CDC Telebriefing Transcript

HHS Issues Cancer Incidence Data By State for First Time

November 18, 2002

CDC MODERATOR: Thank you. This is Kathy Harben with CDC's Press Office.

Before we get started today, I just wanted to let you know that the website will be up by 1 o'clock. It is in queue now, and you will be able to access the website by the time we're finished or shortly thereafter.

Today's telebriefing is about a new report, "U.S. Cancer Statistics: 1999 Incidence." Today, we have three speakers with us. This was a report produced jointly by the Centers for Disease Control and Prevention and the National Cancer Institute, in collaboration with the North American Association of Central Cancer Registries, and we have speakers or people who can respond to questions from each of those agencies.

Dr. Hannah Weir, cancer expert in CDC's Division of Cancer Prevention and Control, will give brief opening remarks and then will open up for Q&As. At that time, we'll be joined by Dr. Brenda Edwards at the National Cancer Institute and Dr. Holly Howe, who is executive director of the North American Association of Central Cancer Registries.

Dr. Weir?

DR. WEIR: Thank you.

Cancer is the second leading cause of death in the United States, and the American Cancer Society estimates that in 2002, approximately 1.3 million Americans will receive a new diagnosis of cancer, and over half a million Americans will die of the disease.

There are effective prevention and treatment measures that could substantially reduce the number of new cancer cases and prevent many cancer-related deaths. Information from population-based cancer registries is critical for directing effective cancer prevention and control programs to reduce the burden of this disease.

The information from cancer registries will be increasingly important as the number of patients diagnosed with cancer is expected to double in the next 50 years due to the anticipated growth and aging of the U.S. population.

As the Centers for Disease Control and Prevention prepares to celebrate the 10th anniversary of the National Program of Cancer Registries, we are proud to announce the release of "United States Cancer Statistics: 1999 Incidence." This report is a joint publication between CDC and the National Cancer Institute and in collaboration with the North American Association of Central Cancer Registries.

This is the first joint report from the two Federal programs that support population-based cancer registries in the United States, CDC's National Program of Cancer Registries and NCI's Surveillance, Epidemiology and End Results Program. This report contains for the first time official Federal Government cancer statistics for more than one million invasive cancer cases diagnosed during 1999, the most recent year for which incidence data are available among residents of 37 states, 6 metropolitan areas and the District of Columbia. These geographic areas represent about 78 percent of the United States population.

This report has five major sections, including three sections on data.

The first data section includes a map showing all states and metropolitan areas that contributed data to the report. Cancer incidence rates for all areas combined by race, all races white and black, are provided for 66 primary cancer sites for males and 70 primary cancer sites for females. Data are not provided for other race or ethnic groups because the quality of these data vary from state-to-state. Work is underway to improve the collection of race and ethnic data, and future reports will include cancer information for these groups.

The second data section includes tables showing the states and metropolitan areas that contributed data to the report by U.S. census region and division. Incidence rates are provided by the major cancer sites and for all cancer sites combined.

The third section provides graphs showing the most common cancers by state and metropolitan areas. This graph ranks the incidence rates for the 15 cancer sites with the highest age-adjusted incidence rates within sex- and race-specific population groups within each state or metropolitan area.

Through the combined efforts of the two Federal programs, there is now a cancer registry operating in all 50 states, 6 metropolitan areas, and the District of Columbia and three U.S. territories. As more and more cancer registries are successful in meeting the data criteria for inclusion, future United States cancer statistics reports will include expanded geographic coverage and data for other race and ethnic populations.

CDC MODERATOR: Thank you, Dr. Weir.

At this point, we are ready to open up for questions and answers.

AT&T OPERATOR: Certainly. Thank you, ma'am.

Ladies and gentlemen, as you've just heard, if you do have any questions or comments, we invite you to queue up at this time. Just press the one on your phone keypad. Now, you will hear a tone indicating that you've been placed in queue, and just as a note, you may remove yourself from the queue by pressing the pound key.

Once again, to queue up for a question, just press the one on your phone keypad.

Seth Borenstein, please go ahead.

QUESTION: Yes, thank you for doing this.

