Glenn A, West G, Flanary M, Helmer L, Wells B, Boyd K (Group 4)

Dr. Karen Lankisch

HCMT 1005C 001
26 October 2014
Kentucky Cancer Registrys Annual Report Summary
In 1990 the Kentucky Cancer Registry was established by legislation. All cancer cases in
the state of Kentucky are mandated to be reported to the registry and are acquired from hospitals,
medical staffs, tumor registrars, health information personnel, freestanding treatment centers,
private pathology labs and physician offices. In December 2008 The Kentucky Cancer Registry
provided an annual report of cancer incidence and mortality, including a special report on
colorectal cancer, in Kentucky from 2001 to 2005. The following is a summary of the report.
The report contains data from the Kentucky Cancer Registry and is compared to data for
U.S. national cases of cancer at the same time, provided by the SEER program. The cancer
incidence rates for both Kentucky and national are age-adjusted by the direct method by using
the 2002 U.S. standard million population. The Kentucky Cancer Registry has attained case
completeness with a range of 101.75% to 106.84% for the NAACCR method and has been
audited since 1995. The report cautions when interpreting data for small counties or racial groups
as the ratios may be misleading and describes the difference between crude rates and ageadjusted rates; age-adjusted rates help compare counties with large proportions of older people to
counties with less.
The report begins with an overview of cancer incidence and mortality rates in Kentucky
as compared to the nation. Graph 1 illustrates the data compared in the annual report. A table of
cancer cases listed by site are compared overall, Kentucky versus U.S. and then broken down by

Kentucky male versus U.S. male and Kentucky female versus U.S. female. This table highlights
areas that Kentucky has higher rates than U.S. rates in red; some of the higher rates include oral
cavity & pharynx, melanoma of the skin, urinary bladder, and Hodgkins Disease.
Cancer incidence rates that stand out are all sites, colon & rectum overall, Kentucky
59.3% to 49.2% U.S., lung & bronchus, Kentucky 101.2% to 59.0% in the overall category,
136.2% to 73.1% in the male category and 76.2% to 48.7% in the female category. The report
states that Kentucky has an 11.8% higher rate for all sites of incidence than for all sites of
incidence for the United States and predicted that 23, 270 Kentuckians would be diagnosed with
cancer in 2008. A second table for cancer mortality in Kentucky also highlights areas where
Kentucky is higher than U.S., areas included are same as areas in the incidence table. All sites
for mortality list Kentucky with 221.5% to 189.8% for U.S., colon & rectum list Kentucky males
with a rate of 26.6% to U.S. males rate of 22.7% and Kentucky females 18.8% to 15.9% for
U.S. Other areas Kentucky is higher in mortality rates include lung & bronchus, melanoma,
breast cancer, cervix (female), urinary bladder, kidney & renal pelvis, brain & other nervous
system, Hodgkins and Non-Hodgkins, and Leukemias. The report predicted that approximately
9,500 Kentuckians would die from cancer in 2008.
Colorectal cancer (CRC) is the third most commonly occurring cancer in men and
women. This particular cancer accounts for 9% of all cancer deaths in the United States. It is
estimated that there will be 148,810 new cases of CRC in the United States in 2008 resulting in
49,960 deaths according to the American Cancer Society. In Kentucky CRC has both incidence
and mortality rates that are higher than the United States average. Graphs 2 and 3 illustrate the
comparison between the incidence and mortality rates for the United States and Kentucky.

