Cancer Reporting in California

Cancer Reporting in California

Reporting Procedures for Physicians

California Cancer Reporting System Standards
Volume Four

Cancer Surveillance Section
Department of Health Services
State of California
October 1999

The California Health and Safety Code, Section 103885 requires hospitals, physicians, and certain other healthcare providers to report all new diagnoses of cancser. Physicians must report diagnoses in those paients who do not undergo diagnostic procedures or treatment of their malignancies at a hospital or other cancer-reporting facility in California. the regional cancer registries, operating under the authority of the Department of Health Services' California Cancer Registry, have the responsibility for abstracting the required data from the reporting physician's records. Confidentiality of data collected is strictly maintained in accordance with Section 100330 of the Health and Safety Code.

Reporting Requirements
Report diagnoses that meet all of the following criteria: Invasive and in situ malignancies, including leukemia and lymphoma. However, the following are not reportable: 1) basal or squamous cell carcinoma of the skin unless it occurs on the genitalia and 2) carcinoma in situ or intraepithelial neoplasia grade III (CIN III) of the cervix. (The California Cancer Registry has adopted the morphology section of the International classification of Diseases for Oncology, Second Edition, 1990, as its list of reportable neoplasms.) A diagnosis must be reported iven if it has not been microscopically confirmed. If in doubt, submit a report.

Patients not previously admitted as an inpatient or outpatient to a California cancer-reporting facility for the primary cancer.

Patients not being referred by you to a hospital or other cancer-reporting facility for diagnosis or treatment of the cancer. If a patient is referred to a cancer-reporting facility for a condition other than the cancer, the case must be reported by the physician.

Reporting Procedures
To report a diagnosis, complete the Confidential Morbidity Report (CMR, Form PM 110) the same form used to notify the State of the occurrence of certain other diseases. CMR forms can be obtained from your local health department. A separate report is required for each of a patient's primary tumors. (For example, if a patient is diagnosed with chronic lymphocytic leukemia and Hutchinson's melanotic freckle, a form must be submitted for each). Send the form to the regional cancer registry resposible for cancer reporting in your area. The regional cancer registries are listed at the end of this document.

In filling out the CMR, type or print the following information:
Name: Enter the patient's full name, including the middle name or initial, so that any other reports for the same person can be identified.
Phone: Enter the patient's current home and work telephone numbers, including the area code.
Race: Classify patients of mixed parentage according to race of mother, if known. Entry is for assignment of the patient to a demographic group for analysis.
Ethnicity: Classify patients to the appropriate category.
Gender: For demographic analysis, and also helps assure correct identification, especially when first names are used by both genders.
Age: Exact age at the time of the initial diagnosis, if possible.
Date of Birth: Enter number of month, day, and the complete year.
Social Security: For identification.
Address: Enter patient's usual residence on the date of the initial diagnosis -- that is, where the patient lives and sleeps most of the time, which is not necessarily the same as the legal or voting address. Recording of the correct address is essential for accurate incidence counts.
Disease: Enter whatever is known about the histology, primary site, and laterality (left or right side) of the cancer. (For example: "adenocarcinoma of the descending colon," "malignant melanoma of the right calf," "chronic lymphocytic leukemia," "cancer of the left breast."
Date of Onset: Not required. See Date of Diagnosis.
Reported by: Enter your name, address, phone number, and license number.
Date of Death: If the patient died of any cause, enter the date. If yo do not know the date, enter "date unknown."
Date of Diagnosis: Day when the first diagnosis was made. This can be the date of the first clinical diagnosis, not necessarily of the microscopic confirmation.

Regional Registry's Procedures
Within about six months of the submission of the report, the regional registry will send a professional abstractor ot your office to gather specific data from the patient's medical record. The data include characteristics of the malignancy (histology, site of occurrence, and extent of disease), date of diagnosis, diagnostic procedures used, treatment, and the patient's name, address, age, marital status, gender, religion, race, ethnicity, birthplace, and occupation before retirement. Physicians are obligated by law to make pertinent medical records available to the registry. However, you may separate or photocopy pages containing the required information, and in photocopies you may expunge irrelevant data with black ink. The registry will prvide you with a copy of the abstract upon request.

Before sending an abstractor, the registry will call your office to make an appointment. The Registry will try to schedule the visit at a convenient time for your office staff and to accommodate your desire to be present or out of the office. Physicians reporting small numbers of cases may be sent a Confidential Physician Cancer Reporting Form from their Regional Registry to complete. Some physicians are never contacted, because the case has been reported by another source.

Depending upon the complexity of the record, it usually takes betweeen twenty and forty minutes to record the data. The time can be minimized if the abstractor is provided with a suitable place to work.

All abstractors sent to physicians' offices are employees of the regional registry and certified or elgible for certification by the National Cancer Registrars Association. They receive special training in how to protect confidentiality and perform their tasks in accordance with the law and strict regulations established by the California Cancer Registry.

Collection of data under the cancer reporting system is subject to the confidentiality provisions in Section 100330 of the Health and Safety Code. The Code protects from action for damages anyone who furnishes such information to the Department of Health Services or its authorized representative. Information about individual patients is never released to unauthorized persons or agencies, and safeguards have been established throughout the cancer reporting system to maintain confidentiality. In the more than fifty years that the California Cancer Registry has been gathering cancer data, there has not been one breach of confidentiality.