Looking at the data, I note that there seems to be, in looking at lung and bronchus cancer there, a very high rate in the State of Kentucky compared to almost every other state and municipality that you put there. I'm wondering, one, is that significant and, two, are there other states and cities that jump out, when you were looking through this data, as unusually high compared to everything else? And if you can comment about Detroit and Michigan seem to have an extremely high prostate cancer rate there, too.

CDC MODERATOR: Seth, this is Kathy Harbin. Is there a particular person you want?

QUESTION: I guess, Dr. Weir might be the best person for that, I don't know. Whoever feels better qualified.

DR. EDWARDS: This is Brenda Edwards.

QUESTION: Okay.

DR. EDWARDS: We've known for a long time that many states have high lung cancer death rates. Kentucky has been among them. Certainly, lung cancer death incidence rates track the smoking prevalence that's then measured in other reports.

With regard to the high rates in Detroit, I believe that's part of our SEER Program, and those rates have also been high. I think, in part, it's related to the portion of Americans who also have a higher smoking rate.

QUESTION: But that's actually prostate cancer in Detroit, in Michigan, much higher prostate cancer than the national average, than almost every other state. Is there--

DR. EDWARDS: I'm not so sure about all of the other states with regard to prostate cancer. I haven't looked at that.

QUESTION: Are there any other, just to follow up, are there any other sort of places, when you look through this, areas or states, cities or states that jump out and say, my goodness, this is unusually high, compared to everyone else. I mean, smoking can't be that much higher in Kentucky than everywhere, you know, than in other places in the South, I would gather.

DR. EDWARDS: Actually, it is, particularly for women. It's also true you'll see some high rates for West Virginia. So it does track quite a bit with the smoking prevalence or at least smoking patterns over a period of time.

We do have an effort in progress to take these data and to use some mapping techniques to help us take a look at the way in which these rates are, the patterns of these rates based on geography. That is not quite ready now, but it is going to take I think some additional tools to be able to look at these patterns.

I think the real important point is that these data are going to be useful for those in each of the various regions, for them to take their own look at the set of cancer rates from their areas and to think more carefully about what is related to the.

DR. WEIR: And this report does indicate that there is variation in the rates, whether you're looking at the states or within the U.S. census regions and divisions, but I'd caution against selecting one or several states as having particularly high rates. We need to remember that not all registries are included in this report at the present time.

QUESTION: But when you're looking at, as you say, 78 percent of the nation, I mean, you're right, you can say number one, but of those reporting, I guess if I lived in Detroit, and I have a newspaper in Detroit, so that's why I'm asking, I mean, wondering why is there such a high prevalence even among the, I mean, obviously, there's, in prostate cancer, there's a much higher prevalence among African Americans, but even among white Americans, according to your statistics, the rate is incredibly much higher in Detroit, and it's incredibly higher compared to other African Americans for other Michigan African Americans.

So I guess people there would want to know is this a cancer cluster that we should be concerned about?

DR. EDWARDS: Well, there are many factors that actually relate to the incidence that's reported, including the extent to which screening or early detection is taking place, and that's especially true for breast and prostate cancer, and to some limited extent, for colorectal.

One thing you might take note of is that we are missing data from many of the states in the South, and I think, perhaps for the prostate cancer rate, we may be missing areas where the rate could also be high and somewhat comparable to Detroit, if we were to have it.

There's also a great deal of geographic variability in cancer prostate rates. We've seen reports published, if you will, a West-East gradient. So there are many factors that actually relate to why incidence might be high, including different risk-factor screening.

QUESTION: Thank you.

AT&T OPERATOR: Thank you, Mr. Borenstein.

Next, representing the Washington Post, we go to the line of Rick Weiss. Please go ahead.

QUESTION: Hi. I'm impressed that my colleague here has already managed to see this. I can't even get into these websites yet, and so my first comment is I think this is not helpful at all to hold a press conference like this, where virtually no information is really given in the press conference, and the map that we need to look at to ask intelligent questions are not available to at least all of us, and I find this extremely frustrating and not a good way to get information to the public through the media.

