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National Program of Cancer Registries
5 Year Relative Survival Analysis
for the years 2001-2011
from 27 States in the National Program of Cancer Registries

Cancer Survival 2001-2011 Data Summary

Summary:    The National Program of Cancer Registries produces this 5 year relative survival analysis for the years 2001-2011, by 24 cancer sites, age group, sex and race categories. Data are from 27 selected states in the National Program of Cancer Registries.
Source:    National Program of Cancer Registries (NPCR).

This relative survival analysis is based on cases diagnosed between 2001-2011 and follow-up of patients through 2011. Data are compiled from 27 state cancer registries that met the data quality criteria for survival analysis, as submitted to CDC's National Program of Cancer Registries in November 2014.

The 27 included states are Alabama, Alaska, Arkansas, California, Colorado, Georgia, Idaho, Kansas, Kentucky, Louisiana, Maine, Maryland, Minnesota, Montana, Nebraska, New Hampshire, New Jersey, New York, North Carolina, Pennsylvania, Rhode Island, Tennessee, Texas, Vermont, West Virginia, Wisconsin and Wyoming. These 27 state cancer registries cover approximately 59% of the U.S. population. For more information, see USCS technical notes, or Data Source Information below.

In WONDER:    You can produce tables, maps, charts, and data extracts. Request these summary statistical measures for the years 2001-2011:
  1. 5-year relative survival (percent);
  2. 95% confidence intervals for relative survival; and
  3. incidence counts (number of diagnoses).
You can limit and index your data by any and all of these variables:
  1. Cancer Sites - 24 cancer sites: All Cancer Sites Combined, Oral Cavity and Pharynx; Esophagus; Stomach; Colon and Rectum; Liver and IBD; Pancreas; Larynx; Lung and Bronchus; Melanoma of the Skin; Breast; Cervical Cancer (Cervix Uteri); Corpus and Uterus, NOS; Ovary; Prostate; Testis; Urinary Bladder; Kidney and Renal Pelvis; Brain and Other Nervous System; Thyroid; Hodgkin Lymphoma; Non-Hodgkin Lymphoma; Myeloma; Leukemia
  2. Age - age groups (all ages combined, <45 years; 45-54 years; 55-64 years; 65-74 years; 75-99 years; <65 years; 65-99 years
  3. Race - All Races Combined; Black or Africa American; White
  4. Sex (Gender) - Both Sexes Combined; Female, Male

Please refer to the following topics:


Cancer Survival Analysis Data Request

Output:    You can produce tables, maps, charts, and data extracts for the following summary statistical measures for the years 2001-2011:
  1. 5-year relative survival (percent);
  2. 95% confidence intervals for relative survival; and
  3. incidence counts (number of cases diagnosed).


Variables:    Group results by or limit the following fields:
  1. Cancer Sites - 24 cancer sites: All Cancer Sites Combined, Oral Cavity and Pharynx; Esophagus; Stomach; Colon and Rectum; Liver and IBD; Pancreas; Larynx; Lung and Bronchus; Melanoma of the Skin; Breast; Cervical Cancer (Cervix Uteri); Corpus and Uterus, NOS; Ovary; Prostate; Testis; Urinary Bladder; Kidney and Renal Pelvis; Brain and Other Nervous System; Thyroid; Hodgkin Lymphoma; Non-Hodgkin Lymphoma; Myeloma; Leukemia;
  2. Age - age groups (all ages combined, <45 years; 45-54 years; 55-64 years; 65-74 years; 75-99 years; <65 years; 65-99 years;
  3. Race - All Races Combined; Black or Africa American; White;
  4. Sex (Gender) - Both Sexes Combined; Female, Male;
How?    The Request screen has sections to guide you through making a data request as a step-by-step process. However, to get your first taste of how the system works, you might want to simply press any Send button, and execute the default data request. The data results for your query appear on the Table screen. After you get your data results, try the Chart and Map screens. Or export your data to a file (tab-delimited line listing) for download to your computer.

