Cancer Incidence and Mortality

State Cancer Profiles (SCP)

SCP is an interactive map engine produced in collaboration between the National Cancer Institute and Centers for Disease Control and Prevention. It was developed with the idea to provide a geographic profile of cancer burden in the United States and reveal geographic disparities in cancer incidence, mortality, risk factors for cancer, and cancer screening, across different population subgroups. The target audiences are health planners, policy makers, and cancer information providers who need quick and easy access to cancer related data and maps to inform and prioritize investments in cancer control.

Cancer incidence data from SCP used in Cancer InFocus comes from the Surveillance, Epidemiology, and End Results SEER*Stat Database and from the National Program of Cancer Registries where applicable. The most recently available incidence data are the 5-year average age-adjusted rates per 100,00 people for 2016-2020.

Cancer mortality data from SCP used in Cancer InFocus comes from the National Vital Statistics System public use data file. The most recently available mortality data are the 5-year age-adjusted mortality rates per 100,000 people for 2016-2020.

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Sociodemographics, Economics & Insurnace, and Housing & Transportation

American Community Survey (ACS), 5-Year Estimates, U.S. Census Bureau

ACS is a nationally representative sample of households that are randomly selected to participate. This survey provides population estimates of demographic information for various geographic areas, aggregated over five consecutive years.

Cancer InFocus contains the following indicators from the ACS. The most recently available ACS data are the 2017-2021 5-year estimates:

Indicator	ACS Table	Population Used
Total Population	B01001	Total population
Under 18 Years Old	B01001	Total population
18 to 64 Years Old	B01001	Total population
Over 64 Years Old	B01001	Total population
White (non-Hispanic)	B01001H	White alone, not Hispanic or Latino population
Black (non-Hispanic)	B01001B	People who are Black or African American alone
Hispanic	B01001I	People who are Hispanic or Latino
Asian (non-Hispanic)	B01001D	People who are Asian alone
Other Non-Hispanic Races	B03002	Total population (calculated by subtracting other indicators)
Did Not Attend High School	B15003	Population 25 years and over
Graduated High School	B15003	Population 25 years and over
Graduated College	B15003	Population 25 years and over
Completed a Graduate Degree	B15003	Population 25 years and over
Annual Labor Force Participation Rate	B23025	Population 16 years and over
Annual Unemployment Rate	B23025	Population 16 years and over
Enrolled in Medicaid	C27007	Civilian noninstitutionalized population
Household Income ($)	B19013	Households
Insured	B27001	Civilian noninstitutionalized population
Living Below Poverty	B17026	Families
Received TANF or SNAP Public Assistance	B19058	Households
Uninsured	B27001	Civilian noninstitutionalized population
Crowded Homes	DP04	Housing units
High Rent Burden	B25070	Renter-occupied housing units
Homes without Broadband Internet	DP02	Households
Homes without Complete Plumbing	DP04	Housing units
Housing in Mobile Homes	DP04	Housing units
Housing in Multi-Unit Structures	DP04	Housing units
Median Gross Rent ($)	DP04	Housing units
Median Home Value ($)	DP04	Housing units
Median Monthly Mortgage ($)	DP04	Housing units
No Household Vehicle Access	B08141	Workers 16 years and over in households
Owner-occupied Housing Units	DP04	Housing units
Single Parent Homes	B11012	Households
Vacant Housing	B25002	Housing units
Black Population Living Below Poverty	B17010B	Families with a householder who is Black or African-American alone
Black Population without Health Insurance	C27001B	Black or African-American alone civilian noninstitutionalized population
Children without Health Insurance	B27010	Civilian noninstitutionalized population
Economic Segregation	B19001	Households
Gender Pay Gap	B24022	Full=time, year-round civilian employed population 16 years and over
Hispanic Population Living Below Poverty	B17010I	Families with a householder who is Hispanic or Latino
Hispanic Population without Health Insurance	C27001I	Hispanic or Latino civilian noninstitutionalized population
Income Inequality (Gini Coefficient)	B19083	Households
Lack Proficiency in English	B16005	Population 5 years and over
Racial Economic Segregation	B19001A/B	Households with a householder who is White alone/Black or African-American alone
Racial Segregation	B03002	Total population

Economic Segregation, Racial Segregation, and Racial Economic Segregation as indices referred to collectively as Indices of Concentrations at the Extremes. These are intended to look at the difference in the proportions of most versus least privileged individuals in an area. For Economic Segregation, most privileged is defined as annual income over $150,000, whereas least privileged is annual income under $30,000. For Racial Segregation, most privileged is White race and least privileged is Black race. For Racial Economic Segregation, most privileged is White race with annual income over $150,000 and least privileged is Black race with annual income under $30,000. These indices range between -1 and +1, with values approaching +1 showing segregation towards greater privilege and values approaching -1 showing segregation towards less privilege.

Gender Pay Gap measures the cents fewer on the dollar that the median female in an area makes per dollar the median male in that area makes. Positive values indicate that the median male makes more than the median female; negative values indicate that the median female makes more than the median male.