So that leaves me simply having to ask you to please tell us what do you think is important and worth telling the public about the data that I guess I'll be able to see later today?

CDC MODERATOR: The site is now live.

QUESTION: I tried it a minute-and-a-half ago, and it didn't come up on mine from the hotlink on your e-mail, but I will continue to try.

Meanwhile--

CDC MODERATOR: If you go to the cdc.gov\cancer\npcr. [Correction: report can be found at www.cdc.gov/cancer]

QUESTION: Well, I'll get there. But anyway it's too late to ask smart questions right now, so could you please give us the answers to the smart questions we ought to be asking?

DR. EDWARDS: I apologize that you're not able to see the data because this is really a rich source of information. I think that it shows us that, in men, we see prostate cancer is the leading cause, followed by lung and bronchus, as well as colorectal. So these are the top three sites.

It also confirms and shows that prostate cancer rates are almost 50-percent higher in African-American men, and I think the point here is because we're seeing the data for so many geographic areas, it confirms some information that we've had from our SEER areas in the past.

It also points out that, regardless of race, breast cancer remains the leading cancer that's diagnosed in women, followed also by lung and bronchus, as well as colorectal cancer. The rates in white women are about 20-percent higher than those in African-American women.

We've, also, I think if you had an opportunity to see the graphs or the tables, will note that there are some sites that are more common in the white population, such as melanoma and testes cancer for white men versus African American or melanoma and brain and other nervous system cancers that are higher in white women, compared to African Americans.

If you were to look at sites that are among the top 15 for the African-American population, you'll see that multiple myeloma is there for African-American men and women, as well as stomach cancer for black women, which doesn't appear in the top 15 for white women, or liver cancer appears in the top 15 for African Americans.

So it actually gives us an opportunity to look at some of the cancer sites, where we may see some differences in these populations or a variability in rates that exists around the country.

QUESTION: As a follow-up, can you tell me if anything you just said is different than what you already knew or is surprising? That's sort of what makes something news or not.

DR. EDWARDS: In some ways, it's consistent with some other reports that we have been looking at from registries, where aggregated for putting together from the NPCR program, as well as SEER.

I think, for me, the thing that I have found most interesting is the rates do vary, and they vary by geographic region of the country. I've been looking at data for over 15 years now, and I've had some surprises, in particular, the incidence for lung cancer is much higher than I had actually thought based on our data. The other one that surprised me is incidence for colorectal cancer is higher than I'd earlier thought.

So, yes, I do see some surprises that I haven't seen, and I can only see it by having a larger and more diverse geographic area in which to look at these data.

QUESTION: I'm sorry, if I could just follow up with one more question, then.

It's not clear to me, just methodologically, why dividing the data up by region allows you to see that a rate of a certain cancer is higher than you thought before.

DR. EDWARDS: Well, we have a much larger group of individuals from the U.S. population that are part of these estimates, and so I think it actually, by giving us a broader spectrum of the U.S. population, we're able to see these patterns and to be able to compare and contrast.

QUESTION: I see. Thank you.

DR. WEIR: I'd also like to add that this report does represent progress in cancer registries and the quality of the data and in the percent coverage of the population.

AT&T OPERATOR: Thank you very much, Mr. Weiss.

Representing USA Today, next, we go to the line of Tim Friend.

QUESTION: --and the answer was rather vague. What, if anything, does explain these geographic differences in various cancer rates, and particularly back against prostate cancer?

DR. WEIR: There are a number of factors that could--

DR. WEIR: --in the rates geographically. The demographics of the population risk factors in the population, and in particular, for prostate cancer and breast cancer it would be screening activities. So a report of this type, where we start to look at the variations in the population, will help us to better direct our research efforts as well as our cancer control and prevention efforts to a particular population.

QUESTION: Is it the incidence in Detroit, for example, is so high, or Michigan, is because they're screening more people?

DR. EDWARDS: I think, in part, the fact that we have the data out there and these questions are being asked is in a sense it helps create and sets up the question. Certainly the explanation for why cancer rates vary or differ from area to the others is not just one answer, and it does require more data and some other assessment of the information we have to try to get a better understanding of what might be accounting for the differences in the rates. So perhaps I don't have an answer for you today. For some of the cancer sites, we have some understanding as to what does explain these differences, and there are many factors. But for any one particular area compared to another does require us to look more carefully at what's going on in terms of risk detection.