For more information, see the following:

Quick Start Guide;
Step 1, Organize table layout;
Step 2, Select demographics;
Step 3, Select cancers of interest.

'By-Variables'    Select variables that serve as keys (indexes) for organizing your data. See How do I organize my data? for more information.
Note:   Maps are not available for these data, because the geographic variables such as region or state are not included.
Help:    Click on any button labeled "Help", located to the right hand side of the screen at the top of each section. Each Control's label, such as the "Location" label next to the Location entry box, is linked to the on-line help for that item.
Send:    Sends your data request to be processed on the CDC WONDER databases. The Send buttons are located on the bottom of the Request page, and also in the upper right corner of each section, for easy access.



Step 1. Organize table layout:
Group Results By:   Select up to four variables to group (summarize, stratify, index) your data. See Group Results By below for more specifics and hints.
Measures:   Check the box to include the summary statistical measure in the results to your query.
  1. 5-year relative survival (percent) are provided by default;
  2. 95% confidence intervals for relative survival; and
  3. incidence counts (number of cases diagnosed).
See How do I change a "Check Box?".
Title:   Enter any desired description to display as a title with your results.



Group Results By:

Select up to four variables that serve as keys for grouping your data. For example, you could select to group (summarize, stratify, index) your data by Race, Sex and Age.

How?    See How do I organize my data? for more information.

Hints:   

  1. To make a chart, choose only one or two By-Variables in section 1 of the Request Form, such as Race and Sex. Then click the Chart tab when your results are shown. To change the Chart, click the "Chart Options" button above the chart on the Chart tab. Charts cannot be drawn when your data has more than two By-Variables.
  2. Maps are not available for these data, because geographic location variables are not included, such as Region or State.
Note:    The "All Categories" option includes the "All Combined" values. The "All Combined" values are summary records. For example, "All Races Combined" shows all instances summed together, regardless of the race category on the individual records.


Relative Survival (Percent)

Five year relative survival is presented as a percentage, representing the proportion of people with cancer who will be alive at a certain time after diagnosis, given that they did not die from something other than their cancer. See Data Source Information below for more information on the methodology for the calculation of relative survival figures.



95% Confidence Intervals for Survival

The calculation of 95% confidence intervals for survival figures is optional. Select the check box on the Request page to include these statistics in your report. The 95% confidence intervals calculated for 5 year relative survival percentages use the log-log transformation method to prevent the confidence intervals from going below 0% or above 100%.

Survival Confidence Intervals

The endpoints of a p x 100% confidence interval are calculated as:


Normal Approximation

CIlow = surv_prob - ( p x SEsurv_prob )
CIhigh = surv_prob + ( p x SEsurv_prob )

Log( - ( Log ) ) Transformation

CIlow = surv_probe(p x abs(SEsurv_prob / (surv_prob x log(surv_prob))))
CIhigh = surv_probe(-p x abs(SEsurv_prob / (surv_prob x log(surv_prob))))

where CI is confidence interval, SE is standard error, abs is absolute value, and e is Euler's constant.



Counts

Showing the number of cases diagnosed or incidence counts is optional. Select the checkbox on the Request page to include these statistics in your report. Cancer case reports in this data set are counted by or summed by the cancer reported. For example, a single person with more than one primary cancer verified by a medical doctor is counted as a case report for each type of primary cancer reported. Having more than one primary cancer occurs in less than 20% of the population. The counts report the frequency of verified cancer diagnoses in the selected population and time period.



Step 2. Select demographics:

Limit the population to specific age group, race category or sex selections here. Alternately, you can leave the settings at the default values (all categories) and choose to organize or group the data results by age, race or sex to show these stratifications.


Age Groups

The Age Groups field contains values for various age groups. Select any combination of values to limit your data to the selected values.

