Presented byThomas C. Tucker, PhD, MPH

Associate DirectorMarkey Cancer Center

Cancer Prevention and Control programUniversity of Kentucky

Associate ProfessorDepartment of Epidemiology

College of Public Health

DirectorKentucky Cancer Registry

Using GIS to Reduce Colorectal Cancer Incidence and Mortality

GIS Day at UK– Nov. 17, 2011

Cancer Control in KentuckyThe Kentucky Cancer Registry develops a profile of the cancer burden for the major cancers in each of the states 15 Area Development Districts (ADD’s) and presents these data annually to the District Cancer Councils that have been established in each ADD

Most Common Cancer Control Sites62 % of Total Cancer Cases in Kentucky All genders, all races, 2001-2005

  Prostate 12%

  Lung and

Bronchus

20%

  Breast

13%  Colon & Rectum 11%

  Cervix Uteri 1%

  Me-lanoma Skin

4%

Other38%

Model for Cancer Control(Cancer control can be defined as “activities designed to reduce morbidity and mortality from cancer”)

Kentucky Cancer Program

Select Target Population

Develop Intervention

Strategy

Evaluate the Impact of

Intervention

Implement Intervention

Plan

Identify Problem

Measure Plan Act Measure

Registry Data

Other Data

Health Care Providers

Community

Health Care Providers

Others

Registry Data

Other Data

Common sources of data useful for cancer control Demographic data (Census)Risk factor data (BRFSS)Incidence data (State Cancer

Registry)Mortality data ( State Vital

Records)

Demographic Characteristics Contribute to…

Risk Factors Contribute to… Incidence

or Late Stage DX Contribute to…

Cancer Mortality

Reason for Combining Sources of Data

Logic Model

2001-2005 Lung Cancer by Area Development District in KY

Area Development District

Under Poverty

Level (%)

High School + Education

(%)

Current Smoker

(%)

Age-Adjusted Incidence Late Stage

Incidence (%)

Age-Adjusted Mortality

N Adj. Rate N Adj. Rate

US 12.4 80.4 23.1 107922 59 82.5 788812 54.1KENTUCKY 15.8 74.1 30.1 21568 101.3 80.6 16701 78.89BARREN RIVER 16.7 70.3 31.9 1358 99.24 78.2 1106 81.13BIG SANDY 27.9 59.6 35.1 1031 123.57 81.1 794 96.3BLUEGRASS 13.1 79.0 27.5 3192 95.88 80.9 2479 75.2BUFFALO TRACE 19.6 66.6 33.5 314 100.6 83.2 239 76.85CUMBERLAND VALLEY 29.1 58.0 34.8 1444 114.5 79.4 1135 90.48FIVCO 18.8 71.2 32.7 846 104.83 81.6 674 84.21GATEWAY 21.2 65.0 32.4 382 95.81 83.6 295 74.45GREEN RIVER 13.7 77.1 30.5 1146 99.1 80.1 924 79.93KENTUCKY RIVER 31.0 56.0 35.3 843 131.7 85.4 698 110.95KIPDA 11.5 81.3 27.9 4575 100.17 80.2 3445 75.8LAKE CUMBERLAND 23.0 61.3 31 1221 103.48 77.4 946 80.06LINCOLN TRAIL 12.9 76.1 30.8 1101 90.99 79.4 798 67.18NORTHERN KENTUCKY 9.0 80.6 28.5 1883 102.17 81.6 1444 79.04PENNYRILE 15.9 71.7 31.6 1132 97.39 82.1 892 76.45

