Cancer Statistics - Karmanos Cancer Institute

Cancer Statistics 

in Metropolitan Detroit 2008 

Metropolitan Detroit Cancer Surveillance System 

Surveillance, Epidemiology and End Results Program 

February 2008

Table of Contents 

Metropolitan Detroit Cancer Surveillance System (MDCSS): 

SEER Program Description and Goals 2 

Geographic Coverage Area: Metropolitan Detroit 3 

Population by Age and Gender, Race/Ethnicity 

Metropolitan Detroit, 2004 4 

Michigan Department of Community Health Collaboration 5 

MDCSS Authority to Collect Cancer Information 6 

Temporal Trends in Metropolitan Detroit 7 

Cancer Incidence, Mortality and Age-Adjusted Rates per 

100,000 Population by Site, Race and Sex, Metropolitan 

Detroit, 2004 — All Races 8 - 9 



Detroit, 2004 — Caucasian 10 - 11 



Detroit, 2004 — African-American 12 - 13 

Survival Analysis of Prostate Cancer by Stage 14 

Survival Analysis of Female Breast Cancer by Stage 15 

Survival Analysis of Lung Cancer by Stage 16 

Survival Analysis of Colorectal Cancer by Stage 17 

2007 Annual Scientific Conference of the North American 

Association of Central Cancer Registries (NAACCR) 18 

Gender Differences in Lung Cancer Survival 19 

Cancer in the Arab and Chaldean American Population 

in the Metropolitan Detroit Area 20 - 21 

Arsenic and Cancer of the Urinary Bladder 22 

Differences in Completeness of Follow-up 

in a Population-Based Cancer Registry 23 

External Investigators: Use of MDCSS Data 24 

List of Studies Conducted at the MDCSS 25 - 26 

List of MDCSS/Detroit SEER Publications 2005-2007 27 - 29 

Affiliations and Acknowledgements 30 

MDCSS Participating Institutions 31 

Appendix A 

Michigan Public Health Code (Excerpts) 32-33 

Health Insurance Portability 

and Accountability Act of 1996 (Excerpts) 34 

Appendix B 

State of Michigan Letter of Authority 35 

Credits 36

Metropolitan Detroit Cancer Surveillance System (MDCSS) 

SEER Program Description and Goals 

Program Description 

Program Goals 

2 

The Metropolitan Detroit Cancer Surveillance System (MDCSS) 

has been recording data on cancer in Wayne, Oakland and Macomb 

Counties since 1973. Cancer is a reportable disease under State of 

Michigan law. The MDCSS is the arm of the Michigan Department 

of Community Health (MDCH) for the collection and reporting of 

cancer data for residents of the tri-county area. The MDCSS is also 

one of 18 cancer registries in the United States providing data to 

the National Cancer Institute as part of the Surveillance, Epidemiology 

and End Results (SEER) Program. The SEER Program was established 

by the National Cancer Act in 1971. The MDCSS is a founding 

participant in that program and is now completing its 34th year of 

data collection as a SEER Registry. 

The MDCSS has a staff of more than 50 people who collect data 

from hospitals, laboratories and other facilities that serve cancer 

patients. A follow-up program tracks more than 95% of the cancer 

survivors diagnosed since 1973, providing yearly updates on their 

status. Funding for the registry is provided by the National Cancer 

Institute to Wayne State University. Additional funding for research 

studies is provided by the National Cancer Institute and other 

agencies through grants and contracts and distributed to university, 

state and national researchers investigating cancer-related topics. 

Strict rules are in place to preserve the confidentiality of individual 

patient information and the hospitals and physicians that 

provide the data. 

The national SEER Program collects cancer data on approximately 

26% of the United States population. Participating registries are 

chosen in part for the special populations represented within their 

borders. The Detroit tri-county area is an ideal location because of 

its urban, industrial setting and diverse population. The goals of the 

Detroit SEER Program are to: 

1. Assemble and report estimates of cancer incidence, survival 

and mortality in the tri-county area. 

2. Monitor annual cancer trends to identify unusual changes 

in specific forms of cancer in population subgroups. 

3. Provide continuing information on changes over time in the 

extent of disease at diagnosis, therapy and patient survival. 

4. Promote and conduct studies designed to identify factors leading 

to cancer causes, prevention and control. 

5. Respond to requests from individuals and organizations for 

data on cancer in the tri-county area. 

Over the past 34 years, we have seen remarkable improvements in 

cancer diagnosis and therapy. We have learned that by getting regular 

physical exercise, following a healthy diet and quitting smoking 

and other types of tobacco use, we can greatly reduce our risk of 

developing certain types of cancer. We have also learned that early 

detection of cancer through self-examination and regular health 

checkups can improve cancer survival.

Geographic Coverage Area: 

Metropolitan Detroit 

The MDCSS and the Detroit 

SEER Program provide reporting 

for Wayne, Oakland and 

Macomb counties in southeastern 

Michigan. These three 

counties are home to 4,043,467 

people, approximately 41% 

of the total state population. 

(2000 US Census.) There are 

2,061,162 individuals residing 

in Wayne County, 46% of these 

in the City of Detroit, which 

has a population of 951,270. 

Oakland County residents 

number 1,194,156 and Macomb 

County has the smallest population 

of the three, with 788,149 

residents. As of the 2000 census, 

about 69% of the population 

in the tri-county area were 

Caucasian and 25% African 

American. An additional 6% 

of the population were of 

other races, primarily Asian 

and Native American. Persons 

of Hispanic origin made up 

about 3% of the total population. 

The tri-county area also 

has great ethnic diversity, 

which includes groups of 

Polish-, German-, Italian-, 

and Arab-Americans. 

In 2004, there were 24,408 new 

invasive and in situ cancers 

diagnosed in residents of the 

Detroit Metropolitan tri-county 

area. This is about half the number 

reported for the entire state. 

Because of the large population 

encompassed in the Detroit 

Metropolitan area and the diversity 

found here, the MDCSS 

is especially vital to both the 

State of Michigan and National 

Cancer statistics reporting. 

Newly Diagnosed Invasive and In Situ Cancers 

in the Metropolitan Detroit Area (2004) 

11,932 

7,275 

5,201 

New Cancers 

Wayne County 


Oakland County 


Macomb County 

3

Population by Age, Gender and Race/Ethnicity 

in Metropolitan Detroit, 2004 

OAKLAND 

MACOMB 

WAYNE 

4 

CAUCASIAN AFRICAN-AMERICAN Hispanic * ASIAN/pacific Other ** All Races 

Age Male Female Male Female Male Female Male Female Male Female Male Female 

0 years 18,129 17,021 8,320 7,896 1,561 1,459 1,419 1,339 51 39 27,919 26,295 

01-04 years 73,755 70,104 33,097 32,017 5,829 5,560 4,919 4,611 304 291 112,075 107,023 

05-09 years 95,726 90,477 43,311 42,206 7,172 6,892 5,922 5,498 782 774 145,741 138,955 

10-14 years 102,231 96,115 54,201 52,848 6,562 6,007 5,108 4,848 823 855 162,363 154,666 

15-19 years 93,636 87,481 41,483 41,226 5,473 5,075 4,339 3,972 782 801 140,240 133,480 

20-24 years 79,013 73,891 34,032 37,502 6,999 5,213 3,199 3,294 747 677 116,991 115,364 

25-29 years 81,716 76,729 32,109 38,509 7,817 5,999 5,599 6,395 689 622 120,113 122,255 

30-34 years 99,421 94,556 35,557 44,439 7,551 6,096 9,094 8,840 697 761 144,769 148,596 

35-39 years 109,810 105,333 32,971 41,101 6,053 5,201 7,726 7,035 746 764 151,253 154,233 

40-44 years 121,599 118,099 32,974 41,150 4,906 4,256 6,082 5,515 806 788 161,461 165,552 

45-49 years 119,658 119,679 33,689 41,725 3,887 3,566 4,601 4,325 735 798 158,683 166,527 

50-54 years 103,923 104,170 28,815 36,725 2,807 2,786 3,433 3,807 610 705 136,781 145,407 

55-59 years 86,397 88,825 22,829 28,910 2,092 2,004 2,940 3,263 448 512 112,614 121,510 

60-64 years 64,304 67,988 15,644 19,818 1,474 1,439 2,181 2,166 334 342 82,463 90,314 

65-69 years 44,521 52,105 10,517 15,100 979 1,121 1,503 1,543 173 243 56,714 68,991 

70-74 years 34,348 47,220 8,582 13,299 729 953 806 1,041 110 174 43,846 61,734 

75-79 years 35,113 49,222 7,498 12,054 720 814 570 818 101 149 43,282 62,243 

80-84 years 23,949 40,182 5,391 8,949 412 472 363 490 54 113 29,757 49,734 

85+ years 16,533 39,929 3,685 8,121 259 364 199 374 34 98 20,451 48,522 

Source: Surveillance, Epidemiology, and End 

Results (SEER) Program (www.seer.cancer.gov) 

SEER*Stat Database: Populations - 

Note: *Person of Hispanic origin may be of any race 

**Other indicates those other than Caucasian, African American or Asian/Pacific 

Total U.S. (1990-2004) - Linked To County 

Attributes - Total U.S., 1969-2004 Counties, 

National Cancer Institute, DCCPS, Surveillance 

Research Program, Cancer Statistics Branch, 

released October 2006.

Michigan Department of Community Health Collaboration 

The 20-year collaboration between the Metropolitan Detroit Cancer Surveillance System (MDCSS) and the Michigan Department of 

Community Health (MDCH) was recently enhanced by the addition of a new liaison position with the MDCH. The Michigan Cancer 

Surveillance Program (MCSP) / SEER Collaboration Project Coordinator is an employee of the MDCH but is housed at the MDCSS. 

The creation of this new position within the State of Michigan Cancer Surveillance Program successfully supplemented cancer 

identification services and quality control oversight for local area hospitals. 

Ms. Jeanne Whitlock is the Michigan Cancer Surveillance 

Program (MCSP) / SEER Collaboration Project Coordinator. 

Ms. Whitlock is a hospital liaison and advocate. Her role is to 

visit area hospitals to enhance data collection efforts. Ms. Whitlock 

is a Certified Tumor Registrar. She has been a Tumor Registrar for 

17 years and has worked as a Quality Assurance Consultant for the 

National Cancer Institute. Ms. Whitlock will visit Metropolitan 

Detroit Tri-County facilities regularly to perform the following 

functions on behalf of the State: 

• Coordinate relationships between the Metropolitan 

Detroit Cancer Surveillance System (MDCSS) and hospitals 

diagnosing/treating tri-county resident cancer patients, 

on behalf of the State 

• Ensure that hospitals are accessing all possible casefinding 

sources within their facility for the State 

• Set up and conduct regular quality control audits by the 

State with area hospitals 

• Identify Wayne, Oakland and Macomb county residents 

diagnosed outside the tri-county and make arrangements 

with those hospitals to have the patients’ medical records 

abstracted 

• Act as a liaison for the State with MDCSS Research 

operations and area hospitals and act as a liaison with 

local health departments 

• Provide guidance on the importance of timely and regular 

data submissions for hospitals that electronically submit 

their data and ensure that those hospitals without timely 

submission practices are brought under the enforcement of 

the State’s 6 month reporting requirement 

• Identify sources and collect follow-up information 

• Provide supplemental data collection for stateapproved 

research 

Ms. Jeanne Whitlock is also the State liaison with the Metropolitan 

Detroit Cancer Surveillance System to support the State of Michigan 

participation in the National Cancer Institute’s Surveillance 

Epidemiology and End Results Program (SEER). 

Ms. Jeanne Whitlock is located at the MDCSS 

and can be contacted as follows: 

Jeanne Whitlock, CTR 

State SEER Project 

Coordinator 

Michigan Cancer Surveillance 

Program (MCSP) / SEER 

Collaboration Project Coordinator 

110 East Warren Avenue 

Detroit, MI 48201 

Whitlockj@michigan.gov 

Toll Free: 1-866-220-5817 

5

MDCSS Authority to Collect Cancer Information 

6 

The Metropolitan Detroit 

Cancer Surveillance System 

(MDCSS) obtains its authority 

to collect and report cancer 

information from State of 

Michigan law. (Michigan 

Compiled Laws Annotated, 

Section 333.2619. See Appendix 

A and B and letter at right.) 

Because the MDCSS is designated 

by the Michigan Department 

of Community Health as 

a “state-authorized entity for 

the collection and reporting of 

individually-identifiable cancer 

information,” HIPAA allows 

hospitals to disclose this 

information to the MDCSS. 

(State of Michigan letter, 

Appendix B, page 35 and 

at right.)

Temporal Trends in Metropolitan Detroit 

Incidence rates for prostate 

cancer peaked in 1992, but 

have remained high due to 

increased detection through the 

PSA (prostate specific antigen) 

test. Female breast cancer 

incidence rates have remained 

steady since the late 1980’s. 

Mammography screening has 

played an important role in the 

early diagnosis of this cancer. 

While rates of lung cancer have 

been declining among males 

since the mid 1990’s, rates 

among females are only now 

leveling off. 

Lung cancer has been the 

leading cause of cancer 

mortality among males since 

1973, but it has declined 

somewhat since 1992. Mortality 

among females from lung cancer 

continues to increase, reflecting 

an increase in smoking. 

Mortality rates for prostate 

and female breast cancer have 

remained relatively stable 

over time. 

RATES PER 100,000 POPULATION 

300 

250 

200 

150 

100 

50 

Age-Adjusted Incidence for Invasive Lung & Bronchus, Prostate 

& Female Breast Cancers, Metropolitan Detroit, 1973-2004 

1975 1980 1985 

1990 1995 2000 

Source: Surveillance, Epidemiology, and End Results (SEER) Program (www.seer.cancer.gov) SEER*Stat Database: Incidence - SEER 9 Regs 

Limited-Use, Nov 2006 Sub (1973-2004) - Linked To County Attributes - Total U.S., 1969-2004 Counties, National Cancer Institute, 

DCCPS, Surveillance Research Program, Cancer Statistics Branch, released April 2007, based on the November 2006 submission. 

Male Lung Female Lung Prostate Female Breast 

Age-Adjusted Mortality Rates for Invasive Lung & Bronchus, Prostate 

& Female Breast Cancers, Metropolitan Detroit, 1973-2004 

7 

RATES PER 100,000 POPULATION 

100 

80 

60 

40 

20 

1975 1980 1985 1990 1995 

2000 

Source: Surveillance, Epidemiology, and End Results (SEER) Program (www.seer.cancer.gov) SEER*Stat Database: Mortality - All COD, Public- 

Use With State, Total U.S. (1969-2004), National Cancer Institute, DCCPS, Surveillance Research Program, Cancer Statistics Branch, released 

April 2007. Underlying mortality data provided by NCHS (www.cdc.gov/nchs).