Age group options include (all ages combined, <45 years; 45-54 years; 55-64 years; 65-74 years; 75-99 years; <65 years; 65-99 years.

How?   See How do I select items from the list box?.

Note:   When the data results are exported to a file, the Age Group Code and label are shown in separate columns.



Race

Select All Races Combined, Black or African American, or White to limit your data.

How?   See How do I select items from the list box?.

Note:    When results are exported, the code and label are shown in separate columns. The Race category code values are

"00"     All Races Combined
"2054-5" Black or African American
"2106-3" White

The Black and White code values are standard Public Health Information Network codes.



Sex

Select Both Sexes Combined, Female or Male to limit your data.

How?   See How do I select items from the list box?.

Note:    When results are exported, the code and label are shown in separate columns. The Sex code values are F for Female and M for Male.




Step 3. Select cancers of interest:
Select specific cancers sites to limit your data. Select All Categories in step 3, and group results by Cancer Sites in step 1, to see a row for each site. All Cancers Combined shows the aggregate value for all cancer sites. All Cancer Sites Combined includes all invasive cancer sites, including sites not specified in the list.

Data are available for the following cancer sites are available:


Code: Label:
00 All Cancer Sites Combined *
 6 Oral Cavity and Pharynx
13 Esophagus
14 Stomach
16 Colon and Rectum
21 Liver and IBD (inflammatory bowel disease)
25 Pancreas
31 Larynx
32 Lung and Bronchus
38 Melanoma of the Skin
40 Breast
44 Cervix Uteri
45 Corpus and Uterus
47 Ovary
52 Prostate
53 Testis
57 Urinary Bladder
58 Kidney and Renal Pelvis
62 Brain and Other Nervous System
64 Thyroid
67 Hodgkin Lymphoma
68 Non-Hodgkin Lymphoma
69 Myeloma
78 Leukemia
  *  All Cancer Sites Combined includes all invasive cancer sites, including sites not specified in the list.

Note: In the "All Sites Combined" category, each cancer patient is counted only once, for the first primary cancer in the time period 2001-2011. Yet for specific cancer site categories, each patient has his or her specific cancers counted individually, regardless of the primary cancer sites. Thus, the sum of the specific cancer sites is greater than the number of patients with first primary cancers reported for the 2001-2011 time period in the "All Sites Combined" category. However, when a specific cancer-site is broken out by age group, it is possible for a patient to be counted for each primary cancer, if primaries occur in different age groups. Because of the inclusion of multiple primaries in the site-specific survival analysis, the aggregated counts of subpopulations of a cancer site may not match the total case count of the cancer site. Refer to Data Source Information for more information.


Data Source Information

U.S. Cancer Statistics Working Group. United States Cancer Statistics: 19992012 Incidence and Mortality Web-based Report. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention and National Cancer Institute; 2015. Available at: www.cdc.gov/uscs

Definition and Calculation of Relative Cancer Survival

The relative cancer survival percentage measures the proportion of people with cancer who will be alive at a certain time after diagnosis, given that they did not die from something other than their cancer. The relative cancer survival percentage is defined as the ratio of the observed all-cause survival in a group of individuals with cancer to the expected all-cause survival of a similar group of individuals who do not have cancer. Because the expected survival of individuals who do not have cancer is difficult to obtain, it is often approximated by the expected all-cause survival of the general population. This is a reasonable approximation because cancer deaths are generally a negligible proportion of all deaths. Thus, the relative cancer survival is calculated as the observed all-cause survival in a group of individuals with cancer divided by the expected all-cause survival of the general population. To learn more on this topic, visit Measures of Cancer Survival.

