DevCan - neue Wege der Kommunikation von Registerdaten?

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1 Workshop Krebsepidemiologie AG Krebsepidemiologie der DGEpi Kassel 05. / 06. März 2007 DevCan - neue Wege der Kommunikation von Registerdaten? Klaus Kraywinkel Hans-Werner Hense EKR NRW ggmbh und Bereich Klinische Epidemiologie Institut für Epidemiologie und Sozialmedizin Universität Münster

2 Putting Cancer in Context Whether people respond to a given health threat depends in part on how large they perceive their personal risk to be. Typical presentations of health risks may do little to inform these perceptions. What is missing from these messages is context: how does the chance of getting or dying of cancer compare with the chance of getting or dying from another disease. Woloshin S et al. JNCI 2002;94:

3 Making sense of risk information on the web Don t forget the basics Nevertheless, even with a clear statement of risk, something is missing is a 2 in 1,000 chance of dying over 10 years a big or a small risk? Mr. Jones needs a context for example, how the risk of prostate cancer compares with that of the average person; or how his chance of dying of prostate cancer compares with his chance of dying of other cancers or heart disease. Woloshin S et al. BMJ 2003;327:695-6

4 What are the basics? Clarity Context Uncertainty Woloshin S et al. BMJ 2003;327:695-6

5 What is DevCan?

6 What is DevCan? DevCan - Probability of Developing or Dying of Cancer Statistical models are used to compute the probability of developing and dying of cancer from birth or conditional on a certain age. DevCan takes cross-sectional counts of incident cases from the standard areas of the Surveillance, Epidemiology, and End Results (SEER) Program conducted by the National Cancer Institute, and mortality counts for the same areas from data collected by the National Centre for Health Statistics, and uses them to calculate incidence and mortality rates using population estimates from census data for these areas.

7 What is DevCan? These rates are converted to the probabilities of developing or dying from cancer for a hypothetical population. DevCan is the current version of the software (released June 2006). It supports rate editing, sensitivity analysis, user-defined databases, confidence intervals, and the ability to get risk estimates from any age to any age. The DevCan software provides greater flexibility than an online database as it includes the ability to analyze own cancer data.

8 What is DevCan? These rates are converted to the probabilities of developing or dying from cancer for a hypothetical population. Please note that when the program refers to cancer or incidence, it is referring only to the cancer site that you requested. DevCan is the current version of the software (released June 2006). It supports rate editing, sensitivity analysis, user-defined databases, confidence intervals, and the ability to get risk estimates from any age to any age. The DevCan software provides greater flexibility than an online database as it includes the ability to analyze own cancer data.

9 What is DevCan? These rates are converted to the probabilities of developing or dying from cancer for a hypothetical population. Please note that when the program refers to cancer or incidence, it is referring only to the cancer site that you requested. DevCan is the current version of the software (released June 2006). It supports rate editing, sensitivity analysis, user-defined databases, confidence intervals, and the ability to get risk estimates from any age to any age. The DevCan software provides greater flexibility than an online database as it includes the ability to analyze own cancer data.

10 What is DevCan? These rates are converted to the probabilities of developing or dying from cancer for a hypothetical population. Please note that when the program refers to cancer or incidence, it is referring only to the cancer site that you requested. DevCan is the current version of the software (released June 2006). It supports rate editing, sensitivity analysis, user-defined databases, confidence intervals, and the ability to get risk estimates from any age to any age. The DevCan software provides greater flexibility than an online database as it includes the ability to analyse own cancer data.

11 What is DevCan? These rates are converted to the probabilities of developing or dying from cancer for a hypothetical population. Please note that when the program refers to cancer or incidence, it is referring only to the cancer site that you requested. DevCan is the current version of the software (released June 2006). It supports rate editing, sensitivity analysis, user-defined databases, confidence intervals, and the ability to get risk estimates from any age to any age. The DevCan software provides greater flexibility than an online database as it includes the ability to analyse own cancer data.

12 What is DevCan? DevCan's age-conditional probability of developing a specific cancer has several advantages over the conventional cumulative rate: it is more general in that one can condition on being cancer free up until a specific age it uses only the first incidence of a cancer (i.e. no DCO), the rates of death from cancer are incorporated into its calculations Fay MP, et al. Age-conditional probabilities of developing cancer. Stat Med 2003;22(11): the rates of first cancer incidence and mortality follow a more plausible model than constant rates over 5 year age groups see Fay MP. Estimating age-conditional probability of developing cancer using a piecewise mid-age join point model for the rates. Stat Res Appl Branch, NCI, Technical Report # A.

