Surveillance of screening-detected cancers (colon and rectum, breast, and cervix) - United States, 2004-2006.

PROBLEM/CONDITION: Population-based screening is conducted to detect diseases or other conditions in persons before symptoms appear; effective screening leads to early detection and treatment, thereby reducing disease-associated morbidity and mortality. Based on systematic reviews of the evidence of the benefits and harms and assessments of the net benefit of screening, the U.S. Preventive Services Task Force (USPSTF) recommends population-based screening for colon and rectum cancer, female breast cancer, and uterine cervix cancer. Few publications have used national data to examine the stage at diagnosis of these screening-amenable cancers. REPORTING PERIOD COVERED: 2004-2006. DESCRIPTION OF SYSTEMS: Data were obtained from cancer registries affiliated with CDC's National Program of Cancer Registries (NPCR) and the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program. Combined data from the NPCR and SEER programs provide the best source of information on national population-based cancer incidence. Data on cancer screening were obtained from the Behavioral Risk Factor Surveillance System. This report provides stage-specific cancer incidence rates and screening prevalence by demographic characteristics and U.S. state. RESULTS: Approximately half of colorectal and cervical cancer cases and one third of breast cancer cases were diagnosed at a late stage of disease. Incidence rates of late-stage cancer differed by age, race/ethnicity, and state. Incidence rates of late-stage colorectal cancer increased with age and were highest among black men and women. Incidence rates of late-stage breast cancer were highest among women aged 60-79 years and black women. Incidence rates of late-stage cervical cancer were highest among women aged 50-79 years and Hispanic women. The percentage of persons who received recommended screening differed by age, race/ethnicity, and state. INTERPRETATION: Differences in late-stage cancer incidence rates might be explained partially by differences in screening use. PUBLIC HEALTH ACTION: The findings in this report emphasize the need for ongoing population-based surveillance and reporting to monitor late-stage cancer incidence trends. Screening can identify colorectal, cervical, and breast cancers in earlier and more treatable stages of disease. Multiple factors, including individual characteristics and health behaviors as well as provider and clinical systems factors, might account for why certain populations are underscreened. Cancer control planners, including comprehensive cancer-control programs, can use late-stage cancer incidence and screening prevalence data to identify populations that would benefit from interventions to increase screening utilization and to monitor performance of early detection programs.

Rapid-learning system for cancer care.

Compelling public interest is propelling national efforts to advance the evidence base for cancer treatment and control measures and to transform the way in which evidence is aggregated and applied. Substantial investments in health information technology, comparative effectiveness research, health care quality and value, and personalized medicine support these efforts and have resulted in considerable progress to date. An emerging initiative, and one that integrates these converging approaches to improving health care, is "rapid-learning health care." In this framework, routinely collected real-time clinical data drive the process of scientific discovery, which becomes a natural outgrowth of patient care. To better understand the state of the rapid-learning health care model and its potential implications for oncology, the National Cancer Policy Forum of the Institute of Medicine held a workshop entitled "A Foundation for Evidence-Driven Practice: A Rapid-Learning System for Cancer Care" in October 2009. Participants examined the elements of a rapid-learning system for cancer, including registries and databases, emerging information technology, patient-centered and -driven clinical decision support, patient engagement, culture change, clinical practice guidelines, point-of-care needs in clinical oncology, and federal policy issues and implications. This Special Article reviews the activities of the workshop and sets the stage to move from vision to action.