The Israel National Cancer Registry

Barbara G. Silverman, MD, MPH

Director, Israel National Cancer Registry

Israel Center for Disease Control

Israel Ministry of Health

January 2015

INCR –the numbers

Population-based, passive registry covering the entire Israeli

population (≈8 million)

Founded in 1960; mandatory reporting beginning in 1982

Currently includes data on over 700,000 cases in approximately

650,000 Israelis

Approximately 30,000 new cases added per year

Data complete through 2012

Reporting to the INCR is mandatory for:

All in situ and malignant neoplasms (including hematologic

malignancies) with the exception of:

Basal cell carcinoma

Squamous cell carcinoma of the skin (excluding SCC of the skin

of the genitals, which must be reported)

All neoplasms of uncertain behavior

Benign neoplasms of the brain and central nervous system

“Suspected” diagnoses based on clinical criteria (rather than

pathology results) must be reported

The requirement for reporting applies to:

Public and private pathology, cytology and hematology

laboratories

Hospitals

Oncology centers

Local health districts (death certificates)

Health funds

Reporting methods:

Regular mail

Secure server

Patient listings by electronic mail

National Bureau of Statistics

Oncology/hematology clinics

(13) Hospital medical records

departments

(29)

Hospital and community

pathology laboratories

(30)

ISRAEL NATIONAL CANCER

REGISTRY

Local health bureaus (death

certificates)

Reporting to the INCR, 2014

Regular

mail Secure

server Electronic

mail Pathology 39,508 30,156 69,664 Discharge summaries 35,347 13,894 9 49,250 Oncology centers 1,735 1,146 15,268 18,149 Death certificates 6,137 404 6,541 Hematology centers 757 757

Total 83,484 45,196 15,681 144,361

Pathology reports

Oncology programs

Medical records

Death certificates/CBS

Site and histology

Tumor size/Lymph

node

involvement/extent

of spread

Surgeries

Site and histology

Stage

Treatment

Demographic data

Vital status

Malignancy as cause of

death

Site and histology

Stage

Treatment

Surgical procedures

International Classification of Diseases

for Oncology (ICD-O-3)

Topography code—anatomic site

Morphology code—histologic diagnosis

Fifth digit of histology code represents

tumor behavior (benign, uncertain, in

situ, malignant)

ICD-O-3 topography (site) codes

ICD-O-3 morphology codes

Cancer coding

Diagnosis ICD-9 ICD-10 ICD-O-3

Topography Morphology

Adenocarcinoma metatastatic to

lung, unknown primary

199.1 C80.0 C80.9 8140/3

Adenocarcinoma, lung 162.9 C34.9 C34.9 8140/3

Squamous cell carcinoma, lung 162.9 C34.9 C34.9 8070/3

Carcinoma (NOS) of breast,

metastatic to lung

174.9 C78.0 C50.9 8010/3

Middle East Cancer Consortium (MECC)/SEER classification:

