1450west

Information about 1450west

Published on October 29, 2007

Author: Reva

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Northern California Cancer Center (NCCC): Research, Resources, and Investigators:  Northern California Cancer Center (NCCC): Research, Resources, and Investigators Dee W. West, Ph.D. Chief Scientific Officer, NCCC Associate Director, Population Sciences Stanford Cancer Center Comprehensive Cancer Research Training Program at Stanford University September 18, 2007 Slide2:  Presentation Objectives To introduce Stanford Trainees and Faculty to on-going research, resources and scientists at the Northern California Cancer Center (NCCC) To identify common and/or complementary research interests and expertise and foster collaborations among Stanford and NCCC scientists To identify resources that may be helpful for Stanford scientists Contact information for specific scientists at NCCC is available on the NCCC website: www.nccc.org Or contact Dee West, Chief Scientific Officer [email protected] NCCC: Founded in 1974:  NCCC: Founded in 1974 Clayton Rich - Stanford University Julius Krevans - UCSF Robert Murphy - American Cancer Society B.J. Feigenbaum - Steinhart & Falconer Saul Rosenberg – Stanford University Cancer Continuum/ Research Initiatives NCCC Focus:  Cancer Continuum/ Research Initiatives NCCC Focus Population Science Clinical Science Basic Science Scientific Questions How would you find answers to::  Scientific Questions How would you find answers to: Are cancer rates increasing or declining? Does HIV infection cause cancer? Do Asian Americans have cancer rates like those in Asia? Do California school teachers have cancer rates different from non-teachers? If so, why? Who is not getting cancer screening? Do all people in the population get recommended cancer care? NCCC in 2007:  NCCC in 2007 Non-profit, independent research and outreach center Governed by a Board of Trustees 33,000 sq ft of space - Fremont, CA 13 Ph.D. Investigators 165 staff $15 million annual budget Provides Human Resources Grants and contracts IRB, etc. NCCC’s Major Activities:  NCCC’s Major Activities Research Prevention Early detection Cancer Surveillance Treatment Outcomes (Survival, quality of life) Outreach Community education Cancer Information Service (CIS) Cancer Detection Program: “Every woman counts” Slide8:  SURVEILLANCE RESEARCH What is cancer surveillance research? “…a discipline in which systematically collected data on cancer patients and population characteristics are analyzed and interpreted to examine and test hypotheses about cancer predictors, incidence, and outcomes in geographically defined populations over time.” (Glaser et al., 2005) Investigators: E. Chang C. Clarke S. Glaser S. Gomez T. Keagan D. West SURVEILLANCE RESEARCH :  SURVEILLANCE RESEARCH Goals Study cancer patterns and issues of public health relevance Use creative methodologies to collect and present data Work with interdisciplinary research teams Identify cancer patients for additional research Data Sources Cancer registry data Greater Bay Area Cancer Registry (9 counties -28,000 annual cases California Cancer Registry (statewide data) SEER Program (data from 24% of US) International Cancer Registry (Cancer in Five Continents) Population risk factor data California Health Interview Survey - CHIS Behavioral Risk Factor Surveillance System - BRFSS Linkage to Medicare, Medical, and other databases How Do We Get Our Data?:  How Do We Get Our Data? Since 1988 physicians, hospitals & other treatment facilities required by state law to report new cases of cancer to a cancer registry – for research Data include details about the patient, cancer, where diagnosed and treated, treatment, and survival (increasingly molecular characteristics) Strict confidentiality rules GBACR* Region:  GBACR* Region *GBACR = Greater Bay Area Cancer Registry Region 8: Marin Alameda Contra Costa San Francisco San Mateo Region 1: Santa Clara Monterey San Benito Santa Cruz Slide12:  Data Sources for Cancer Cases STATE REGISTRY Radiation Facilities Death Certificates Clinics Laboratories Other Registries Skilled Nursing Facilities Physicians Hospitals Slide13:  Cancer Registries Information Collected Personal Information Physicians and Hospitals Cancer Information Treatment Survival Slide14:  Cancer incidence among men aged 25-54, San Francisco