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Investigating Cancer Incidence in Occupational Cohorts using SEER*Stat MP-SIR

This presentation, by Chris Johnson, MPH Epidemiologist, explores the use of SEER*Stat MP-SIR to investigate cancer incidence among occupational cohorts. The presentation discusses disease clusters, the role of occupational and medical clusters in understanding cancer etiology, and the challenges and lessons learned from two recent worksite/occupational cancer cluster investigations.

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Investigating Cancer Incidence in Occupational Cohorts using SEER*Stat MP-SIR

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  1. Using SEER*Stat MP-SIR to investigate cancer incidence among occupational cohortsor“Are you catching cancer at work?” Presented by: Chris Johnson, MPH Epidemiologist, Cancer Data Registry of Idaho 2014 NAACCR ANNUAL CONFERENCE Wednesday, June 25, 2014 Ottawa, Ontario

  2. Many Thanks To Steve Scoppa Senior Systems Analyst Information Management Services Inc. Angela Mariotto Chief, Data Modeling Branch National Cancer Institute The Centers for Disease Control and Prevention is acknowledged for support of CDRI under cooperative agreement U58DP003882. The findings and conclusions in this presentation are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention or the National Cancer Institute.

  3. What is a disease cluster? • A disease cluster is the occurrence of more than the expected number of people diagnosed with a certain disease within a specific group, a geographic area or a period of time.

  4. Cancer Cluster Investigation Themes • Occupational and medical clusters have aided our understanding of cancer etiology. • Studies of geographic clusters rarely identify environmental risk factors. • Science can be overtaken by public concern. • Geography might be symptom rather than cause.

  5. CDRI has a protocol for investigating non-infectious disease clusters

  6. CDRI is developing a protocol for investigating worksite/occupational cancer clusters CDRI Protocol Worksite Cancer Clusters ??? 2014

  7. Two Recent Worksite/Occupational Cancer Cluster Investigations • Study #1 - Worksite • Study #2 – Occupational group (licensed)

  8. Study #2 – Background • An oncologist noticed what she believed to be an unusually large number of cases in a particular occupational group (licensed professional) among her patients. • October 2013: this concern was brought to the state of Idaho Board that governs this group. • January 2014: the Board voted to share data with CDRI to investigate the concern.

  9. Study #2 – Background • February 2014: CDRI received dataset on the current and historical licensed professionals • No SSN • Month and year of birth, not day • February-March 2014: deduplication, linkages, Accurint & SSDI lookups • April 2014: statistical analysis • May 2014: report writing • ??? 2014: meet with Board to share results  At least 8 months…

  10. Mock-up of Case and Person-time Contributions by Licensed Professional

  11. Study #2 – Statistical Methods • We compared the observed numbers of cancer cases among occupational cohort to expected numbers based on referent rates from Idaho and the US. • Standardized incidence ratio (SIR) = obs/exp • Referent rates: • National Cancer Institute’s Surveillance, Epidemiology, and End Results Program (SEER ) for whites • Idaho overall • Results were tabulated using CDRI annual report primary site categories, which include malignant cases and benign brain and other nervous system cases.

  12. SEER*Stat MP-SIR Session • MP-SIR (Multiple Primary -- Standardized Incidence Ratios) sessions can be used to compare incidence of cancer in a defined cohort of persons previously diagnosed with cancer to the incidence of cancer in the general population. • Can also be used to compare incidence of cancer in other cohorts to the incidence of cancer in the general population.

  13. Study #2 – Results • Analytic datasets contained 881 records. • If a person in the occupational cohort did not link to CDRI, they have 1 record for person-time calculations. • For persons who did link to CDRI, they have one record for every primary cancer case. • 86 cancer cases among cohort, spanning 1971-2013. • 59 deceased persons in cohort. • As with Study #1, some cancer cases occurred before the person joined the occupational cohort.

  14. Study #2 – Results – Table 1

  15. Study #2 – Results – Table 2

  16. Study #2 – Results – Table 3

  17. Lessons Learned from the 2 Studies • CDRI not in control of employer/licensure data • Availability • Content • Completeness • Timeliness  May take a long time from initial request to final report • What you have to do in terms of data cleanup, extra linkages, depends on employer data • Difficulty of linkages with cancer registry depends on fields available from employer data and data quality

  18. Lessons Learned from the 2 Studies • Interpretability of results may be contingent on structure of human resources database • Compared to geographic cancer clusters, seemingly more buy-in from concerned persons if negative results • SEER*Stat provides a user-friendly interface and consistent approach to conducting worksite/occupational cancer cluster investigations

  19. SEER*Stat MP-SIR • It is hoped that this approach to the analysis of cancer incidence among occupational cohorts could be easily adopted by other central cancer registries and will be a useful model for addressing worksite cancer cluster concerns. • “SEER*Stat does that!”

  20. Thank You Chris Johnson, CDRI Epidemiologist 208-489-1380 cjohnson@teamiha.org www.idcancer.org

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