and promote the discipline and professional practice of epidemiology in
Ontario public health units
|Please click here to visit our new website
|4B Cancer Incidence
|Description | Specific Indicators | Ontario Public Health Standards (OPHS)| Corresponding Health Indicator(s) from Statistics Canada and CIHI | Corresponding Indicator(s) from Other Sources | Data Sources | Alternative Data Sources | ICD Codes | Analysis Check List | Method of Calculation | Basic Categories | Indicator Comments | Cited References | Other References | Changes Made
Specific IndicatorsIncidence rate, age-specific incidence rate, SRATE and Standardized Incidence Ratio (SIR) for the following cancers:
- Female breast cancer
- Malignant melanoma
Ontario Public Health Standards (OPHS)
The Ontario Public Health Standards (OPHS) establish requirements for the fundamental public health programs and services carried out by boards of health, which include assessment and surveillance, health promotion and policy development, disease and injury prevention, and health protection. The OPHS consist of one Foundational Standard and 13 Program Standards that articulate broad societal goals that result from the activities undertaken by boards of health and many others, including community partners, non-governmental organizations, and governmental bodies. These results have been expressed in terms of two levels of outcomes: societal outcomes and board of health outcomes. Societal outcomes entail changes in health status, organizations, systems, norms, policies, environments, and practices and result from the work of many sectors of society, including boards of health, for the improvement of the overall health of the population. Board of health outcomes are the results of endeavours by boards of health and often focus on changes in awareness, knowledge, attitudes, skills, practices, environments, and policies. Boards of health are accountable for these outcomes. The standards also outline the requirements that boards of health must implement to achieve the stated results.
Assessment and/or Surveillance Requirement Related to this Indicator
- The board of health shall collect or access the following types of population health data and information:
iii) Morbidity, including incidence of reportable diseases, surveillance of other infectious diseases of public health importance, incidence of injury as assessed by in-patient hospitalizations and emergency department visits, and prevalence of chronic diseases;
Corresponding Health Indicator(s) from Statistics Canada and CIHI
The Internet publication Health Indicators, produced jointly by Statistics Canada and the Canadian Institute for Health Information, provides over 80 indicators measuring the health of the Canadian population and the effectiveness of the health care system. Designed to provide comparable information at the health region and provincial/territorial levels, these data are produced from a wide range of the most recently available sources.
Click on Publications.
Type in ‘Health Indicators' into search box.
Scroll down and click on the html version of ‘Health Indicators'.
Click on "Data Tables and Maps" and then "Cancer Incidence"
- National Indicators are based on three years of data in both numerator and denominator. Cancer incidence data in this product are based on three years of data (e.g., 2001 to 2003) averaged over the population estimate of the middle year (e.g., 2002)
- Rates are tabulated using the June 2007 tabulation file, the International Classification of Diseases for Oncology 3rd Edition (ICD-O-3) from the World Health Organization, and the International Agency for Research on Cancer (IARC) rules for determining multiple primaries sites.
- Specific cancer sites include: colon, rectum and rectosigmoid junction (International Classification of Diseases for Oncology, Third Edition (ICD-O-3) codes C180 to C189, C199, C209, C260), lung and bronchus (ICD-O-3 codes C340 to C349), female breast (ICD-O-3 codes C500 to C509) and prostate (ICD-O-3 code C619). The four categories exclude morphology types M-9050 to M-9055 (mesothelioma); M-9140 (Kaposi's sarcoma); M-9590 to M-9989(lymphoma, leukemia and related).1
- Cancer incidence data were assigned to health regions using postal codes reported with place of residence and the automated geo-coding system (PCCF+) developed in Health Statistics Division. Where possible, remaining cancer incidence data (for which there were no postal codes available) were linked to health regions using the census subdivision (CSD) of residence.1
Corresponding Indicator from Other Sources
Indicators for Chronic Disease Surveillance, Consensus of CSTE, NACDD, and CDC:
- Crude counts, crude rates and age-standardized rates for all invasive cancers, lung and bronchus cancer, colon and rectum cancer, female breast cancer, cervical cancer, prostate cancer, bladder cancer (in situ and invasive), melanoma, and cancer of the oral cavity or pharynx.