county, California Example: survival following colorectal cancer, males:  Example: survival following colorectal cancer, males Surveillance Research Breast Cancer:  Surveillance Research Breast Cancer Design: Greater Bay Area, California, and SEER program cancer registry data; California Health Interview Survey (CHIS) and Behavioral Risk Factor Survey (BRFS) risk factor data Primary focuses: Incidence trends, survival, racial/ethnic variation in incidence and survival, risk factor prevalence, mammography utilization, treatment choices, male breast cancer Major findings: Incidence rates in Greater Bay Area populations among highest in world and explained mostly by higher distributions of risk factors Asian women less likely to receive breast conserving surgery In males, blacks have decreased survival compared to whites. Asians and Hispanics have increased survival Slide17:  Incidence of breast cancer among non-Hispanic white women aged 50-74, California 1990-2004 Rates per 100,000 non-Hispanic white women age-adjusted to 2000 US standard. Source: California Cancer Registry October 2005 submission (1988-2004) 2001-2004 -17% -25% -5% -7% Slide18:  Rates per 100,000 non-Hispanic white women aged 50-74 age-adjusted to 2000 US standard. Source: Kaiser Permanente Northern California and California Cancer Registry October 2005 submission (1988-2004) Clarke et al, JCO 2006 HERS published 8/1988 WHI published 7/2002 Slide19:  Invasive breast cancer rates for California white women aged 50-74 overlaid onto San Francisco mammography registry hormone use trends San Francisco mammography registry data from Haas et al, Ann Intern Med, 2004 Slide20:  California: regional differences in EP use track closely to breast cancer declines     Data limited to non-Hispanic white women aged 45-74 at diagnosis * Includes the counties of Butte, El Dorado, Kern, Kings, Madera, Mendocino/Lake, Placer, Riverside, San Joaquin, San Mateo, Siskiyou/Lassen/Modoc/Trinity, Stanislaus, Sutter/Yuba, and Tehama/Colusa/Glenn. † Includes the counties of Fresno, Humboldt/Del Norte, Imperial, Los Angeles, Merced, Monterey/San Benito, Nevada/Plumas/Sierra, Orange, Sacramento, San Bernardino, San Diego, San Luis Obispo, Santa Barbara, Santa Clara, Shasta, Solano, Sonoma, Tulare, and Tuolumne/Alpine/  Amador/Calaveras/Inyo/Mariposa/Mono ‡ Includes the counties of Alameda, Contra Costa, Marin, Napa, San Francisco, and Santa Cruz. Robbins and Clarke, JCO 2007 Surveillance Research Racial/ethnic variation:  Surveillance Research Racial/ethnic variation Design: Greater Bay Area, California, SEER program, and international cancer registry data; risk factor survey data (e.g., CHIS) Primary focuses: Incidence, treatment, survival, trends; methods for racial/ethnic and immigration classification; risk factors; interplay with SES and stage at diagnosis Major findings: US Asians have different cancer profiles than Asians in Asia Survival patterns differ among Asian subgroups Disease stage and SES impact survival in blacks Hospital policies/practices on collection of demographic data (e.g., race) differ within and across facilities Slide22:  API Immigration to US (1850 – present) Breast Cancer: Incidence rates among Asians in the US & Asia, 1988-1992:  Breast Cancer: Incidence rates among Asians in the US & Asia, 1988-1992 Chinese Japanese Filipino Korean Vietnamese Adapted from “Cancer Incidence among Chinese, Japanese, and Filipinos in the United States and Asia,” NCCC Slide24:  Cervix Uteri US China HK/Singapore US Japan US Philippines US Korea US Thailand Age-adjusted incidence rates per 100,000 persons * Not available US Vietnam Chinese Japanese Filipino Korean Vietnamese Thai * Early Detection Research :  Early Detection Research Early Detection Colorectal Screening in Vietnamese Study (B. Nguyen):  Early Detection Colorectal Screening in Vietnamese Study (B. Nguyen) Design: Longitudinal cohort quasi-experimental Settings: Intervention Area: Alameda and Santa Clara Counties, California Control Area: Harris County, Texas (Houston) Intervention: Radio, TV, and newspaper articles and ads Vietnamese language booklets and flyers Physician training DVD’s Evaluation: Pre- and post-intervention survey Ever screened: FOBT, Sig/Col, Any Patients age 50 and older (Wong, 2004):  Ever screened: FOBT, Sig/Col, Any Patients age 50 and older (Wong, 2004) Slide28:  Study Design – Randomized