Georgia epidemiology report, Vol. 16, no. 8 (Aug. 2000)

August 2000

volume 16 number 8

Division of Public Health http://health.state.ga.us
Kathleen E. Toomey, M.D., M.P.H. Director
State Health Officer
Epidemiology Branch http://health.state.ga.us/epi
Paul A. Blake, M.D., M.P.H. Director
State Epidemiologist
Mel Ralston Public Health Advisor
Georgia Epidemiology Report Editorial Board
Carol A. Hoban, M.S., M.P.H. - Editor Kathryn E. Arnold, M.D. Paul A. Blake, M.D., M.P.H.
Susan Lance-Parker, D.V.M., Ph.D. Kathleen E. Toomey, M.D., M.P.H.
Angela Alexander - Mailing List Jimmy Clanton, Jr. - Graphics
Georgia Department of Human Resources
Division of Public Health Epidemiology Branch Two Peachtree St., N.W. Atlanta, GA 30303-3186 Phone: (404) 657-2588 Fax: (404) 657-2608
Please send comments to: Gaepinfo@dhr.state.ga.us
The Georgia Epidemiology Report is a publication of the Epidemiology Branch,
Division of Public Health, Georgia Department of Human Resources

Georgia Comprehensive Cancer Registry
I. Summary & Highlights:
The Georgia Comprehensive Cancer Registry (Registry) was established to help Georgia health professionals at all levels better understand and address the cancer burden. The Registry provides data to estimate cancer incidence rates within Georgia, monitor cancer trends, evaluate possible clusters of cancer, respond to inquiries about cancer from the public, and conduct research. Data from the Registry help state and local agencies focus early detection programs and efforts to prevent and reduce risk behaviors, such as tobacco use and prolonged sun exposure. Data from the Registry are essential for identifying when and where Georgias cancer screening efforts should be enhanced and help prioritize health resource allocations.
For the data in the Registry to be used with confidence, at least 90% of the newly diagnosed cancer cases must be included. In 1997, the most recent year for which reporting is complete, only 72 % of the expected new cases of cancer were reported. With reporting completeness of less than 90%, cancer incidence will be underestimated, giving a false impression of the magnitude of the cancer problem in Georgia.
II. Background:
Cancer is the second leading cause of death in Georgia. The Georgia Division of Public Health estimates that 36,000 new cancer cases will be diagnosed and 13,000 people will die from cancer in Georgia in 2000; these estimates do not include cancer in situ or basal and squamous cell skin cancer. It is estimated that cancer costs the United States around $107 billion dollars annually, including health care expenditures and lost productivity from illness and death. According to the American Cancer Society, more than 380,000 lives could be saved annually through effective cancer control efforts directed at primary prevention such as tobacco prevention, prevention of over exposure to sun, nutrition and physical activity. Many more cancer deaths could be prevented through secondary cancer control efforts aimed at early detection and treatment.
III. Need for the Registry:
Cancer registry data are important because of their potential use by cancer control programs in all phases of prevention. Knowing how often and where each type of cancer occurs within the population helps focus limited resources and helps determine if primary and secondary prevention efforts have been effective. A decrease in cancer incidence can indicate successful efforts in the prevention of cancer; for instance, the decreasing trend in cervical cancer incidence in the United States is due to the introduction of Pap smear screening and the treatment of precancerous lesions. Conversely, the increasing trend in the prevalence of smoking among women is reflected in increasing rates of lung cancer. In other cases, the cause or causes of changes in cancer incidence may not be apparent, indicating the need for more research. For example, prostate cancer mortality increased from 1980 through 1992 and has fallen since 1993. These changes may be due to the interaction of multiple factors and need to be further investigated.
District Health Director Positions Available - p. 3

Cancer is a common concern among Georgia citizens and reports of what is perceived to be a high number of cancers in a neighborhood are often reported. Most often, clusters of cancer cases are due to known risk factors. For example, older people may congregate in neighborhoods, or people with similar smoking, sunlight exposure, diet, physical activity, or sexual behaviors may congregate. The Registry data can help identify true cancer clusters that need further investigation. Using Registry data, the Division of Public Health responded to 80 inquiries from the public and health professionals in 1999. The Registry also participates in national studies to further understand the relationship between risk factors such as diet on cancer, to evaluate the long term effectiveness of breast cancer screening and early detection, as well as to evaluate the effect of access to state-of-the-art treatment on survival among children with cancer.
A systematic look at the cancer data and their distribution within the population leads to important developments in cancer prevention and control. On-going review of the Registry data allows the state to be responsive to its citizens and to prevent early cancer deaths.

licensed beds are required to report either electronically or by photocopying the medical records of the reportable cases (Figure 1).
3. Outpatient diagnostic and/or treatment facilities and independent laboratory facilities are required to report annually. In January of each year, these facilities should send to the Registry a list of all cancer patients diagnosed and/or treated in the previous calendar year (Table 1), but do not have to submit all required data fields. The Registry matches the list against the cancer registry database. For the few cases that are not already in the Registry database, the facility is asked to report additional information.
B. Development and Implementation of Statewide Training:
1. Within the last three years the Registry conducted twelve cancer registry training courses targeted to hospitals and nonhospital based facilities.