- Specific site codes: colon/rectum (ICD-O-3 C18-C20, C260 and behavior >= 3 (malignant, primary site, excluding histologic types M-9590 to M-9989)), lung/bronchus (ICD-O-3 C340 to C349 and behavior >= 3 (malignant, primary site, excluding histologic types M-9590 to M-9989)), female breast (ICD-O-3 C500 to C509 and behavior >= 3 (malignant, primary site, excluding histologic types M-9590 to M-9989)), prostate (ICD-O-3 C619 and behavior >= 3 (malignant, primary site, excluding histologic types M-9590 to M-9989)), cervix (ICD-O-3 C530 to C539 and behavior >= 3 (malignant, primary site, excluding histologic types M-9590 to M-9989)), melanoma (ICD-O-3 C440 to C449 and behavior >= 3 (malignant, primary site) and histologic types M-8720 to M-8790), oral cavity & pharynx (ICD-O-3 C00-C14.8 and behavior >= 3 (malignant, primary site, excluding histologic types M-9590 to M-9989)), all invasive cancers (ICD-O-3 code C000 to C809 and behavior >= 3 (malignant, primary site), or C670 to C679 (bladder cancer) and behavior >= 2 or 3 (in-situ or malignant, primary site))
Note: If using these indicators, analyses should be restricted to malignant cases only (behavior=3). This is done automatically when calculating incidence in SEERStat unless malignant behavior box is unchecked.
Numerator: Cancer Incidence
Original source: Cancer Care Ontario (CCO)
1. Cancer Care Ontario
Suggested citation (see Data Citation Notes):
1. Cancer Care Ontario (Ontario Cancer Registry), SEER*Stat Release [number] - OCRIS [date]
Denominator: Population Estimates
Original source: Statistics Canada
1. Cancer Care Ontario
2. intelliHEALTH Ontario, Ontario MOHLTC
Suggested citation (see Data Citation Notes):
1. Population Estimates [years]*, Cancer Care Ontario SEER*Stat Release [number] - OCRIS [date]
2. Population Estimates [years]* intelliHEALTH Ontario Extracted: [date], Ontario MOHLTC
* Note: Use the total years of the estimates, including the most recent year, even if not all were used in the analysis. The years used in the analysis should be included in the report itself.
Alternative Data Sources
Population Estimates from intelliHEALTH Ontario
SEER*Stat cancer definitions are based on ICD-O-3. For comparability with published results from international and national agencies and Cancer Care Ontario, choose the incidence option labelled "Site recode with Kaposi and mesothelioma" option. This selection will remove codes in the ICD-0-3 ranges M-9050-M-9055 (mesothelioma), M-9140 (Kaposi sarcoma) and M-9590-M-9989 (lymphoma, leukemia and related) ranges.
All malignant cancers
140 to 208, 238.6
C000 to C809
C500 to C509 (excluding M-9590 to M-9989, and sometimes M-9050 to M-9055, M-9140+) *select females only
C530 to C539 (excluding M-9590 to M-9989, and sometimes M-9050 to M-9055, M-9140+)
153, 154.0 to 154.1, 159.0
C180 to C189, C199, C209, C260 (excluding M-9590 to M-9989, and sometimes M-9050 to M-9055, M-9140+)
162.2 to 162.5, 162.8 to 162.9
C340 to C349 (excluding M-9590 to M-9989, and sometimes M-9050 to M-9055, M-9140+)
C440 to C449 and M-8720 to M-8790 (morphology "M" codes must be included)
C619 (excluding M-9590 to M-9989, and sometimes M-9050 to M-9055, M-9140+)
Oral cavity and pharynx
C000 to C009, C019 to C069, C079 to C119, C129 to C140, C142 to C148 (excluding M-9590 to M-9989, and sometimes M-9050 to M-9055, M-9140+)
*Source: Cancer Care Ontario (Ontario Cancer Registry), SEER*Stat.
**ICD-O-3 Refers to the Third Edition of the International Classification of Diseases for Oncology.
+ The Site Recode variable can be created with or without Mesothelioma (9050-9055) and Kaposi Sarcoma (9140) as separate groupings.
Analysis Check List
- Suppress numbers <6 or rates and proportions based on counts less than 6. Null values are acceptable for release.
For intelliHEALTH Ontario Population estimates:
- use the Population Estimates County PHU Municipality or the Population Estimates and Projections LHIN data source in the Populations folder in Intellihealth; select the # people measure and the appropriate geography (PHU or LHIN), age group(s), and sex.
Method of Calculation
Total Incidence Rate:
|total number of new cancer cases by ICD code|
| X 100,000|
Age-specific Incidence Rate:
|total number of new cancer cases by ICD code in an age group |
total population in that age group
| X 100,000|
SRATE (See Resources: Standardization of Rates):
|Sum of (age-specific incidence rate in a given age group X 1991 Canadian population in that age group)|
Sum of 1991 Canadian population
| X 100,000|
SIR (See Resources: Standardization of Rates):
|Sum of new cancer cases in the population|
Sum of (Ontario age-specific rate x population in that age group)
Age groups for age-specific rates: 0-14, 15-29, 30-49, 50-64, 65-79, 80+
- Sex: male, female and total
- Geographic areas of patient residence: public health unit, census division (data not available at census-subdivision level except by special request to Cancer Care Ontario), LHIN, province
- Cancer incidence data are available through Cancer Care Ontario on a SEER*Stat CD, which contains cancer data, population files and software for running queries on cancer registry data. For information on requesting data see http://www.cancercare.on.ca/cms/One.aspx?portalId=1377&pageId=11864.
