A New Approach to Estimating U.S. Annual Cancer Rates using SEER Data

每年，美国国家癌症研究所、美国癌症协会、疾病控制中心和北美中央癌症登记协会都会向美国国家发布一份年度癌症状况报告。这些报告载有每年总体癌症发病率和死亡率的估计，以及按性别、种族、民族和其他特征界定的人口亚组的发病率/死亡率。这些年度报告的发现影响着癌症研究的优先级、癌症预防项目和公共卫生支出。为了准确地确定癌症发病率逐年变化的存在及其幅度，这些发病率的估计值必须具有两个性质：1)所关注的亚组（例如，黑人女性）的估计值必须不受其他风险因素（例如，年龄和经济地位）存在的年度差异的影响；2)如果所有其他风险因素在每一年都是相同的，那么所关注的亚组的年之间估计的差异必须是无偏的，因为癌症发病率的差异是可以看到的。《年度报告》使用一种叫做直接年龄标准化的方法来估算癌症发病率。我们已经证明，由直接年龄标准化产生的估计既不具备所需的性质[1]。我们开发了一种新的标准化方法，它具有这两种特性。我们还表明，目前从年度报告中得出的结论与这种新方法产生的标准化比率差异的因素是一一对应的。在我们目前所检查的SEER数据分析中，直接年龄标准化法和我们的新方法的标准化率有很大的不同。使用当前方法估计癌症发病率的偏差在少数群体中最大。到目前为止，我们的工作使我们能够使用新的标准化方法来估计具有所需特性的癌症发病率。然而，我们还没有开发出必要的统计方法和软件来从SEER数据的分析中做出正式的推论。最终，我们的目标是生产免费可用的、用户友好的软件，允许任何研究人员利用新的标准化程序来分析SEER数据。在这个应用程序中，我们要求为软件开发的初始阶段提供资金。

DESCRIPTION (provided by applicant): PROJECT SUMMARY Each year the National Cancer Institute, the American Cancer Society, the Centers for Disease Control, and the North American Association of Central Cancer Registries produce an Annual Report to the Nation on the Status of Cancer in the United States. These reports contain estimates of overall annual cancer incidence and mortality, as well as incidence/mortality within population subgroups defined by sex, race, ethnicity, and other characteristics. The findings in these Annual Reports influence cancer research priorities, cancer prevention programs, and public health expenditures. In order to accurately determine the existence and magnitude of year-to-year changes in cancer rates, the estimates of these rates must have two properties: 1) the estimates for the subgroup of interest (for instance, black females), must not be influenced by between-year differences that exist in other risk factors (for instance, age and economic status); 2) the differences in the between-year estimates for the subgroup of interest must be unbiased for the difference in cancer rates that would have been seen if all the other risk factors were identical in each year. The Annual Reports produces estimates of cancer rates using a procedure called direct age-standardization. We have proven that the estimates produced by direct age-standardization have neither of the required properties [1]. We have developed a new method of standardization that has both of these properties [1]. We have also shown that the conclusions currently made from the Annual Reports have a one-to-one correspondence with the factors that give rise to differences in standardized rates produced by this new method [1]. In the analyses of SEER data that we have so far examined, the standardized rates from the direct age-standardization method and our new method are quite different. The biases in the estimates of cancer rates using the current method are greatest for minority groups. Our work to date allows us to use the new method of standardization to produce estimates of cancer rates with the desired properties. However, we have not yet developed the statistical methods and software necessary to make formal inferences from analyses of SEER data. Ultimately our goal is to produce freely available, user-friendly software that will allow any researcher to utilize the new standardization procedures to analyze SEER data. In this application we request funding for the initial stage of software development. PUBLIC HEALTH RELEVANCE: Each year the National Cancer Institute, the American Cancer Society, the Centers for Disease Control, and the North American Association of Central Cancer Registries produce an Annual Report to the Nation on the Status of Cancer in the United States. Based on the year-to-year changes in the incidence of specific cancers, these findings influence cancer research priorities, cancer prevention programs, and public health expenditures. The current method of estimating these rates produces biased estimates of cancer rates, with the magnitude of the bias largest in minority groups. We have developed a method for producing unbiased estimates of these cancer rates.