During 2001-2005 there were 12,520 cases of invasive CRC diagnosed in Kentucky.
These diagnoses can be broken down by men and women, 6,330 (50.6%) and 5,910 (49.4%)
respectively. CRC diagnoses can be further broken down by race; white, black, and unknownand age; under 50, 50-70, and over 70 years of age.
The National Cancer Institutes (NCI) SEER program the age-adjusted incidence and
mortality rates were higher in Kentucky than in the United States from 2001-2005. During this
same time period CRC incidence and mortality rates in the United States were higher for men
than women and blacks in the United States have higher age-adjusted incidence and mortality
rates than whites by 24.3%. In addition the incidence rates for men and women in Kentucky are
both higher than the rates of the United States. These rates vary by race, and similarly blacks in
Kentucky hold higher incidence and mortality rates than whites, both being higher than the rates
of blacks and whites in the United States.
There is a high percentage of CRC that is diagnosed in late stages, although there have
been increased screening efforts to detect CRC in earlier stages. There were 57.9% of cases
classified as late stage diagnosed from 2001-2005. Kentucky has a lower percentage of new CRC
cases diagnosed in later stages than that of rates for the United States. Of these men had lower
rates for late stage diagnoses than women in Kentucky, additionally blacks in Kentucky had a
higher rate of late stage diagnoses than whites.
According to the American Cancer Society guidelines, adults over the age of 50 should
participate in regular CRC screening. There is a low rate of CRC screening in the United States.
Only 26.5% of adults over 50 years old have been screened in in the two years before 2004,
according to the Behavioral Risk Factor Surveillance System. Of this percentage more men than
women reported having screening including sigmoidoscopy or colonoscopy. In Kentucky these

rates are lower than the United States rates. Only 24% of adults have reported screenings in the
same time frame in Kentucky. Contrastingly more women than men in Kentucky have has
screening including sigmoidoscopy or colonoscopy. Graphs 4 and 5 illustrate the rates of
diagnosis for both early and late stage cases.
There are 51 counties out of 120 in Kentucky that are classified as Appalachian. The ageadjusted incidence rates of CRC in Appalachian Kentucky was higher than that of NonAppalachian Kentucky. The mortality rates in Appalachian Kentucky are similar to those of
Non-Appalachian Kentucky. There were 3,734 CRC cases in Appalachian Kentucky, of these
52% were diagnosed in later stages. This is a higher percentage of those in Non-Appalachian
Kentucky diagnosed in later stages. The incidence rate and mortality rates for women in
Appalachian Kentucky was higher than those in Non-Appalachian Kentucky. For men it was the
opposite with men holding a higher rate than those in Appalachian Kentucky were as the
mortality rates were similar.
In regards to urban and rural areas, the age-adjusted incidence rate for CRC in urban
Kentucky was slightly higher than rural Kentucky rates. In Kentucky urban men, women, blacks
and whites have higher incidence rates than those living in rural areas. Urban Kentucky also held
a higher rate of late stage diagnosis than rural areas. In urban Kentucky CRC mortality rates was
higher than that of rural areas. Men and blacks in Kentucky have higher mortality rates than men
in rural areas, with whites holding similar rates.
There are screening methods available for CRC, in spite of these methods being available
the rates in Kentucky fall below that of the national average. Taking in account of the rates for
incidence and mortality rates within the state of Kentucky it is a fair assessment that more
aggressive and collaborative efforts need to be taken within the state. In specific populations and

regions these methods are needed more than others in order to lower the rates of morbidity and
mortality from CRC.
All of the information located in this report can be found at the Kentucky Cancer
Registries website www.kcr.uky.edu. This website was created in order to provide user friendly
information and data on cancer to the public. Information on cancer incidence data reported to
the KCR was first provided to the online world in 1995. In 2002, the website was updated to
include both incidence and mortality data to the public.
The information and data presented by this website is available to the public and private
sectors in order to understand trends and occurrence of cancer cases in Kentucky. The
information provided from this website is used to plan and maintain appropriate care for cancer
patients, develop and implement programs in certain ADDs, and allocation of healthcare
resources.
The Kentucky Cancer Registry recognizes types of data that can be released for purposes
of surveillance and research. There are four recognized categories or levels that can be released
for cancer research and surveillance according to the Kentucky Cancer Registry. Anyone who
wants to use data from the registry for any type of research purpose has to complete an
application that must be reviewed by the KCR review panel. These applications need to include a
detail description of the research proposal along with assurances of the maintenance of the
confidentiality of all sensitive data. In addition all studies levels two through four must include
approval documentation by a constituted institutional review board or human subjects review
committee. All population based research studies are dedicated to the understanding, prevention,
and treating of cancer.

