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MUII Comprehensive Exam – Awatef Ben Ramadan


Awatef Ben Ramadan






CE706, Clinical Education & Support Building

Steps in Transforming the Missouri Cancer Registry (MCR) from an Incidence Registry to a Survival Registry

The Problem: Breast cancer is the most common invasive cancer among women of all races and ethnicities in the United States (US). About 12 percent of women will be diagnosed with breast cancer in one stage of their lives in the US.

Significance: The Missouri Cancer Registry (MCR) needs to be transformed from an incidence registry to a survival registry to accurately measure the impact of Missouri public health programs. Using interactive mapping software reports of maps and statistics to improve data visualization and assess reports-user interface. Many studies have concluded the importance of estimation of cancer incidence, mortality and survival together.

Aims: To estimate breast cancer burden in Missouri during recent years in terms of breast cancer incidence, mortality and survival rates; to visualize these results; and to assess the usability of the Missouri Cancer Registry and Research Center’s (MCR-ARC’s) interactive maps and profile reports.


Incidence: An observational epidemiological study by doing secondary analysis of all registered female breast cancer cases in the MCR database from 2008 to 2012. Incidence rates by race, age, county, and senatorial district will be measured as well as percent of cases diagnosed at late stage and grade. These statistics will be presented using InstantAtlas.

Mortality: Mortality counts and rates will be from the NCHS Mortality database 2008–2012 via the SEER Program. The mortality rates will be measured by age, race, and Senate District Groups of Counties (SDGCs). The rates will be visualized using InstantAtlas.

Survival: An observational longitudinal epidemiological study by doing secondary analysis of all registered female breast cancer cases in the MCR database from 2004 to 2010 after matching registry breast cancer cases with unknown vital status and/or cause of death following linkage with Missouri Department of Health and Senior Services’ (DHSS) death files with the Social Security Death Index (SSDI) and the National Center for Health Statistics’ (NCHS’s) National Death Index (NDI) database. Survival rates will be measured by age, race, stage at diagnosis, grade at diagnosis, county, and by senate district. The results will be presented using InstantAtlas.

Usability: The investigators will conduct a scoping review to explore perceptions of public health professionals about the use of geographic information tools in public health. Also, the investigators will conduct a pilot study to measure the usability of the MCR-ARC’s published InstantAtlas reports using a sample of health professionals.

Expected outcomes: The results will be very informative for Missouri decision makers and public health leaders. InstantAtlas reports will enhance the communication between collaborators from different fields related to breast cancer and to disseminate female breast cancer data and inform health professionals and the public.

Keywords: Breast cancer, incidence, mortality, survival, MCR, MCR-ARC, NDI, SSDI, Usability