QUESTION: Why are the--we have 78 percent of the population. Why are the other areas not reporting? Why are they--like, for example, the State of Texas is a big, giant blank on the map. Why do we not have data for these other groups?

DR. WEIR: To be included in this report, the registries' data were evaluated and had to meet the particular data standards, both quality and completeness of the data, and not all registries were successful in achieving those standard at present. But I would like to point out that over the last couple of years there has been tremendous progress made in bringing the number of registries up to meeting national data standards, and we really do anticipate that in the near future, these reports will include expanded coverage, geographic coverage.

AT&T OPERATOR: And thank you very much, sir, for your question. Next, we go to Newsday's Ridgely Oakes. Please go ahead.

QUESTION: Hi. I also haven't been able to get online to see this yet, so I'm just going to go back to what someone else said. I would like a little bit more information on the colorectal and lung cancer incidence rates that seemed higher. How much higher were they than what we already reported through Seer data or American Cancer Society?

DR. EDWARDS: I don't have a quantitative statement. I forgot to do that calculation. I think they're several percentage points higher. But in some sense, I would like to say that much of the data that you're seeing here in this report and other reports that have come out have been--we've been using some of this data together in those reports, so in that sense, it's not a complete new finding. What is new is that we now can see these lung cancer rates or the colorectal cancer rates in many more geographic areas than we've been able to look at them--up to the 78 percent. So we just have a--there's a greater width or breadth to our ability to take a look at these data at this present time.

And certainly, for something like colorectal cancer, there are many risk factors for colorectal cancer as well as the diffusion of screening that may be going on. So that would, I think, cause us to take a look at what is going on locally in each of these regions where we may see differences.

AT&T OPERATOR: Thank you. Next we'll go to the line of Marian Uhlman, with the Philadelphia Inquirer. Please go ahead.

QUESTION: Hello. I'd like you all to comment a little bit on the fact that there are six metropolitan areas that are doing this, and why not more on that level? For instance, is a city like Philadelphia moving in that direction or not?

DR. EDWARDS: The reason we put those six geographic areas in is because those are areas sponsored by the Seer program, that have been collecting data for either 10 or 30 years. So we wanted to highlight them. Those data are included in the state reports. So in every state that you have identified there, all of the major metropolitan areas would be contributing their data to the state, and it's the state that has the authority for reporting them. But because we have several metropolitan areas that have a long history, we decided to include those in this report as a separate line.

AT&T OPERATOR: Next we go to the line of Pat Anstett, of the Detroit Free Press.

QUESTION: Yes, thank you. And I, too, I was not even alerted of the press conference, let alone don't have the report. However, I, too, am going to jump in here. Forgive my skepticism, but I need to ask why is this information reliable, given the fact that you have so many missing states? And my other questions, related to that, is Detroit has one of the oldest--as you just said--Seer databases in the country. Isn't it possible that our good data collection is skewing our incidence rates? Help me understand why I should write a story that Detroit is on of the leaders in the nation of prostate cancer when we have so many missing states that might, with their data, might change the picture?

DR. WEIR: This report covers 78 percent of the population. In the past, reports have been published based on the Seer program, which was--it represented the sample of 14 percent of the United States population. So I think that, as I said, this report does demonstrate tremendous progress in ensuring that more and more geographic coverage will ensure the representativeness and the reliability of the data.

DR. EDWARDS: In terms of your question about why write a story, I guess I think the variability in the rates is, for me as the one involved in surveillancing cancer control, is very intriguing; and it's not merely identifying those areas where the rate is higher than some other, but also taking note of why the rates are low. So I guess I think it's the variability as opposed to which one, in this one report for one year of data, might be at the top.

AT&T OPERATOR: Next we go to the line of Lee Hopper with the Houston Chronicle. Please go ahead.