All Races 

Cancer Incidence, Mortality and Age Adjusted Rates per 100,000 

Population by Site, Race and Sex, Metropolitan Detroit, 2004 

8 

All Races Incidence Rate Mortality Rate 

Total Male Female Total Male Female Total Male Female Total Male Female 

All Sites (Invasive) 20,783 10,828 9,955 507.9 616.6 434.6 7,769 3,957 3,812 190.2 235.0 161.4 

Oral Cavity and Pharynx 466 328 138 11.2 17.5 6.1 120 89 31 2.9 5.0 1.4 

Lip 20 13 7 0.5 0.8 0.3 * * 0 * * 0 

Tongue 126 95 31 3.0 5.0 1.4 24 17 7 0.6 0.9 0.3 

Salivary Gland 43 17 26 1.1 1.0 1.1 6 * * 0.1 * * 

Floor of Mouth 38 27 11 0.9 1.3 0.5 * * 0 * * 0 

Gum and Other Mouth 71 48 23 1.7 2.7 1.0 19 12 7 0.5 0.8 0.3 

Nasopharynx 22 15 7 0.5 0.8 0.3 14 10 * 0.3 0.5 * 

Tonsil 73 58 15 1.7 2.9 0.7 8 8 0 0.2 0.4 0 

Oropharynx 16 15 * 0.4 0.8 * 9 7 * 0.2 0.4 0.1 

Hypopharynx 39 31 8 0.9 1.7 0.4 * * 0 * * 0 

Other Oral Cavity 

and Pharynx 

18 9 9 0.4 0.5 0.4 32 24 8 0.7 1.3 0.3 

Digestive System 3,842 2,072 1,770 93.6 118.4 74.8 1,906 1,021 885 46.5 59.8 36.5 

Esophagus 235 166 69 5.8 9.3 3.0 194 151 43 4.7 8.7 1.8 

Stomach 343 210 133 8.3 12.2 5.5 167 85 82 4.0 5.1 3.3 

Small Intestine 94 49 45 2.2 2.6 1.9 20 11 9 0.5 0.6 0.4 

Colon and Rectum 2,072 1,051 1,021 50.7 61.1 43.2 727 352 375 17.7 21.3 15.2 

Colon excluding Rectum 1,485 725 760 36.3 42.8 32.0 641 305 336 15.6 18.5 13.7 

Cecum 336 138 198 8.2 8.3 8.3 † † † † † † 

Appendix 23 7 16 0.5 0.4 0.7 † † † † † † 

Ascending Colon 310 153 157 7.5 9.1 6.6 † † † † † † 

Hepatic Flexure 75 40 35 1.9 2.3 1.5 † † † † † † 

Transverse Colon 122 61 61 3.0 3.5 2.5 † † † † † † 

Splenic Flexure 60 31 29 1.5 1.9 1.2 † † † † † † 

Descending Colon 94 51 43 2.3 3.0 1.9 † † † † † † 

Sigmoid Colon 385 202 183 9.5 11.7 7.8 † † † † † † 

Large Intestine, NOS 80 42 38 2.0 2.6 1.6 † † † † † † 

Rectum and 

Rectosigmoid Junction 

587 326 261 14.3 18.4 11.2 86 47 39 2.1 2.8 1.5 

Rectosigmoid Junction 206 112 94 5.1 6.4 4.1 † † † † † † 

Rectum 381 214 167 9.2 12.0 7.1 † † † † † † 

Anus, Anal Canal 

and Anorectum 65 28 37 1.6 1.5 1.6 8 * * 0.2 * * 

Liver and 

Intrahepatic Bile Duct 

285 199 86 6.8 10.6 3.7 237 138 99 5.7 7.5 4.2 

Liver 268 194 74 6.4 10.3 3.2 192 116 76 4.6 6.3 3.2 

Intrahepatic Bile Duct 17 * 12 0.4 * 0.5 45 22 23 1.1 1.3 1.0 

Gallbladder 57 12 45 1.4 0.7 1.9 30 7 23 0.8 0.4 1.0 

Other Biliary 64 38 26 1.5 2.2 1.0 26 13 13 0.7 0.8 0.5 

Pancreas 553 292 261 13.5 16.6 10.9 465 241 224 11.4 14.0 9.4 

Retroperitoneum 22 11 11 0.5 0.6 0.5 * * 0 * * 0.0 

Peritoneum, Omentum 

and Mesentery 

26 * 23 0.6 * 1.0 10 * 7 0.2 * 0.3 

Other Digestive Organs 26 13 13 0.6 0.7 0.5 19 12 7 0.5 0.7 0.3 

Respiratory System 3,451 1,857 1,594 85.7 108.2 70.0 2,334 1,295 1,039 57.9 76.4 45.0 

Nose, Nasal Cavity 

and Middle Ear 

33 22 11 0.8 1.2 0.5 * * * * * * 

Larynx 215 164 51 5.2 9.1 2.3 63 53 10 1.5 2.9 0.5 

Lung and Bronchus 3,150 1,628 1,522 78.3 95.2 66.8 2,262 1,237 1,025 56.1 73.1 44.4 

Pleura 38 33 * 1.0 2.0 * * * 0 * * 0.0 

Trachea, Mediastinum and 

Other Respiratory Organs 

15 10 * 0.4 0.6 * * * * * * * 

Bones and Joints 41 22 19 1.0 1.1 0.8 23 14 9 0.6 0.7 0.4 

Soft Tissue including Heart 123 64 59 3.0 3.6 2.6 53 24 29 1.3 1.5 1.2 

Skin excluding Basal 

and Squamous 

693 380 313 17.0 21.3 14.3 99 71 28 2.4 4.2 1.2 

Melanoma of the Skin 619 345 274 15.2 19.2 12.6 75 53 22 1.8 3.1 0.9 

Other Non-Epithelial Skin 74 35 39 1.8 2.1 1.7 24 18 6 0.6 1.1 0.2 

Breast 2,904 31 2,873 69.7 1.7 126.0 606 * 602 14.7 * 25.8

All Races Incidence Rate Mortality Rate 

total Male Female Total Male Female Total Male Female Total Male Female 

Female Genital System 1,170 0 1,170 28.2 0.0 51.4 379 0 379 9.3 0.0 16.2 

Cervix Uteri 170 0 170 4.1 0.0 7.8 58 0 58 1.4 0.0 2.6 

Corpus and Uterus, NOS 612 0 612 14.8 0.0 26.8 117 0 117 2.9 0.0 5.0 

Corpus Uteri 588 0 588 14.2 0.0 25.8 47 0 47 1.2 0.0 2.1 

Uterus, NOS 24 0 24 0.6 0.0 1.1 70 0 70 1.7 0.0 3.0 

Ovary 295 0 295 7.1 0.0 12.7 183 0 183 4.4 0.0 7.8 

Vagina 23 0 23 0.6 0.0 1.0 7 0 7 0.2 0.0 0.3 

Vulva 58 0 58 1.4 0.0 2.5 11 0 11 0.3 0.0 0.4 

Other Female Genital Organs 12 0 12 0.3 0.0 0.5 * 0 * * 0.0 * 

Male Genital System 3,592 3,592 0 88.4 203.8 0.0 398 398 0 9.7 25.6 0.0 

Prostate 3,458 3,458 0 85.1 196.6 0.0 389 389 0 9.4 25.1 0.0 

Testis 110 110 0 2.8 5.6 0.0 6 6 0 0.1 0.3 0.0 

Penis 17 17 0 0.4 1.1 0.0 * * 0 * * 0.0 

Other Male Genital Organs 7 7 0 0.2 0.4 0.0 0 0 0 0.0 0.0 0.0 

Urinary System 1,560 1,046 514 38.2 60.9 22.1 303 207 96 7.3 12.4 3.9 

Urinary Bladder 905 665 240 22.4 39.9 10.2 142 104 38 3.4 6.6 1.5 

Kidney and Renal Pelvis 620 360 260 15.0 19.7 11.3 157 101 56 3.8 5.6 2.3 

Ureter 21 13 8 0.5 0.9 0.3 * * 0 * * 0.0 

Other Urinary Organs 14 8 6 0.3 0.5 0.2 * 0 * * 0.0 * 

Eye and Orbit 26 14 12 0.6 0.8 0.6 * * 0 * * 0.0 

Brain and Other 

Nervous System 

254 137 117 6.2 7.3 5.3 155 86 69 3.8 4.7 3.0 

Brain 229 124 105 5.6 6.6 4.8 † † † † † † 

Cranial Nerves Other 


25 13 12 0.6 0.7 0.5 † † † † † † 

Endocrine System 404 115 289 9.9 6.1 13.6 29 17 12 0.7 0.9 0.5 

Thyroid 372 99 273 9.1 5.2 12.8 16 7 9 0.4 0.4 0.4 

Other Endocrine 

including Thymus 

32 16 16 0.8 0.9 0.8 13 10 * 0.3 0.5 * 

Lymphoma 1,056 528 528 25.9 29.3 23.3 309 172 137 7.5 10.3 5.7 

Hodgkin’s Lymphoma 131 56 75 3.3 2.9 3.7 19 14 * 0.5 0.8 * 

Hodgkin’s - Nodal 129 55 74 3.3 2.9 3.7 † † † † † † 

Hodgkin’s - Extranodal * * * * * * † † † † † † 

Non-Hodgkin’s 

Lymphoma (NHL) 

925 472 453 22.6 26.3 19.6 290 158 132 7.1 9.5 5.5 

NHL - Nodal 611 298 313 14.9 16.7 13.6 † † † † † † 

NHL - Extranodal 314 174 140 7.6 9.6 6.1 † † † † † † 

Myeloma 271 153 118 6.7 8.9 5.1 161 90 71 4.0 5.4 3.0 

Leukemia 560 324 236 13.8 18.6 10.2 316 180 136 7.8 10.9 5.7 

Lymphocytic Leukemia 256 163 93 6.3 9.3 4.0 95 59 36 2.3 3.5 1.4 

Acute Lymphocytic 

Leukemia 

45 25 20 1.1 1.3 1.0 15 9 6 0.4 0.5 0.3 

Chronic Lymphocytic 

Leukemia 

191 125 66 4.7 7.3 2.8 77 49 28 1.9 3.0 1.1 

Other Lymphocytic 

Leukemia 

20 13 7 0.5 0.7 0.3 * * * * * * 

Myeloid and Monocytic 

Leukemia 

260 147 113 6.4 8.4 4.9 131 78 53 3.3 4.7 2.3 

Acute Myeloid Leukemia 147 83 64 3.6 4.8 2.8 105 63 42 2.6 3.7 1.9 

Acute Monocytic Leukemia 12 * 7 0.3 * 0.3 * * 0 * * 0.0 

Chronic Myeloid Leukemia 86 51 35 2.1 2.9 1.5 14 6 8 0.3 0.3 0.3 

Other Myeloid/Monocytic 

Leukemia 

15 8 7 0.4 0.4 0.3 11 8 * 0.3 0.5 * 

Other Leukemia 44 14 30 1.1 0.9 1.3 90 43 47 2.2 2.8 1.9 

Other Acute Leukemia 12 6 6 0.3 0.4 0.2 40 20 20 1.0 1.3 0.8 

Aleukemic, Subleukemic 

and NOS 32 8 24 0.8 0.5 1.1 50 23 27 1.2 1.5 1.1 

Miscellaneous 370 165 205 8.8 9.4 8.4 574 285 289 13.9 16.7 11.8 

9 

Rates are per 100,000 and age-adjusted to the 2000 US Std Population (19 age groups - Census P25-1130) standard. 

† Not reported * Statistic not displayed due to fewer than 6 cases. 

Source: Surveillance, Epidemiology, and End Results (SEER) Program (www.seer.cancer.gov) SEER*Stat Database. Underlying mortality data provided by NCHS (www.cdc.gov/nchs).

Caucasian 



10 

Caucasian Incidence Rate Mortality Rate 

total Male Female Total Male Female Total Male Female Total Male Female 

All Sites (Invasive) 15,725 8,088 7,637 502.6 593.4 443.1 5,750 2,905 2,845 180.9 220.5 155.4 


Lip 15 9 6 0.5 0.7 0.3 0 0 0 0.0 0.0 0.0 

Tongue 101 77 24 3.2 5.3 1.4 20 15 * 0.6 1.1 * 

Salivary Gland 40 16 24 1.3 1.2 1.4 * * * * * * 

Floor of Mouth 26 19 7 0.8 1.2 0.4 * * 0 * * 0.0 

Gum and Other Mouth 55 38 17 1.8 2.8 1.0 13 8 * 0.4 0.6 * 

Nasopharynx 18 12 6 0.6 0.8 0.4 8 * * 0.3 * * 

Tonsil 56 43 13 1.7 2.8 0.8 6 6 0 0.2 0.4 0.0 

Oropharynx 9 8 * 0.3 0.5 * 6 6 0 0.2 0.5 0.0 

Hypopharynx 27 23 * 0.9 1.7 * * * 0 * * 0.0 


and Pharynx 

11 7 * 0.3 0.5 * 22 17 * 0.7 1.2 * 

Digestive System 2,783 1,494 1,289 87.7 109.8 70.5 1,392 731 661 43.4 54.8 34.7 

Esophagus 175 127 48 5.6 9.2 2.7 158 125 33 5.0 9.1 1.7 

Stomach 248 153 95 7.8 11.3 5.1 108 51 57 3.4 3.9 3.0 

Small Intestine 58 28 30 1.8 1.9 1.7 13 7 6 0.4 0.5 0.3 

Colon and Rectum 1,512 773 739 47.7 57.5 40.5 530 251 279 16.4 19.3 14.3 

Colon excluding Rectum 1,063 520 543 33.4 39.1 29.4 464 215 249 14.4 16.5 12.8 

Cecum 235 94 141 7.3 7.3 7.5 † † † † † † 

Appendix 20 6 14 0.6 0.4 0.8 † † † † † † 






Sigmoid Colon 287 155 132 9.1 11.4 7.3 † † † † † † 


Rectum and 


449 253 196 14.3 18.4 11.1 66 36 30 2.0 2.7 1.5 


Rectum 289 172 117 9.1 12.3 6.6 † † † † † † 

Anus, Anal Canal and 

Anorectum 

47 17 30 1.5 1.2 1.7 7 * * 0.2 * * 

Liver and Intrahepatic 

Bile Duct 

179 123 56 5.7 8.8 3.2 160 86 74 5.0 6.2 4.1 

Liver 166 120 46 5.2 8.6 2.6 127 71 56 4.0 5.1 3.0 

Intrahepatic Bile Duct 13 * 10 0.4 * 0.6 33 15 18 1.0 1.1 1.0 

Gallbladder 44 8 36 1.4 0.6 1.9 26 7 19 0.8 0.6 1.0 

Other Biliary 49 28 21 1.5 2.1 1.1 20 9 11 0.6 0.7 0.6 

Pancreas 411 215 196 12.9 15.6 10.5 345 177 168 10.8 13.1 8.9 

Retroperitoneum 19 10 9 0.6 0.7 0.6 * * 0 * * 0.0 


and Mesentery 

22 * 19 0.7 * 1.1 9 * 6 0.3 * 0.4 

Other Digestive Organs 19 9 10 0.6 0.7 0.5 14 9 * 0.4 0.7 * 

Respiratory System 2,623 1,388 1,235 84.6 103.9 71.1 1,743 937 806 55.7 70.9 45.5 


