SEER Program
Surveillance, Epidemiology, and End Results
(SEER) - Medicare Linked Database
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NCI has contracted with universities and state health
departments since 1973 to operate populationpopulation-based
cancer registries.
Gerald Riley M.S.P.H.
Centers for Medicare and Medicaid
Services
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All incident cases are captured, except nonnonmelanoma skin cancer and in situ cervical cancer
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Recurrences not reported.
Joan Warren Ph.D.
National Cancer Institute
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Since 1992, 12 geographic areas, 14.5% of U.S.
population; expanded in 2001 to include 25% of U.S.
population
SEER Reporting Areas
SEER Data
1992 SEER
2001 SEER
Seattle/
Puget Sound
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SEER data have been linked for the entire time each
registry has participated in the SEER program; some
registries go back to 1973
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Each individual is assigned a unique case number
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Demographic information
age at diagnosis
race/ethnicity, sex, marital status
year and place of birth
followfollow-up vital status w/cause of death
Metropolitan
Detroit
Connecticut
San Jose/
Monterey
New Jersey
IA
San Francisco/
Oakland
CA
Los Angeles
UT
KY
Atlanta
NM
LA
Hawaii
Medicare data
SEER Data (cont.)
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For each incident cancer:
month and year of diagnosis
site of cancer
histology
behavior
grade
extent of disease Æ staging
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Medicare claims (all types) are available from
19911991-2002, except for inpatient hospital data
that are available back to 1986
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Enrollment data
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Selected information on hospital and provider
characteristics (POS, HCRIS)
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In addition to Medicare data for persons with
cancer, the same files are available for a 5%
random sample of cancercancer-free individuals
who reside in the SEER areas.
surgery and adjuvant radiation given or
planned during the first course of treatment
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Current update
Other variables available for
cancer and nonnon-cancer cases
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Census variables at the census tract and zip
code level for:
„ Median household income
„ Median household wealth
„ % of population with high school education
„ Population density
„ Urban, suburban, rural codes
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Linkage is updated every 3 years
Current update began Fall 2004
Preliminary match completed
Added SEER cases for 20002000-2002
Added data from 4 new registries –
„ Louisiana
„ Kentucky
„ New Jersey
„ Greater California
Data from new registries will be for 20012001-2002
Release date not yet scheduled
Health Care Service Area from Area Resource
File
Matched cases by registry
1991 - 2002 (preliminary)
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Total
Los Angeles 1991 - 2002
Detroit 1991 - 2002
Connecticut 1991 - 2002
Seattle – Puget Sound 1991 - 2002
San Francisco – Oakland 1991 - 2002
Iowa 1991 - 2002
Greater California 2001 - 2002
Atlanta 1991 - 2002
San Jose – Monterey 1991 - 2002
New Jersey 2001 - 2002
New Mexico 1991 - 2002
Utah 1991 - 2002
Kentucky 2001 - 2002
Louisiana 2001 - 2002
Hawaii 1991 - 2002
Rural Georgia 1991 - 2002
Matched cases by year of diagnosis 1991 –
2002 (preliminary)
250000
1,647,756
290,886
193,141
167,463
157,583
156,625
149,034
104,227
71,890
71,168
66,151
58,869
52,863
30,241
28,850
44,225
4,540
200000
150000
100000
50000
0
1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002
Matched cases by selected cancer sites,
1991 – 2002 (preliminary)
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Prostate
Breast
Lung and bronchus
Colon and rectum
Urinary bladder
NonNon-Hodgkins lymphoma
302,898
240,426
224,429
214,826
78,620
58,996
Matched cases by selected cancer sites,
1991 – 2002 (preliminary)
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Pancreas
Ovary
Larynx
Esophagus
Brain
Liver
38,031
24,236
15,193
15,060
13,797
13,609
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Example of a Study of Post-diagnostic Surveillance
using the SEER-Medicare Data: Frequency of Cystoscopy
Following a Diagnosis of Superficial Bladder Cancer
Examples of Studies Using
SEER-Medicare Data
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Patients diagnosed with superficial bladder cancer who have
not undergone total cystectomy are at high risk for recurrence
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Bladder surveillance with cystoscopy is recommended for