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17 Each (Y,Z) estimate is displayed as : Estimate 95% Upper Limit 95% Lower Limit C _3

18 Each (Y,Z) estimate is displayed as : Estimate 95% Upper Limit 95% Lower Limit C _3

19 Each (Y,Z) estimate is displayed as : Estimate 95% Upper Limit 95% Lower Limit C _3

20 Each (Y,Z) estimate is displayed as : Estimate 95% Upper Limit 95% Lower Limit C _3

21 Wie hoch ist mein Krebsrisiko?? Frauen Wahrscheinlichkeit einer Krebserkrankung bis zum Alter von Jahren Ohne Krebserkrankung bis zum Alter von 30 1% 4% 10% 19% 30% 40-3% 9% 18% 29% % 16% 27% % 23% % Jahre Auf der Basis der aktuellen Daten des EKR-MS unter Verwendung des Programmes DevCan Statistical Research and Applications Branch, National Cancer Institute, USA, 2006

22 Wie hoch ist mein Krebsrisiko?? Männer Wahrscheinlichkeit einer Krebserkrankung bis zum Alter von Jahren Ohne Krebserkrankung bis zum Alter von 30 1% 3% 9% 22% 39% 40-2% 8% 22% 39% % 21% 39% % 37% % Jahre Auf der Basis der aktuellen Daten des EKR-MS unter Verwendung des Programmes DevCan Statistical Research and Applications Branch, National Cancer Institute, USA, 2006

23 Wie hoch ist mein Krebsrisiko?? 35% 10-Jahres- Erkrankungswahrscheinlichkeit Krebs gesamt nach Alter und Geschlecht (Reg.-Bez. Münster) 30% 25% 20% 15% 10% Männer Frauen 5% 0% Alter in Jahren

24 Wie hoch ist mein Krebsrisiko?? Eingabe: Alter 20 uf 5 gerundet) Geschlecht w (m/w ) Ausgabe: Krebs gesamt Erkrankungsrisiko (kumulativ) bis zum Alter x 50% 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% Krebs gesamt Brustkrebs Lungenkrebs Prostatakrebs Alter

25 Wie hoch ist mein Krebsrisiko?? Eingabe: Alter 20 uf 5 gerundet) Geschlecht m (m/w ) Ausgabe: Krebs gesamt Erkrankungsrisiko (kumulativ) bis zum Alter x 50% 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% Alter Krebs gesamt Brustkrebs Lungenkrebs Prostatakrebs

26 Wie hoch ist mein Krebsrisiko?? Eingabe: Alter 50 uf 5 gerundet) Geschlecht w (m/w ) Ausgabe: Krebs gesamt Erkrankungsrisiko (kumulativ) bis zum Alter x 50% 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% Alter Krebs gesamt Brustkrebs Lungenkrebs Prostatakrebs

27 Wie hoch ist mein Krebsrisiko?? Eingabe: Alter 50 uf 5 gerundet) Geschlecht m (m/w ) Ausgabe: Krebs gesamt Erkrankungsrisiko (kumulativ) bis zum Alter x 50% 45% 40% 35% 30% 25% 20% 15% 10% 5% Krebs gesamt Brustkrebs Lungenkrebs Prostatakrebs 0% Alter

28 Wie hoch ist mein Krebsrisiko?? Eingabe: Alter 10 (auf 5 gerundet) Geschlecht w (m/w) Sterberisiko (kumulativ) bis zum Alter x 10% 9% 8% 7% 6% 5% 4% 3% Brustkrebs Lungenkrebs Herzinfarkt Schlaganfall Prostatakrebs Verkehrsunfall 2% 1% 0% Alter

29 Wie hoch ist mein Krebsrisiko?? Eingabe: Alter 10 (auf 5 gerundet) Geschlecht m (m/w) Sterberisiko (kumulativ) bis zum Alter x 10% 9% 8% 7% 6% 5% 4% 3% Brustkrebs Lungenkrebs Herzinfarkt Schlaganfall Prostatakrebs Verkehrsunfall 2% 1% 0% Alter

30 DevCan bietet eine Reihe interessanter Aspekte für die Risikokommunikation 1. Individuelle Datenbasis je EKR nutzbar 2. Interaktivität für Nutzer programmierbar 3. Vergleichbarkeit (Kontext) 4. Präzision (95%-KI) 5. Aktualität 6. Weitere Optionen: Intermediates, Prävalenz etc.