Surveillance, Epidemiology and End Results (SEER)

Initiated by the 1971 National Cancer Program, the purpose of the SEER Program has been to provide the Nd with baseline data on cancer incidence and mortality, and cancer patient survival in the United States. The current participants in the Program, including the registries added in 2001, cover over 25 percent of the total U.S. population. The SEER coverage areas include 15 percent of the population that reside in counties classified as rural, and 28 percent of the population that reside in counties considered to be below the poverty level. Coverage of racial/ethnic groups is as follows: African Americans 23 percent; Hispanics 40 percent; American Indians, Eskimos, and Aleuts 42 percent; Asians 53 percent; and Hawaiian and Pacific islanders 70 percent. The SEER database contains data on roughly 5.7 million cancers diagnosed during the period 1973-2006, and approximately 380,000 new cases are added each year. History of registry acquisition The SEER Program was begun in 1972 in seven geographic areas of the United States with case ascertainment beginning with January 1, 1973 diagnoses. The initial seven geographic areas included in the Program were the states of Connecticut, Iowa, New Mexico, Utah, and Hawaii, and the metropolitan areas of Detroit, Michigan, and San Francisco-Oakland, California. These areas were selected because of their diverse ethnic subgroups, and because they had existing cancer registration activities either through the Regional Medical Program, the Third National Cancer Survey, or the End Results Group. The Commonwealth of Puerto Rico was also included as a participant at that time. The rationale for including Puerto Rico was to monitor cancer incidence in an industrially developing area with overall low cancer risk. Because there were no participants in either the southern or northwestern United States, the Program was expanded in 1974 to include the metropolitan area of New Orleans, Louisiana, and the thirteen-county Seattle-Puget Sound area in the state of Washington. The Program was further expanded in 1975 to include Atlanta and in 1979 to add ten rural counties in Georgia in order to obtain data on a rural African American population. New Orleans was unable to continue in the Program beyond the 1977 data collection year because of unsatisfactory contract performance. Further expansion of SEER took place in 1983 when, in order to increase the coverage of African American and Hispanic populations, a competitively procured contract was awarded to the State of New Jersey. Because of budgetary limitations, however, the coverage was limited to the four-county Newark area. In 1989, New Jersey and Puerto Rico were dropped from the SEER Program because of low technical scores received as part of the review process associated with the non-competitive renewal of the SEER contracts. The SEER Program was again expanded in 1992 to include the county of Los Angeles, and the San Jose'- Monterey area south of San Francisco. This expansion provided for increased coverage of Hispanics and other minority groups. In response to review group recommendations, another expansion was implemented in 2001, when Kentucky, Louisiana, New Jersey, and the entire state of California were added through a competitive solicitation.