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Spatial Statistics for Cancer Surveillance

Martin Kulldorff Harvard Medical School and Harvard Pilgrim Health Care

Two Applications of Spatial Data and GIS in Cancer Research

Studies of Specific Hypotheses: Evaluate the relationship between cancer and geographical variables of interest such as radon, pesticide use or income levels, adjusting for geographical variation. Surveillance: Evaluate the geographical variation of cancer, adjusting for known or suspected variables such as age, gender or income.

Reasons for Geographical Cancer Surveillance

Disease Etiology Known Etiology but Unknown Presence Health Services Public Education Outbreak Detection New Diseases

Cancer Prevention and Control

Are people in some geographical area at higher risk of brain cancer? This could be due to environmental, socio-economical, behavioral or genetic risk factors.

Cancer Prevention and Control

Are there geographical differences in the access to and/or use of early detection programs, such as mammography screening?

Cancer Prevention and Control

Are there geographical differences in the access to and/or use of state-of-the-art breast cancer treatment?

Different Types of Cancer Data

Count Data: Incidence, Mortality, Prevalence Categorical Data: Stage, Histology, Treatment Continuous Data: Survival

For Incidence and Mortality Poisson Data

Numerator: Number of Cases Denominator: Person-years at risk

For Prevalence

Bernoulli Data (0/1 Data)

Numerator: People with Thyroid Cancer Denominator: Those without Thyroid Cancer Note: When prevalence is low, a Poisson model is a very good approximation for Bernoulli data.

For Stage, Histology and Treatment Bernoulli Data (0/1 Data)

Numerator: Cases of a specific type, e.g. late stage. Denominator: All cases.

Ordinal Data
For example: Stage 1, 2, 3, 4

For Survival Survival Data

Length of Survival (Censored Data is Common)

Data Aggregation (spatial resolution)

Exact Location Census Block Group Zip Code Census Tract County State

Data Aggregation
Same level of aggregation usually needed due to data availability. Less aggregation is typically better as more information is retained. Many statistical methods can be used irrespectively of aggregation level.

Course Outline
Geographical Cancer Surveillance 1. Mapping Rates and Proportions 2. Smoothed Maps 3. Tests for Spatial Randomness 4. Spatial Scan Statistic 5. Global Clustering Tests 6. Brain Cancer Mortality 7. Survival Data

Course Outline
Space-Time Cancer Surveillance 8. Space-Time Scan Statistic for the Early Detection of Disease Outbreaks
Statistical Software 9. SaTScan Demonstration

Comments and Questions


Software and Slide Presentation