III. The Problem:
For the Registry to be useful, at least 90% of incident cases must be reported. Reporting to the Georgia Comprehensive Cancer Registry is complete only for 1995, the first year cancer incidence data were required to be reported by all health care providers. As of March, 2000, reporting for 1995 was 93% complete, 1996 75% complete, 1997 72% complete, and 1998 only 51% complete. The primary reason for incomplete data is that 19 hospitals and many outpatient diagnostic and/or treatment facilities do not report at all or do not report adequately. Review of Registry data indicates that if all hospitals, large laboratories, outpatient treatment, and diagnostic facilities reported all newly diagnosed cancer cases adequately the cancer registry data would be more than 90% complete.
IV. Steps taken to Expand the Georgia Comprehensive Cancer Registry Statewide:
A. Development and Enforcement of Policies and Procedures: Cancer was made a reportable disease in 1989 in Georgia, but not until May 1997 were all health care providers including physicians, hospitals, laboratories and free-standing diagnostic and/or treatment facilities required to report all cancers to the Department of Human Resources Georgia Comprehensive Cancer Registry.
In 1997, the most recent year for which reporting should be complete, 2,970 (72%) of the expected 32,000 cases were reported. Reporting is incomplete because 12% of hospitals and 69% of independent diagnostic and/or treatment facilities did not report. To improve reporting, the following procedures have been put in place:
1. Within the last three years the Registry has developed two Policy and Procedure Manuals, one for hospital based facilities and one for non-hospital based facilities.
2. Hospitals are required to report cancer data monthly to the Registry. Hospitals with 100 licensed beds or more are required to report electronically; hospitals with less than 100

2. Regional cancer registry coordinators are being hired to provide on site technical assistance, training, and coordination. For Registry purposes, the state has been divided into five regions: central, east, north, southeast, and southwest. Regional cancer registry coordinators have been hired in the southeast, southwest and east regions.
3. The Registry in collaboration with the Centers for Disease Control and Prevention (CDC) developed a cancer registry software Abstract Plus, and made it available free of charge to hospitals statewide. The Registry provided technical support and training in use of the software.
C. Use of cancer data: Epidemiologists with the Registry analyzed Georgia cancer mortality data from 1992-1996 and 1994-1998, and placed the 1992-1996 cancer mortality rates on the Georgia Public Health web site at, http://health.state.ga.us/programs/cancer/ stats.shtml. They are working to make the 1994-1998 cancer mortality report available in hard copy as well as on the public health web site. The Registry conducted additional analyses of cancer morbidity and mortality data, and produced cancer estimates for health care professionals and different public health programs. The Registry provided cancer data to the following cancer studies: the AARP study on Diet and Cancer, Childhood Cancer Clinical Trial: Who Has Access and the Breast Cancer Detection Demonstration Project Cancer Record Linkage Study to further our knowledge of cancer .
V. Future Directions:
To improve completeness of the cancer registry data and to increase use of these data, the Registry plans to: (1) implement new strategies to encourage the remaining non-reporting hospitals and large outpatient diagnostic and/or treatment facilities to report; (2) survey independent facilities and physicians to estimate the number of cancer cases that are currently not being reported; (3) produce the Georgia Cancer Data Report 2000 in collaboration with the American Cancer Society, Southeast Division; and (4) post the Georgia five year cancer mortality rates, and the number of reported cancer cases on the Georgia Division of Public Health web site.

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VI. Conclusion:

The Registrys goal is to have complete cancer incidence data for use by health care professionals in Georgia. Presently cancer incidence data are complete only for 1995. The Registry needs the help of all health care professionals to improve the quality of data for 1996 to present. Data will be used to monitor cancer incidence in Georgia, evaluate possible clusters, respond to public and professional inquiries, conduct research, and describe the cancer burden in Georgia. For more information call Rana Bayakly, 404-657-6611, Cancer Control Section, Division of Public Health, Georgia Department of Human Resources.

Table 1. Information* to be submitted by independent treatment and/ or diagnostic and laboratory facilities.

Variable Name Patient Last Name Patient First Name Sex Race Date of Birth Social Security Number Cancer Site Laterality Histology

Variable Name Behavior Grade Treatment Start Date Date of Last Contact Medical Record Number Patient Address County State

*For Specific coding instructions see, the Non-Hospital Based Policy and Procedure Manual or Contact Rana Bayakly at 404-657-6611.

This article was written by A. Rana Bayakly, M.P.H.

Figure 1. Algorithm to determine if case needs to be reported.

Was initial diagnosis of this cancer made on or before
01/01/1995, or is date of diagnosis
unknown?

YES

NO

Did patient have cancer while an inpatient or
outpatient at your facility?

YES

NO

Do Not Report

Has your facility previously reported this case?