U.S. Bureau of Labor Statistics (BLS)

The BLS measures labor market activity, working conditions, price changes, and productivity in the U.S. economy to support public and private decision making. Cancer InFocus uses BLS to obtain the monthly unemployment rate (not seasonally adjusted). This data is updated monthly and typically runs on a two month delay. BLS data is not included in the Cancer InFocus mapping applications.

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Screening & Risk Factors and Other Health Factors

PLACES

PLACES is a collaboration between CDC, the Robert Wood Johnson Foundation, and the CDC Foundation. PLACES provides health data for small areas across the country. This allows local health departments and jurisdictions, regardless of population size and rurality, to better understand the burden and geographic distribution of health measures in their areas and assist them in planning public health interventions.

PLACES provides model-based, population-level analysis and community estimates of health measures to all counties, places (incorporated and census designated places), census tracts, and ZIP Code Tabulation Areas (ZCTAs) across the United States.

Cancer InFocus contains the following indicators from the PLACES, which are based off of data from the Behavioral Risk Factor Surveillance System:

Indicator	Most Recent Survey Variable Name	Most Recent Year Used
Met Breast Screening Recommendations	_MAM5023	2020
Had Pap Test in Last 3 Years, Age 21-65	_RFPAP35	2020
Met Colorectal Screening Recommendations	_CRCREC	2020
Currently Smoke (adults)	_RFSMOK3	2020
Obese (BMI over 30)	_BMI5CAT	2020
Physically Inactive	_TOTINDA	2020
Binge Drink	_RFBING5	2020
Sleep < 7 Hours a Night	SLEPTIM1	2020
History of Cancer Diagnosis	CHCOCNCR	2020
Report Fair or Poor Overall Health	_RFHLTH	2020
Report Frequent Physical Health Distress	_PHYS14D	2020
Report Frequent Mental Health Distress	_MENT14D	2020
Have Depression	ADDEPEV3	2020
Diagnosed with Diabetes	DIABETE4	2020
Have High Blood Pressure	_RFHYPE5	2019
On Blood Pressure Medicine	BPMEDS	2019
Have Coronary Heart Disease	CVDCRHD4	2020
Had a Stroke	CVDSTRK3	2020
Have Chronic Kidney Disease	CHCKDNY2	2020
Diagnosed with Asthma	_LTASTH1	2020
Have COPD	CHCCOPD2	2020
All Adult Teeth Lost	_ALTETH3	2020
Had a Medical Checkup in the Last Year	CHECKUP1	2020
Had a Dental Visit in the Last Year	_DENVST3	2020

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Environment

Economic Research Service, U.S. Department of Agriculture (USDA ERS)

The mission of USDA’s Economic Research Service is to anticipate trends and emerging issues in agriculture, food, the environment, and rural America and to conduct high-quality, objective economic research to inform and enhance public and private decision making. ERS research and analysis covers a broad range of economic and policy topics, including food/nutrition and poverty.

Cancer InFocus uses the indicator Food Deserts (LILA Vehicle) from the USDA ERS. The most recently available data is from 2015.

Federal Communications Commission (FCC)

The FCC regulates interstate and international communications by radio, television, wire, satellite, and cable in all 50 states, the District of Columbia and U.S. territories. An independent U.S. government agency overseen by Congress, the Commission is the federal agency responsible for implementing and enforcing America’s communications law and regulations.

Cancer InFocus uses the FCC Form 477 broadband data on average maximum advertised upload and download speeds at the Census block group level. This data is updated twice yearly in June and December and runs about one year behind. FCC data is not included in the Cancer InFocus mapping applications.

Environmental Protection Agency (EPA) Environmental Justice Screening (EJScreen)

EJScreen is an EPA's environmental justice mapping and screening tool that provides EPA with a nationally consistent dataset and approach for combining environmental and demographic socioeconomic indicators.

Cancer InFocus uses the 12 raw environmental justice indicator variables given at the Census tract level from the 2022 EJScreen dataset.

EPA Safe Drinking Water Information System (SDWIS)

The EPA's SDWIS databases store information about drinking water. The federal version (SDWIS/FED) stores the information the U.S. Environmental Protection Agency (EPA) needs to monitor approximately 156,000 public water systems.

Cancer InFocus uses the indicator Public Water Systems Violations (Health Based) from the SDWIS. This data is aggregated from the most recently completed year back to 2016.

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Facilities & Providers

EPA Envirofacts

The Envirofacts Multisystem Search integrates information from a variety of databases and includes latitude and longitude information. Each of these databases contains information about facilities that are required to report activity to a state or federal system.

Cancer InFocus draws information on Superfund sites from the Superfund Enterprise Management System (SEMS) and information on facilities releasing known carcinogens from the Toxic Release Inventory. Superfund site data is available in real-time; the most recently available Toxic Release Inventory data is from 2021.

Health Resources & Services Administration (HRSA), Department of Health & Human Services

HRSA programs provide health care to people who are geographically isolated, economically or medically vulnerable. This includes people living with HIV/AIDS, pregnant women, mothers and their families, and those otherwise unable to access high quality health care. HRSA also supports access to health care in rural areas, the training of health professionals, the distribution of providers to areas where they are needed most, and improvements in health care delivery.