Staging

Stage Description

0 In situ in situ/

localized 1 Localized

2 Regional, direct extension

Regional spread 3 Regional, lymph nodes

4 Regional, direct extension & lymph nodes

5 Regional, NOS

7 Distant Distant spread

9 Undetermined

SEER summary staging-lung cancer

-400 -300 -200 -100 0 100 200 300 400

0-4

5-9

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80-84

85-89

90+

Population in thousands

age

gro

up

s

males females

150 100 50 0 50 100 150

0-4

5-9

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80-84

85-89

90-94

95+

Population in thousands

age

gro

up

s

males females

Age distribution of the Israeli population, 2012

Jewish Arab

Most common cancers, by gender and

population group, Israel 2012

Males Females

Jewish Arab Jewish Arab

Site % of

cases

Site % of

cases

Site % of

cases

Site % of

cases

Prostate 20.9 Lung 19.7 Breast 32.9 Breast 33.1

Colon/rectum 13.2 Prostate 12.5 Colon/rectum 10.8 Colon/rectum 10.7

Lung 11.0 Colon/rectum 12.0 Lung 6.5 Thyroid 7.6

Bladder 6.4 Bladder 5.5 Uterus 5.7 Non-Hodgkin

lymphoma

5.5

Non-Hodgkin

lymphoma

5.7 Non-Hodgkin

lymphoma

5.4 Thyroid 5.4 Uterus 5.3

Most common causes of cancer deaths, by

gender and population group, Israel, 2012

Males Females

Jewish Arab Jewish Arab

Site % of

cases

Site % of

cases

Site % of

cases

Site % of

cases

Lung 19.9 Lung 34.3 Breast 19.1 Breast 18.7

Colon/rectum 13.2 Colon/rectum 9.3 Colon/rectum 12.9 Colon/rectum 11.8

Pancreas 9.1 Pancreas 6.3 Lung 11.4 Lung 8.0

Prostate 8.1 Stomach 5.6 Pancreas 7.7 Leukemia 7.7

Non-Hodgkin

lymphoma

5.8 Leukemia 5.4 Ovary 5.8 Stomach 6.3

Lung cancer in Israel ICD-O-3 site codes C34.* (excluding lymphomas and

mesothelioma)

Classification of histology

Squamous cell carcinoma (ICD-O-3 histology codes 8050-8078, 8083-8084)

Adenocarcinoma (ICD-O-3 histology codes 8140, 8211, 8230-8231, 8250-8260, 8323, 8480-8490, 8550-8551, 8570-8574, 8576)

Small cell carcinoma (ICD-O-3 histology codes 8041-8045, 8246)

Large cell carcinoma (ICD-O-3 histology codes 8010-8012, 8014-8031,8035,8310)

All other histology codes

Age-standardized rates (ASR), lung cancer, Israel

1980-2012

0

10

20

30

40

50

60

Jewish males Jewish females Arab males Arab females

Lung cancer, by histologic group, Israel

1960-2012

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

SCC AdenoCA small cell large cell other

Crude lung cancer incidence, by age group,

gender, and population group, 1960-2012

0

20

40

60

80

100

120

140

160

180

200

לור

יעש

-10

0,00

0

+45בגילאים , נשים ערביות +45בגילאים , גברים ערבים +45בגיאלים , נשים יהודיות +45בגילאים , גברים יהודים 45נשים ערביות מתחת לגיל 45גברים ערבים מתחת לגיל 45מתחת לגיל , נשים יהודיות 45מתחת לגיל , גברים יהודים

Lung cancer incidence, selected countries

Globocan 2012: Estimated cancer incidence, mortality and prevalence worldwide

in 2012

http://globocan.iarc.fr/Default.aspx

-100 -80 -60 -40 -20 0 20 40 60

Hungary

Turkey

Poland

Belgium

Lithuania

Spain

France (metropolitan)

Bulgaria

Russian Federation

Czech Republic

Greece

Estonia

Ukraine

The Netherlands

United States of America

Canada

Denmark

Luxembourg

Germany

Italy

Austria

Ireland

Switzerland

United Kingdom

Norway

Portugal

Finland

Israel

Sweden

Females Males

Lung cancer mortality, selected countries

-80 -60 -40 -20 0 20 40

Hungary

Turkey

Poland

Belgium

Estonia

Bulgaria

Lithuania

Russian Federation

Greece

Spain

France (metropolitan)

Czech Republic

Ukraine

The Netherlands

Denmark

United States of America

Italy

Luxembourg

Canada

Germany

United Kingdom

Ireland

Austria

Israel

Portugal

Norway

Finland

Switzerland

Sweden

Females Males

Globocan 2012: Estimated cancer incidence, mortality and prevalence worldwide

in 2012

http://globocan.iarc.fr/Default.aspx

Global surveillance of cancer survival 1995-2009: analysis of individual data for 25,676,887 patients

from 279 population-based registries in 67 countries (CONCORD-2) . Allemani C, Weir HK, Carreira

H, et al., and the CONCORD Working Group, Lancet 2014

The CONCORD study of net cancer survival

Calculating net (relative) survival

Net survival=percentage of cancer patients surviving to a

given end point, after eliminating other potential causes of

death

Takes into account competing risks of death that are more

likely in elderly patients than in younger patients

Expected background mortality calculated using population

data from the countries represented by the participating

registries

Supplement to: Allemani C, Weir HK, Carreira H, et al, and the CONCORD Working Group. Global surveillance of cancer survival 1995–2009: analysis

of individual data for 25 676 887 patients from 279 population-based registries in 67 countries (CONCORD-2). Lancet 2014; published online Nov 26.

http://dx.doi.org/10.1016/S0140-6736(14)62038-9.

