Director's Update: October 28, 2003
In 1973, the National Cancer Institute (NCI) launched its Surveillance, Epidemiology, and End Results (SEER) Program in an effort to systematically measure the burden of cancer on our nation. As an outgrowth of earlier NCI cancer tracking systems, SEER was originally designed to collect data on cancer cases in only five states and two metropolitan areas. Over the past 30 years, however, this program has grown impressively. Today, the SEER Program is the world model for tracking population trends in cancer morbidity and mortality. Its 15 registries, which serve as the gold standard for surveillance data systems, cover 26 percent of the U.S. population and contain data that are representative of our entire population, including racial and ethnic minorities and groups living in rural areas. And, through public and private partnerships, SEER now includes expanded, quality data on risk factors; health behaviors; extent of disease; treatment; lifestyle; and quality of life for cancer survivors. Such data are central to the development of national reports (for example, the "Annual Report to the Nation on the Status of Cancer") and of statistical resources (for example, the online State Cancer Profiles).
SEER data enable three types of cancer research. Through "surveillance" activities, NCI identifies and studies cancer trends, tracks the impact of cancer on the general population, and provides information that researchers need to answer critical questions about why certain populations are affected by cancer more severely than others. Surveillance can include sentinel or early warnings, descriptive studies, health disparities, and geographic clusters. Through surveillance studies, scientists were able to identify the association between endometrial cancer and post-menopausal estrogen use in the 1970s and the relationship between Kaposi's sarcoma and AIDS in the 1980s. By efficiently analyzing cancer incidence data, researchers were able to identify the potential risk of these exposures more rapidly than they could have through epidemiologic cohort studies.
"Epidemiology" studies have benefited immensely from the SEER network, which serves as a key resource for descriptive and correlational studies of cancer in the United States as well as for population-based case-control and cohort studies. SEER data are often where changes in cancer rates are first detected, prompting follow-on studies to identify the cause of the change and risk or protective factors. Seminal epidemiologic studies using SEER data include the Agricultural Health Study - a collaborative effort developed to determine the health risk posed by agricultural pesticides and other potential hazards of farm work - and the study of environmental tobacco smoke (ETS) and lung cancer. The ETS study provided the weight of the evidence for a 1993 Environmental Protection Agency report in which ETS was first labeled as a human carcinogen.
"End results" studies are valuable to physicians and health services researchers because they elucidate patterns of cancer care, quality of life, years of survival, and the chances of developing a second malignancy among cancer patients. The Prostate Cancer Outcomes Study - a pivotal example of an end results study - is examining how prostate cancer and its treatment affect quality of life. The linkage between SEER and the comprehensive Medicare administrative database, another example of an end results study, is providing valuable information for efforts addressing the use of cancer screening and treatment, their outcomes, and the associated costs.
SEER is both a means of understanding the past and a window to the future. SEER scientists continue to enhance this network so it not only tracks cancer rates accurately but also enhances our ability to form hypotheses for cancer research, make critical scientific and public health decisions, develop and monitor prevention and control measures, and assess whether interventions are making a difference. This valuable resource is helping us to understand and measure the impact of our advancements in cancer prevention, detection, and treatment and to chart progress toward our goal of eliminating the suffering and death due to cancer.
Databases like SEER are critical to our future efforts in cancer control. Over the next year, NCI will vigorously pursue opportunities to expand and integrate databases, such as those from state cancer registries. And the creation of databases that include data from outcomes research and post-marketing surveillance of late-term side effects of drugs that have been granted accelerated FDA approval will also provide vital information for the cancer research community.
As we celebrate the 30th anniversary of this program, I invite you to visit the SEER Web site to learn more about current SEER reports and documents as well as the scientific contributions of the SEER Program over the past 30 years.
Andrew C. von Eschenbach, M.D.
Director, National Cancer Institute
|