and Middle Ear 

25 14 11 0.8 1.0 0.7 * * * * * * 

Larynx 145 112 33 4.6 8.0 2.0 43 38 * 1.4 2.7 * 

Lung and Bronchus 2,409 1,225 1,184 77.7 92.0 68.1 1,691 894 797 54.1 67.8 45.0 

Pleura 32 28 * 1.0 2.2 * * * 0 * * 0.0 



12 9 * 0.4 0.7 * * * * * * * 

Bones and Joints 30 17 13 1.0 1.2 0.8 15 9 6 0.5 0.6 0.4 

Soft Tissue including Heart 90 48 42 3.0 3.5 2.6 41 20 21 1.3 1.5 1.1 


and Squamous 662 365 297 21.7 26.5 18.9 95 69 26 3.0 5.2 1.5 

Melanoma of the Skin 602 340 262 19.8 24.5 16.9 73 53 20 2.3 4.0 1.2 

Other Non-Epithelial Skin 60 25 35 1.9 2.0 2.1 22 16 6 0.7 1.2 0.3 

Breast 2,221 23 2,198 70.1 1.6 128.9 415 * 411 13.0 * 22.9

Caucasian Incidence Rate Mortality Rate 


Female Genital System 895 0 895 28.4 0.0 52.6 273 0 273 8.5 0.0 15.1 

Cervix Uteri 98 0 98 3.3 0.0 6.4 35 0 35 1.1 0.0 2.1 


Corpus Uteri 474 0 474 14.9 0.0 27.6 31 0 31 1.0 0.0 1.7 

Uterus, NOS 17 0 17 0.5 0.0 1.0 50 0 50 1.5 0.0 2.7 

Ovary 236 0 236 7.4 0.0 13.6 141 0 141 4.4 0.0 7.7 

Vagina 14 0 14 0.4 0.0 0.8 6 0 6 0.2 0.0 0.3 

Vulva 45 0 45 1.4 0.0 2.6 8 0 8 0.2 0.0 0.4 

Other Female Genital Organs 11 0 11 0.3 0.0 0.6 * 0 * * 0.0 * 

Male Genital System 2,499 2,499 0 80.4 182.3 0.0 252 252 0 7.7 20.4 0.0 

Prostate 2,378 2,378 0 76.1 173.4 0.0 244 244 0 7.4 19.8 0.0 

Testis 103 103 0 3.8 7.4 0.0 6 6 0 0.2 0.4 0.0 

Penis 11 11 0 0.4 0.8 0.0 * * 0 * * 0.0 


Urinary System 1,289 882 407 40.9 65.7 22.9 247 174 73 7.6 13.2 3.8 



Ureter 20 12 8 0.6 1.0 0.4 * * 0 * * 0.0 

Other Urinary Organs 9 6 * 0.3 0.5 * * 0 * * 0.0 * 

Eye and Orbit 24 13 11 0.8 0.9 0.8 * * 0 * * 0.0 



202 112 90 6.7 8.0 5.5 126 74 52 4.0 5.2 3.0 

Brain 189 106 83 6.3 7.5 5.1 † † † † † † 


Nervous System 13 6 7 0.4 0.4 0.4 † † † † † † 

Endocrine System 326 96 230 10.9 6.6 15.3 21 13 8 0.7 0.9 0.4 

Thyroid 302 83 219 10.1 5.7 14.6 14 6 8 0.4 0.4 0.4 


including Thymus 24 13 11 0.8 0.9 0.7 7 7 0 0.2 0.5 0.0 

Lymphoma 847 423 424 27.3 30.6 24.8 262 148 114 8.2 11.2 6.1 

Hodgkin’s Lymphoma 103 44 59 3.7 3.2 4.2 15 11 * 0.5 0.8 * 


Hodgkin’s - Extranodal * * 0 * * 0.0 † † † † † † 


Lymphoma (NHL) 744 379 365 23.7 27.5 20.6 247 137 110 7.7 10.4 5.9 

NHL - Nodal 483 233 250 15.4 17.0 14.0 † † † † † † 


Myeloma 163 99 64 5.2 7.4 3.6 96 53 43 3.0 4.2 2.3 

Leukemia 432 248 184 14.0 18.6 10.5 257 143 114 8.2 11.1 6.1 



Leukemia 

33 23 10 1.2 1.7 0.7 10 6 * 0.3 0.4 * 


Leukemia 

150 94 56 4.8 7.0 3.1 61 40 21 1.9 3.1 1.0 


Leukemia 

14 9 * 0.5 0.7 * * * * * * * 


Leukemia 

206 114 92 6.7 8.5 5.4 111 63 48 3.6 4.9 2.8 

Acute Myeloid Leukemia 118 64 54 3.8 4.8 3.2 89 51 38 2.9 3.9 2.2 

Acute Monocytic Leukemia 12 * 7 0.4 * 0.4 * * 0 * * 0.0 

Chronic Myeloid Leukemia 67 40 27 2.2 2.9 1.6 10 * 7 0.3 * 0.4 


Leukemia 

9 * * 0.3 * * 11 8 * 0.4 0.7 * 

Other Leukemia 29 8 21 0.9 0.7 1.1 72 33 39 2.2 2.7 2.0 

Other Acute Leukemia 8 * * 0.3 * * 33 16 17 1.0 1.3 0.9 


and NOS 21 * 16 0.7 * 0.9 39 17 22 1.2 1.4 1.1 


11 




African-American 



12 

African-American Incidence Rate Mortality Rate 


All Sites (Invasive) 4,614 2,465 2,149 537.5 712.8 422.3 1,930 999 931 233.3 305.3 188.4 


Lip * * 0 * * 0.0 * * 0 * * 0.0 

Tongue 22 15 7 2.3 3.8 1.3 * * * * * * 

Salivary Gland * * * * * * * 0 * * 0.0 * 

Floor of Mouth 12 8 * 1.2 1.8 * * * 0 * * 0.0 

Gum and Other Mouth 12 7 * 1.3 1.7 * * * * * * * 

Nasopharynx * * * * * * * * 0 * * 0.0 

Tonsil 17 15 * 1.7 3.5 * * * 0 * * 0.0 

Oropharynx 7 7 0 0.8 1.8 0.0 * * * * * * 

Hypopharynx 12 8 * 1.3 2.1 * * * 0 * * 0.0 


and Pharynx 7 * * 0.7 * * 10 7 * 1.1 1.8 * 

Digestive System 991 539 452 117.8 156.6 91.0 485 272 213 59.3 82.2 43.8 

Esophagus 58 37 21 6.7 10.2 4.2 36 26 10 4.2 7.6 1.9 

Stomach 89 52 37 10.7 15.7 7.5 54 30 24 6.7 9.7 4.9 

Small Intestine 36 21 15 4.2 5.7 3.0 7 * * 0.8 * * 

Colon and Rectum 528 261 267 63.6 78.9 53.8 190 97 93 23.7 31.2 19.2 

Colon excluding Rectum 399 193 206 48.4 59.6 41.6 170 86 84 21.3 28.1 17.5 

Cecum 97 43 54 11.6 13.1 10.9 † † † † † † 

Appendix * * * * * * † † † † † † 






Sigmoid Colon 88 41 47 10.6 12.4 9.3 † † † † † † 


Rectum and 


129 68 61 15.2 19.3 12.2 20 11 9 2.4 3.2 1.8 


Rectum 87 40 47 10.3 11.9 9.2 † † † † † † 

Anus, Anal Canal 

and Anorectum 

18 11 7 2.1 2.8 1.4 * * 0 * * 0.0 

Liver and Intrahepatic 

Bile Duct 

92 68 24 10.0 17.2 4.6 67 45 22 7.7 11.7 4.5 

Liver 88 66 22 9.5 16.6 4.2 56 39 17 6.3 10.0 3.4 

Intrahepatic Bile Duct * * * * * * 11 6 * 1.4 1.8 * 

Gallbladder 11 * 8 1.3 * 1.6 * 0 * * 0.0 * 

Other Biliary 13 9 * 1.6 2.6 * 6 * * 0.8 * * 

Pancreas 133 72 61 16.3 21.4 12.6 114 61 53 14.1 18.1 11.1 

Retroperitoneum * * * * * * * * 0 * * 0.0 


and Mesentery 

* 0 * * 0.0 * * 0 * * 0.0 * 

Other Digestive Organs 7 * * 0.7 * * * * * * * * 

Respiratory System 799 455 344 95.1 133.9 69.1 569 343 226 69.0 102.6 46.4 


and Middle Ear 7 7 0 0.9 2.1 0.0 0 0 0 0.0 0.0 0.0 

Larynx 65 48 17 7.5 13.9 3.3 19 14 * 2.3 4.1 * 

Lung and Bronchus 718 394 324 85.7 116.2 65.2 550 329 221 66.7 98.5 45.3 

Pleura 6 * * 0.7 * * 0 0 0 0.0 0.0 0.0 



* * * * * * 0 0 0 0.0 0.0 0.0 

Bones and Joints 11 * 6 1.2 * 1.1 8 * * 0.8 * * 

Soft Tissue including Heart 33 16 17 3.6 4.2 3.2 11 * 7 1.3 * 1.5 


and Squamous 

15 7 8 1.6 1.7 1.5 * * * * * * 

Melanoma of the Skin * 0 * * 0.0 * * 0 * * 0.0 * 

Other Non-Epithelial Skin 11 7 * 1.1 1.7 * * * 0 * * 0.0 

Breast 629 6 623 70.3 1.4 120.2 181 0 181 20.9 0.0 35.5

African-American Incidence Rate Mortality Rate 


Female Genital System 257 0 257 28.7 0.0 49.6 103 0 103 12.5 0.0 21.0 

Cervix Uteri 68 0 68 7.0 0.0 12.4 23 0 23 2.6 0.0 4.5 


Corpus Uteri 104 0 104 12.0 0.0 20.6 16 0 16 2.0 0.0 3.4 

Uterus, NOS 6 0 6 0.7 0.0 1.2 18 0 18 2.0 0.0 3.5 

Ovary 57 0 57 6.6 0.0 11.2 41 0 41 5.2 0.0 8.6 

Vagina 8 0 8 0.9 0.0 1.5 * 0 * * 0.0 * 

Vulva 13 0 13 1.4 0.0 2.4 * 0 * * 0.0 * 

Other Female Genital Organs * 0 * * 0.0 * * 0 * * 0.0 * 

Male Genital System 935 935 0 111.6 274.7 0.0 144 144 0 18.6 50.3 0.0 

Prostate 925 925 0 110.5 271.8 0.0 143 143 0 18.4 50.0 0.0 

Testis * * 0 * * 0.0 0 0 0 0.0 0.0 0.0 

Penis * * 0 * * 0.0 * * 0 * * 0.0 


Urinary System 250 151 99 29.6 43.9 20.0 52 29 23 6.4 8.7 4.8 



Ureter * * 0 * * 0.0 0 0 0 0.0 0.0 0.0 

Other Urinary Organs * * * * * * 0 0 0 0.0 0.0 0.0 

Eye and Orbit * * 0 * * 0.0 0 0 0 0.0 0.0 0.0 



44 19 25 4.8 4.7 4.9 28 11 17 3.3 3.0 3.5 

Brain 32 12 20 3.4 2.8 3.9 † † † † † † 


Nervous System 12 7 * 1.4 1.9 * † † † † † † 

Endocrine System 66 14 52 7.0 3.5 9.7 8 * * 0.9 * * 

Thyroid 58 11 47 6.1 2.8 8.8 * * * * * * 


including Thymus 8 * * 0.8 * * 6 * * 0.6 * * 

Lymphoma 188 96 92 20.8 25.0 17.9 44 22 22 5.2 6.9 4.2 

Hodgkin’s Lymphoma 25 10 15 2.5 2.1 2.9 * * * * * * 


Hodgkin’s - Extranodal * 0 * * 0.0 * † † † † † † 


Lymphoma (NHL) 163 86 77 18.2 22.9 15.1 41 20 21 4.9 6.3 4.1 

NHL - Nodal 117 60 57 13.1 16.3 11.1 † † † † † † 


Myeloma 103 52 51 12.5 15.5 10.6 64 36 28 7.9 10.9 5.9 

Leukemia 110 66 44 12.5 18.9 8.4 56 34 22 6.6 10.3 4.3 



Leukemia 9 * 7 0.9 * 1.3 * * * * * * 


Leukemia 32 25 7 3.8 7.5 1.4 15 8 7 1.9 2.7 1.4 


Leukemia * * * * * * 0 0 0 0.0 0.0 0.0 


Leukemia 50 30 20 5.8 8.5 4.0 18 13 * 2.1 3.6 * 

Acute Myeloid Leukemia 26 17 9 3.0 5.0 1.8 15 11 * 1.7 3.2 * 

Acute Monocytic Leukemia 0 0 0 0.0 0.0 0.0 0 0 0 0.0 0.0 0.0 

Chronic Myeloid Leukemia 18 10 8 2.1 2.7 1.6 * * * * * * 


Leukemia 6 * * 0.7 * * 0 0 0 0.0 0.0 0.0 

Other Leukemia 14 * 9 1.4 * 1.6 18 10 8 2.3 3.4 1.6 

Other Acute Leukemia * * * * * * 7 * * 0.9 * * 


and NOS 10 * 8 1.0 * 1.4 11 6 * 1.4 2.0 * 


13 




Survival Analysis of Prostate Cancer by Stage 

Over the past 29 years, the 

treatment of men with prostate 

cancer diagnosed at an early 

stage has improved tremendously. 

In the tri-county area, 

the current five-year relative 

survival for men diagnosed with 

local stage prostate cancer is 

near 100%. Dramatic improvement 

in survival of men with 

prostate cancer that is diagnosed 

after it has spread to 

other parts of the body has not 

been seen. The five-year relative 

survival for men diagnosed 

with distant stage disease has 

fluctuated for the last 29 years 

between 20-38%. 

Armed with successful treatment 

for early stage disease, 

there has been a concerted 

effort to identify these cancers 

while they are in local stage. 

There has been success in this 

effort mainly due to the use of 

the prostate-specific antigen 

(PSA) blood test. Currently, 

about 95% of the men who are 

newly diagnosed with prostate 

cancer in the tri-county area are 

diagnosed at local or regional 

stages. The PSA blood test is 

usually given to men when they 

turn 50, and younger if they 

are at high risk. A few of the 

risk factors for developing the 

disease are age, race (African 

American), and family history 

(men with close blood relatives 

such as fathers or brothers who 

have been diagnosed with the 

disease). 

Localized/Regional 

Distant 

14 

100 

Invasive Prostate Cancer – Caucasian Males 

Stage Distribution 1972-2004 Metropolitan Detroit 

Invasive Prostate Cancer – African-American Males 


100 

80 

100 

PERCENTAGE PERCENTAGE 

80 

60 

60 

40 

40 

20 

PERCENTAGE 

80 

60 

40 

20 

20 

1975 1980 

2000 

1975 

1980 1985 1990 1995 2000 

YEAR DIAGNOSED - 3 YEAR MOVING AVERAGE 

1975 1980 1985 1990 1995 


2000 

100 

100 

80 

5-Year Relative Survival Rates for Prostate Cancer – 

Caucasian Males by Stage, 1973-2004 Metropolitan Detroit 

5 -Year Relative Survival Rates for Prostate Cancer – 

African-American Males by Stage, 1973-2004 Metropolitan Detroit 

100 


80 

60 

60 

40 

40 

20 

PERCENTAGE 

80 

60 

40 

20 

20 

1975 1980 

2000 

1975 

1980 1985 1990 1995 2000 


1975 1980 1985 1990 1995 


2000

Survival Analysis of Female Breast Cancer by Stage 

Both diagnosis and treatment 

for female breast cancer have 

improved greatly since 1973. 

Due to mammography screening, 

more cases are diagnosed 

at an earlier stage. Currently, 

five-year relative survival for 

cases diagnosed at local stage is 

95% for women in the general 

population. For women with 

regional stage disease, survival 

has also improved. For women 

diagnosed with late stage 

disease, survival has remained 

relatively steady, at 10-20% for 

women in the general population. 

African American women 

tend to have a higher proportion 

of late stage diagnoses and 

five-year survival, regardless of 

stage, tends to be poorer than 

for Caucasian women. 

Gender and age are the greatest 

risk factors for developing 

breast cancer. Breast cancer 

can strike men and women 

both, but women are many 

times more likely to develop 

the disease than men. A family 

history of breast cancer has 

also been linked to increasing a 

woman’s likelihood of developing 

the disease. Gender, age, 

and family history are things 

that cannot be prevented, 

however women can increase 

their chances of surviving this 

disease by consulting with their 

physician, following recommended 

screening for their 

specific age and risk group, and 

by conducting monthly breast 

self-examinations starting at 

age 20. Women who are at an 

increased risk due to a family 

history should consult with 

their doctor about whether they 

should begin mammography 

screening at an earlier age than 

the recommended age of 40 and 

about the frequency of clinical 

breast examinations. 

Localized 

Regional 

Distant 

100 

Invasive Breast Cancer – Caucasian Females 


Invasive Breast Cancer – African-American Females 


15 

100 

80 

100 


80 

60 

60 

40 

40 

20 

PERCENTAGE 

80 

60 

40 

20 

20 

1975 1980 

1985 1990 1995 2000 

1975 

1980 1985 1990 1995 2000 


1975 1980 1985 1990 1995 2000 


5-Year Relative Survival Rates for Breast Cancer – 

100Caucasian Females by Stage, 1973-2004 Metropolitan Detroit 

100 

80 


80 

60 

60 

40 

40 

20 

PERCENTAGE 

5-Year Relative Survival Rates for Breast Cancer – 

African-American Females by Stage, 1973-2004 Metropolitan Detroit 

100 

80 

60 

40 

20 

20 

1975 1980 

1985 1990 1995 2000 

1975 

1980 1985 1990 1995 2000 


1975 1980 1985 1990 1995 2000 

YEAR DIAGNOSED - 3 YEAR MOVING AVERAGE

Survival Analysis of Lung Cancer by Stage 

Diagnosis of lung cancer in 

local stage is difficult because 

symptoms usually do not appear 

until the disease is advanced. 

Only about 23% of lung cancers 

in Caucasians and 18-19% in 

African-Americans are diagnosed 

at the local stage. Most 

early stage lung cancer cases 

are diagnosed incidentally. The 

five-year survival rate for local 

stage cancer is less than 50% for 

the general population. The fiveyear 

survival for distant stage 

cancer is approximately 2%. 

An effective method for screening 

for lung cancer has not yet 

been developed although promising 

methods are being tested. 

When a new method is developed, 

the hope is that it will be 

as effective and universally used 

as mammography screening 

has been for breast cancer and 

the PSA blood test has been for 

prostate cancer. 

The major risk factor for lung 

cancer is tobacco smoking. 

The risk increases over time 

as a person continues to smoke. 

However, if a person is able 

to quit smoking before cancer 

has developed, the lung tissue 

can begin to repair itself. An 

ex-smoker can lower his risk of 

lung cancer, but his risk will still 

be higher than that of someone 

who has never smoked. Nonsmokers 

who are exposed to 

second hand smoke in the home 

or workplace are also at increased 

risk for developing lung 

cancer. Exposure to carcinogens 

in the workplace or the environment 

and having a family 

history of lung cancer have 

also been found to contribute 

to an increased risk for getting 

the disease. 