Standardized five year net survival for lung cancer in Israeli adults rose from

17.3% (95% CI 16.3-18.3) in patients diagnosed in 1995-1999 to 23.8%

(95% CI 22.8-24.9) in patients diagnosed in 2005-2009

http://www.health.gov.il/UnitsOffice/HD/ICDC/ICR/CancerIncidence/Pages/about.aspx

INCR on the internet

Analysis of cancer trends, overall and by site

Survival analyses

Linkage projects to study cancer incidence in selected

populations (according to diagnosis, treatment history,

occupation, area of residence, demographic factors)

Evaluation of intervention programs

Research using INCR data

Recent publications using INCR data Lavy R, Kapiev A, Poluksht N, Halevy A, Keinan-Boker L. "Incidence trends and mortality rates of gastric cancer in

Israel" (2013). Gastric Cancer 16(2):121-5.

Nakash O, Barchana M, Liphshitz I, Keinan-Boker L, Levav I. "The effect of cancer on suicide in ethnic groups with a differential suicide risk" (2013). European Journal of Public Health 23(1): 114-5.

Keinan-Boker L, Baron-Epel O, Fishler Y, Liphshitz I, Barchana M, Dichtiar R, Goodman M. "Breast Cancer Trends in Israeli Jewish and Arab women, 1996-2007" (2013). European Journal of Cancer Prevention 22(2):112-120.

Nakash O, Liphshitz I, Keinan-Boker L, Levav I. "The effect of cancer on suicide among elderly Holocaust survivors" (2013). Suicide and Life Threatening Behavior 43(3):290-5.

Levine H, Afek A, Shamis A, Derazne E, Tzur D, Astman N, Keinan-Boker L, Mimouni D, Kark JD. "Country of origin, age of migration and risk of cutaneous melanoma: a migrant cohort study of 1,100,000,Israeli men" (2013). International Journal of Cancer 133(2):486-94.

Levi Z, Kark JD, Shamis A, Derazne E, Tsur D, Keinan-Boker L, Liphshitz I, Niv Y, Furman A, Afek A. "Body mass index and socioeconomic status in adolescence, country of origin, and the incidence of gastro-eosophageal adenocarcinoma in a cohort of 1 million men" (2013). Cancer 119(23):4086-93.

Recent publications using INCR data Leiba A, Kark JD, Afek A, Derazne E, Keinan-Boker L, Holtzman, EJ, Shamiss A, Kreiss I. "Hypertension in

Adolescence is not an Independent Risk Factor for Renal Cancer: A cohort study of 919,000 males" (2013).

Journal of the American Society of Hypertension 7(4):283-8.

Kohn R, Levav I, Liphshitz I, Barchana M, Keinan-Boker L. "Cancer incidence and mortality following exposure

to distal and proximal major stressors". (2014). Social Psychiatry and Psychiatric Epidemiology 49;703-9.

Leiba M, Kreiss I, Leiba A, Afek A, Derazne E, Keinan-Boker L, Nagler A, Shamiss A, Kark JD. "Second

generation Jewish immigrants of middle eastern origin have a lower incidence of Multiple Myeloma compared to

Ashkenazi Jews in a cohort of 746,200 Israeli men followed from late adolescence" (2014). Leukemia and

Lymphoma Jan 28. [Epub ahead of print]

Laitman Y, Simeonov M, Keinan-Boker L, Liphshitz I, Friedman E. "Breast cancer risk prediction accuracy in

Jewish Israeli high risk women using the BOADICEA and IBIS risk models". (2014). Genetics Research

95(6):174-7.

Any questions?

Barbara G. Silverman MD, MPH

Barbara.silverman@moh.health.gov.il

03-737-1516