Was any cancer directed therapy given or planned for this patient while an inpatient or outpatient
at your facility?

YES Do Not Report

NO YES
Report this case

NO Do Not Report

District Health Director Positions Available
The Division of Public Health, Georgia Department of Human Resources, is seeking two (2) experienced professional physicians to serve as District Health Directors in Brunswick and Dalton, Georgia. The District Health Directors have full responsibility for directing, planning, developing, and managing all clinical, administrative, and operational programs in the public health regions including environmental and epidemiological services. The District Health Director is responsible for the leadership of approximately 235 professional, technical, and administrative staff, with fiscal responsibility for approximately $12 million in state, county and federal funds annually. The incumbent serves as executive officer for each of the six (6) individual county boards of health within the District. Other responsibilities include developing organizational structures and staffing patterns for program delivery services in compliance with applicable policies, rules, and regulations.
The Coastal Brunswick District is in the beautiful coastal region of Georgia, with a population of 216,000. Brunswick is approximately 320 miles south of Atlanta. The Northwest Georgia District is in the beautiful mountain region of Georgia, with a population of 237,000. Dalton is approximately 88 miles north of Atlanta. The candidate selected will join a team of public health leaders at the local, district and state levels with substantial public health experience and a strong commitment to community-based health improvement.
Qualifications: Applicants must have a valid medical license from any state; once hired, a Georgia medical license will be required. Applicant must have at least two (2) years of professional management experience in public health or preventive medicine. A Masters Degree in Public Health is desirable. The compensation package includes an excellent salary and participation in our comprehensive benefits program. These positions will remain open until filled. Please send curriculum vitae to Georgia Department of Human Resources, Two Peachtree Street NW, Office 28.262, Atlanta, Georgia 30303-3142. Attn. Office of Human Resources. Please indicate position # 72390 for Brunswick and position # 72375 for Dalton. For additional information call 404-657-2733.
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The Georgia Epidemiology Report Epidemiology Branch Two Peachtree St., NW Atlanta, GA 30303-3186

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August 2000

Volume 16 Number 8

Reported Cases of Selected Notifiable Diseases in Georgia Profile* for May 2000

Selected Notifiable Diseases

Total Reported for May 2000
2000

Previous 3 Months Total Ending in May
1998 1999 2000

Previous 12 Months Total Ending in May
1998 1999 2000

Campylobacteriosis

61

Chlamydia genital infection

2660

Cryptosporidiosis

7

E. coli O157:H7

4

Giardiasis

82

Gonorrhea

1527

Haemophilus influenzae (invasive)

5

Hepatitis A (acute)

21

Hepatitis B (acute)

23

Legionellosis

0

Lyme Disease

0

Meningococcal Disease (invasive)

5

Mumps

0

Pertussis

0

Rubella

0

Salmonellosis

102

Shigellosis

22

Syphilis - Primary

12

Syphilis - Secondary

18

Syphilis - Early Latent

36

Syphilis - Other**

47

Syphilis - Congenital

2

Tuberculosis

81

174

185

153

6418

9480

7328

24

48

30

3

4

7

220

237

257

5154

5708

4116

11

24

26

230

149

66

69

44

62

3

0

3

2

0

0

24

24

13

1

1

1

11

11

5

0

0

0

228

310

257

295

64

72

34

26

34

72

57

76

225

206

152

208

176

121

2

3

5

147

154

193

836 16733
107 27 1001 16290 50 883 281 7 12 109 2 22 0 1356 1283 148 305 978 996 15 616

817 27850
194 84 1297 20755 79 772 166 5 1 81 2 40 0 1973 810 120 240 804 797 22 613

628 30601
151 47 1362 20789 85 349 253 9 0 65 5 57 0 1885 291 146 300 629 735 18 686

* The cumulative numbers in the above table reflect the date the disease was first diagnosed rather than the date the report was received at the state office, and therefore are subject to change over time due to late reporting. The 3 month delay in the disease profile for a given month is designed to minimize any changes that may occur. This method of summarizing data is expected to provide a better overall measure of disease trends and patterns in Georgia.
** Other syphilis includes latent (unknown duration), late latent, late with symptomatic manifestations, and neurosyphilis.

Report Period
Latest 12 Months: 6/99 - 5/00 Five Years Ago: 6/94 - 5/95 Cumulative: 7/81 - 5/00

Total Cases Reported*

Percent Female

AIDS Profile Update
Risk Group Distribution (%) MSM IDU MSM&IDU HS Blood

Unknown

1258

26.8

29.5

13.2

2.8

16.5

1.3

36.7

2387

18.8

45.9

21.9

6

14.5

1.9

9.7

21837

16.2

49.4

18.7

5.7

13

1.9

11.2

MSM - Men having sex with men

IDU - Injection drug users

HS - Heterosexual

* Case totals are accumulated by date of report to the Epidemiology Section

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Race Distribution (%) White Black Other

19.1 78.2

2.7

34.5 63.6

1.9

36.6 61.4

2.1