Localized 

Regional 

Distant 

16 

100 

Invasive Lung Cancer – Caucasian Population 


Invasive Lung Cancer – African-American Population 


100 

80 

100 


80 

60 

60 

40 

40 

20 

PERCENTAGE 

80 

60 

40 

20 

20 

1975 1980 

1985 1990 1995 2000 

1975 

1980 1985 1990 1995 2000 


1975 1980 1985 1990 1995 


2000 

5-Year Relative Survival Rates for Lung Cancer – 

100Caucasian Population by Stage, 1973-2004 Metropolitan Detroit 

100 

80 


80 

60 

60 

40 

40 

20 

PERCENTAGE 

100 

5-Year Relative Survival Rates for Lung Cancer – 

African-American Population by Stage, 1973-2004 Metropolitan Detroit 

80 

60 

40 

20 

20 

1975 1980 

1985 1990 1995 2000 

1975 

1980 1985 1990 1995 2000 


1975 1980 1985 1990 1995 


2000

Survival Analysis of Colorectal Cancer by Stage 

The five-year survival rate for 

colorectal cancer has gradually 

increased over the past 29 years 

for the general population. 

Currently, the five-year relative 

survival rate for local stage 

cancer is over 90% compared to 

73% in 1973. At distant stage, 

the five-year relative survival 

rate is over 10% compared to 

4% in 1973. This improved 

survival has been linked to improved 

early detection practices 

including the increased use of 

screening sigmoidoscopy. 

Age, family history, and diet 

are risk factors in developing 

colorectal cancer. The symptoms 

of colorectal cancer may mimic 

some other conditions such as 

hemorrhoids or inflammatory 

bowel disease. It is best to consult 

with a physician to determine 

the correct cause of the 

symptoms. Screening typically 

begins at age 50 for the general 

population. If there is family 

history of the disease, a patient 

needs to confer with their physician 

to discuss when screening 

should begin. 

Localized 

Regional 

Distant 

100 

Invasive Colorectal Cancer – Caucasian Population 


Invasive Colorectal Cancer – African-American Population 


17 

100 

80 

100 


80 

60 

60 

40 

40 

20 

PERCENTAGE 

80 

60 

40 

20 

20 

1975 1980 

1985 1990 1995 2000 

1975 

1980 1985 1990 1995 2000 


1975 1980 1985 1990 1995 


2000 

5-Year Relative Survival Rates for Colorectal Cancer – 

100Caucasian Population by Stage, 1973-2004 Metropolitan Detroit 

100 

80 


80 

60 

60 

40 

40 

20 

PERCENTAGE 

5-Year Relative Survival Rates for Colorectal Cancer – 

African-American Population by Stage, 1973-2004 Metropolitan Detroit 

100 

80 

60 

40 

20 

20 

1975 1980 

1985 1990 1995 2000 

1975 

1980 1985 1990 1995 2000 


1975 1980 1985 1990 1995 


2000

2007 Annual Scientific Conference of the North American 

Association of Central Cancer Registries (NAACCR) 

John J. Graff, PhD, MS 

18 

In June of 2007, the Metropolitan Detroit 

Cancer Surveillance System (MDCSS), Wayne 

State University School of Medicine (WSU- 

SOM), and the Karmanos Cancer Institute 

hosted the Annual Conference for the North 

American Association of Central Cancer Registries 

(NAACCR). Dr. John Graff, a Co-Principal 

Investigator of the MDCSS and Assistant 

Professor at WSUSOM, was the Program Chair 

for the NAACCR Scientific Conference. 

The theme for the 2007 Conference was “Cancer Knows No Borders”, 

highlighting the international scope of NAACCR and its members as 

well as the integration of the numerous specialties and disciplines 

that are involved in cancer registration, treatment and research. 

Plenary session topics included: “Geographic Information Systems – 

Cartographies of Cancer”, “Determining Quality of Cancer Care Using 

Cancer Registry Data”, and “Interoperability of Cancer Registration 

Standards.” Other topics presented in the concurrent sessions 

of the Conference included: “Electronic Reporting”, “Data Quality 

Assurance”, “Collaborative Staging of Cancer”, “Rare Cancers”, and 

many others. The final Conference program consisted of 11 plenary 

speakers, 91 concurrent session speakers and 50 poster presentations, 

and was attended by over 400 clinicians, scientists and cancer 

registration professionals. 

The Detroit Renaissance Marriott, location of the 

2007 NAACCR Annual Conference 

MDCSS investigators and their collaborators who 

presented at the 2007 NAACCR Conference 

Investigator 

Kendra Schwartz, MD, MSPH 

Cathryn H. Bock, PhD 

Allison Van Dyke 

Steven J. Katz, MD, MPH 

Monina Bartoces, PhD 

Nancy Lozon, BS, CTR 

George Dombi, PhD 

Title of Presentation 

Mammography Screening among 

Arab Immigrants 

High Degree of Accuracy in Census 

Tract Assignment within the MDCSS 

Race, Hormones & Menopausal 

Status as Risk Factors in Women 

with NSMLC 

Breaking the Mastectomy Over- 

Treatment Myth 

Quality of Life of Women with 

Cervical Cancer 

SEER*DMS 1.5 Years Later 

Utilizing SEER*DMS Tables to 

Generate Monthly Hospital 

ACoS Follow-up Reports 

Dr. John Graff welcomes the NAACCR Annual Conference 

guests to Detroit 

The 2007 Detroit-based Conference was a record attendance for the 

NAACCR membership. The NAACCR Program Committee received 

rave reviews from all 2007 Conference attendees on the Detroit 

Riverfront Marriott location, the downtown Detroit experience and 

the overall Conference content.

Gender Differences in Lung Cancer Survival 

Investigator: Michele L. Cote, PhD 

Lung cancer is the leading cause of cancer 

death in the United States. 1 It is estimated that 

in 2005, 172,570 individuals in the United 

States were diagnosed with lung cancer, and 

163,510 died of the disease. 1 Men are more 

likely to be diagnosed with lung cancer than 

women. In 2002, the age-adjusted incidence 

rates of lung cancer were 77.8 cases per 

100,000 men, and 50.8 cases per 100,000 

women. 2 Only prostate cancer in men and breast cancer in women 

were diagnosed more often. Survival from lung cancer is poor, with 

a five-year survival rate of 13.6% for men and 17.5% in women 

from 1995-2001. 2 Approximately 6 in 10 individuals with lung 

cancer die within a year of diagnosis. 1 Survival is greater for women 

than for men at every stage of diagnosis. Little is known about 

gender-related differences in risk and survival. 

Current or former cigarette smoking remains the greatest risk 

factor for lung cancer development, yet women are more likely to 

report never smoking than men, and also tend to smoke less than 

their male counterparts. 3 Histologic type of lung cancer varies by 

gender as well, with women more likely to develop adenocarcinomas 

compared to men. 4 Evidence suggests these differences could be 

due, in part, to hormonal variation and exposure to estrogens. 5 

Women have higher circulating endogenous levels of estrogen compared 

to men, and are also exposed to synthetic estrogens through 

hormone replacement therapy and oral contraceptives. Estrogens 

can increase cell proliferation. 6 Estrogens may also increase lung 

cancer risk by modulating gene expression of other enzymes, particularly 

the polycyclic aromatic hydrocarbon metabolizing enzymes 

such as the cytochrome p450s. 7 Several other genes thought to 

increase risk of lung cancer, including the c-erbB2 receptor, are also 

activated by estrogens. 8 Cellular response to estrogens is mediated 

by estrogen receptors (ER). Two receptors, ER-α and ER-β, which 

are encoded by separate genes have been identified and are expressed 

in the lung. It is feasible that ER status plays a role in lung 

carcinogenesis, may impact survival, and may be a potential target 

for therapy. 

We have recently received funding by the National Lung Cancer 

Partnership and the LUNGevity Foundation to examine the effect 

of ER expression on survival after a lung cancer diagnosis. We seek 

to clarify whether ER status and aromatase expression is associated 

with prognosis and may serve as therapeutic targets. Targeting 

hormone receptors has been successful in both chemoprevention 

and treatment in a variety of cancers. The role hormones play in 

lung cancer prognosis in humans has yet to be fully explored. These 

analyses will aid in the understanding of the underlying biological 

processes of lung cancer, and potentially lead to novel targets for 

treatment of lung cancer. 

PERCENTAGE 

25 

20 

15 

10 

5 

References: 

5 Year Relative Survival Rates for Lung Cancer 

by Gender in Metropolitan Detroit, 1973 – 2004 

1975 1980 1985 1990 1995 


Female 

Male 

2000 

2000 

1. American Cancer Society I. Key Statistics for Lung Cancer, 2004 

2. Ries LAG EM, Kosary CL, Hankey BF, Miller BA, Clegg L, Mariotto A, Feuer EJ, 

Edwards BK (eds). SEER Cancer Statistics Review, 1975-2002. In: Ries LAG EM, 

Kosary CL, Hankey BF, Miller BA, Clegg L, Mariotto A, Fay MP, Feuer EJ, Edwards 

BK (eds). ed: National Cancer Institute. Bethesda, MD, 2005 

3. (CDC) CfDCaP. Behavioral Risk Factor Surveillance System Survey Data. 

In: Services USDoHaH, ed. Atlanta, Georgia, 2003 

4. Charloux A, Quoix E, Wolkove N, et al. The increasing incidence of lung 

adenocarcinoma: reality or artefact? A review of the epidemiology of lung 

adenocarcinoma. Int J Epidemiol 1997; 26:14-23. 

5. Taioli E, Wynder EL. Re: Endocrine factors and adenocarcinoma of the lung 

in women. J Natl Cancer Inst 1994; 86:869-870 

6. Ethier SP. Growth factor synthesis and human breast cancer progression. 

J Natl Cancer Inst 1995; 87:964-973 

7. Thomsen JS, Wang X, Hines RN, et al. Restoration of aryl hydrocarbon (Ah) 

responsiveness in MDA-MB-231 human breast cancer cells by transient expression 

of the estrogen receptor. Carcinogenesis 1994; 15:933-937 

8. Matsuda S, Kadowaki Y, Ichino M, et al. 17 beta-estradiol mimics ligand activity 

of the c-erbB2 protooncogene product. Proc Natl Acad Sci U S A 1993; 

90:10803-10807 

* Source: Surveillance, Epidemiology, and End Results (SEER) Program 

(www.seer.cancer.gov) SEER*Stat Database: Incidence - SEER 17 Regs Limited-Use, 

Nov 2006 Sub (1973-2004 varying) - Linked To County Attributes - Total U.S., 

1969-2004 Counties, National Cancer Institute, DCCPS, Surveillance Research 

Program, Cancer Statistics Branch, released April 2007, based on the November 

2006 submission. 

19

Cancer in the Arab and Chaldean American Population 

in the Metropolitan Detroit Area 

Julie J. Ruterbusch, MPH and Kendra Schwartz, MD, MSPH (Principal Investigator) 

20 

The Detroit metropolitan area is home to one of the largest populations 

of people of Arab and Chaldean descent in the United States. 

Although Arab Americans are one of the fastest growing immigrant 

groups in this country, they are currently not recognized as a 

minority group by the government. In fact, people of Arab ancestry 

are often listed as Caucasians in census data and medical research 

databases. Thus, the cancer disease burden in the Arab community 

is unknown. 

To help address this problem, we have systematically compiled a 

database of Arab and Chaldean surnames. 1 We began the process 

of collecting Arab/Chaldean surnames using the Michigan Department 

of Community Health’s birth and death records. These 

records list the country of origin and we flagged surnames from 

the following countries and territories: Algeria, Bahrain, Djibouti, 

Egypt, Ethiopia, the Gaza Strip, Iraq, Jordan, Kuwait, Labanon, 

Libya, Morocco, North Africa, Oman, Palestine, Qatar, Saudi Arabia, 

Somalia, Sudan, Syria, Tunisia, United Arab Emirates, Yemen, and 

the Western Sahara. By working with several Arab and Chaldean 

community organizations, such as the Arab Community Center for 

Economic and Social Services, the Arab American and Chaldean 

Council, and the National Arab American Medical Association, we 

were able to obtain surnames (with no other identifiers) from their 

member lists. We also abstracted metropolitan Detroit telephone 

directories for both first and surnames. Our surname list has gone 

through rigorous reviews for accuracy and quality control measures 

indicate a 89.5% sensitivity at identifying Arab ancestry in the 

general public and a 100% negative predictive value when used to 

identify non-Arab names in the SEER registry. 

This surname database has been linked to the SEER population cancer 

registry to identify individuals who are likely of Arab descent. 

In 2004, there were 475 people with an Arab or Chaldean surname 

diagnosed with an invasive cancer in the Detroit metropolitan area. 

Using the entire cancer database from 1973-2004, we compared 

the ratio of specific cancer sites to all cancer sites between Arab/ 

Chaldean Americans and Caucasians. As a population group, Arab/ 

Chaldean Americans have a higher proportion of leukemia, multiple 

myeloma, gallbladder, liver, kidney, bladder, thyroid, and stomach 

cancer. They also have a lower proportion of melanoma, other 

cancers of the skin, esophagus, and oral cavity. In the table, these 

values are presented as proportional incidence ratios. A value over 

1 indicates a greater proportion of that specific cancer among Arab/ 

Chaldean Americans, after adjusting for age. 

On the third Friday of every month, we meet in the morning to 

present and discuss current research issues related to the cancer 

burden in Arab Americans. All those interested in working in this 

area are invited to attend these meetings. For further information 

please contact Julie Ruterbusch (ruterbus@med.wayne.edu). 

Table 1 - Cancer cases identified by the Arab/Chaldean 

surname database from MDCSS for 1973-2004 

Male 

Female 

Cancer site Obs PIR CI Obs PIR CI 

Bones & Joints 21 1.13 0.70 - 1.73 18 1.33 0.79 - 2.11 

Brain 114 1.12 0.93 - 1.35 85 1.10 0.88 - 1.36 

Breast 18 1.65 0.98 - 2.61 1499 1.04 0.99 - 1.09 

Cervix Uteri - - - 131 0.85 0.71 - 1.01 

Colorectal 618 1.01 0.93 - 1.09 476 0.90 0.82 - 0.99 

Corpus Uteri - - - 319 0.98 0.88 - 1.10 

Esophagus 45 0.66 0.48 - 0.88 18 0.84 0.50 - 1.33 

Gallbladder 13 1.46 0.78 - 2.50 31 1.53 1.04 - 2.17 

Hodgkin’s 77 1.17 0.92 - 1.46 69 1.24 0.96 - 1.57 

Lymphoma 

Kidney 202 1.33 1.15 - 1.53 91 1.01 0.81 - 1.24 

Larynx 96 0.93 0.75 - 1.14 21 0.96 0.59 - 1.46 

Leukemia 214 1.16 1.01 - 1.33 144 1.08 0.91 - 1.27 

Liver 67 1.66 1.29 - 2.11 27 1.39 0.91 - 2.02 

Lung & Bronchus 904 0.96 0.90 - 1.03 493 0.93 0.85 - 1.01 

Multiple Myeloma 75 1.42 1.12 - 1.78 46 1.04 0.76 - 1.38 

Non-Hodgkin’s 197 1.02 0.89 - 1.18 177 1.10 0.94 - 1.27 

Lymphoma 

Oral Cavity 146 0.74 0.62 - 0.87 82 0.94 0.75 - 1.17 

Ovary - - - 200 1.04 0.90 - 1.19 

Pancreas 137 1.14 0.96 - 1.35 99 0.94 0.77 - 1.15 

Prostate 1338 1.03 0.97 - 1.08 - - - 

Skin 72 0.48 0.38 - 0.60 67 0.63 0.49 - 0.80 

Skin – Melanoma 90 0.53 0.43 - 0.66 99 0.68 0.55 - 0.83 

Stomach 137 1.11 0.93 - 1.32 88 1.30 1.04 - 1.60 

Thyroid 46 1.06 0.77 - 1.41 171 1.35 1.16 - 1.57 

Ureter 16 1.71 0.98 - 2.78 9 2.07 0.95 - 3.93 

Urinary Bladder 309 1.15 1.03 - 1.29 81 0.98 0.78 - 1.21 

Obs - Observed number of cases 

PIR - Proportional incidence ratio (O/E) 

CI - Confidence Interval 

Significantly lower proportion 

Significantly higher proportion 

Reference: 

1. Schwartz KL, Kulwicki A, Weiss LK, Fakhouri H, Sakr W, Kau G, et al. Cancer among Arab Americans in the metropolitan Detroit area. Ethn Dis 2004;14(1):141-6.