PURCHASE 15.0 77.1 28.9 1100 91.12 82.5 832 68.3

50.0 55.0 60.0 65.0 70.0 75.0 80.0 85.025

27

29

31

33

35

37

39

R² = 0.802906579478174

Education vs. Current Smoker by Area Development Districts

Percent of High School + Education

Ra

te o

f C

urr

en

t S

mo

ke

rLung Cancer, 2001-2005

Lung Cancer, 2001-2005

26 28 30 32 34 3680

90

100

110

120

130

R² = 0.514498426757318

Current Smoker vs. Lung Cancer In-cidence

by Area Development Districts

Rate of Current Smoker

Lu

ng

Ca

nc

er

Inc

ide

nc

e

Lung Cancer, 2001-2005

90 100 110 120 130 14060

70

80

90

100

110

120

R² = 0.958625140771083

Lung Cancer Incidence vs. Mortality by Area Development Districts

Lung Cancer Incidence Rate

Lu

ng

Ca

nc

er

Mo

rta

lity

Ra

te

2001-2005 Lung Cancer by Area Development District Rank Sum

Area Development District

High School Ed. + Current Smoker Age-Adjusted Incidence

Age Adjusted Mortality Overall

Rank% Rank % Rank Rate Rank Rate Rank

KENTUCKY RIVER 56.0 1 35.3 1 131.7 1 110.95 1 4

BIG SANDY 59.6 3 35.1 2 123.57 2 96.3 2 9

CUMBERLAND VALLEY 58.0 2 34.8 3 114.5 3 90.48 3 11

FIVCO 71.2 8 32.7 5 104.83 4 84.21 4 21

LAKE CUMBERLAND 61.3 4 31 9 103.48 5 80.06 5 23

BUFFALO TRACE 66.6 6 33.5 4 100.6 7 76.85 7 24

BARREN RIVER 70.3 7 31.9 7 99.24 9 81.13 9 32

GATEWAY 65.0 5 32.4 6 95.81 13 74.45 13 37

NORTHERN KENTUCKY 80.6 14 28.5 13 102.17 6 79.04 6 39

PENNYRILE 71.7 9 31.6 8 97.39 11 76.45 11 39

GREEN RIVER 77.1 11 30.5 11 99.1 10 79.93 10 42

KIPDA 81.3 15 27.9 14 100.17 8 75.8 8 45

LINCOLN TRAIL 76.1 10 30.8 10 90.99 15 67.18 15 50

BLUEGRASS 79.0 13 27.5 15 95.88 12 75.2 12 52

PURCHASE 77.1 12 28.9 12 91.12 14 68.3 14 52

An Example

In 2001, Kentucky had the highest colorectal cancer incidence rate in the U.S. compared to all of the other states

In 2001, it was also noted that Kentucky was ranked 49th in colorectal cancer screening compared to all other states with the second to the lowest rate (34.7% of the age eligible population).

Using the process for cancer control that was previously described, data about the burden of colorectal cancer was assembled and presented to each of the 15 District Cancer Councils. Following these presentations, all of the District Cancer Councils implemented cancer control programs aimed at increasing colorectal cancer screening for age eligible people living in Kentucky

What has happened since the implementation of these cancer prevention and control programs?

1999 2002 2004 2006 200810

20

30

40

50

60

70

80

34.7

43.947.2

58.6

63.7

BRFSS Colorectal Cancer Screening Rates, Kentucky 1999-2008

BRFSS Colorectal Cancer Screening Rates

Year

Perc

ent

over

age 5

0 e

ver

havin

g a

c

olo

nosco

py o

r sig

moid

osco

py

Source: CDC/BRFSS Website, Accessed Jan. 2010

Kentucky is now ranked 23rd among all states in colorectal cancer screening. This is a remarkable improvement not matched by any other state. In other words, no state improved it’s colorectal cancer screening rate in such a short period of time more then Kentucky.

The increase in colorectal cancer screening has also been accompanied by a 16% decrease in both the incidence and mortality of colorectal cancer in Kentucky. It is important to note that these changes are statistically significant (P<.05). In other words, it is unlikely that these changes happened by random accident.

1999 2000 2001 2002 2003 2004 2005 200610

20

30

40

50

60

70

80

66.3 67.9 68.565 64.4

63.460.2

57.1

Colorectal Cancer Incidence, Kentucky

(1999-2006)

Incidence

Year

Rate

P<.05Source: KCR Website, Accessed Jan. 2010

1999 2000 2001 2002 2003 2004 2005 200610

15

20

25

30

35

40

45

22.623.6

22.424.1

22.820.3 20.3

18.9

Colorectal Cancer Mortality, Kentucky (1999-2006)

Mortality

Year

Rate

P<.05Source: KCR Website, Accessed Jan. 2010

Combining Cancer Surveillance Data in a

GIS Format

Cancer Control Activities

Together this can make a real difference in peoples lives

The EndQuestions