such patients every 3-6 months
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Investigators used the SEER-Medicare data to examine the
frequency with which these patients underwent cystoscopy
during each of five contiguous 6-month intervals from
month 7 to month 36 following diagnosis
Surveillance among Medicare Eligible Patients with
Superficial Bladder Cancer over a 3030-month interval
following diagnosis, by Age Group
Results/Conclusion
100
% Receiving Followup
90
80
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Only 40% of the entire cohort had an examination during
all five intervals
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Exams were significantly lower for old olds, blacks and
persons living in rural areas
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The actual practice of surveillance for patients with
superficial bladder cancer differs substantially from the
standards recommended in clinical guidelines
70
60
50
65-69
70-74
75-79
80-84
85+
40
30
20
10
0
1+
2+
3+
4+
5
Number of Followups
Source: Schrag D et al. Adherence to surveillance among patients with superficial bladder cancer.
J Natl Cancer Inst. 2003 Apr 16;95(8):588-97.
Example of a Volume-Outcome Study Using the SEERMedicare data: Hospital and Surgeon Volume and
Outcomes following Prostatectomy
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Studies of outcomes of cancer surgery have
demonstrated variations among hospitals and
among surgeons by procedure volume
Investigators used SEER-Medicare data to
examine variations in morbidity after radical
prostatectomy, focusing on hospital and
surgeon volume
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30
25
Percent
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Percentage of Patients Experiencing Late Complications
(stricture or fistula) Within One Year of Radical
Prostatectomy, by Volume of Procedures
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Hospitals
15
Physicians
10
5
0
Low
Medium
High
Very High
Volume of procedures
Source: Begg CB et al. Variations in morbidity after radical prostatectomy. N Engl J Med. 2002 Apr
11;346(15):1138-44.
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Limitations of SEERSEER-Medicare data
Results/Conclusion
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For men undergoing prostatectomy, the rates of
postoperative and late urinary complications are
significantly reduced if the procedure is performed in a
high-volume hospital and by a surgeon who performs a
high number of such procedures
However, even with high-volume surgeons, there was
substantial variation in outcome among individual
surgeons after adjustment for hospital volume and case
mix
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Does not include claims for care provided to persons in HMOs
(about 22% in SEER areas)
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NonNon-covered services excluded - prescription drugs, nursing
home care, free screenings
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Under 65 population includes only the disabled/ESRD
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Reasons for tests are not known; this raises challenges with
identifying screening
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Results of tests not available
Support for SEERSEER-Medicare data users
How to obtain SEER-Medicare data
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SEER-Medicare are de-identified. Because of the
remote possibility of re-identification, these data are not
available as public use files.
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Researchers must submit to NCI a proposal or copy of
grant submission that describes
„ Use of the data
„ How data will be protected
„ Investigators using the data
„ SEER-Medicare data use agreement
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SEERSEER-Medicare WEB site:
http://healthservices.cancer.gov/seermedicare
http://healthservices.cancer.gov/seermedicare//
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Medical Care Vol. 40, no. 8 August 2002
Supplement
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SEER web site: http://seer.cancer.gov
Publications, Manuals, Cancer Statistics,
Scientific Systems: SEER*Stat, DEVCAN, etc.
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RESDAC support for Medicare data users
http://www.resdac.umn.edu/
Funding Opportunities
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NCI Program Announcement
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http://appliedresearch.cancer.gov/funding.html
http://appliedresearch.cancer.gov/funding.html
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Note: Cancer Surveillance Using Health ClaimsClaims-Based
Data System
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Note: Economic Studies in Cancer Prevention,
Screening, and Care
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