Arab American Cancer Cases, 1973-2004 

Tri-County Area 

Estimated Numbers of Arab American Cancer Cases, 1973-2004 

Tri-County Area 

Oakland 

Macomb 

21 

Wayne 

Legend 

County 

City 

Census Tract 

Total Cases 

120 to 160 

80 to 119 

40 to 79 

1 to 39 

0 

Source: MDCSS 

© WSU/Department of Family Medicine & Public Health Sciences July, 2007/jcb 

© WSU/Department of Family Medicine & Public Health Sciences July, 2007/jcb

Arsenic and Cancer of the Urinary Bladder 

Investigator: Jennifer L. Beebe-Dimmer MPH, PhD 

22 

RATE PER 100,000 

Age Adjusted Urinary Bladder Cancer Incidence Rates per 100,000 

Population by Race and Sex, Metropolitan Detroit, 1975 – 2004 

60 

48 

36 

24 

12 

African-American 

Male 

It is estimated that 67,160 new cases of bladder cancer will be 

diagnosed and 13,750 deaths will occur in the United States in 2007 

making it the fifth most common cancer diagnosed among men and 

women in the United States (Ries et al., 2007). Bladder cancer is diagnosed 

3 to 4 times more frequently in men compared to women. 

And while the incidence of bladder cancer is higher in whites compared 

to blacks, racial differences in mortality are not as marked. 

Survival among blacks is poorer than whites, which is only partially 

explained by differences in stage at diagnosis. The overall 5-year 

relative survival rate for cancers diagnosed between 1996-2003 was 

80%, however when relative survival rates are stratified by race, 

81% of white men and women diagnosed with bladder cancer survive 

at least 5 years compared to only 65% of black men and women 

(Ries et al., 2007). 

Cigarette smoking is the most well-established risk factor for bladder 

cancer as smokers are two to three times more likely to be diagnosed 

with bladder cancer compared to non-smokers (Silverman 

et al, 2006). Evidence suggests that aromatic amines are the most 

powerful bladder carcinogens and that the most common source of 

exposure to aromatic amines is tobacco smoke. Tobacco smoke is 

also a significant source of a number of polycyclic aromatic hydrocarbons 

which have been connected to a number of cancers, including 

cancer of the bladder (Engel et al., 2002). Several occupations 

have also been linked with an excess in bladder cancer incidence and 

mortality including employment in the dyestuffs industry, rubber 

and leather manufacturing, as well as 

the manufacturing of aromatic amines. 

Ingestion of high-levels of inorganic arsenic is a cause of human 

bladder cancer (National Research Council, 1999). The relationship 

was initially discovered through investigations of areas of chronic 

arsenic toxicity (600-1200 μg/L) in Taiwan and Bangladesh. The 

effect of low to moderate levels of arsenic (

Differences in Completeness of Follow-up 

in a Population-Based Cancer Registry 

George W. Dombi, Cecilia Yee, Richard K. Severson, Jeannette Korczak and Ikuko Kato (Principal Investigator) 

Population-based cancer registries play a pivotal role in providing 

unbiased information on the occurrence of cancer arising in a 

defined population 1 . This information is crucial to monitor emerging 

patterns of cancer incidence, prevalence and survival. In the 

US, the Surveillance, Epidemiology and End Results (SEER) data 

have revealed differences in cancer incidence and survival between 

Caucasians and African Americans 2 . The most commonly diagnosed 

cancers in US women and men are breast and prostate cancers, 

respectively, and racial disparities in the 5-year relative survival for 

these two types of cancer have long been recognized 3, 4 . Validity of 

these comparisons depends on the assumption that completeness 

of follow-up is not only highly satisfactory, but also comparable between 

races. Because cases lost to follow-up may not be representative 

samples of the whole patient population, any racial differences 

in follow-up could potentially introduce bias into the observed 

racial disparities in cancer survival. Thus, we conducted a study to: 

(i) identify characteristics of breast cancer and prostate cancer patients 

who are lost to follow-up and (ii) assess whether there is any 

differential follow-up between African Americans and Caucasians, 

after adjustment for other factors related to loss to follow-up. 

Test set included 36,925 female breast cancer patients and 40,943 

prostate cancer patients, either Caucasian or African Americans, 

who were diagnosed between 1992 and 2002 and at age greater 

than 20 years were included in the study. During the average 6.6 

years of follow-up, 2.4% of the breast cancer patients and 1.4% of 

the prostate cancer patients were lost. Losses to follow-up occurred 

more frequently in Caucasians than African Americans, particularly 

for breast cancer. Unknown social security number (SSN) was 

the strongest predictor. Patients younger than 65 years, married 

women and men with unknown marital status were more likely to 

be lost. Local tumor stage and non-hospital reporting source were 

associated with higher risk of loss to follow-up in the logistic regression, 

but not in the time-dependent Cox proportional model. While 

a history of multiple primary cancers appeared to reduce the risk of 

loss to follow-up, no surgery or no radiation treatment records were 

associated with an increased risk of follow-up loss for either cancer. 

These observations are contrary to our working hypothesis that 

African Americans, as well as patients with lower socio-economical 

status, may be more likely to be lost to follow-up. The causes for 

the unexpected lower rate of African Americans lost to follow-up 

remains to be elucidated. It is not surprising that an advanced stage 

of disease showed a strong inverse association with loss to followup 

because all deceased cases were considered to be completely 

followed. Major determinants of loss to follow-up were concerned 

with incomplete patient information. According to the results of 

this study, it is highly recommended that complete and accurate 

personal identifying information be obtained; otherwise additional 

information concerning potential contacts of the patients would be 

helpful. Aside from that, results from the logistic regression analyses 

may prove to be especially useful in planning targeted follow-up 

to identify those patients who are likely to be lost following the 

initial diagnosis and treatment period. 

23 

100 MDCSS (1992 – 2002) Breast Cancer Patients Lost to Follow-up 

100 MDCSS (1992 - 2002) Prostate Cancer Patients Lost to Follow-up 

80 

Caucasian 

African American 

1.7% 

2.6% 

80 

Caucasian 

African American 

1.5% 

1.0% 

PERCENTAGE 

=65 years old 

40 Not married 

1.0% 

1.5% 

4.3% 

PERCENTAGE 

1.1% 

1.0% 

2.9% 

Married 

3.1% 

3.8% 

1.1% 

20 Unknown 

=65 years old 

40 Not married 

Married 

20 Unknown 

4.3% 

SSN known 

SSN unknown 1975 1980 

2.1% 39.7% 

SSN known 0.9% 51.5% 

SSN unknown 1975 1980 

0% 1% 2% 3% 4% 5% … 

Lost to Follow-up 

37% 38% 39% 40% 0% 1% 2% 3% 4% 5% … 49% 50% 51% 52% 

Lost to Follow-up 

References: 

1. Parkin DM. The evolution of the population-based cancer registry. 

Nat Rev Cancer. 2006;6:603-12. 

2. Ries LAG, Harkins D, Krapcho M, et al (eds). SEER Cancer Statistics Review, 

1975-2003, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/ 

csr/1975_2003/,based on November 2005 SEER data submission, posted to 

the SEER web site, 2006. 

3. Young JL Jr, Ries LG, Pollack ES. Cancer patient survival among ethnic groups 

in the United States. J Natl Cancer Inst 1984 ;73:341-352. 

4. Clegg LX, Li FP, Hankey BF, Chu K, Edwards BK. Cancer survival among US whites 

and minorities: a SEER (Surveillance, Epidemiology, and End Results) Program 

population-based study. Arch Intern Med. 2002 Sep 23;162(17):1985-93.

External Investigators: Use of MDCSS Data 

24 

Data collected through the MDCSS provides a wealth of opportunities 

to researchers working both internally as well as externally to 

the MDCSS. These collaborative research initiatives provide important 

information for a wide variety of audiences including health 

care providers, health economists, policy makers, health educators 

and, perhaps most importantly, patients and families affected by 

cancer. Additionally, collaborative studies strengthen relationships 

and foster additional opportunities for future cancer research. The 

MDCSS both supports and encourages outside research investigators 

to contact MDCSS research faculty with potential research 

initiatives. It is important to note that under no circumstances 

does the MDCSS provide external researchers access to patient or 

physician identifiers and, following IRB approvals, all contact with 

patients and physicians is conducted by the MDCSS. 

What follows are just a few examples of joint research initiatives 

between faculty at MDCSS and outside investigators: 

• Steven Katz, MD, MPH of University of Michigan has collaborated 

on a number of different projects with MDCSS 

researchers. Dr. Katz and MDCSS Investigator John Graff, 

PhD are currently collaborating on a study, “Health System 

Factors and Patient Outcomes in Breast Cancer” funded by the 

National Cancer Institute. The specific aims of this study are: 

1) To collect information from attending surgeons, oncologists 

and their practices who treated a population-based sample of 

female patients recently diagnosed with breast cancer derived 

from the Detroit SEER registry via a self-administered mailed 

survey (or telephone survey option). Provider and practice survey 

information will be linked to information from the patient 

survey which will also be augmented by sociodemographic and 

clinical data from the SEER registry; 2) To develop and refine 

measures of delivery system innovations and between-provider 

communication factors that are relevant to patient experiences 

and outcomes in cancer; 3) to describe variations in and 

the interplay between provider characteristics, practice characteristics, 

delivery system innovations and between-provider 

communication factors across provider groups; 4) to examine 

the association of three patient outcomes with delivery system 

innovations and between-provider communication factors. 

• Another research collaboration with Dr. Katz was “A Survey 

of Surgeons’ Knowledge and Attitude Towards Breast Surgery 

Treatment Decisions”, also funded by the National Cancer 

Institute as a supplement to the patient study. The study 

surveyed attending surgeons in the Detroit metropolitan 

area using self-administered questionnaires and telephone 

interviews to learn about surgeon perspectives on the 

decision-making process for breast cancer treatment. The 

surgeons were identified through the Metropolitan Detroit 

Cancer Surveillance System as having performed the primary 

treatment surgeries (e.g., lumpectomies and mastectomies) 

on the women in the patient study. 

• Jennifer Griggs, MD, MPH of University of Michigan and 

MDCSS Investigator John Graff, PhD are also collaborating on 

a study, “Disparity in Quality of Breast Cancer Treatment and 

Effect on Outcomes” funded by the National Cancer Institute. 

The purpose of this study is to assess the effect of breast cancer 

adjuvant treatment quality of care on outcomes, to quantify 

differences in treatment according to race, socioeconomic 

status, and obesity status, and to identify the dimensions of 

quality that generate disparities in outcomes. Clinical, pathological, 

treatment, and outcome data will be abstracted from 

the medical records of over 3000 women, stratified by race 

and site, who were treated for Stages I, II, or III breast cancer 

at two sites. Census block group data will be merged with the 

abstracted medical record data to provide SES measures. The 

ultimate goal of this project is to use the results to develop 

effective interventions to improve quality of care and address 

disparities in cancer outcomes. 

• Mousumi Banerjee, PhD of University of Michigan, MDCSS 

Investigator Kendra Schwartz, MD, MSPH, and Isaac Powell, 

MD of Wayne State University are collaborating on a study, 

“Racial Disparities in Treatment for Prostate Cancer” funded 

by the Lance Armstrong Foundation. In this retrospective medical 

record review study, statistical analyses will be performed 

to determine the factors associated with treatment received 

and prostate cancer survival among prostate cancer patients 

at a large urban comprehensive cancer center. In the statistical 

analysis patient factors will be examined such as age, SES, 

comorbidities, and tumor pathology to determine if these 

factors are associated with treatment received. Insurance type 

as a sytem level factor will also be included. Because all the 

patients are treated at a single large comprehensive cancer center, 

variablity of physician and hospital factors will be less of a 

concern. Findings from this research will 1) enable us to identify 

the causes for potential “undertreatment” of African American 

prostate cancer patients, and 2) empower us to objectively address 

the factors that contribute to the disparate prostate cancer 

mortality in African Americans by targeting patient education 

and intervention efforts in focused populations. 

As is evidenced by the examples above, there is a wide range of 

potential research opportunities available to outside investigators. 

Any interested parties should contact Dr. John Graff for more information 

on how to proceed with potential collaborative endeavors. 

John J. Graff, Ph.D., M.S. 

Assistant Professor; Chief, Cancer Surveillance, Research, Epidemiology Section 


110 E. Warren Avenue, Detroit, MI 48201-1379 | (313) 578-4205 

jgraff@med.wayne.edu

List of Studies Conducted at the 


The Metropolitan Detroit Cancer Surveillance System participates in 

a number of collaborative research projects. A brief description of a 

sample of these projects conducted during the past 2 years follows. 

Genetic Epidemiology of Lung Cancer 

This study is a case-control family study of lung cancer susceptibility 

genes and the study of gene-environment interactions. Dr. Ann 

Schwartz is the PI. This study is funded by the National 

Cancer Institute. 

Genetic Epidemiology of Lung Cancer I 

This study is designed to create a family registry and search for lung 

cancer genes in high risk lung cancer families. Dr. Ann Schwartz 

is the PI. This study is funded by the National Cancer Institute and the 

University of Cinncinnati. 

Adenocarcinoma of the Lung in Women 

The role of tobacco smoke and estrogens in determining risk of 

adenocarcinoma of the lung is being evaluated in a case-control study. 

In addition to questionnaire data, blood is collected for genotyping 

of metabolic enzyme loci and tumor blocks are evaluated for estrogen 

receptor status. Dr. Ann Schwartz is the PI. This study is funded by the 

National Cancer Institute. 

EXHALE 

This study is a case-control study of lung cancer in African Americans 

that will use admixture mapping to identify genes for lung cancer. Dr. 

Ann Schwartz is the PI of this National Cancer Institute funded study. 

The Role of Estrogen in Lung Cancer 

The aim of this study is to evaluate the contribution of tobacco 

exposure, estrogen use and reproductive history in determining the 

risk of lung cancer in women, using data from the Women’s Health 

Initiative. Dr. Ann Schwartz is the PI for this study which was funded 

by the Lung Cancer Online Foundation. 

Genetic Epidemiology of Pancreatic Cancer 

This project establishes the PACGENE Consortium of six institutions 

throughout the United States and Canada whose purpose is to identify 

and recruit kindreds with familial pancreatic cancer for gene discovery 

research. Dr. Ann Schwartz is the local PI of a subcontract to the Mayo 

Clinic, where the PI of the Consortium is Dr. Gloria Petersen. The 

overall study is funded by the National Cancer Institute. 

Study Centers for Case-Control Study of Renal 

Cell Cancer among Caucasians & African-Americans 

in the U.S. 

This is a population-based case-control study of renal cell cancer in 

areas of the United States with a high proportion of African-American 

residents. In-person interviews are conducted with cases and controls 

to elicit information on demographic background and history of 

exposures. In addition, blood, buccal cells and tumor tissue are collected 

for analysis. This study is funded by the National Cancer Institute. 

Dr. Kendra Schwartz is the local PI. 

Racial Disparities in the Treatment of Prostate Cancer 

This study investigates the following questions: 1) Are there variations 

in the receipt of prostate cancer treatment between African Americans 

and Caucasians? 2) If so, for which types of treatment do these 

variations exist? 3) Are there variations in time from diagnosis 

to primary treatment? 4) Do these treatment variations result in 

disparities in prostate cancer outcomes? This study is funded by the 

University of Michigan and the Lance Armstrong Foundation. Dr. 

Kendra Schwartz is the local Investigator and Dr. Mousumi Banerjee 

of the University of Michigan is the PI. 

Health System Factors and Patient Outcomes 

in Breast Cancer 

This study measures the impact of the breast cancer experience on 

women, addressing topics such as barriers to diagnosis and treatment, 

coordination of care and employment difficulties related to treatment. 

Dr. John J. Graff is the local PI at Wayne State University (WSU) and 

Dr. Steven Katz is the Principal Investigator of the parent contract 

with University of Michigan (UM) for this National Cancer Institute 

funded project. 

