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Using census and mortality data to target small areas for breast, colorectal, and cervical cancer screening
H F Andrews1, J F Kerner, A G Zauber
1Memorial Sloan-Kettering Cancer Center, New York, NY.
Objectives:
The goal of this study was to develop and validate quantitative models for estimating cancer incidence in small areas.
Methods:
The outcome for each cancer site was the incidence of disease that had reached a late stage at the time of diagnosis. Two sets of predictors were used: (1) census-based demographic variables and (2) census-based demographic variables together with the cancer-specific mortality rate.
Results:
The best models accounted for a substantial percentage of between area variability in late-stage rates for cancer of the breast (46%), cervix (61%), and colon/rectum (58%). A validation procedure indicated that correct identification of small areas with high rates of late-stage disease was two to three times more likely when model-based estimates were used than when areas were selected at random.
Conclusions:
Additional testing is needed to establish the generality of the geographic targeting methodology developed in this paper. However, there are strong indications that small-area estimation models will be useful in many regions where planners wish to target cancer screening programs on a geographic basis.