2015 AZ Invasive Melanoma 16.1 19.9 19.4 19.9 21.9 23.8 U.S Invasive Melanoma 19.9 20.5 20.5 21.0 21.4 AZ Insitu Melanoma 9.4 11.9 15.5 16.8 17.6 20.9 SEER Insitu Melanoma 18.5 19.3 19.8 20.5 21.4 23.3 0.0 5.0 10.0 15.0 20.0 25.0

Age Adjusted Rate per 100,000 Persons

Diagnosis Year Arizona, U.S.*, and SEER** Invasive & In Situ Age Adjusted Melanoma Rates For Diagnosis Year 2010 -2015

Arizona Cancer Reporting

Physician Reporting – Melanoma Task Force

* United States Cancer Statistics: 1999 - 2014 Incidence, WONDER Online Database. United States Department of Health and Human Services, Centers for Disease Control and Prevention and National Cancer Institute; 2016. Accessed at http://wonder.cdc.gov/cancer-v2014.html on Apr 19, 2018. ** Surveillance, Epidemiology, and End Results (SEER) Program (www.seer.cancer.gov) SEER*Stat Database: Incidence - SEER 9 Regs Research Data, Nov 2017 Sub (1973-2015) <Katrina/Rita Population Adjustment> - Linked To County Attributes - Total U.S., 1969-2016 Counties, National Cancer Institute, DCCPS, Surveillance Research Program, released April 2018, based on the November 2017 submission.

• IHS Linkage Required

– The central cancer registry links with IHS at least every five years. Central cancer registries with IHS Contract Health Service Delivery Area counties link their records with patient registration records from IHS annually.

Arizona Cancer Reporting

CDC National Program of Cancer Registries

322.6 295.5 295.6 302.0 283.8 256.5 286.8 263.2 263.5 263.2 244.8 218.1 0.0 50.0 100.0 150.0 200.0 250.0 300.0 350.0 2010 2011 2012 2013 2014 2015

Age Adjusted Rate per 100,000 persons Diagnosis Year Comparison of Age Adjusted Incidence Rates

• f All Invasive Cancer 2010-2015 in American Indians

IHS Link vs. No IHS Link AZ American Indian - With IHS Link AZ American Indian - No IHS Link

Arizona Cancer Reporting

Data Linkage with IHS

NATIONAL ORGANIZATIONS

Forty-six states, the District of Columbia, Puerto Rico, the U.S. Pacific Island Jurisdictions, and the U.S. Virgin Islands receive funding through CDC’s National Program of Cancer Registries (NPCR).

CDC NATIONAL PROGRAM OF CANCER REGISTRIES

NCI SEER PROGRAM

Nine States, 6 Metro Areas

CANCER INCIDENCE

2010 2011 2012 2013 2014 2015 Arizona All Race/Ethnicity Rate 406.0 406.8 391.4 387.8 388.7 379.9 U.S. All Race/Ethnicity Rate 464.7 463.7 450.0 445.7 436.6 Arizona American Indian Rate 322.6 295.5 295.6 302.0 283.8 256.5 U.S. American Indian Rate 301.3 299.2 284.8 291.8 274.0

0.0 50.0 100.0 150.0 200.0 250.0 300.0 350.0 400.0 450.0 500.0

Age Adjusted Rate per 100,000 persons

Diagnosis Year Comparison of Arizona and U.S.* Age Adjusted Incidence Rates For All Race/Ethnicity and American Indians

• f All Invasive Cancer 2010-2015

*United States Cancer Statistics: 1999 - 2014 Incidence, WONDER Online Database. United States Department of Health and Human Services, Centers

for Disease Control and Prevention and National Cancer Institute; 2016. Accessed at http://wonder.cdc.gov/cancer-v2014.html on Apr 24, 2018

