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2001 Annual Report What?s New for 2001?Diagnosis year 2001 marks the sixth year of complete cancer reporting for Oregon. Five years of complete data are included in this annual report, 1997-2001. Limited data for 1996 are included. Please refer to last year?s report, Cancer in Oregon, 2000, for complete historical data for 1996. Also in 2001, changes affecting coding for both cancer sites and staging came into effect for cases collected by cancer registries nationwide. These changes are described in this section. Please review the technical documentation for specific information on data collection and analysis changes from prior years. High Quality Data As part of federal funding requirements, OSCaR is audited by an outside agency every five years to assess the quality and completeness of registry data. In July 2003, Macro International Inc. conducted an audit of OSCaR data. The results of the audit estimated OSCaR?s overall case completeness rate as 98.9%, and the overall data accuracy rate for 13 essential data elements was 96.0%. OSCaR was commended for exceeding national standards for both of these outcomes. The North American Association of Central Cancer Registries (NAACCR) annually reviews cancer registries for their ability to produce complete, accurate, and timely data. The NAACCR registry certification program recognizes registries that meet the highest standards with a Gold or Silver Certification. Data for diagnosis year 2001 received Gold Certification from NAACCR. OSCaR has received NAACCR certification for every year of complete data. Additional information about NAACCR certification is available on the web: http://www.naaccr.org Summary Stage 2000 Staging is the grouping of cases into broad categories based on extent of disease. Summary Stage is a coded format that has been used by cancer registries since 1977. It allows electronic analysis of cases with similar characteristics. Increasing stage number means more widespread involvement or severity. New guidelines for staging cancer, called Summary Stage 2000, were put into effect for cancer cases diagnosed on or after January 1, 2001. Overall, the changes in the guidelines should result in increased accuracy and consistency in coding of stage. The instructions are highly detailed, site-specific, and include illustrations to assist coders. However, there are also differences in timing rules for determining stage and some sites are coded differently using the new guidelines. For instance, a lung cancer case that has a separate tumor nodule in a different lobe (of the same lung) was staged as localized using the old summary staging system but is now coded as distant/metastatic in the Summary Stage 2000. This means that, for some sites, comparing stage data from 1996-2000 with 2001 data are difficult. In particular, the staging criteria for lung, ovarian, and colorectal cancers has changed with Summary Stage 2000. However, the differences in coding stage reflect a new understanding of the natural history of cancer, and the new criteria should improve the usefulness of staging as an accurate predictor of prognosis and survival for cases staged under the new system. The new guidelines are detailed in SEER Summary Staging Manual ? 2000. ICD-0-3 The International Classification of Disease for Oncology (ICD-O) has been the standard coding system for neoplasms for over 25 years. The coding system includes a four-character code for primary site, a four-digit numeric code for cell type, a one-digit code for tumor behavior, and a one-digit code for tumor aggressiveness. An updated version of the ICD-O system, ICD-O-3, is now used for cases diagnosed on or after January 1, 2001. The changes in ICD-O-3 reflect improvements in the understanding of cancer pathology over the last decade. The ICD-O-3 system has no changes in the primary site codes but has significant changes regarding cell type (histology). This affects leukemias and lymphomas particularly. A small number of cancers that were coded as borderline behavior are now coded as malignant, including refractory anemia, polycythemia vera, papillary meningioma, and a number of other hematopoietic diseases. (See Appendix A.) There are also a number of previously reported borderline tumors of the ovary that are now considered benign. This means that counts of ovarian cancers, lymphomas, leukemias, and some hematopoietic diseases will change due to the changes in reportability or definition. As with coding of stage, this means it is difficult to compare 2001 cases for those cancer sites with data from prior years. But, like Summary Stage 2000, the differences reflect advances in the understanding of the pathology and behavior of cancers. Other changes in ICD-O-3 include new codes, terms, synonyms, and guidelines intended to improve accuracy and consistency of coding. The ICD-O-3 manual is available from the World Health Organization?s North American distributor, WHO Publications Center USA, 49 Sheridan Avenue, Albany, NY 12210. |
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