Case Inclusion and Exclusion Criteria

Cancer incidence data submitted to National Program of Cancer Registries (NPCR) as of November 30, 2014, were used to create a data set in SEER*Stat for this analysis. Cases were included in the analysis if-

  • The case was an invasive cancer diagnosed from 2001 through 2011. Cases diagnosed in 2012 do not have adequate follow-up time to be included in the survival analysis.
  • Data from the central cancer registry met National Program of Cancer Registries (NPCR) publication criteria for all years 2001 through 2011.
  • The central cancer registry conducted linkage with the National Death Index and/or active patient follow-up for all years 2001 through 2011.
  • The age of the case was known and was 0 through 99 years.
  • The sex of the case was known.
  • The case was not identified solely on the basis of a death certificate or autopsy.

Data from 27 NPCR central cancer registries that met the USCS publication criteria and conducted linkage with the National Death Index and/or active patient follow-up for all years 2001 through 2011 were included in the analysis. These cancer registries include Alabama, Alaska, Arkansas, California, Colorado, Georgia, Idaho, Kansas, Kentucky, Louisiana, Maine, Maryland, Minnesota, Montana, Nebraska, New Hampshire, New Jersey, New York, North Carolina, Pennsylvania, Rhode Island, Tennessee, Texas, Vermont, West Virginia, Wisconsin, and Wyoming. These data cover 59% of the U.S. population.

Analytic Methods

Survival time in months for each case was calculated. Date of start of follow-up (month, day, and year) was set to date of diagnosis. Date of last follow-up (month, day, and year) was set to date of death if the case was matched to the state death files, to the National Death Index, or to date of last contact (if case was actively followed). Cases not linking to the state death files or to the National Death Index were presumed to be alive, and the date of last follow-up was set to December 31, 2011. Where day or month for date of diagnosis, date of death, or date of last contact were missing, the full date was imputed using a standard algorithm. 1 Cases that survived past the maximum age (99 years) were censored at age 99. Observed all-cause survival by sex and race (white, black, and all races combined) for individuals with any cancer and for individuals with 23 common cancer sites was then calculated using the actuarial life table method. 2 Cases with multiple primary cancers were included in the dataset, although only the first primary cancer was included in calculating relative survival for all cancer sites combined. Where a patient had multiple primary cancers of different sites, each cancer was included in calculating cancer-specific relative survival. Where a patient was diagnosed with multiple primary cancers of the same site at the same age, only the first primary cancer was included in calculating relative survival for that cancer site, but if diagnosed at different ages, each cancer was included in the calculation. 3

Expected all-cause survival for the general population by sex and race (white, black and all races combined) were obtained using annual U.S. life tables provided by the National Center for Health Statistics and modified by SEER. The life tables were embedded in SEER*Stat. See Expected Survival Life Tables for more information.

Relative cancer survival was then calculated using the Ederer II method 4 for all cancer sites combined and for 23 common cancer sites by sex, race (all races combined, white, and black), and age group (younger than 45, 45 to 54, 55 to 64, 6 to 74, 75 or older). See Measures of Cancer Survival for more information.

The quality and completeness of individual data items used in this analysis are discussed in a study by Wilson and others.5

References

1. Johnson CJ, Weir HK, Yin D, Niu X. The impact of patient follow-up on population-based survival ratios. Journal of Registry Management 2010;37(3):86-103.

2. Lee ET. Life-table analysis. In: Statistical Methods for Survival Data Analysis, 2nd ed. New York, NY: John Wiley & Sons, 1992: 78-100.

3. Brenner H, Hakulinen T. Patients with previous cancer should not be excluded in international comparative cancer survival studies. International Journal of Cancer 2007;121(10):2274-2278.

4. Cho H, Howlader N, Mariotto AB, Cronin KA. Estimating relative survival for cancer patients from the SEER Program using expected rates based on Ederer I versus Ederer II method. Surveillance Research Program, National Cancer Institute; 2011. Technical Report #2011-01. Available from: http://surveillance.cancer.gov/reports/.

5. Wilson RJ, O'Neil ME, Ntekop E, Zhang K, Ren Y. Coding completeness and quality of relative survival-related variables in the National Program of Cancer Registries Cancer Surveillance System, 1995-2008. Journal of Registry Management 2014;41(2):65-71.