Cancer InFocus uses facility data for Federally-Qualified Health Centers (FQHC), FQHC Look-a-Likes (FQHC LAL), Rural Health Clinics (RHC), and Correctional Facility clinics. All of these facilities fall under the general classification of Health Professional Shortage Area (HPSA) facilities. This data is available in real-time, reflecting all such facilities currently recognized by HRSA.

Lung Cancer Screening Registry (LCSR), American College of Radiology

The ACR Lung Cancer Screening Registry (LCSR) is designed to systematically audit the quality of interpretation of screening lung CT exams. The registry is based on the ACR Lung Imaging Reporting and Data System (Lung-RADS), which is the product of the ACR Lung Cancer Screening Committee subgroup on Lung-RADS. This Lung-RADS system is a quality assurance tool designed to standardize lung cancer screening CT reporting and management recommendations, reduce confusion in lung cancer screening CT interpretations and facilitate outcome monitoring. The ACR LCSR will capture Lung-RADS recommendations and monitor and compare appropriate use of Lung-RADS

Cancer InFocus uses the location data for Lung Cancer Screening Sites from the LCSR. This data is available in real-time, reflecting active lung cancer screening locations in the LCSR.

Note: Not all lung cancer screening sites are required to be a part of the LCSR. The ACR estimates that the LCSR reflects between 80%-90% of all active sites in the nation.

National Plan & Provider Enumeration System (NPPES)

Centers for Medicare & Medicaid Services CMS has developed the NPPES to assign unique identifiers to health care providers. The National Provider Indentifier (NPI) has been the standard identifier for all HIPAA-covered entities (health care providers) since May 23, 2007. Small health plans were required to obtain and use an NPI by May 23, 2008.

Cancer InFocus uses the location data for gastroenterologists and colon & rectal surgeons from the NPPES. This data is available in real-time, reflecting all practicing providers.

United States Food and Drug Administration (FDA)

The Mammography Quality Standards Act requires mammography facilities across the nation to meet uniform quality standards. Congress passed this law in 1992 to assure high-quality mammography for early breast cancer detection, which can lead to early treatment, a range of treatment options, and increased chances of survival. Under the law, all mammography facilities must: 1) be accredited by an FDA-approved accreditation body, 2) be certified by FDA, or its State, as meeting the standards, 3) undergo an annual MQSA inspection, and 4) prominently display the certificate issued by the agency.

Cancer InFocus uses the location data for Mammography Sites from the FDA Certified Mammography Facilities list. This data is updated on a weekly basis to reflect real-time presence of mammography facilities.

What It Does

Cancer InFocus begins with a data gathering program known as CIFTools. This program receives a set of US counties as an input and uses that input to pull and filter data from numerous publicly available online sources, such as the US Census Bureau's American Community Survey, CDC Places, the FDA Certified Mammography facility list, and more (see available data sources here). Data is then processed into a standard format, organized by category and geographic level, and written to files for use.

After the data files are produced, they can be used independently or read into the Cancer InFocus Shiny application code (see below) to create an interactive mapping application. This application can be deployed online for use by anyone interested in better understanding the impacts of cancer where they live and work.

The generalized nature and rapid processing of these tools allows data and applications to be easily updated over time, making the workflow of characterizing the cancer burden in an area more efficient. Increased efficiency means less time spent gathering data and building tools and more time spent on working to improve cancer outcomes.

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How You Can Use It

There are two ways in which cancer centers and other interested parties can take advantage of the data gathering aspect of Cancer InFocus. Data has already been gathered and made available for download for the defined catchment areas of all NCI-designated cancer centers here . Additional cancer centers that are not NCI-designated can request to have their catchment/service areas added to this application by emailing ciodata@uky.edu.

Researchers can also request access to the code behind the data gathering process by filling out the following request form .

If a cancer center is interested in creating their own site-specific version of the Cancer InFocus interactive mapping application (example), they may do so through the completion of a no-cost licensing agreement with the University of Kentucky Markey Cancer Center. The licensing form may be obtained by emailing ciodata@uky.edu. Centers who license access to the Cancer InFocus Shiny application code will be responsible for deploying and maintaining their own versions of Cancer InFocus.

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Acknowledgments

This work was aided and inspired by the work of others seeking to emphasize the importance of cancer center catchment areas and assess the holes left to be filled. Two articles dealing with the geographic scope of US cancer centers were of particular importance to us: Assessing the Coverage of US Cancer Center Primary Catchment Areas (2022), by Leader, McNair et al. and A National Map of NCI-Designated Cancer Center Catchment Areas on the 50th Anniversary of the Cancer Centers Program (2022) by DelNero, Buller et al.

Citation

Justin Todd Burus, Lee Park, Caree R. McAfee, Natalie P. Wilhite, Pamela C. Hull; Cancer InFocus: Tools for Cancer Center Catchment Area Geographic Data Collection and Visualization. Cancer Epidemiol Biomarkers Prev 2023; https://doi.org/10.1158/1055-9965.EPI-22-1319