Patterns and Correlates of Chemotherapy 

Delivery Quality 

This study will investigate patient demographic and social support 

factors, oncologist factors and delivery system factors associated with 

disparities in the receipt of suboptimal chemotherapy doses in the 

adjuvant treatment of breast cancer. Dr. John J. Graff is the local PI at 

Wayne State University (WSU) and Dr. Steven Katz and Dr. Jennifer 

Griggs are the Principal Investigators of the parent contract with 

University of Michigan (UM) for this National Cancer Institute 


Disparity in Quality of Breast Cancer Treatment 

and Effect on Outcomes 

This study will investigate whether 1) the quality of breast cancer 

adjuvant treatment and disease-free and overall survival are related; 2) 

racial, socioeconomic and weight-based disparities exist in the quality 

of breast cancer adjuvant treatment and timing of treatments; and 3) 

disparities in outcomes exist and if they are reduced by controlling for 

disparities in the quality of treatments. The ultimate goal of this project 

is to use the results to develop effective interventions to improve 

quality of care and address disparities in outcomes. Dr. John J. Graff is 

the local PI at WSU and Dr. Jennifer Griggs is the Principal Investigator 

of the parent contract with UM for this National Cancer Institute 


25

26 

Assessing Smoking and Drinking in the Development 

of Tongue Cancer and Evaluation of Quality of 

Life Following Different Treatment Options – 

A Feasibility Study 

This is a feasibility study to assess tobacco and alcohol use among 

patients diagnosed with tongue cancer and to evaluate their quality of 

life after making decisions about cancer treatment. Self-administered 

surveys will be mailed to newly diagnosed subjects over a one-year 

period of rapid case ascertainment. Dr. John Graff is the PI of this 

National Cancer Institute funded study. 

Luminal Lipid Exposure, Genetics & Colon Cancer Risk 

This case-control study of colon cancer risk will determine whether 

specific genotypes are associated with risk of colon cancer and 

whether the effect of a high fat diet on the risk of colon cancer is more 

pronounced in the subjects with these genotypes. Dr. Ikuko Kato is the 

PI of this study which is funded by the National Cancer Institute. 

SEER Patterns of Care Study 

Each year, the National Cancer Institute and 14 national SEER sites 

collaborate in this study to assess trends in treatment for selected 

cancer sites. This study examines trends in treatment by age, race/ 

ethnicity, gender and other demographic characteristics, in relation to 

tumor morphology, hospital and insurer characteristics and the impact 

of treatment changes on survival. Dr. Ikuko Kato is the local PI. This 

study was funded by the National Cancer Institute. 

Feasibility of Expanded Patterns of Care Study 

of Adolescent and Young Adult Cancers 

This expanded Patterns of Care Study will assess the feasibility of 

enrolling adolescent and young adult cancer patients in a study to 

determine current treatment patterns for Non-Hodgkin’s Lymphoma, 

Hodgkin’s Lymphoma, Acute Lymphoblastic Leukemia, Germ Cell 

Cancer and Osteo, Ewing’s and Synovial Sarcoma. Participants will 

complete a short, online survey and are also asked for consent to obtain 

their medical records. Dr. Ikuko Kato is the local PI of this National 

Cancer Institute funded study. 

Does Use of Alternative Medicine Delay Treatment 

of Head and Neck Cancer? 

The primary goal of this population-based study is to assess whether 

complementary and alternative medicine (CAM) use is associated with 

a delay in initiation of conventional cancer treatment for head and neck 

cancer, which would predict poorer survival. Dr. Ikuko Kato is the PI for 

this National Cancer Institute funded project. 

Molecular Epidemiology of Steroid Hormone 

Metabolism in Relation to Breast Cancer Risk in 

African Americans 

This study seeks to genotype cases and controls for specifically or 

predominantly African American polymorphisms at steroid hormone 

metabolism loci and to test for associations of these polymorphisms 

with breast cancer risk. This study was funded by the Susan G. Komen 

Breast Cancer Foundation. Dr. Ikuko Kato is the PI on this study. 

Does Completeness of SEER Follow-up Vary 

by Race/Ethnicity? 

The purpose of this study is to evaluate the completeness of follow-up 

information for all patients in the Detroit SEER Registry who were 

diagnosed with lung, breast, prostate, or colorectal cancer and all 

children who were diagnosed with leukemia, lymphoma or brain cancer 

during 1992-2002. For each of these cancer types, we will explore the 

impact of race/ethnicity on the completeness of follow-up information, 

as well as other patient-, tumor-, or medical care provider-associated 

factors. Results of this study will increase our understanding of possible 

biases in research studies of cancer survivors and identify areas where 

more intensive follow-up efforts are indicated. The Co-Investigators of 

this study are Dr. Ikuko Kato and Dr. Jeannette Korczak. This study was 

funded by the National Cancer Institute. 

Hormonal Factors and Lung Cancer: 

A Potential Target for Therapy 

The goal of this study is to further our understanding of the role 

of estrogen-related tumor characteristics in predicting sex-specific 

survival after a lung cancer diagnosis. Specifically, tumors from 275 

early-onset lung cancer cases (144 men, 131 women) will be examined 

for estrogen receptor beta status and aromatase expression. We will 

determine the proportion of tumors that are ER-β positive and/ 

or express aromatase. We will also assess whether ER-β expression 

and aromatase expression are correlated, and whether expression is 

associated with gender. Lastly, we will evaluate whether ER-β and 

aromatase expression is associated with survival. Dr. Michele Cote is 

the PI for this National Cancer Institute funded study. 

Oxidative Stress, Antioxidants and 

Racial Disparities in Prostate Cancer 

This study will examine three genes in the oxidative stress pathway 

along with intake of three antioxidants to determine whether variation 

in the genes modifies prostate cancer risk associated with intake of each 

of the antioxidants. Dr. Cathy Bock is the PI on this National Cancer 

Institute funded study. 

Analysis of Ethnic Admixture in Prostate Cancer 

The goal of this research proposal is to use a novel approach to gene 

mapping, admixture mapping, to find potential prostate cancer 

susceptibility genes in a group of African-American men. Dr. Cathy 

Bock is the PI on this Department of Defense funded study.

List of Metropolitan Detroit Cancer 

Surveillance System/Detroit SEER Publications 2005-2007 

In Press 

Banerjee M, Schwartz K, George J, Yee C, Hryniuk W. Disentangling 

the effects of race on breast cancer treatment. Cancer, in press. 

Cheng H, Sathiakumar N, Graff JJ, Matthews R, Delzell E. 1,3-Butadiene 

and Leukemia Among Synthetic Rubber Workers: Exposure-Response 

Relationships. Chem Biol Interact, 166(1-3):15-24, 2007. 

Cozen W, Engels EA, Cerhan JR, Linet M, Bernstein L, Colt JS, Davis S, 

Severson RK, Martinez-Maza O, Hartge P. The effect of atopy, childhood 

crowding and other immune-related risk factors on non-Hodgkin 

lymphoma risk. Cancer Causes Control, in press. 

Fagerlin A, Lakhani I, Lantz PM, Janz NK, Morrow M, Schwartz K, Deapen 

D, Salem B, Liu L, Katz SJ. An informed decision? Breast cancer patients 

and their knowledge about treatment. Patient Education and Counseling, 

in press. 

Janz N, Lantz P, Hawley ST, Schwartz K, Liu L, Katz SJ. Symptom 

experience and quality of life in women following breast cancer 

treatment. J Women’s Health, in press. 

Kato I, Neale AN. Does use of alternative medicine delay treatment of head 

and neck cancer?: a Surveillance, Epidemiology, and End Results (SEER)- 

cancer registry study. Head and Neck, in press. 

Morton LM, Bernstein L, Wang SS, Hein DW, Rothman N, Colt JS, Davis S, 

Cerhan JR, Severson RK, Welch R, Hartge P, Zahm SH. Hair dye use, 

genetic variation in N-acetyltransferase 1 (NAT1) and 2 (NAT2), and risk 

of non-Hodgkin lymphoma. Carcinogenesis, in press. 

Wang SS, Hartge P, Cerhan J, Cozen W, Davis S, Severson R, Chatterjee N, 

Yeager M, Chanock S, Rothman N. Immune Gene Polymorphisms and 

Risk of Non Hodgkin Lymphoma in the NCI-SEER Case Control Study. 

J Clin Oncol, in press. 

2007 

Cerhan JR, Habermann TM, Ansell SM, Geyer SM, Maurer MJ, 

Hartge P, Wang S, Morton LM, Chanock S, Rothman N, Lynch CF, 

CozenW, Davis S, Severson RK. Prognostic significance of host 

immune gene polymorphisms in follicular lymphoma survival. 

Blood 109:5439-5446, 2007. 

Clegg LX, Reichman ME, Hankey BF, Miller BA, Lin YD, Johnson NJ, 

Schwartz SM, Bernstein L, Chen VW, Goodman MT, Gomez SL, Graff JJ, 

Lynch CF, Lin CC, Edwards BK. Quality of Race, Hispanic Ethnicity, and 

Immigrant Status in Population-based Cancer Registry Data: Implications 

for Health Disparity Studies. Cancer Causes Control, 18(2): 177-87, 2007. 

Colt JS, Hartge P, Purdue M, Davis S, Cerhan J, Cozen W, Severson RK. 

Hobbies with solvent exposure and risk of non-Hodgkin lymphoma. 

Cancer Causes Control 18:385-390, 2007. 

Cote ML, Wenzlaff AS, Bock CH, Land SJ, Santer SK, Schwartz DR, 

Schwartz AG. Combinations of cytochrome P-450 genotypes and risk 

of early-onset lung cancer in Caucasians and African Americans: 

A population-based study. Lung Cancer 55(3): 255-262, 2007. 

Katz SJ, Hofer TP, Hawley ST, Lantz PM, Janz NK, Schwartz K, Liu L, 

Deapen D, Morrow M. Patterns and correlates of patient referrals to 

surgeons for treatment of breast cancer. J Clin Oncol 25:271-6, 2007. 

Naff JL, Cote ML, Wenzlaff AS, Schwartz AG. Racial differences in 

cancer risk among relatives of early-onset lung cancer cases. 

Chest; May 131(5):1289-94, 2007. 

Opatt D, Morrow M, Hawley ST, Schwartz K, Janz NK, Katz SJ. Conflicts 

in decision-making for breast cancer surgery. Ann Surg Oncol DOI: 

10.1245/s10434-007-9431-7, 2007. 

Schwartz AG, Prysak GM, Bock CH, Cote ML. The molecular epidemiology 

of lung cancer. Carcinogenesis 28: 507-18, 2007. 

Wang M, Vikis HG, Wang Y, Jia D, Wang D, Bierut LJ, Bailey-Wilson JE, 

Amos CI, Pinney SM, Petersen GM, de Andrade M, Yang P, Wiest JS, Fain 

PR, Schwartz AG, Gazdar A, Minna J, Gaba C, Rothschild H, Mandal D, 

Kupert E, Seminara D, Liu Y, Viswanathan A, Govindan R, Anderson MW, 

You M. Identification of a novel tumor suppressor gene p34 on human 

chromosome 6q25.1. Cancer Res 1:93-99, 2007. 

Wang SS, Cozen W, Cerhan JR, Colt J, Morton LM, Engels EA, Davis S, 

Severson RK, Rothman N, Chanock SJ, Hartge P. Immune mechanisms 

in non-Hodgkin lymphoma: joint effects of the TNF G308A and IL10 

T3575A polymorphisms with non-Hodgkin lymphoma risk factors. 

Cancer Res 67:5042-5054, 2007. 

Wang SS, Slager S, Brennan P, Becker N, Bernstein L, Cerhan JR, Chiu BCH, 

Cocco PL, Costantini AS, Cozen W, Dal Maso L, Davis S, De Sanjose S, 

Foretova L, Franceschi S, Holly EA, La Vecchia C, Lan EZ, Maynadie M, 

Mensah F, Roman E, Severson RK, Spinelli J, Staines A, Vornanen M, 

Zhang Y, Hartge P. Family history of hematopoietic malignancies and 

risk of non-Hodgkin lymphoma (NHL): a pooled analysis of 10,211 cases 

and 11,905 controls from the International Lymphoma Epidemiology 

Consortium (InterLymph). Blood 109:3479-3488, 2007. 

2006 

Bangsi D, Zhou JY, Sun Y, Patel NP, Darga LL, Heilbrun LK, Powell IJ, 

Severson RK, Everson RB. Impact of a Genetic Variant in CYP3A4 on 

Risk and Clinical Presentation of Prostate Cancer Risk Among White 

and African American Men. Urol Oncol 24:21-7, 2006. 

Colt JS, Davis S, Severson RK, Lynch CF, Cozen W, Camann D, Engels EA, 

Blair A, Hartge P. Residential insecticide use and Risk of Non-Hodgkin 

Lymphoma. Cancer Epidemiol Biomarkers Prev 15:251-257, 2006. 

Cote ML, Wenzlaff AS, Bock CH, Land SJ, Santer SK, Schwartz DR, 

Schwartz AG. Combinations of cytochrom P-450 genotypes and risk 

of early-onset lung cancer in Caucasians and African Americans: 

A population-based study. Lung Cancer 2006, Epub. 

Cote ML, Wenzlaff AS, Philip PA, Schwartz AG. Secondary cancers after a 

lung carcinoid primary: A population-based analysis. Lung Cancer June; 

52(3):273-9, 2006. 

De Roos AJ, Gold LS, Wang S, Hartge P, Cerhan J, Cozen W, Yeager M, 

Chanock S, Rothman N, Severson R. Metabolic gene variants and 

risk of non-Hodgkin lymphoma. Cancer Epidemiol Biomarkers Prev 

15:1647-1653, 2006. 

Fagerlin A, Lakhani I, Lantz PM, Janz NK, Morrow M, Schwartz K, Deapen 

D, Salem B, Liu L, Katz SJ. An informed decision? Breast cancer patients 

and their knowledge about treatment. Patient Education and Counseling 

64:303-12., 2006. 

Hartge P, Lim U, Freedman DM, Colt JS, Cerhan JR, Cozen W, Severson RK, 

Davis S. Ultraviolet radiation, dietary vitamin D, and risk of non-Hodgkin 

lymphoma. Cancer Causes Control 17:1045-1052, 2006. 

Hawley ST, Hofer TP, Janz, NK, Lantz P, Alderman A, Mujahid M, Schwartz 

K, Liu L, Deapen D, Morrow M, Katz SJ. Correlates of between-surgeon 

variation in breast cancer treatment. Med Care 44: 609-16, 2006. 

27

28 

Hill DA, Wang SS, Cerhan JR, Davis S, Cozen W, Severson RK, Hartge P, 

Yeager M, Chanock SJ, Rothman N. Risk of non-Hodgkin lymphoma 

(NHL) in relation to germline variation in DNA repair or related genes. 

Blood 108:3161-3167, 2006. 

Lantz PM, Mujahid M, Schwartz K, Janz NK, Fagerlin A, Salem B, Liu 

L, Deapen D, Katz SJ. The influence of race, ethnicity, and individual 

socioeconomic factors on breast cancer stage at diagnosis. Am J Public 

Health 96:2173-8, 2006. 

Lee WJ, Purdue M, Stewart P, Schenk M, De Roos A, Cerhan J, Severson 

RK, Cozen W, Hartge P, Blair A. Occupational exposure to pesticides, 

asthma history, and the risk of non-Hodgkin lymphoma. Int J Cancer 

118:3174-3176, 2006. 

Linet MS, Colt J, Hartge P, Severson RK, Cerhan JR, Cozen W, Davis S. 

Use of mobile telephones and non-Hodgkin lymphoma. Int J Cancer 

119:2382-2388, 2006. 

Maibenco DC, Dombi G, Kau TY, Severson RK. Significance of 

micrometastases on the survival of women with T1 breast cancer. 

Cancer 107:1234-1239, 2006. 

Raimondi S, Paracchini V, Autrup H, Barros-Dios JM, Benhamou S, Boffetta 

P, Cote ML, Dialyna IA, Dolzan V, Filiberti R, Garte S, Hirvonen A, 

Husgafvel-Pursiainen K, Imyanitov EN, Kalina I, Kang D, Kiyohara C, 

Kohno T, Kremers P, Lan Q, London S, Povey AC, Rannug A, Reszka E, 

Risch A, Romkes M, Schneider J, Seow A, Shields PG, Sobti RC, Sørensen 

M, Spinola M, Spitz MR, Strange RC, Stücker I, Sugimura H, To-Figueras 

J, Tokudome S, Yang P, Yuan J-M, Warholm M and Taioli E. Meta and 

pooled analysis of GSTT1 and lung cancer: a HuGE-GSEC review. 

AJE 2006; Sept. 25. 

