Greetings from Robert A. Smith, Ph.D.
Director of Cancer Screening, American Cancer Society

Dr. Smith expressed his pleasure at being able to represent the American Cancer Society (ACS) and offered some remarks from the perspective of an end user of SEER products.

The annual SEER Cancer Statistics Review provides data that serve as a source of feedback to clinicians and health workers. SEER's database contributes significant insight into absolute risks of cancer, incidence of invasive and in situ disease, staging data, survival, premature mortality, and years of potential life lost (YPLL).

For example, Dr. Smith pointed out that there has been a dramatic increase in the utilization of screening mammograms nationwide. Yet although more women are receiving screening, the mortality rate from breast cancer does not appear to be declining. He observed that there is an enormous challenge in understanding the effects of screening because current deaths from breast cancer are dominated by advanced cases that were diagnosed in the previous decade. In addition, in any given year, incidence and mortality rates reflect different underlying trends. Incidence reflects changes in risk and screening utilization, whereas mortality reflects trends in incidence over time and related factors such as stage-at-diagnosis. There has been an impressive shift in stage I and in situ disease, but diagnosis of stage III and stage IV disease has been fairly flat. Deaths from these cancers dominate near-term mortality rates and represent women who have been harder to reach.

Is screening resulting in over-diagnosis? When one looks at age-specific incidence rates in the postmenopausal period, one can see little difference among age groups. In younger women, screening has less opportunity to diagnose disease, either because of growth rates or breast density or a combination of these factors.

Dr. Smith said that SEER data can serve hypothesis generation, raising questions such as: Why are disparities increasing in groups appearing to have similar screening rates? What are the trends in tumor size and stage, and do they differ in important ways? What do these trends suggest about access to care and delivery of care? To examine these questions, a new project in Atlanta will link detection data to registry data.

Dr. Smith congratulated the SEER group and NCI on the continuation of an enormously important tool in the nation's cancer-fighting efforts.