Patient Information Sheet
It is the reporting physician's responsibility to inform patients that their cancer diagnosis has been reported to the California Cancer Registry as required by law. The Department of Health Services has developed a "Patient Information Sheet" which you may elect to use to inform your patients. A copy is included as an insert and additinal copies can be obtained through the California Cancer Registry. If you choose, you may create your own information sheet to distribute and post in your office.

California's Cancer Reporting System
The State's cancer reporting system developed from a successful study initiated in 1947 to determine the feasibility of basing a central cancer registry on data obtained from hospitals. Gradually, reporting was extended from nine hospitals to 55 plus a private cancer clinic, then to the entire San Francisco-Oakland Standard Metropolitan Statistical Area. Because of the medical and epidemiological value of the data reported, the state legislature in 1985 authorized the Department of Health Services to establish "a statewide system for the collection of information concerning the incidence of cancer."

Hospitals still have the primary responsibility for reporting the information. However, since an increasing number of people with cancer are not hospitalized at the time of diagnosis, a supplemental reporting mechanism is essential to assure that the data is accurately reflect the incidence of cancer in the state. Therefore Section 103885 of the Health and Safety Code states:

Any physician, dentist, podiatrist, or other health care practitioner diagnosing or providing treatment for cancer patients shall report each cancer case to the department [of Health Services] or the authorized representative of the department except for those cases directly referred to a treatment facility for diagnosis or treatment of that instance of cancer.

Over the years, cancer reporting in California has produced a number of important benefits. It has made it possible for the Department of Health Service's to estimate the incidence of cancer in the state, evaluate risk factors in the occurrence of the disease, ascertain variations in risks among different ethnic groups and social classes, identify changes in the incidence of various forms of cancer in subroups of the population, and study long-term changes in the interrelationship of incidence, early diagnosis, treatment, length of survival, and mortality for a greater understanding of cancer. In addition, it has greatly increased the number of cases available to researchers for epidemiological studies of human cancer and its relationship to the environment, genetics, cancer in different species, and other fields. These achievements have been made possible by the cooperation of California's health-care institutions and professionals in the state's premier cancer-reporting system.

Regional Cancer Registries
Region 1/8
Region 2
Region 3
Region 4
Region 5
Region 6
Region 7/10
Region 9

California Department of Health Services
California Cancer Registry
Cancer Surveillance Section
1700 Tribute Road, Suite 100
Sacramento, CA 95815-4402
(916) 779-0800


Region 1/8
Northern California Cancer Center
32960 Alvarado-Niles Rd, Suite 600
Union City, CA 94587
(510) 429-2500
FAX (510) 429-2550
   Region 1: Santa Clara Region (Monterey, San Benito, Santa Clara and Santa Cruz Counties).
   Region 8: Bay Area Region (Alameda, Contra Costa, Marin, San Francisco and San Mateo Counties).


Region 2
Cancer Registry of Central California
1625 East Shaw Ave., Suite 155
Fresno, CA 93710-8100
(559) 244-4550
FAX (559) 221-1821
Counties: Central Region (Fresno, Kern, Kings, Madera, Mariposa, Merced, Stanislaus, Tulare and Tuolumne Counties).


Region 3
Cancer Surveillance Program Region 3
2800 L Street
Sacramento, CA 95816
(916) 454-6522
FAX (916) 454-6523
Counties: Sacramento Region (Alpine, Amador, Calaveras, El Dorado, Nevada, Placer, Sacramento, San Joaquin, Sierra, Solano, Sutter, Yolo and Yuba Counties).


Region 4
Tri-Counties Regional Cancer Registry
345 Camino Del Remedio, Room M340
Santa Barbara, CA 93110
(805) 681-5136
FAX (805) 681-5159
Counties: Tri-County Region (San Luis Obispo, Santa Barbara and Ventura Counties).


Region 5
Desert Sierra Cancer Surveillance Program
11368 Mountain View Avenue, Suite C
Loma Linda, CA 92354
(909) 558-6170
FAX (909) 558-6178
Counties: Inland Empire Region (Inyo, Mono, Riverside and San Bernardino Counties).


Region 6
Cancer Registry of Northern California
1560 Humboldt Road, Suite 4
Chico, CA 95928
(530) 345-2483
FAX (530) 345-3214
Counties: North Region (Butte, Colusa, Del Norte, Glenn, Humboldt, Lake, Lassen, Mendocino, Modoc, Napa, Plumas, Shasta, Siskiyou, Sonoma, Tehama and Trinity Counties).


Region 7/10
CSPOC/SANDIOCC, Epidemiology Program
Department of Medicine
224 Irvine Hall
University of California
Irvine, CA 92717
(949) 824-7416
FAX (949) 824-4773
   Region 7: San Diego Region (Imperial and San Diego Counties).
   Region 10: Orange County.


Region 9
Cancer Surveillance Program
University of Southern California
1540 Alcazar Street, CHP-204
Los Angeles, CA 90033-9921
(323) 442-2300
FAX (323) 442-2301
Counties: Los Angeles County.


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