Status Report On Colon Cancer In Malta: Potential Data Sources Reports Example
Cancer that develops in colonic tissues, typically in the cells that generate and secrete fluids, is referred to as colon cancer. In statistics, it is often lumped together with rectal cancers or the malignancies that occur in rectal tissue. In 2012, approximately 1.4 million new colorectal cancer cases were diagnosed worldwide leading to a global incidence that ranks third behind breast and lung cancer (World Cancer Research Fund International 2013). While genetics play a role in colon cancer, health promotion interventions can also reduce the risk. For related programs to be effective, these must be based on the epidemiological status of the disease.
Preparing a Status Report
In preparing a status report, data must be obtained from the most reliable sources available.
National Mortality Registry Annual Report
The National Mortality Registry is the most reliable source of mortality data. The Registry bases its annual report on death certificates that indicate actual deaths in the country, the gender and age of those deceased, where they died, and the causes of death (Department of Health Information and Research 2012). The latter information can be contentious because in reality, not all causes of death can be clearly identified especially among those who have been diagnosed with comorbid conditions. In cases such as these, information from the autopsy report and the medical record of the disease will be used to verify the cause of death.
As there may be deaths that occur in Malta of persons who are not residents, the Registry separates data for residents and non-residents thus ensuring that mortality data for residents only are available (Department of Health Information and Research 2012). The Registry staff also has ways to ensure the accuracy of data through various checks during the different stages of data input. At the same time, the coding used is the ICD which is the same system employed by the Economic Union (EU) and international organisations such as the World Health Organisation (WHO). Thus, the National Morbidity Registry data can be readily used for regional and global reports for Malta and comparisons with other countries.
The types of mortality data available in the National Mortality Registry annual report include the number of deaths for colorectal cancer, the rate, and percentage per the total number of deaths for the year (Department of Health Information and Research 2012). It also ranks the top causes of mortality so it becomes clear if colorectal cancer is a major cause of death. The leading causes of mortality by gender are also presented in the report which enables researchers to ascertain if colorectal cancer deaths affect females differently than males. Moreover, the top causes of death by age group is presented in the report, the age groups being 1-14, 15-44, 45-64, 65-84, and 85 and above although shorter age groups would seem better so that adolescents are separate from adults, and young adults are separate from middle adults. Data by age allows users to determine if colon cancer deaths occur in certain age groups more than others.
National Cancer Registry
The most accurate colon cancer incidence and prevalence data by age and gender can be sourced from the National Cancer Registry based, of course, on the assumption that reliable reporting systems are in place in hospitals, clinics, and pathology centres in the country. The goal of the registry is to obtain and maintain data on all residents diagnosed with malignancies for surveillance purposes (Malta National Cancer Registry 2013). After analysing the data, the registry issues periodic reports on cancer trends by gender and age. In doing so, users can determine if gender and age are significant risk factors as well. The registry also reports mortality per specific cancer type which can be cross-checked with the National Mortality Registry data to ensure accuracy. However, there is no aggregate data pertaining to social class.
European Cancer Observatory
The European Cancer Observatory, on the other hand, provides prevalence data at the national level for Malta and other countries in the EU. Given that this measure is not available in the National Cancer Registry, the Observatory is a good data source albeit it uses estimates. Prevalence data for 2012 in figures is separate for men and women and a graph shows colon cancer prevalence at one year, three years, and five years (European Cancer Observatory 2012).
European Health Examination Survey
In terms of risk factors, there is no local source that compiles and monitors data on risk factors specific to cancer and specific to colon malignancies. Given that lifestyle factors such as sedentariness, a diet low in fruits and vegetables, smoking, obesity, and excessive alcohol consumption are common risk factors for colon cancer, the degree of risk of the population can be estimated using data from the recently concluded European Health Examination Survey (EHIS). The advantage of the survey is that is entails actual measurements of body mass index (BMI) and waist circumference as well as blood sugar and cholesterol levels (Calleja & Muscat 2010). These measures are indirect indicators of the level of physical activity and the kind of diet consumed by the population given that lifestyle influences these biological measures (Kushner 2012). The EHIS also obtains data on smoking status in relation to lung function measurements. The EHIS survey uses a randomised sample of the population randomised by gender, age, and geographical location.
European Core Health Indicators
Surveillance data on alcohol consumption, smoking, consumption of fruit, consumption of vegetables, and physical activity as risk factors of colon cancer is available in the European Core Health Indicators (ECHI) website. Litres of pure alcohol consumed per person aged 15+ per year is an indicator based on the production, export, import, and sales of alcohol that is taxed and also alcohol that is sold beyond the government regulations (World Health Organisation Regional Office for Europe 2014). Including taxed and untaxed alcohol data yields an accurate and objective measure. For Malta, the ECHI provides annual data on alcohol consumption from 2005 to 2012 as individual figures and also as a line graph to show the trend. The indicators for smoking status, fruit and vegetable consumption, and physical activity meanwhile rely on self-report data obtained through surveys per age group (World Health Organisation Regional Office for Europe 2014).
The smoking status pertains to the proportion of males and females aged 15 years and over who consider themselves daily smokers. It is also the only indicator that considers one aspect of social status, i.e. the proportion of the population whose highest level of completed education corresponds to a scale of 0 through 6 based on the International Standard Classification of Education (ISCED) (World Health Organisation Regional Office for Europe 2014). Use of the ISCED permits comparison between the different educational systems in EU countries.
Calleja, N & Muscat, NA. 2010. European Health Examination Survey 2010 – Pilot study (online). Available at https://ehealth.gov.mt/download.aspx?id=7693. (Accessed: 14 January 2015).
European Cancer Observatory. 2012. European Cancer Observatory (online). Available at http://eu-cancer.iarc.fr/Default.aspx. (Accessed: 15 January 2015).
Kushner, RF. 2012. Clinical assessment and management of adult obesity. Circulation. 126. pp.2870-7.
Malta National Cancer Registry. 2013. National Cancer Registry (online). Available at https://ehealth.gov.mt/HealthPortal/Chief_Medical_Officer/healthinfor_research/registries/cancers.aspx. (Accessed: 14 January 2015).
World Health Organisation Regional Office for Europe. 2014. European Health for All Database (online). Available at http://data.euro.who.int/hfadb/. (Accessed: 15 January 2015).
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