Controlled Trial L= Tailored letter S= Survey Slide29:  Screening can help find and prevent colon cancer effectively. Screening for a cancer is better than waiting for it to develop. For long life, Test the colon! Logo: “THO”: Longevity Colon Screening Project Northern California Cancer Center For more information, please contact: (510) 608-5058 Early Detection Colorectal Screening in Vietnamese Study:  Early Detection Colorectal Screening in Vietnamese Study Progress: Completed 867 pre-intervention surveys Intervention will end in 9/06 Conduct post-intervention survey in 10/06 CANCER ETIOLOGY:  CANCER ETIOLOGY Cohort studies California Teachers Study Family-based studies Breast Cancer Family Registry Colon Cancer Family Registry Case-control studies Population-based case-control studies of specific cancers Etiology of Female Cancers Ongoing Studies:  Etiology of Female Cancers Ongoing Studies Breast Cancer Multiethnic Case-Control Study John, Horn-Ross, Clarke, Glaser California Teachers Study (CTS) Horn-Ross, Reynolds, Clarke, West Breast Cancer Family Registry John, West, Whittemore (Stanford) Epstein-Barr Virus Glaser, Chang Novel Investigations Clarke, Glaser, Horn-Ross Growth & Lifestyle Study Horn-Ross Young Women Reynolds Nail Salon Workers Reynolds Endometrial Cancer Multiethnic Case-Control Study Horn-Ross, John California Teachers Study (CTS) Horn-Ross Ovarian Cancer California Teachers Study (CTS) Chang, Horn-Ross Ovarian Cancer Family Registry Whittemore (Stanford), West, John Etiology of Female Cancers Selected Examples:  Etiology of Female Cancers Selected Examples Multiethnic Case-Control Study (E. John) California Teachers Study (P. Horn-Ross) Cancer Family Registries (E. John, D. West) Novel Hypotheses Hygiene Hypothesis (T. Clarke) HLA / Immune Function (S. Glaser) Early Soy Consumption (P. Horn-Ross) Etiology of Female Cancers Multiethnic Case-Control Study of Breast Cancer (E. John):  Etiology of Female Cancers Multiethnic Case-Control Study of Breast Cancer (E. John) Design: Case-control study of breast cancer in Hispanic, African-American and white women (1995-2002) Interview data for 2,258 cases & 2,706 controls Biospecimens for 1,276 cases & 1,465 controls Primary Focus: Modifiable lifestyle factors Genetic factors Racial/ethnic differences in breast cancer risk factors Spin-off Studies: Endometrial cases (P. Horn-Ross) Re-contact for Hygiene study (T. Clarke) Re-contact for Genetic Ancestry study (E. Ziv, UCSF) Etiology of Female Cancers Multiethnic Case-Control Study (E. John):  Etiology of Female Cancers Multiethnic Case-Control Study (E. John) Major Findings: Physical activity reduces risk of breast & endometrial cancer Sun exposure reduces risk of advanced, but not localized breast cancer, regardless of VDR genotype Phytoestrogens, at the levels consumed in non-Asian populations, do not affect risk of breast & endometrial cancer High intake of red meat and benzo[a]pyrene, produced by high-temperature cooking, is associated with increased BC risk Known breast cancer risk factors do not explain the lower risk of breast cancer in foreign-born postmenopausal Hispanic women Acculturation is strongly correlated with breast cancer risk factors in Hispanics Etiology of Female Cancers California Teachers Study (P. Horn-Ross, D. West, P. Reynolds, C. Clarke):  Etiology of Female Cancers California Teachers Study (P. Horn-Ross, D. West, P. Reynolds, C. Clarke) Design: Cohort study of 133,479 women (1995-) Self-administered mailed questionnaire Biospecimens: 2500 breast cancer cases & 2500 controls 400 endometrial cancer cases & 800 controls 2225 other women (many with a family history of cancer) Follow-up: Cancer outcomes: California Cancer Registry (CCR) >99% as long as participants reside in California (n=107,733 (81%) as of Jan 1, 2006) 5% not residents at baseline & 5% moved out of California Vital status: Annual record linkages n=11,666 (9%) deaths as of December 31, 2005 Updated and new exposure information: Three follow-up questionnaires (86% responded to at least one) Refusals: n=1726 (1%) Etiology of Female Cancers California Teachers Study (P. Horn-Ross, D. West, P. Reynolds, C. Clarke):  Etiology of Female Cancers California Teachers Study (P. Horn-Ross, D. West, P. Reynolds, C. Clarke) Cancer Occurrence (as of December 31, 2003): 3327 invasive and 724 in-situ breast cancers 634 