Rothman N, Skibola C, Wang S, Morgan G, Lan Q, Smith MT, Spinelli JJ, 

Willett E, De Sanjose S, Cocco P, Berndt S, Brennan P, Brooks-Wilson A, 

Wacholder S, Becker N, Hartge P, Zheng T, Roman E, Holly EA, Boffetta 

P, Armstrong B, Cozen W, Linet M, Bosch FX, Ennas MG, Holford TR, 

Gallagher RP, Rollinson S, Bracci PM, Cerhan JR, Whitby D, Moore 

PS, Leaderer B, Lai A, Spink C, Davis S, Bosch R, Scarpa A, Zhang Y, 

Severson RK, Yeager-Jeffery M, Chanock S, Nieters A. Genetic variation 

in TNF and IL10 and risk of non-Hodgkin lymphoma: A report from the 

Interlymph Consortium. Lancet Oncology 7:27-38, 2006. 

Schwartz AG. Lung cancer: Family history matters. Chest 130: 936-7, 2006. 

Schwartz AG, Ruckdeschel JC. Familial lung cancer: genetic susceptibility 

and relationship to COPD. Am J Respiratory Critical Care Med 

173:16-22, 2006. 

Simon MS, Banerjee M, Crossley-May H, Vigneau FD, Noone AM, 

Schwartz K. Racial differences in breast cancer survival in the Detroit 

metropolitan area. Breast Cancer Res Treat 97(2): 149-51, 2006. 

Simon MS, Korczak JF, Yee CL, Malone KF, Ursin G, Bernstein L, McDonald 

JA, Deapen D, Strom BL, Press MF, Marchbanks PA, Burkman RT, 

Weiss LK, Schwartz AG. Breast cancer risk estimates for relatives of 

white and African American women with breast cancer in the Women’s 

Contraceptive and Reproductive Experiences Study. J Clin Oncol 

24: 2498-504, 2006. 

Stewart SL, Wike JM, Kato I, Lewis DR, and Michaud F. A population-based 

study of colorectal cancer histology. Cancer 107: 1128-1141, 2006. 

Vandevord PJ, Wooley PH, Darga LL, Severson RK, Wu B, Nelson DA. 

Genetic determinants of bone mass do not relate with breast cancer risk 

in US white and African-American women. Breast Cancer Res Treat 

June 22, 2006. 

Wang SS, Cozen W, Severson RK, Hartge P, Cerhan JR, Davis S, Welch R, 

Rothman N, Chanock SJ. Cyclin D1 (CCND1) splice variant and risk for 

non-Hodgkin lymphoma (NHL). Human Genetics 120:297-300, 2006. 

Wang SS, Davis S, Cerhan JR, Hartge P, Davis S, Severson RK, Cozen W, 

Lan Q, Welch R, Chanock SJ, Rothman N. Polymorphisms in oxidative 

stress genes and risk for non-Hodgkin lymphoma. Carcinogenesis 

27:1828-34, 2006. 

Wang SS, Hartge P, Cerhan JR, Cozen W, Davis S, Severson RK, Chatterjee 

N, Yeager M, Chanock SJ, Rothman N. Common genetic variants in 

pro-inflammatory and other immunoregulatory genes and risk for 

non-Hodgkin lymphoma (NHL). Cancer Res 66:9771-9780, 2006. 

2005 

Barnholtz-Sloan JS, Charkraborty R, Sellers TA, Schwartz AG. Examining 

population stratification via individual ancestry estimates versus selfreported 

race. Cancer, Epidemiology, Biomarkers and Prevention 

14: 1545-51, 2005. 

Barnholtz-Sloan JS, Severson RK, Stanton B, Hamre M, Sloan AE. 

Pediatric brain tumors in Hispanics, non-Hispanics, African Americans 

and Asians: differences in survival after diagnosis. Cancer Causes Control, 

16: 587-592, 2005. 

Bednarek H, Bradley C. Work and Retirement Beyond Cancer Diagnosis. 

Research in Nursing & Health, 28(2): 126-135, 2005 

Bock CH, Wenzlaff AS, Cote ML, Land SJ, Schwartz AG. NQO1 T allele 

associated with decreased risk of later age at diagnosis lung cancer among 

never smokers: results from a population-based study. Carcinogenesis 

26: 381-386, 2005. 

Bradley CJ, Neumark D, Luo Z, Bednarek H, Schenk M. Employment 

outcomes of men treated for prostate cancer. Journal of National Cancer 

Inst, 97(13): 958-965, 2005. 

Bradley CJ, Neumark D, Bednarek H, Schenk M. Short-term effects of breast 

cancer on labor market attachment: results from a longitudinal study 

J Health Econ. 24(1):137-60, 2005. 

Cerhan JR, Bernstein L, Severson RK, Davis S, Colt JS, Blair A, Hartge P. 

Anthropometrics, physical activity, related medical conditions, 

and the risk of non-Hodgkin lymphoma. Cancer Causes Control, 

16:1203-1214, 2005. 

Chatterjee S, Dombi GW, Severson RK, Mayes MD. Risk of malignancy in 

scleroderma: a population-based cohort study. Arthritis Rheum, 52(8): 

2415-2424, 2005. 

Chuba PJ, Hamre MR, Yap J, Severson RK, Lucas D, Shamsa F, Aref A. 

Bilateral risk for subsequent breast cancer after lobular carcinoma in situ. 

J Clin Oncol 23:5534-5541, 2005. 

Colt JS, Severson RK, Lubin J, Camann D, Davis S, Cerhan J, Cozen W, 

Rothman N, Hartge P. Organochlorine compounds in carpet dust and risk 

of non-Hodgkin lymphoma. Epidemiol 16:516-525, 2005. 

Colt J, Wacholder S, Schwartz K, Davis F, Graubard B, Chow W. Response 

rates in a case-control study: Effect of disclosure of biologic sample 

collection in the initial contact letter. Ann Epidemiol 15: 700-704, 2005. 

Cote, M.L., Kardia, S.L.R., Wenzlaff, A.S., Land, S.J., Schwartz, A.G. 

Combinations of glutathione S-transferase genotypes and risk of lung 

cancer in early onset African American and Caucasian populations: 

A population-based study. Carcinogenesis, 26(4):811-819, 2005.

Cote ML, Kardia SLR, Wenzlaff AS, Ruckdeschel J, Schwartz AG. Racial 

differences in familial aggregation of lung cancer in first degree relatives 

of early onset lung cancer cases. JAMA 293:3036-3042, 2005. 

De Roos AJ, Hartge P, Lubin J, Colt JS, Davis S, Cerhan JR, Severson 

RK, Cozen W, Patterson DG, Needham LL, Rothman N. Persistent 

organochlorine chemicals in plasma and risk of non-Hodgkin lymphoma. 

Cancer Res 65:11214-11226, 2005. 

Divine KK, Pulling LC, Marron-Terada PG, Liechty KC, Kang T, Schwartz 

AG, Bocklage TJ, Coons TA, Gilliland FD, Belinsky SA. Multiplicity of 

abnormal promoter methylation in lung adenocarcinomas from smokers 

and never smokers. Int J Cancer 114: 400-405, 2005. 

Engels EA, Cerhan JR, Linet MS, Cozen W, Colt JS, Davis S, Gridley 

G, Severson RK, Hartge P. Immune-related conditions and immunemodulating 

medications as risk factors for non-Hodgkin lymphoma: 

a case-control study. Am J Epidemiol 162:1153-1161, 2005. 

Engels EA, Chen J, Hartge P, Cerhan JR, Davis S, Severson RK, Cozen W, 

Viscidi RP. Antibody responses to simian virus 40 T antigen: a casecontrol 

study of non-Hodgkin lymphoma. Cancer Epidemiol Biomarkers 

Prev 14:521-524, 2005. 

Engels EA, Rollison DE, Hartge P, Baris D, Cerhan JR, Severson RK, 

Cozen W, Davis S, Biggar RJ, Goedert JJ, Viscidi RP. Antibodies to JC and 

BK viruses among persons with non-Hodgkin lymphoma. Int J Cancer 

117:1013-1019, 2005. 

Fu JB, Kau TY, Severson RK, Kalemkerian GP. Lung cancer in women: 

analysis of the national Surveillance, Epidemiology and End Results 

database. Chest 127:768-777, 2005. 

Hartge P, Colt JS, Severson RK, Cerhan JR, Cozen W, Camann D, Zahm SH, 

Davis S. Residential Herbicide Use and Risk of Non-Hodgkin Lymphoma. 

Cancer Epidemiol Biomarkers Prev 14:934-937, 2005. 

Katz SJ, Lantz PM, Janz NK, Fagerlin A, Schwartz K, Liu L, Deapen D, 

Lakhani I, Morrow M. Patterns and correlates of local therapy for women 

with ductal carcinoma in situ. J Clin Oncol 23: 3001-7, 2005. 

Katz SJ, Lantz PM, Janz NK, Fagerlin A, Schwartz K, Liu L, Deapen D, 

Salem B, Lakhani I, Morrow M. Surgeon perspectives about local therapy 

for breast cancer. Cancer 104: 1854-61, 2005. 

Katz SJ, Lantz PM, Janz NK, Fagerlin A, Schwartz K, Liu L, Salem B, 

Lakhani I, Morrow M. Patient involvement in surgery treatment 

decisions for breast cancer. Journal of Clin Onc 23:5526-33, 2005. 

Lantz PM, Janz NK, Fagerlin A, Schwartz K, Liu L, Lakhani I, Salem B, 

Katz SJ. Satisfaction with surgery outcomes and the decision process in 

a population-based sample of women with breast cancer. Health Services 

Research 40(3):745-68, 2005. 

Morrow M, Mujahid M, Lantz PM, Janz NK, Fagerlin A, Schwartz K, 

Liu L, Deapen D, Salem B, Lahkani I, Katz SJ. Correlates of breast 

reconstruction: results from a population-based study. Cancer 

104:2340-6, 2005. 

Morton LM, Hartge P, Holford TR, Holly EA, Chiu BCH, Vineis P, Stagnaro 

E, Willett EV, Franceschi S, La Vecchia C, Hughes AM, Cozen W, Davis 

S, Severson RK, Bernstein L, Mayne ST, Dee FR, Cerhan JR, Zheng T. 

Cigarette smoking and risk of non-Hodgkin lymphoma: a pooled analysis 

from the InterLymph consortium. Cancer Epidemiol Biomarkers Prev 

14:925-933, 2005. 

Morton LM, Zheng T, Holford TR, Holly EA, Chiu BCH, Costantini AS, 

Stagnaro E, Willett EV, Maso LD, Serraino D, Chang ET, Cozen W, 

Davis S, Severson RK, Bernstein L, Mayne ST, Dee FR, Cerhan JR, 

Hartge P. Alcohol consumption and risk of non-Hodgkin lymphoma: 

a pooled analysis from the InterLymph consortium. Lancet Oncol 

6:469-476, 2005. 

Patel DA, Barnholtz-Sloan JS, Patel MK, Malone JM Jr, Chuba PJ, Schwartz 

K. A survival advantage for Hispanic women with invasive cervical cancer: 

Analysis of Surveillance, Epidemiology, and End Results Data. Gynecol 

Oncol 97: 550-8, 2005. 

Patel DA, Bock CH, Schwartz K, Wenzlaff AS, Demers RY, Severson RK. 

Sexually Transmitted Diseases and Other Urogenital Conditions as Risk 

Factors for Prostate Cancer: A Case-Control Study in Wayne County, 

Michigan. Cancer Causes and Control 16: 263-273, 2005. 

Patel DA, Knowles A, Schwartz AG, Schwartz K. Evaluation of African 

American and white racial classification in a Surveillance, Epidemiology 

and End Results cancer registry. Ethnicity & Disease, 15:713-19, 2005. 

Schwartz AG. Genetic Susceptibility to Lung Cancer. In: Lung Cancer: 

Principles and Practice, 3rd Edition. HI Pass, JB Mitchell, D Johnson, 

A Turissi, J Minna (Eds). JB Lippincott, Philadelphia, PA. 2005. 

Schwartz AG. The Changing Face of Lung Cancer, pp628-632. American 

Society of Clinical Oncology Education Book. Perry MC (Ed). 2005 ASCO. 

Alexandria, VA. 

Schwartz AG, Prysak GM, Murphy V, Lonardo F, Pass H, Schwartz J, 

Brooks S. Nuclear estrogen receptor β in lung cancer: expression and 

survival differences by sex. Clinical Cancer Research 11:7280-7, 2005. 

Simon MS, Korczak JF, Yee CL, Schwartz AG. Racial Differences in the 

Familial Aggregation of Breast Cancer and Other Female Cancers. 

Breast Cancer Research and Treatment 89:227-235, 2005. 

Wenzlaff AS, Cote ML, Bock CH, Land SJ, Santer SK, Schwartz DR, 

Schwartz AG. CYP1A1 and CYP1B1 polymorphisms and risk of lung 

cancer among never smokers: a population-based study. Carcinogenesis 

26: 2207-2212, 2005. 

Wenzlaff AS, Cote ML, Bock CH, Land SJ, Schwartz AG. GSTM1, GSTT1 

and GSTP1 polymorphisms, environmental tobacco smoke exposure 

and risk of lung cancer among never smokers: a population-based study. 

Carcinogenesis 26: 395-401, 2005. 

29

Affiliations and Acknowledgments 

STATE OF MICHIGAN 

30 

The cancer statistics collected and disseminated here could not have 

been presented without the untiring work of the cancer registrar, 

editing, follow-up and management teams of the Metropolitan 

Detroit Cancer Surveillance System. Nor could this work have been 

presented without the collaboration of each of the facilities on the 

following page and the entities listed here. 

Special thanks go to the Michigan Department of Community 

Health for their ongoing assistance, and also to the many physicians 

who support our efforts to ensure complete cancer reporting for 

tri-county residents. Finally, we would like to acknowledge the 

cancer patients and their families. It is to you we dedicate this work. 

The Metropolitan Detroit Cancer Surveillance System is funded by: 

The Division of Cancer Prevention and Control 

National Cancer Institute 

Department of Health and Human Services 

SEER Contract # NO1-PC-35145


Participating Institutions 

The following hospitals, pathology laboratories and radiation 

oncology treatment facilities are participants in the Metropolitan 

Detroit Cancer Surveillance System. Their collaboration makes 

possible Detroit area population-based cancer reporting. 

Hospitals and Associated Path Labs, Radiation Facilities and Clinics 

Bon Secours Cottage Health 

Services 

Botsford General Hospital 

Children’s Hospital of Michigan 

Crittenton Hospital 

Detroit Receiving Hospital 

Garden City Osteopathic Hospital 

Harper Hospital 

Henry Ford Hospital 

Henry Ford Bi-County Hospital 

Henry Ford Hospital – Macomb 

Center 

Henry Ford Wyandotte Hospital 

Huron Valley-Sinai Hospital 

Hutzel Hospital 

John D. Dingell Dept. of Veterans 

Administration Medical Center 

Karmanos Cancer Center 

Michigan Orthopedic Specialty 

Hospital 

Monsignor Clement Kern Hospital 

Mt. Clemens General Hospital 

North Oakland Medical Center 

Oakwood Hospital 

Oakwood Annapolis Hospital 

Oakwood Heritage Hospital 

Oakwoood Southshore Medical 

Center 

Pontiac Osteopathic Hospital 

Regional Medical Center 

Providence Hospital and 

Medical Center 

St. John Detroit Riverview Hospital 

St. John Hospital and Medical 

Center 

St. John Macomb Hospital Center 

St. John Northshore Hospital 

St. John Oakland Hospital 

St. Joseph Mercy Hospital 

Ann Arbor* 

St. Joseph Mercy Hospital Oakland 

St. Mary Hospital 

Sinai-Grace Hospital 

Straith Memorial Hospital 

University Hospital Ann Arbor* 

Veterans Administration Medical 

Center-Ann Arbor* 

William Beaumont Hospital- 

Royal Oak 

William Beaumont Hospital-Troy 

31 

Independent Pathology Laboratories 

Beaumont Reference Laboratory 

Histopathology Associates, Inc. 

Oppenheimer Urologic Laboratory 

Tri-County Urology Laboratory 

Contemporary Imaging Associates 

Hospital Consolidated Laboratories 

Pinkus Laboratory 

University Dermatologists, PC 

Detroit Bio-Medical Laboratories 

Lakewood Pathology 

Quest Diagnostics, Inc. 

UroCor, Inc. 