To learn more about the methods and source of these data please refer to: Relative Cancer Survival.


Additional Information

Suggested Citation:    National Program of Cancer Registries
5 Year Relative Survival Analysis
for the years 2001-2011
from 27 States in the National Program of Cancer Registries
on CDC WONDER Online Database, February 2016.
Contact:    Contact CDC's Cancer Prevention and Control division at http://www.cdc.gov/cancer/comments.htm or e-mail CancerInfo@cdc.gov.
Notes:    Cancer survival cautions and limitations:

  • The relative cancer survival rate measures the proportion of people with cancer who will be alive at a certain time after diagnosis, given that they did not die from something other than their cancer. The relative cancer survival rate is defined as the ratio of the observed all-cause survival in a group of individuals with cancer to the expected all-cause survival of a similar group of individuals who do not have cancer. Because the expected survival of individuals who do not have cancer is difficult to obtain, it is often approximated by the expected all-cause survival of the general population. This is a reasonable approximation because cancer deaths are generally a negligible proportion of all deaths.
  • Cancer incidence data from the central cancer registry met United States Cancer Statistics (USCS) publication criteria for all years 2001-2011. The case was an invasive cancer diagnosed during 2001-2011. The age of the case was known and was between 0-99 years. The sex of the case was known. The case was not identified solely on the basis of a death certificate or autopsy. Data from 27 NPCR central cancer registries that met the USCS publication criteria and conducted linkage with the National Death Index or conducted active follow-up for all years 2001-2011, were included in the analysis. These cancer registries include: Alabama, Alaska, Arkansas, California, Colorado, Georgia, Idaho, Kansas, Kentucky, Louisiana, Maine, Maryland, Minnesota, Montana, Nebraska, New Hampshire, New Jersey, New York, North Carolina, Pennsylvania, Rhode Island, Tennessee, Texas, Vermont, West Virginia, Wisconsin and Wyoming. These data cover 59 percent of the U.S. population.
  • Five year relative survival is presented as a percentage, representing the proportion of people with cancer who will be alive at a certain time after diagnosis, given that they did not die from something other than their cancer. See Data Source Information for more information on the methodology for the calculation of relative survival figures.
  • Cancer case reports in this data set are counted by or summed by the cancer reported. For example, a single person with more than one primary cancer verified by a medical doctor is counted as a case report for each type of primary cancer reported. Having more than one primary cancer occurs in less than 20% of the population. The counts report the frequency of verified cancer diagnoses in the selected population and time period.
  • In the "All Sites Combined" category, each cancer patient is counted only once, for the first primary cancer in the time period 2001-2011. Yet for specific cancer site categories, each patient has his or her specific cancers counted individually, regardless of the primary cancer sites. Thus, the sum of the specific cancer sites is greater than the number of patients with first primary cancers reported for the 2001-2011 time period in the "All Sites Combined" category. However, when a specific cancer-site is broken out by age group, it is possible for a patient to be counted for each primary cancer, if primaries occur in different age groups. Because of the inclusion of multiple primaries in the site-specific survival analysis, the aggregated counts of subpopulations of a cancer site may not match the total case count of the cancer site.
  • The "All Races Combined" category contains other races (Asian/Pacific Islander, American Indian/Alaska Native, Other) and thus does not equal the sum of "White" and "Black or African American" categories.
  • Some larger age groups include other smaller age groups. For example, the "<65 years" category includes the cases diagnosed in the "45-54 years" age group and the "55-64 years" age group.
  • Assurance of Confidentiality:  No personal information for any patient's diagnosis and death are included. Only summary statistics are available for this analysis from CDC WONDER. Totals and sub-totals are not available as such, refer instead to the summary figures for each category, and the "all combined" categories.




This page last reviewed: Thursday, February 11, 2016
This information is provided as technical reference material. Please contact us at cwus@cdc.gov to request a simple text version of this document.
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