endometrial and 283 ovarian cancers 8384 cancers of all sites Primary Focus: Diet, alcohol, phytochemicals, body composition (P. Horn-Ross) Environmental exposures (P. Reynolds) Psychosocial factors (P. Reynolds) Physical activity, hormones, reproductive factors (USC) Family history (UCI) Genetic modification of risk (all centers) Contributions to Collaborative Analyses: Diet and cancer Pooling Project (Harvard) Pooled genetic analyses with the Multiethnic Cohort Age-specific incidence rates of invasive breast cancer: Teachers vs. Non-Hispanic white women in California, 1996-1998:  Age-specific incidence rates of invasive breast cancer: Teachers vs. Non-Hispanic white women in California, 1996-1998 Analysis 5-01 Etiology of Female Cancers California Teachers Study (P. Horn-Ross, D. West, P. Reynolds, C. Clarke):  Etiology of Female Cancers California Teachers Study (P. Horn-Ross, D. West, P. Reynolds, C. Clarke) Major Findings: Breast (RR=1.7 in-situ & 1.5 invasive), endometrial (RR=1.7), and ovarian (RR=1.3) cancer risk is elevated in this cohort SES & personal risk factors account for very little of the geographic variation in breast cancer rates 20+ g/d of alcohol increases breast cancer risk (RR=1.3), particularly among combination HT users (RR=2.2) Household second-hand smoke does not increase breast cancer risk Wine may increase (RR=1.7) and phytoestrogens reduce (RR=0.6) ovarian cancer risk Obesity is not associated with breast & endometrial cancer risk among long-term HT users; although the HT itself increases risk Slide40:  Family Registry for Breast Cancer, with special focus on minority populations (1995-present) John, Whittemore, West Family Registry for Ovarian Cancer (1996-2001) Whittemore, John, West Cancer Family Registries Breast Cancer Family Registry (E.John, D.West):  Cancer Family Registries Breast Cancer Family Registry (E.John, D.West) Design: - Screen breast cancer cases identified through cancer registry - Enroll probands: all high-risk probands random sample of sporadics, oversample minorities - Enroll relatives: affected and unaffected 1st degree relatives affected 2nd degree relatives - Enroll unrelated RDD controls (1999-2000) Data and Biospecimen Collection: - Clinical data from cancer registry - Detailed family history - Epidemiologic risk factors, diet, treatment - Blood or mouthwash samples  DNA, cell lines, plasma - Tumor tumor blocks  slides, TMAs - Pathology review - Annual follow-up Cancer Family Registries Ethnic Diversity:  Cancer Family Registries Ethnic Diversity Slide43:  Cancer Risk in Relatives of Breast and Ovarian Cancer Patients Lee, John, McGuire, West, Whittemore Cancer Epidemiology, Biomarkers and Prevention 15:359-316, 2006 Findings :  Findings Additional unidentified genes modify breast and ovarian cancer risks in carriers of BRCA1 mutations Unidentified genes alter breast and ovarian cancer risks in non-carriers of BRCA1 mutations The evidence is strong in relatives of early-onset breast cancer patients Cancer Family Registries Breast & Ovarian Cancer Family Registries (E. John, D. West, A. Whittemore):  Cancer Family Registries Breast & Ovarian Cancer Family Registries (E. John, D. West, A. Whittemore) Additional Major Findings: Risk of early onset BC is not increased in BRCA mutation carriers who use OCs Ovarian cancer risk reductions associated with OC use, tubal ligation, and parity are similar in BRCA1 mutation carriers and non-carriers. The patterns of breast and ovarian cancer in relatives of patients with these cancers support the presence of genes that modify risk specific to cancer site, in both carriers and noncarriers of BRCA1 and BRCA2 mutations CHEK2*1100delC is associated with increased BC risk and among BC cases <45 yrs, carrier status is associated with exposure to diagnostic radiation Validity of self-reported family history of breast cancer varies little by race/ethnicity Etiology of Female Cancers Selected Examples:  Etiology of Female Cancers Selected Examples Multiethnic Case-Control Study (E. John) California Teachers Study (P. Horn-Ross) Cancer Family Registries (E. John, D. West) Novel Hypotheses Hygiene Hypothesis (T. Clarke) HLA / Immune Function (S. Glaser) Early Soy Consumption (P. Horn-Ross) Etiology of Female Cancers Hygiene Hypothesis (T. Clarke):  Etiology of Female Cancers Hygiene Hypothesis (T. Clarke) Breast cancer incidence patterns