Documentation

Background
Data Sources
Mission and goals

Technical Notes
Annual Updates
Cancer Incidence Classification
Cancer Sites
Definitions
Grade/Cell Disorder
Rate Calculation
Stage

Background
The Missouri Cancer Registry (MCR) is mandated by the state of Missouri (192.650-192.657 RSMo; http://www.mogo.state.mo.us/statutes/c192.htm). MCR is a collaborative partnership between the Missouri Department of Health and Senior Services (DHSS) and the University of Missouri-Columbia.* Since 1995, MCR has received financial support from the Centers for Disease Control and Prevention's National Program of Cancer Registries (CDC-NPCR). (For more informaiton about MCR, go to their website: http://mcr.umh.edu).

With submission of 1998 data to the North American Association of Central Cancer Registries (NAACCR) in 2000, MCR became a NAACCR-certified registry. MCR data for 1999 through 2003 meet the Gold Certification standard. (See NAACCR Criteria and Standards for High Quality Data for Registry Certification, http://www.naaccr.org/index.asp?Col_SectionKey=12&Col_ContentID=54.)

Mission and Goals
MCR's mission is to maintain a statewide cancer surveillance system and participate in research in support of the prevention of cancer and the reduction of the cancer burden among Missouri residents.

The goals of MCR are to:

Data Sources
MCR is the only source of population-based cancer incidence data for the state. Hospitals and other entities where cancer is diagnosed and/or treated report newly-diagnosed cancer cases occurring among Missouri residents or residents of other states/territories/countries to MCR monthly or quarterly, depending on their caseload.

For the years 1996-1999, mandatory reporting of cancer was limited to hospital inpatient cases only. Some hospitals, generally those accredited by the American College of Surgeons (ACoS), voluntarily reported outpatient cases prior to 1999. With enactment of an expanded reporting requirement in 1999, all known in-state sources of cancer cases are now covered by Missouri statute (192.650 RSMo). Since 1999, reporting of cancer cases has been required from inpatient hospital settings, outpatient hospital settings, pathology laboratories, ambulatory surgical centers, free-standing cancer clinics and treatment centers, skilled nursing facilities, intermediate care facilities, residential care facilities I and II and physician offices. The rule governing expanded reporting, 19 CSR 70-21.010, became effective 30 December 2000 and can be found at: http://www.sos.mo.gov/adrules/csr/current/19csr/19csr.asp#19-30.

In common with other registries funded by CDC-NPCR or the NCI-SEER program, MCR collects data using uniform data items and codes as documented by the North American Association of Central Cancer Registries (NAACCR).1,2 This uniformity ensures that data items collected by all central registries and federal programs are comparable. Information on primary site and histology is coded according to the International Classification of Diseases for Oncology, Thrid Edition (ICD-0-3)3 and categorized according to the revised SEER recodes dated January 27, 2003, which define standard groupings of primary cancer sites ( http://seer.cancer.gov/siterecode/icdo3_d01272003/).4 MCR and other NPCR and SEER cancer registries consider as reportable all incident cases with a behavior code of 2 (in situ, non-invasive) or 3 (invasive, primary site only) in the ICD-0-3 with the exception of in situ cancer of the cervix. Basal and squamous cell carcinomas of the skin are also excluded, with the exception of those on the skin of the genital organs.3

MCR obtains additional cases or treatment information from other central cancer registries with which MCR has case-sharing agreements. Currently, through this machanism 20 other states report incidence data to MCR on Missouri residents diagnosed and/or treated for cancer in their states. Registries in Kansas, Texas, Illinois, Arkansas, Nebraska and Iowa provide the majority of these cases. Additional cases are identified through a review of death certificates. In a process called "death clearance and follow-back", MCR staff update the vital status of patients already in the database and identify potentially missed cases of cancer. Hospitals and other reporting facilities are contacted for information when the death certificate lists some type of cancer as a cause of death but the death cannot be matched with a case in the MCR database.