NA NA

ARIZONA INCIDENCE - TOP TEN INVASIVE CANCER SITES, DIAGNOSIS YEARS 2010-2015

ALL RACES

AGE ADJUSTED RATE

AMERICAN INDIAN

AGE ADJUSTED RATE

• 1. Female Breast

113.4

• 2. Lung & Bronchus

50.0

• 3. Prostate

82.2

• 4. Colorectal

34.2

• 5. Melanoma

20.0

• 6. Bladder

19.1

• 7. Lymphoma

18.1

• 8. Ill Defined&Unspecified

16.6

• 9. Thyroid

15.3 10.Leukemia 11.8

• 1. Prostate

63.7

• 2. Female Breast

60.2

• 3. Colorectal

27.2

• 4. Kidney & Renal Pelvis

26.7

• 5. Uterus Total

25.3

• 6. Lung & Bronchus

19.7

• 7. Liver&IntrahepaticBileDuct 15.6
• 8. Ill Defined&Unspecified

15.5

• 9. Lymphoma

12.5 10.Stomach 10.4

ARIZONA INCIDENCE – TOP TEN INVASIVE CANCER SITES

FOR

AMERICAN INDIAN BY SEX, DIAGNOSIS YEARS 2010- 2015

MALES

AGE-ADJUSTED RATE

FEMALES

AGE-ADJUSTED RATE

• 1. Prostate

63.7

• 2. Kidney/Renal Pelvis

37.6

• 3. Colorectal

32.3

• 4. Lung and Bronchus

22.3

• 5. Liver and Intrahepatic Bile

Duct

20.5

• 6. Ill-Defined and Unspecified 17.7
• 7. Lymphoma

13.4

• 8. Stomach

14.7

• 9. Myeloma

10.7 10.Leukemia 9.8

• 1. Breast

60.2

• 2. Uterus Total

25.3

• 3. Colorectal

22.9

• 4. Kidney/ Renal Pelvis

18.0

• 5. Thyroid

14.6

• 6. Lung and Bronchus

18.1

• 7. Ovary

12.9

• 8. Ill-Defined and Unspecified

13.5

• 9. Lymphoma

11.5

• 10. Liver and Intrahepatic Bile

Duct

11.5

FEMALE BREAST CANCER TELLING THE STORY “DEEP DIVE”

957 953 927 1036 990 4194 4212 4506 4693 4626 1000 2000 3000 4000 5000

2011 2012 2013 2014 2015 Case Count

Diagnosis Year Female Breast Cancer Invasive and In Situ Case Count by Diagnosis Year, 2011-2015 In Situ Invasive

67.9% 68.6% 67.8% 69.3% 71.2% 26.8% 25.8% 25.2% 24.5% 25.2% 5.3% 5.6% 6.9% 6.1% 3.6%

0.0% 20.0% 40.0% 60.0% 80.0% 100.0%

2011 2012 2013 2014 2015

Percent of Early/Late Stage

Diagnosis Year

Female Breast Cancer Percent of Early/Late Stage by Diagnosis Year, 2011-2015

Early Late Unknown

*Early Stage = In Situ and Local SEER Summary Stage 2000; Late Stage= Regional and Distant SEER Summary Stage 2000. Note: The sum of the percent of Early/Late Stage for each diagnosis year does not equal 100% due to rounding.

125.7 74.1 106.3 58.0 77.3 113.0 0.0 30.0 60.0 90.0 120.0 150.0

White Non- Hispanic White Hispanic Black American Indian Asian & Pacific Islander All Races

Age Adjusted Rate per 100,000 Females Race/Ethnicity Invasive Female Breast Cancer Incidence Age Adjusted Rate by Race/Ethnicity, 2011-2015

Note: 282 invasive cases had other or unknown race.

24.6% 30.1% 30.2% 33.9% 25.3% 25.5%

0.0% 10.0% 20.0% 30.0% 40.0%

White Non- Hispanic White Hispanic Black American Indian Asian & Pacific Islander All Races

Percent of Cancer Cases Race/Ethnicity Percent of Female Breast Cancer Cases Diagnosed in Late Stage* by Race/Ethnicity, 2011-2015

0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% Triple Negative Triple Positive All Other ER,PR,HER2 NA/Unk.

Percent of Cases ER, PR, & HER2 Assay Combination Value

Female Breast Cancer ER, PR, HER2 Assay Combination by Race/Ethnicity, 2011-2015

White Non-Hispanic White Hispanic Black American Indian Asian & Pacific Islander

Note: 286 cases with an other or unknown race are excluded from the analysis.

Less than 40 years 40-49 years 50-64 years 65 years and

• lder

White Non-Hispanic 4.4% 14.3% 36.9% 44.4% White Hispanic 12.1% 23.0% 39.5% 25.4% Black 12.7% 20.0% 45.4% 21.9% American Indian 6.5% 25.3% 38.2% 30.0% Asian & Pacific Islander 14.2% 24.1% 41.4% 20.4% 0.0% 10.0% 20.0% 30.0% 40.0% 50.0%

Percent of Cases Age Group

Percent Female Breast Cancer Cases Diagnosed In Late Stage* Race/Ethnicity by Age Group, 2011-2015

*Late Stage = Derived SEER Summary Stage 2000 Regional and Distant Stages. Percent of cases are derived from the total of invasive and in situ cases. The sum of the percent of cases by age group does not equal 100% due to rounding. Note: 65 late stage cases had other or unknown race/ethnicity.