A level 1 project is a report of data stratified by non-confidential data fields including

race, sex, or county of residence and their case counts. A level 2 project presents data files which
contain individual, record-level data without personal identifiers. A level 3 project presents files
containing individual record-level data without personal identifiers that are used in order to
record any linkage either electronic or manual, without patient contact. Level 4 projects are
requests for files that contain individual, record-level data with personal identifiers that are used
for research purposes involving direct contact with patients or their families. During the 20072008 year a number of research projects were conducted in conjunction with the Kentucky
Cancer Registry including three level 1 projects, seven level 2 projects, four level 3 projects, and
two level 4 projects. View table 1 for full details on all projects and data requests.

Graph 1: Cancer Mortality in Kentucky versus the United States, 2001-2005

Type of Cancer

Cancer Mortality in Kentucky 2001 - 2005

Leukemias
Hodgkins Disease
Brain & Other Nervous System
Urinary Bladder
Prostate (male only)
Corpus Uteri (female only)
Breast (female)
Lung & Bronchus
Liver & Intrahepatic Bile Duct
Stomach
All Sites
0

50

100

150

200

250

Percentage Rates of Mortality Cases

US**

KY*

Graph 2: Colorectal Cancer Incidence Rates for Kentucky versus the United States, 2001-2005

Colorectal Cancer Incidence

U.S. Men

KY Men

U.S. Women

KY Women

90
81.3

TOTAL PERCENTAGE

80
70
60
50
40

70.3
57.3
51.4
42.9

70.1
65.5

69.8

53.9

56.5
50.6
42

30
20
10
0
All

Black
SUBGROUP CLASSIFICATIONS

White

Graph 3: Colorectal Cancer Mortality Rates for Kentucky versus the United States, 2001-2005

Colorectal Cancer Mortality

U.S. Men
35

TOTAL PERCENTAGE

26.6
22.7

20
15

U.S. Women

KY Women

33.2
31.8
30.1

30
25

KY Men

26.2
22.4

18.8
15.9

22.1
18.2
15.3

10
5
0
All

Black
SUBGROUP CLASSIFCATIONS

Graph 4: Early Stage Colorectal Cancer Diagnosis, 2001-2005

White

Total Percentages

Early Stage Colorectal Cancer

Diagnosis, 2001-2005
42.70% 41.40%

MALE

48.80%
41.40%

37.50%

FEMALE

42.70%

45.70%

BLACK

49.40%

WHITE

Subgroup of those Diagnosed

United States

Kentucky

Graph 5: Late State Colorectal Cancer Diagnosis, 2001-2005

Total Percentages

Late Stage Colorectal Cancer

Diagnosis, 2001-2005
57.30%

58.60%
49.50%

MALE

62.50%
51.20%

FEMALE

54.30%

BLACK

Subgroup of those Diagnosed

United States

Kentucky

57.30%

50.60%

WHITE

Table 1: Compilation of all the requests and projects done in conjunction with the Kentucky

Name

Level

Principal Investigators

Location

Li Li, MS, Senior Clinical Information Analyst

Co
Investigators
None

Norton Healthcare
Quality Report
Norton Healthcare:
Examining Disparities in
Cancer
Evaluation of a Local
Pilot Cancer Control
Program
Prostate Cancer
Treatment Efficacy
Disparities in Stage at
Diagnosis Among
Adults with Oral Cancer
in Kentucky
Disparities in Access to
Screening
Mammography in the
Rural South
Radon, Tobacco
Smoke, and Lung
Cancer in Kentucky
Development of Breast
Cancer Recurrence
Prediction Model Using
Machine Learning
Algorithm
Geographic Disparities
in Gynecologic Cancer
Incidence and
Mortality in Kentucky
Patterns of Cancer Care
in Kentucky