- ICD-O-3 codes used by CCO to categorize site specific cancers follow the Incidence site recode groups used by the U.S. National Cancer Institute's Surveillance Epidemiology and End Results (SEER).2
- When comparing CCO cancer data to other Canadian cancer incidence data sources, users must be aware that ICD codes used for cancer sites can vary. Discrepancies are highlighted in the document Comparisons - Differences in Canadian Cancer Incidence/Death definitions.
- Population data included with CCO's SEER*Stat may differ slightly from population figures supplied by intelliHEALTH Ontario.
- When using Cancer Care Ontario's SEER*Stat data, be sure to read the accompanying documentation, particularly any document with details of issues concerning data and data quality.
- Changes in incidence may reflect trends in risk factors or changes in early detection and diagnostic practices.3
- Cancers of the lung, breast, prostate, and colorectal are the highest in terms of cancer incidence and mortality.3
- To best understand disease (incidence) trends in a population, it is important to determine crude rates, age-specific rates and age-standardized rates (SRATES) or ratios (SIRs). The crude incidence rate is the number of incidence cases divided by the number of people in the population. This rate depicts the "true" picture of disease in a community although it is greatly influenced by the age structure of the population. Age-specific rates can best describe the "true" disease pattern of a community and allow comparison of populations that have different age structures.
- Since many age-specific rates are cumbersome to present, age standardized rates have the advantage of providing a single summary number that allows different populations to be compared; however, they present an "artificial" picture of the disease pattern in a community. It is important to examine the data carefully before standardizing. In general, the SIR is used to compare an area (e.g., health unit) with one other area (e.g., Ontario). This indirect form of standardization requires a comparator that has a large population and stable age-specific rates. SRATEs, on the other hand, are generally used to compare a number of rates at the same time, e.g., health units across a region or rates over time. This direct form of standardization requires all comparators to have relatively stable age-specific rates. For more information about standardization, refer to the Resources section: Standardization of Rates.
- For additional information related to cancer data and its analysis, refer to the Resources section for a series of presentations: Cancer Data and Analysis Resources.
- Statistics Canada and Canadian Institute for Health Information. Health Indicators, Data quality, concepts and methodology, 2008; 1(1). Available online at: http://www.statcan.gc.ca/pub/82-221-x/2007001/quality-qualite/4063855-eng.htm#223 (Accessed May 15, 2009).
- National Cancer Institute. SEER Site Recode ICD-O-3 (1/27/2003) Definition. Available online at: http://seer.cancer.gov/siterecode/icdo3_d01272003/ (Accessed May 13, 2009).
- Canadian Cancer Statistics Steering Committee: Canadian Cancer Statistics 2009, Toronto: Canadian Cancer Society, 2009. Available online at: http://www.cancer.ca/Canada-wide/About%20cancer/Cancer%20statistics.aspx?sc_lang=en (Accessed May 15, 2009).
Formal Review or Ad Hoc?
Changes made by
June 16, 2009
Cancer, Smoking and Sun Safety subgroup of Core Indicators.
- The Mandatory Program and Services Guideline Objectives were updated to the Corresponding Outcomes from the Ontario Public Health Standards.
- Other changes were made to reflect the new Guide to Creating and Editing Core Indicators.
- ICD codes were updated to reflect and coincide with those cancer grouping codes used by Cancer Care Ontario.
May 30, 2011
- Included reference to the Cancer Data and Analysis presentations listed on the 'Resources' page
| October 14, 2014|| Ad Hoc||N. Greenidge on behalf of the Core Indicators Work Group|
To reflect and coincide with Cancer Care Ontario methodology, the following changes were made:
- Corresponding indicators from other sources - "Note" added to provide guidance of using these indicators
- ICD codes for "All malignant cancers" - changed from "C000 to C800" to "C000 to C809"
- ICD codes for "Malignant melanoma" - added instructions to always include morphology "M" codes M-8720 to M-8790
- Basic categories - age groups for age-specific rates changed from "<1, 1-9, 10-19, 20-44, 45-64, 65-74, 75+, total" to "0-14, 15-29, 30-49, 50-64, 65-79, 80+"