Dianon Systems 

Medical Diagnostic Lab 

St. John Oral Pathology 

Hilbrich Dermatology Lab, PLC 

Oakwood Medical Laboratory 

Independent Radiation Oncology Facilities 

Downriver Center for Oncology 

Michigan Institute for Radiation 

Oncology 

Radiation Therapy Associates 

*Hospital not located in the tri-county area.

Appendix A 

Michigan Public Health Code (Excerpts) 

Act 368 of 1978 

32 

333.2619 Cancer registry; establishment; purpose; reports; records; 

rules; medical or department examination or supervision not 

required; contracts; evaluation of reports; publication of summary 

reports; commencement of reporting; effective date of section. 

Sec. 2619. 

(1) The department shall establish a registry to record cases 

of cancer and other specified tumorous and precancerous 

diseases that occur in the state, and to record 

information concerning these cases as the department 

considers necessary and appropriate in order to conduct 

epidemiologic surveys of cancer and cancer-related 

diseases in the state. 

(2) Each diagnosed case of cancer and other specified 

tumorous and precancerous diseases shall be reported to 

the department pursuant to subsection (4), or reported 

to a cancer reporting registry if the cancer reporting 

registry meets standards established pursuant to 

subsection (4) to ensure the accuracy and completeness of 

the reported information. A person or facility required to 

report a diagnosis pursuant to subsection (4) may elect to 

report the diagnosis to the state through an existing cancer 

registry only if the registry meets minimum reporting 

standards established by the department. 

(3) The department shall maintain comprehensive records 

of all reports submitted pursuant to this section. These reports 

shall be subject to the same requirements of confidentiality as 

provided in section 2631 for data or records concerning medical 

research projects. 

(4) The director shall promulgate rules which provide for 

all of the following: 

(a) A list of tumorous and precancerous diseases other than 

cancer to be reported pursuant to subsection (2). 

(b) The quality and manner in which the cases and other 

information described in subsection (1) are reported 

to the department. 

(c) The terms and conditions under which records disclosing the 

name and medical condition of a specific individual and kept 

pursuant to this section are released by the department. 

(5) This section does not compel an individual to submit 

to medical or department examination or supervision. 

(6) The department may contract for the collection and 

analysis of, and research related to, the epidemiologic 

data required under this section. 

(7) Within 2 years after the effective date of this section, the 

department shall begin evaluating the reports collected 

pursuant to subsection (2). The department shall publish 

and make available to the public reports summarizing the 

information collected. The first summary report shall be 

published not later than 180 days after the end of the first 

2 full calendar years after the effective date of this section. 

Subsequent annual summary reports shall be made on a full 

calendar year basis and published not later than 180 days after 

the end of each calendar year. 

(8) Reporting pursuant to subsection (2) shall begin the next 

calendar year after the effective date of this section. 

(9) This section shall take effect July 1, 1984. 

History: Add. 1984, Act 82, Eff. July 1, 1984 

Popular Name: Act 368 

333.2621 Comprehensive policy for conduct and support of 

research and demonstration activities; conducting and supporting 

demonstration projects and scientific evaluations. 

Sec. 2621. 

(1) The department shall establish a comprehensive policy 

pursuant to and consistent with section 2611(2) for the 

conduct and support of research and demonstration activities 

related to the department’s responsibility for the health care 

needs of the people of this state. 

(2) The department shall conduct research and demonstration 

activities related to the department’s responsibility for the 

environmental, preventive, and personal health needs of the 

communities and people of this state, including: 

(a) The causes, effects, and methods of prevention of illness. 

(b) The determinants of health, including behavior related 

to health. 

(c) The accessibility, acceptability, availability, organization, 

distribution, utilization, quality, and financing of health 

care, especially those services for the medically needy. 

(3) The department may conduct and support demonstration 

projects to carry out subsection (2). 

(4) The department shall conduct or support the conduct of 

scientific evaluations of the effectiveness, efficiency, and 

relevance of programs conducted or supported by the 

department. 

History: 1978, Act 368, Eff. Sept. 30, 1978 

Popular Name: Act 368

333.2631 Data concerning medical research project; 

confidentiality; use. 

Sec. 2631. 

The information, records of interviews, written reports, 

statements, notes, memoranda, or other data or records 

furnished to, procured by, or voluntarily shared with the 

department in the conduct of a medical research project, 

or a person, agency, or organization which has been designated 

in advance by the department as a medical research project 

which regularly furnishes statistical or summary data with 

respect to that project to the department for the purpose of 

reducing the morbidity or mortality from any cause or condition 

of health are confidential and shall be used solely for statistical, 

scientific, and medical research purposes relating to the cause 

or condition of health. 



333.2632 Data concerning medical research project; inadmissible 

as evidence; exhibition or disclosure. 

Sec. 2632. 

The information, records, reports, statements, notes, 

memoranda, or other data described in section 2631 are not 

admissible as evidence in an action in a court or before any 

other tribunal, board, agency, or person. Furnishing the data 

to the department in the conduct of a medical research project 

or to a designated medical research project does not result in 

the loss of any privilege which the data may otherwise have 

making them inadmissible as evidence. The information, records, 

reports, notes, memoranda, or other data shall not be exhibited 

nor their contents disclosed in any way, in whole or in part, by 

the department or its representative, or by any other person, 

agency, or organization, except as is necessary for the purpose 

of furthering the medical research project to which they relate 

consistent with section 2637 and the rules promulgated under 

section 2678. A person participating in a designated medical 

research project shall not disclose the information obtained 

except in strict conformity with the research project. 



333.2633 Data concerning medical research projects; liability for 

furnishing. 

Sec. 2633. 

The furnishing of information, records, reports, statements, 

notes, memoranda, or other data to the department, either 

voluntarily or as required by this code, or to a person, agency, or 

organization designated as a medical research project does not 

subject a physician, hospital, sanatorium, rest home, nursing 

home, or other person or agency furnishing the information, 

records, reports, statements, notes, memoranda, or other data 

to liability in an action for damages or other relief, and is not 

considered to be the willful betrayal of a professional secret or the 

violation of a confidential relationship. 

History: 1978, Act 368, Eff. Sept. 30, 1978 ;-- Am. 1988, Act 122, 

Eff. Mar. 30, 1989 


33 

Rendered 6/7/2005 16:58:30 

Michigan Compiled Laws 

© 2004 Legislative Council, State of Michigan Rendered 6/7/2005 16:58:30 Michigan Compiled © 2005 Laws Legislative Complete Council, Through State PA of 33 Michigan of 2005 

© 2005 Legislative Council, State of Michigan Courtesy of www.legislature.mi.gov Courtesy of www.legislature.mi.gov

Appendix A (continued) 

Health Insurance Portability and Accountability Act of 1996 (Excerpts) 

Law and Federal Rules (Excerpts); Public Law 104-191; 104th Congress; August 21, 1996 

34 

AN ACT 

To amend the Internal Revenue Code of 1986 to improve portability 

and continuity of health insurance coverage in the group and 

individual markets, to combat waste, fraud, and abuse in health 

insurance and health care delivery, to promote the use of medical 

savings accounts, to improve access to long-term care services and 

coverage, to simplify the administration of health insurance, and 

for other purposes. 

• • • 

TITLE I--HEALTH CARE ACCESS, PORTABILITY, 

AND RENEWABILITY 

• • • 

TITLE II--PREVENTING HEALTH CARE FRAUD AND ABUSE; 

ADMINISTRATIVE SIMPLIFICATION; MEDICAL LIABILITY 

REFORM 

• • • 

Part C--Administrative Simplification 

Sec. 1171. Definitions. 

Sec. 1172. General requirements for adoption of standards. 

Sec. 1173. Standards for information transactions and data 

elements. 

Sec. 1174. Timetables for adoption of standards. 

Sec. 1175. Requirements. 

Sec. 1176. General penalty for failure to comply with 

requirements and standards. 

Sec. 1177. Wrongful disclosure of individually identifiable health 

information. 

Sec. 1178. Effect on State law. 

Sec. 1179. Processing payment transactions. 

• • • 

SEC. 264. RECOMMENDATIONS WITH RESPECT TO PRIVACY OF 

CERTAIN HEALTH INFORMATION. 

(a) IN GENERAL.--Not later than the date that is 12 months 

after the date of the enactment of this Act, the Secretary of 

Health and Human Services shall submit to the Committee on 

Labor and Human Resources and the Committee on Finance of 

the Senate and the Committee on Commerce and the Committee 

on Ways and Means of the House of Representatives detailed 

recommendations on standards with respect to the privacy of 

individually identifiable health information. 

(b) SUBJECTS FOR RECOMMENDATIONS.--The 

recommendations under subsection (a) shall address 

at least the following: 

(1) The rights that an individual who is a subject of 

individually identifiable health information should have. 

(2) The procedures that should be established for the exercise 

of such rights. 

(3) The uses and disclosures of such information that should 

be authorized or required. 

(c) REGULATIONS.-- 

(1) IN GENERAL.--If legislation governing standards with 

respect to the privacy of individually identifiable health 

information transmitted in connection with the transactions 

described in section 1173(a) of the Social Security Act (as 

added by section 262) is not enacted by the date that is 

36 months after the date of the enactment of this Act, the 

Secretary of Health and Human Services shall promulgate 

final regulations containing such standards not later than 

the date that is 42 months after the date of the enactment 

of this Act. Such regulations shall address at least the subjects 

described in subsection (b). 

(2) PREEMPTION--A regulation promulgated 

under paragraph (1) shall not supercede a contrary 

provision of State law, if the provision of State law 

imposes requirements, standards, or implementation 

specifications that are more stringent than the 

requirements, standards, or implementation 

specifications imposed under the regulation. 

EFFECT ON STATE LAW 

• • • 

• • • 

SEC. 1178. EFFECT ON STATE LAW 

(b) PUBLIC HEALTH.--Nothing in this part shall be 

construed to invalidate or limit the authority, power, or 

procedures established under any law providing for the 

reporting of disease or injury, child abuse, birth, or death, 

public health surveillance, or public health investigation 

or intervention. 

(c) STATE REGULATORY REPORTING.--Nothing in this 

part shall limit the ability of a State to require a health 

plan to report, or to provide access to, information for 

management audits, financial audits, program monitoring 

and evaluation, facility licensure or certification, or 

individual licensure or certification. 

• • • 

Source: http://aspe.hhs.gov/admnsimp/pl104191.htm (emphasis added)

Appendix B 

State of Michigan Letter of Authority 

The text of the original letter shown on page 6 has been reproduced here for ease of review. 

August 5, 2003 

Ann G. Schwartz, PhD, MPH, Director 


Wayne State University 

110 East Warren Avenue 

Detroit, Michigan 48201-1379 

Dear Dr. Schwartz: 

Michigan law requires the Michigan Department of Community 

Health to establish a state-wide cancer registry to “record cases of 

cancer and other specified tumorous and precancerous diseases....” 

MCLA 333.2619(1). All health care facilities where diagnoses of 

cancer occur are required to report such diagnoses. Pursuant to 

this statute, a facility may satisfy their reporting requirement by 

reporting the diagnoses to an existing cancer registry that “meets 

the minimum reporting standards established by the department.” 

MCLA 333.2619(2). The Metropolitan Detroit Cancer Surveillance 

System (MDCSS) housed at Wayne State University is such a 

cancer registry. The Michigan Department of Community Health 

ahs granted for many years — and continues to grant — authority 

for the collection of individually identifiable cancer diagnoses, 

treatment, and survival to the MDCSS. This authority is valid for 

the duration of the project unless terminated earlier. 

The MDCSS is also a designated medical research project of the 

state. This designation is made under the authority of sections 

333.2621 through 333.2634 of the Michigan Compiled Laws, 

as amended. The designation of the MDCSS cancer registration 

effort as a medical research project has the effect of shielding 

the data you assemble from use as evidence in a court, as well as 

providing protection from liability to those facilities that provide 

you with the data. It also obligates you to continue to maintain the 

confidentiality of these data in strict conformity to the objectives 

of your research effort. 

Federal privacy regulations, adopted under the Health Insurance 

Portability and Accountability Act (HIPAA), allow “covered entities” 

(such as hospitals) to disclose individually-identifiable cancer 

data for public health purposes. In this regard, the HIPAA privacy 

regulations state that an individual authorization is not required to 

disclose protected health information to a “public health authority 

that is authorized by law to collect or receive such information 

for the purpose of preventing or controlling disease, injury, or 

disability, … and the conduct of public health surveillance, public 

health investigations, and public health interventions.” 45 CFR 

§164.512(b)(1)(i). 

The Michigan Department of Community Health is a public health 

authority under the HIPAA. It is authorized by the Public Health 

Code to collect and utilize health information, provide for research 

studies for the purpose of protecting the public health, and make 

investigations and inquiries as to the causes of disease and the 

causes of morbidity and mortality. MCL 333.2221. Indeed, the 

Department must establish a comprehensive health information 

system that includes statistics relative to the causes, effects, extent, 

and nature of illness and disability of the people of this state. MCL 

333.2616-2617. Additionally, as stated above, the Public Health 

Code specifically requires that the Department establish a statewide 

cancer registry to record information regarding cancer and cancerrelated 

diseases. MCL 333.2619. 

A “public health authority” includes a person or entity acting under 

a grant of authority from the Michigan Department of Community 

Health. Based upon both the state statutes and federal regulations, 

the Department recognizes the MDCSS as a state-authorized entity 

for the collection and reporting of individually-identifiable cancer 

information and as a state-authorized medical research project. 

This means that the HIPAA Privacy Rule allows covered entities 

to report cancer data to MDCSS without individual authorization; 

hospitals and other covered entities must simply document that 

reporting has occurred. The grant of authority to MDCSS includes 

all information reasonably necessary to identify and track patients 

and their diagnoses, treatment, subsequent primaries and survival 

status. The information being requested represents the minimum 

necessary to carry out the public health purposes of the projects 

pursuant to 45 CFR §164.514(d) of the Privacy Rule. 

The association between the Michigan Department of Community 

Health and the Wayne State Unviersity has a long history, dating 

back several decades. By assembling cancer data from the many 

participating hospitals and laboratories, your efforts contribute 

significantly to the efficiency and the quality of the statewide 

cancer registry effort. The close consultation and collaboration 

with your organization on specific research efforts, cancer control 

issues and general data collection and processing concerns have 

proven very beneficial to the many cancer related activities 

ongoing within the department. 

Sincerely, 

Janet Olszewski 

Director 

35


Epidemiology Section | 110 E. Warren Avenue | Detroit, MI 48201 

For Additional Information: 

Telephone: (313) 578-4231 

Fax: (313) 578-4306 

http://seer.cancer.gov/registries/detroit.html 

36 

Prepared By 

Md. Khairul Islam, Ph.D. 

Biostatistician, Epidemiology Section 

Fawn D. Vigneau, J.D., M.P.H. 

Manager of Research, Epidemiology Section 

Patricia Arballo-Spong, B.S. 

SEER Project Coordinator 


Chief of Cancer Surveillance Research 

Contributing Authors 


Michele L. Cote, Ph.D. 

Julie J. Ruterbusch, M.P.H. and Kendra Schwartz, M.D., M.S.P.H. 

Jennifer L. Beebe-Dimmer, Ph.D., M.P.H. 

George W. Dombi, Ph.D., Cecilia Yee, M.S., Richard K. Severson, 

Ph.D., Jeannette Korczak, Ph.D. and Ikuko Kato, M.D., Ph.D. 

Leadership Team 

Ann G. Schwartz, Ph.D., M.P.H. 

Director, Metropolitan Detroit Cancer Surveillance System 

SEER Principal Investigator 

Associate Center Director, Population Sciences 

Kendra Schwartz, M.D., M.S.P.H. 

SEER Co-Investigator 

John Graff, Ph.D., M.S. 

Chief of Cancer Surveillance Research 

SEER Co-Investigator 

Fawn D. Vigneau, J.D., M.P.H. 

Manager of Research, Epidemiology Section 

Patricia Arballo-Spong, B.S. 

SEER Project Coordinator 

Sharon Moton, B.S. 

Administrator 

Joanne Harris, C.T.R. 

Chief of Cancer Surveillance 

Nancy Lozon, B.S., C.T.R. 

Manager of Cancer Surveillance – Office Operations 

Patrick Nicolin, B.A., C.T.R. 

Manager of Cancer Surveillance – Quality Control and Field Operations 

Inhee Han, B.S. 

Senior Applications Analyst 

Gloria Kwiatkowski, B.S. 

Senior Applications Analyst 

Published February 2008

Cancer Statistics - Karmanos Cancer Institute

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