COLORECTAL

48.5% 55.5% 51.6% 49.1% 53.2% 49.3% 0.0% 20.0% 40.0% 60.0% White Non- Hispanic White Hispanic Black American Indian Asian & Pacific Islander All Races

Percent of Cancer Cases

Race/Ethnicity Percent of Colorectal Cancer Cases Diagnosed in Late Stage* by Race/Ethnicity, 2011-2015

*Late Stage = Derived SEER Summary Stage 2000 Regional and Distant Stages. Percent of cases are derived from the total of invasive and in situ cases. Note: 183 cases had other or unknown race and were excluded.

0-39 yrs 40-49 yrs 50-64 yrs 65 yrs and older White Non-Hispanic 55.5% 57.9% 52.0% 46.0% White Hispanic 72.0% 67.2% 58.3% 49.2% Black 40.0% 56.1% 52.5% 52.0% American Indian 51.7% 65.8% 44.0% 48.6% Asian & Pacific Islander 64.3% 55.0% 51.5% 51.7% 0.0% 20.0% 40.0% 60.0% 80.0%

Percent Late Stage Race/Ethnicity Late Stage Colorectal Cancer: Race/Ethnicity by Age, 2011-2015

Note: 366 Cases with an other or unknown race/ethnicity are excluded.

CANCER MORTALITY

2010 2011 2012 2013 2014 2015 2016 Diseases of heart 135.9 111.1 122.7 122.9 107.5 119.9 139.9 Accidents (Unintentional Injuries) 99.2 100.6 94.8 104.5 85.4 139.0 139.1 Malignant Neoplasms 106.4 100.8 100.8 118.2 97.1 124.4 101.2 Chronic liver disease and cirrhosis 64.6 43.6 59.2 62.0 52.7 77.6 85.9 Diabetes 79.3 61.3 80.2 65.7 63.2 73.9 79.9 0.0 20.0 40.0 60.0 80.0 100.0 120.0 140.0 160.0 Age Adjusted per 100,000 Persons Year of Death

American Indian Age Adjusted Mortality Rate* Selected Causes of Death by Year of Death For Years 2010-2016**

*Based on age-adjusted mortality rates: Number of deaths per 100,000 population age-adjusted to the 2000 U.S. standard. ** Sagna, M., Gupta, S., & Torres, C. (2017, November). Health Status Profile of American Indians in Arizona: 2016Data Book. Retrieved April 26, 2018.

ARIZONA MORTALITY – TOP TEN CANCER DEATHS, YEARS 2010-2016

ALL RACES

(Pct. of All Cases)

AMERICAN INDIAN

(Pct. of Am. Indian Cases)

• 1. Lung & Bronchus

24.6%

• 2. Colorectal

8.8%

• 3. Pancreas

7.1%

• 4. Female Breast

7.0%

• 5. Miscellaneous Malignant

Cancer

6.7%

• 6. Prostate

5.4%

• 7. Liver & Intrahepatic Bile Duct 4.5%
• 8. Leukemia

4.2%

• 9. Lymphoma

3.7%

• 10. Bladder

2.9%

• 1. Liver & Intrahepatic Bile Duct 11.8%
• 2. Miscellaneous Malignant

Cancer

9.8%

• 3. Colorectal

9.5%

• 4. Lung & Bronchus

7.7%

• 5. Pancreas

6.9%

• 6. Stomach

6.0%

• 7. Prostate

6.0%

• 8. Kidney & Renal Pelvis

5.8%

• 9. Female Breast

5.7%

• 10. Ovary

4.1%

NATIONAL DATA

CDC CENTERS FOR DISEASE CONTROL AND PREVENTION – DATA TOOLS

Source: CDC, United States Cancer Statistics: Data Visualizations https://gis.cdc.gov/grasp/USCS/DataViz.html CDC, United States Cancer Statistics(USCS) , Interactive Cancer Atlas (InCA) https://nccd.cdc.gov/DCPC_INCA/ CDC, United States Cancer Statistics https://nccd.cdc.gov/uscs/

Arizona Data Tools

http://azdhs.gov/preparedness/public-health-statistics/cancer-registry/index.php

Collaborative Relationships

AZ Cancer Control Programs and Tribes

THANK YOU

Georgia Yee and Chris Newton Georgia.yee@azdhs.gov chris.newton@azdhs.gov azhealth.gov @azdhs facebook.com/azdhs

The Centers for Disease Control and Prevention provide support for enhancement to the registry under cooperative agreement NU58DP006341. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention