Bidirectional Reporting of Cancer Registry Data

Michigan Cancer Surveillance Program

The field of cancer genomics is expanding and evolving rapidly. Providers and policy makers find it challenging to remain abreast of the developments in cancer genomics and determine those that are of greatest public health benefit. Through a cooperative agreement with CDC, the Michigan Department of Community Health (MDCH) Cancer Genomics Program, in partnership with the Michigan Cancer Surveillance Program (MCSP), proposed using a bidirectional reporting system to facilitate translation of cancer genomics for providers. In a three-year cooperative agreement, surveillance, provider education, and health plan policy are being conducted for two evidence-based recommendations (United States Preventive Services Task Force and Evaluation of Genomic Applications in Practice and Prevention) for Lynch syndrome and BRCA1/2.

MCSP provided MDCH with data that included selected primary cancers (breast, ovarian, colorectal, and endometrial) reported by Michigan facilities between 1990 and 2007. MDCH created unique reports for all 129 National Program of Cancer Registries (NPCR) facilities in Michigan highlighting the number of diagnoses by their facility for: female breast or endometrial cancer of a young age (< 50 years); male breast cancer; colorectal cancer; ovarian cancer; and multiple primary cancer diagnoses. These diagnoses are at risk for hereditary cancer syndromes and may benefit from increased cancer surveillance, genetic testing, or special medical management.

Between 2006 and 2007 in Michigan—

• 3,025 female breast cancers were diagnosed at a young age.
• 459 endometrial cancers were diagnosed at a young age.
• 10,340 colorectal cancers were diagnosed.
• 147 male breast cancers were diagnosed.
• 1,544 ovarian cancers were diagnosed.
• 1,985 people with selected multiple primary cancers with at least one primary cancer diagnosed in this two-year period.

In 2010, 99 NPCR facilities received surveillance reports that highlighted their reported cases for each of these diagnoses. The facility-specific reports also included evidence-based cancer genomics recommendations and a directory of cancer genetic counseling providers. These reports have been sent to about 300 key administrators with the goal of increasing the providers' cancer genomics competency. The report also helps the facilities meet the American College of Surgeons Cancer Program Patient Care Improvement Standards 6.2 or 8.2.

This is the MCSP's first bidirectional reporting system, and the first time cancer genomics education has been provided using the NPCR reporting facilities framework. MDCH is sharing this system with other cancer registries as a model for surveillance reporting of cancers that may be inherited.