are similar to those observed for asthma/allergies Reduced or delayed exposure to microbes, especially in childhood, implicated in etiology of asthma/allergies Immunologic changes (including Th2 > Th1 balance) thought to result from reduced microbial exposure could impact hormones Hypothesis: that reduced/delayed exposure to microbes, especially in childhood, could amplify traditional hormonal pathways to breast cancer First step: examine associations of breast cancer with markers of microbial exposure, including childhood social class, exposure to farming, Etiology of Female Cancers HLA / Immune Function (S. Glaser):  Etiology of Female Cancers HLA / Immune Function (S. Glaser) Racial-ethnic differences in breast cancer incidence not fully explained HLA genotype associated with breast cancer risk in a few studies HLA genotype well-established to vary across racial-ethnic groups HLA genotyping of women from Multiethnic Case-Control study HLA type associated with risk overall and variably by racial/ethnic group Etiology of Female Cancers Early Soy Consumption (P. Horn-Ross):  Etiology of Female Cancers Early Soy Consumption (P. Horn-Ross) Studies of soy consumption & breast cancer risk are confounded by ethnicity Ethnicity, amount of soy consumption, and early exposure are highly correlated Puberty is a critical period during which soy consumption may reduce breast cancer risk Genetic variation may also play a role Cohort study of 215 girls, age 10-13 years at baseline, followed for 2 years Hypothesis: Onset of menarche (a risk factor for breast cancer) will be delayed in high soy consumers Genetic variation in genes that regulate steroid hormones may modify this association Etiology of Female Cancers Ethnic Diversity:  Etiology of Female Cancers Ethnic Diversity Leukemias and Lymphomas Ongoing Studies:  Leukemias and Lymphomas Ongoing Studies Leukemias Northern CA Childhood Leukemia P. Reynolds Study Exposure insights using GIS P. Reynolds, R. Rull Lymphomas Socioeconomic disparities in T. Keegan, S. Glaser survival after Hodgkin lymphoma Body size, physical activity and S. Glaser, T. Keegan Clarke Hodgkin’s disease Familial Hodgkin lymphoma pilot S. Glaser Genetic variation in lymphomas E. Chang Leukemias and Lymphomas Northern CA Childhood Leukemia Study (P. Reynolds) :  Leukemias and Lymphomas Northern CA Childhood Leukemia Study (P. Reynolds) Design: population-based case-control study of childhood leukemia in 35 Northern California counties Primary focus: examination of environmental risk factors for childhood leukemia, with special attention to variability by molecular subtypes Major findings: Decreased risk with daycare attendance (hygiene hypothesis) Decreased risk with vitamin C consumption Increased risk with some household pesticide use Increased risk with paternal smoking Leukemias and Lymphomas EBV and Hodgkin lymphoma (S. Glaser, C. Clarke, E. Chang, T. Keagan):  Leukemias and Lymphomas EBV and Hodgkin lymphoma (S. Glaser, C. Clarke, E. Chang, T. Keagan) Design: cross-sectional study of 2,459 California Hodgkin lymphoma patients, combining CCR demographic and tumor data with tumor EBV status determined from archival tumor specimens Primary focus: characterize complex epidemiologic features of EBV-associated Hodgkin lymphoma in population-based case series Major findings: EBV in tumors of 29% of 1,370 patients on whom specimens were obtained EBV presence varies by age, sex, race/ethnicity, histology, HIV Age, sex, race/ethnicity, histologic subtype independent predictors Poorer survival for older EBV-positive patients with nodular sclerosis histologic subtype (Clarke, Keegan) HIV-related Hodgkin lymphoma strongly EBV-associated with poor survival but  virulence in HAART era Leukemias and Lymphomas Reproductive factors, Hodgkin lymphoma:  Leukemias and Lymphomas Reproductive factors, Hodgkin lymphoma Design: population-based case-control study of 320 female Hodgkin lymphoma patients and 326 RDD controls from Greater Bay Area Primary focus: effect of reproductive experience and exogenous hormone use on risk with control for childhood social class Major findings: risk with nursing, hormone use, recurrent miscarriage; interaction of parity and nursing From numerous secondary data analyses, observations regarding: changing risk with social class increased risk with smoking in EBV-positive patients