Cancer Incidence Selection and Classification
In order to compare incidence across years and with other sources, only cases with "SEER Behavior Recode for Analysis" equal to either 2 (in situ) or 3 (malignant in both ICD-O-2 and ICD-O-3) are selected for inclusion in MICA. For the definition of "SEER Behavior Recode for Analysis" see http://seer.cancer.gov/behavrecode/ under the heading "SEER 1973-2004 Data". The International Classification of Diseases for Oncology (ICD-0-3)3 codes and the major and minor cancer site groups of the National Cancer Institute's (NCI) Surveillance, Epidemiology and End Results (SEER) program http://seer.cancer.gov/siterecode/icdo3_d01272003/) have been used to define cancer sites and histologies. These standardized classification schemes allow comparisons of Missouri data with international, national and state publications.

Annual Updates
Cancer incidence data are updated annually. Following national guidelines, an annual data set is finalized 24 months after the close of a diagnosis year and reported to CDC-NPCR in the 25th month. Missouri's official cancer incidence dataset is the file used for MICA. This dataset is submitted to CDC-NPCR in January of each year and contains not only incidence data for the report year but also updated files for all previous years from 1996 onward.

Cancer Sites
There are three state and BRFSS regional MICAs from which to choose. Two contain seven major cancer sites: Breast; Cervix; Colon, Rectum, and Rectosigmoid Junction; Lung and Bronchus; Prostate; Urinary Bladder; Corpus and Uterus, NOS; and all, which includes not only seven major sites but all other sites as well. One of the seven-site MICA contains county-level data but restricts the years of interest to groups of three. The other seven-site MICA allows single year data, but does not display county-level data. The final MICA contains nineteen cancer sites; the seven major sites can be found within this list either directly or through drill-downs.

Grade/Cell Disorder
When selecting grade from the drop-down list, please note that levels of differentiation are applicable to ALL cancers; however, T-cell, B-cell, and Null-cell choices are only applicable to leukemias and lymphomas. For more information on grade, please go to: http://www.cancer.gov/cancertopics/factsheet/Detection/tumor-grade.

Stage
When creating a rate to be compared with other national or state cancer incidence data, use "invasive" only. This is because "in situ" and "all stages" (which includes "in situ") are not included in data from Surveillance, Epidemiology and End Results (SEER). SEER is a major source of cancer data provided by the National Cancer Institute, and is the standard for national and state cancer incidence data. Please note that, for bladder cancer, "in situ" is included in "invasive." As noted above, in the MICA containing county-level data, the cancer sites provided include both "in situ" and "invasive" cases. When selecting rates "invasive" stage should be selected to make the rates compatible with national SEER data.

Rate Calculation
The cancer incidence rate is the number of new cancers of a specific site/type occurring among Missouri residents during a year, expressed as the number of cancers per 100,000 population. Incidence rates are determined by dividing the number of newly-identified cases in a given year by the mid-year Missouri population estimates. Rates based upon fewer then 16 cases are suppressed as they are likely to be unreliable. They are shown as "@.@".

Population estimates used in calculating rates for the Cancer MICA are derived from files created by the US Census Bureau and the National Center for Health Statistics (NCHS). For more information about the Population data used, go to: http://health.mo.gov/data/mica/PopulationMICA/Documentation.html.

Footnote
* This project was supported in part by a cooperative agreement between the Centers for Disease Control and Prevention (CDC) and the Missouri Department of Health and Senior Services (DHSS) (#U55/CCU721904) and a Surveillance Contract between DHSS and the University of Missouri. For more information about the National Program of Cancer Registries, go to: http://www.cdc.gov/cancer/npcr/about.htm.

References
1Fritz A, Ries LAG. The SEER Program Code Manual, 3rd ed. Bethesda, MD: National Cancer Institute; 1998.

2Havener L, Hulstrom D. Standards for Cancer Registries, Volume III: Data Standards and Data Dictionary, 10th ed., Version 11. Springfield, IL: North American Association of Central Cancer Registries; 2004.

3Fritz A, Percy C, Jack A, Shanmugaratnam K, Sobin L, Parkin DM, Whelan S. International Classification of Diseases for Oncology, Third Edition. Geneva, Switzerland: World Health Organization; 2000.

4LAG, Harkins D, Krapcho M, Mariotto A, Miller BA, Feuer EJ, Clegg L, Eisner MP, Horner MJ, Howlader N, Hayat M, Hankey BF, Edwards BK (eds). SEER Cancer Statistics Review, 1975-2003, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2003/, based on November 2005 SEER data submission, posted to the SEER web site, 2006.