The surveillance, epidemiology, and end results program: a national resource.


The fight against cancer escalated in 1971 with the introduction of the National Cancer Act during the presidency of Richard M. Nixon. Since that time, there have been dramatic developments in a number of research areas including prevention, screening, and treatment that have had a major impact on our ability to control cancer. An integral part of the fight against cancer has been the ability to monitor the occurrence of cancer in the population and assess the impact of the introduction of advances in prevention, screening, and treatment. For more than 25 years, these functions have been performed by the SEER Program, which is based at the NCI in the Division of Cancer Control and Population Sciences. The purpose of this review is to briefly describe cancer surveillance at the NCI. The SEER Program is the centerpiece of these activities, with various surveillance and research functions arrayed around it to take full advantage of its potential. The SEER Program is a sequel to two earlier NCI programs, the End Results Program and the Third National Cancer Survey (1). Case ascertainment and data collection for the SEER Program began with January 1, 1973 diagnoses in several geographic areas of the United States and its territories. Those areas that have participated in the program since 1975 include the states of Connecticut, Iowa, New Mexico, Utah, and Hawaii and the metropolitan areas of Detroit, San Francisco/ Oakland, Seattle, and Atlanta. Subsequent additions to the program included 10 predominantly black rural counties in Georgia in 1978 and American Indians residing in Arizona in 1980. In 1992, the program was further expanded to increase coverage of minority populations, especially Hispanics. The two new areas added were Los Angeles County and four counties in the San Jose/Monterey area south of San Francisco. Alaska natives in Alaska are currently being added to those populations covered by SEER. The SEER Program currently includes population-based data from about 14% of the United States population and is reasonably representative of subsets of the different racial/ethnic groups residing in the United States. Fig. 1 provides a map of the SEER areas, and Fig. 2 gives the percentages and sizes of various populations included in the SEER Program. The issue of the representativeness of SEER areas with regard to cancer incidence is frequently raised. Fig. 3 presents some comparisons of interest for SEER areas versus the total United States based on ecological data from the 1990 census. SEER areas tend to be more urban and have a larger percentage of foreign-born individuals. This at least partially explains why SEER cancer mortality rates deviate somewhat from those for the total United States, even within racial/ethnic groups. However, with few exceptions, the trends in mortality rates for individual cancers observed for SEER areas are generally consistent with those for the total United States (2). These observations indicate that it is reasonable to assume that cancer incidence trends for SEER are generally representative of those for the total United States. The objectives of the SEER Program include: (a) developing and reporting estimates of cancer incidence and mortality on a periodic basis for the total United States; (b) monitoring annual cancer incidence trends to identify unusual changes in specific forms of cancer occurring in population subgroups defined by geographic, demographic, and social characteristics and providing insight into their etiology; (c) providing continuing information on changes over time in the extent of disease at diagnosis, trends in therapy, and associated changes in patient survival; and (d) promoting studies designed to identify factors pertaining to the environment, occupation, socioeconomic status, tobacco, diet, screening practices, patterns of care, and determinants of the length and quality of patient survival that are amenable to cancer control interventions. The primary cancer surveillance publication is the Cancer Statistics Review, which is produced annually (3). It includes data for the time period 1973 to the most recent year for which data are available. Cancer incidence, mortality, and patient survival rates and other statistics of interest are presented by anatomical site. For major cancers, the rates are also broken down by race/ethnicity and geographic area. Monographs are also produced periodically. A monograph on the histology of cancer was published in 1995 as a supplement to the journal Cancer (4). More recently, a monograph entitled Racial/Ethnic Patterns of Cancer in the United States 1988–1992 (5) provides a description of the occurrence of the major cancers among most racial/ethnic groups in the United States. A monograph on prostate cancer entitled SEER Prostate Cancer Trends, 1973–1995 (6) that provides detailed data on incidence, mortality, patient survival, and treatment is currently being published. Other monographs are in preparation, including one on childhood cancer and one on patient survival. A detailed list of SEER publications including monographs, recent reports, data collection manuals, manuals on registry operations, and training manuals pertaining to data collection are available from the SEER Web site. It is also possible to view/print many of these publications directly from the Web. Received 4/21/99; revised 6/29/99; accepted 7/8/99. The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked advertisement in accordance with 18 U.S.C. Section 1734 solely to indicate this fact. 1 To whom requests for reprints should be addressed, at Health & Human Services, National Cancer Institute, EPN, Room 343J, 6130 Executive Boulevard, Bethesda, MD 20892. 2 The abbreviations used are: SEER, Surveillance, Epidemiology, and End Results; NCI, National Cancer Institute; PC, personal computer. 3 The SEER Web site is located at 1117 Vol. 8, 1117–1121, December 1999 Cancer Epidemiology, Biomarkers & Prevention

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@article{Hankey1999TheSE, title={The surveillance, epidemiology, and end results program: a national resource.}, author={Benjamin F. Hankey and Lynn A. Gloeckler Ries and Brenda Kay Edwards}, journal={Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology}, year={1999}, volume={8 12}, pages={1117-21} }