reliability of registry histologic classification, etc. Leukemias and Lymphomas Ethnic Diversity:  Leukemias and Lymphomas Ethnic Diversity Slide56:  Social and Built Environment and Cancer Risk Assessment of social and built environment through community-level geo-spatial data Population and housing density, housing characteristics, immigration/acculturation, racial/ethnic composition, medical care, businesses/services, walkability, commute, residential segregation, unemployment Impact of built environment on physical activity and breast cancer risk Impact of nutrition environment on dietary patterns and cancer risk CANCER ETIOLOGY (Gomez) Slide57:  Focus on Early detection and screening Survival Treatment Quality of life Quality of care Co-morbidity Social and built environment OUTCOMES RESEARCH OUTCOMES RESEARCH :  OUTCOMES RESEARCH Breast Cancer Treatment Choices (S. Gomez) Pilot study to develop linguistically- and culturally-appropriate survey instrument Incorporation of mixed methodology: qualitative, focus groups, cognitive, epidemiologic pilot interviews Focus on: Cultural factors in decision-making processes for early-stage breast cancer Family influences on decision-making Treatment impacts on quality of life; Provider perspectives OUTCOMES RESEARCH :  OUTCOMES RESEARCH Survival in High-risk Breast Cancer Families (D. West) Genetic and non-genetic factors associated with survival BRCA1 mutations Polymorphisms in a variety of genes (IGF, TGFB) Family history, hormonal factors, physical activity Outcomes Research Cancer Care Outcomes Research and Surveillance Consortium (CanCORS) (D. West):  Outcomes Research Cancer Care Outcomes Research and Surveillance Consortium (CanCORS) (D. West) Design: Multi-center cohort study of 10,000 newly diagnosed patients NCCC: 994 lung and 1038 colorectal diagnosed in 2003-2004 Primary focus: Characterization and beliefs of patients, caregivers, and providers Characteristics and systems of organizations delivering cancer care Impact on Effective treatment and experience good outcomes Continuum of care (diagnosis to recovery or death) Disparities (age, gender, race, ethnicity, insurance, residence) Outcomes Research Cancer Care Outcomes Research and Surveillance Consortium (CanCORS) (D. West):  Outcomes Research Cancer Care Outcomes Research and Surveillance Consortium (CanCORS) (D. West) Findings Patients with better health are more satisfied with cancer care Reports of patient respect for MD & RN is high (96%-98%) and consistent across racial/ethnic groups Blacks within 3% of whites on almost all measures Hispanics and Asians report: Less effective communication with physicians Less access to desired cancer specialists OUTCOMES RESEARCH :  OUTCOMES RESEARCH Young Breast Cancer Survivors – 10 Years Later (I. Oakley-Girvan) Design: Multi-ethnic case control study Includes women diagnosed at age 50 or less Research Question: Compared to survival at 5 yrs., what is the survival experience at 10 years with respect to? physical well-being psychological well-being social well-being spiritual well-being Findings: More intense physical and social concerns fewer psychological concerns Outcomes Research On-going studies matrix (1):  Outcomes Research On-going studies matrix (1) Outcomes Research On-going studies matrix (2):  Outcomes Research On-going studies matrix (2) Outcomes Research On-going studies matrix (3):  Outcomes Research On-going studies matrix (3) Slide66:  Outcomes Research Using Cancer Registries to Assess Quality of Cancer Care: A collaborative Study of Colorectal Cancer (D. West) Harvard Medical School Northern California Cancer Center California Cancer Registry Funded by the Agency for Healthcare Research and Quality & National Cancer Institute CHEMOTHERAPY FOR STAGE III COLON CANCER: UNDER-TREATMENT OR UNDER-REPORTING?:  CHEMOTHERAPY FOR STAGE III COLON CANCER: UNDER-TREATMENT OR UNDER-REPORTING? 1 2 3 4 5 6 7 8 9 10 California Regions, 1996-97 Percent RECEIPT OF INDICATED ADJUVANT THERAPY BY AGE:  RECEIPT OF INDICATED ADJUVANT THERAPY BY AGE Registry & Follow-Back Data Chemotherapy Colon & Rectal Cancer Radiation Therapy Rectal Cancer Percent Slide69:  Contact information for specific scientists at NCCC is available on the NCCC website: www.nccc.org Or contact Dee West, Chief Scientific Officer: [email protected]

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