1
1

Tina Hembree, MPH, Program Coordinator

None

Norton Cancer Institute, Prevention and Early Detection, Louisville,

Kentucky

Brittney Thomas, BA, MPH candidate

None

University of Kentucky, College of Public Health, Lexington, KY

David Clark, MPH, DrPH candidate

None

University of Kentucky, College of Public Health, Lexington, KY

Juan F. Yepes, DDS, MD, MPH candidate

None

University of Kentucky, College of Dentistry, Lexington, KY

Linda Elting, DrPH, MD

None

Anderson Cancer Center, Health Services Research, Houston, TX

Gwendolyn Hayes, MS, ARNP, PhD/MPH

candidate

None

University of Kentucky, College of Nursing, Lexington, KY

Sujin Kim, PhD

None

University of Kentucky, School of Library and Information Science,

Lexington, KY

Mary Gordinear, MD

Carol
Hanchette,
PhD

University of Louisville, James G. Brown Cancer Center, Louisville,

KY

Ramesh Gupta, PhD

Frank Groves,
MD, MPH

University of Louisville, School of Medicine, Louisville, KY

The Black Womens

Health Study
Health Effects of
Occupational Exposure
in Paducah Gaseous
Diffusion Plant Workers
Smoking and Cervical
Cancer Survival
Adjuvant Treatment
Decision Making for
Lung Cancer
Insulin-like Growth
Factors, Diet and Risk
of Colon Cancer: A
Population-Based CaseControl Study
Differences in Quality
of Life Between Rural
and Urban Dwelling
Cancer Survivors

Lynn Rosenberg, ScD

None

Boston University, Boston MA

David J. Tollerud, MD, MPH

Gail Brion
PhD,

University of Louisville, School of Public Health and Information

Sciences, Louisville, KY

Anna Coker, PhD

None

Jamie L. Studts, PhD

None

University of Kentucky, Department of Obstetrics and Gynecology,

Lexington, KY
University of Kentucky, College of Medicine, Department of
Behavioral Science, Lexington, KY

Li Li, MD, PhD

Thomas C.
Tucker, PhD,
MPH

Case Western Reserve University, Cleveland, OH

Michael Andrykowski, PhD

None

University of Kentucky, Department of Behavioral Science,

Lexington, KY

Cancer Registry 2007-2008

Norton Healthcare, Louisville, Kentucky

Additional Information Gathered from the Kentucky Cancer Registrys Annual Report
From the report, determine if a vendor is used to develop the information.

Data for this report was obtained from the Kentucky Cancer Registry. The KCR retained
case records of each cancer seen at any of the Kentucky acute care hospitals and freestanding outpatient diagnostic and treatment facilities since January 1995. All
information of new cancer cases was abstracted by a hospital based tumor registrar or by
a KCR regional abstractor, who have received formal training for cancer case abstracting
in the KCR format.

Also, determine what data security methods are used for the system.

Abstracting of data conforms to the guidelines established by the American College of

Surgeons for cancer registries and by the Surveillance, Epidemiology and End Results
Programs of the National Cancer Institute. KCR uses well-established and tested
procedures to ensure no duplicate cases are counted.

What if any measures are taken to ensure confidentiality of the data?

All cases included in the Kentucky Cancer Registry are classified according to the
International Classification of Disease for Oncology (ICD-O), third edition.

References
Kentucky Cancer Registry. (2013, October 2). Retrieved from http://www.kcr.uky.edu
Tucker, PhD, MPH director, T. C. (2008). Annual Report Cancer Incidence and Mortality, 20012005. Retrieved from Kentucky Cancer Registry website: http://www.kcr.uky.edu/KCR
AnnualReport08.pdf