QUESTION: Hi. Thank you. My question goes back to one asked earlier. Is anything being done to help bring some of these Southern states on board. I have a call in to our state health department, but still don't know yet what was wrong with their data, where they couldn't be included. It seems like Texas and Houston in particular would have some interesting statistics.

DR. WEIR: The states in the South all participate in the National Program of Cancer Registries, and we have been working with the registries since their participation in the program beginning in 1995. And I would say that all of these registries have demonstrated progress toward meeting the goals of having high-quality data, and we do anticipate including them in future reports. For particular registries, I would suggest contacting the cancer registry, and if you go to the National Program of Cancer Registries web page, there is contact information to find out why individual cancer registries are not included in the report.

AT&T OPERATOR: Thank you very much, Ms. Hopper. Next we go to the line of the Sun Sentinel's Nancy Metzeger [ph]. Please go ahead.

QUESTION: Yes, I also have not been able to look at the data, so I don't even know if Florida's information is on there. But because we are such a transient society down here and people are moving in all the time, how would this data--do we trace back where all these folks came from originally, and is that included when you do a study like this?

DR. EDWARDS: These data should reflect cancer rates that are occurring in people who are residents of each of those states. We do try to provide information if someone is diagnosed in one state and may be living there part-time but actually live--their permanent residence is another state. There is an exchange of information. It does come in a little more slowly, but we do--our reporting rules are that these should represent people who are residents of these states.

QUESTION: And Florida actually is included in the report?

CDC MODERATOR: The report is live online now at www.cdc.gov/cancer. It's on that home page there. You should be able to access it.

AT&T OPERATOR: Thank you. Our next question comes from Maggie Fox with Reuters. Please go ahead.

QUESTION: Hi. I'm sorry, I've just dialed in late because the number was invalid that we got on the e-mail. But I wanted to ask, does this report show this widely reported cluster of breast cancer cases in California?

DR. EDWARDS: We didn't provide data by county, so the rates are typically high for certain parts of California but lower in other segments. So this would not be able to identify any particular small geographic area for California.

AT&T OPERATOR: Thank you. We have a question from Chris Barrish, with the News Journal of Wilmington. Please go ahead.

QUESTION: Yeah, once again, I'm trying to get this information up online, and I share my colleagues' frustration. It's almost like, you know, driving through a tunnel in the dark. So could you guys summarize, for us people that can't look at this information and want to maybe file something on deadline, what are the areas or who are the leaders overall in cancer--who leads for women, who leads for breast cancer? So there it is.

DR. WEIR: At CDC, in the Division of Cancer Prevention and Control--

DR. WEIR: --we have a number of initiatives directed around breast and cervical cancer screening programs and around comprehensive cancer control. These are initiatives that are directed toward helping--providing screening to the medically underserved. And it's hard to identify one particular leader, other than to say that, you know, there are a number of surveillance programs and screening initiatives that are directed at women's issues.

AT&T OPERATOR: The next question is from the line of Seth Borenstein with Knight Ridder, with a follow-up question. Please go ahead.

QUESTION: I guess, and it follows up perfectly for that, and I guess for Dr. Edwards, I was looking at all incidence rates on there, and it seems demonstrably higher in New England for both male and female, for all cancer incidences, and demonstrably lower in the mountain states, as you called them, in general.

Are you saying that that's mostly screening issues or is there something else there? As you say, there's a dramatic geographic difference here.

DR. EDWARDS: I'm sorry. Were you looking at all sites together?

QUESTION: All sites together.

DR. EDWARDS: Well, I don't think screening actually accounts for many of the sites because we don't have a screening technique.

I actually must say that I wasn't aware that the New England area for all cancer sites was persistently high than some of the other areas of the country. I'm sitting here scanning my notes, the tables, but I must apologize. I really hadn't noted that the incidence rates were significantly higher.

DR. WEIR: Also, it could be due to other characteristics of the population, the prevalence of risk factors, and I think that, as you're pointing out now, I mean, we're starting to identify these geographic regions with the higher variations in incidence, and these are where the research questions should be focused so that we can actually start to answer the very questions that you're raising here.

This publication provides the descriptive bases that can then start generating the hypotheses for the follow-up research.

AT&T OPERATOR: We also have a follow-up question from Rick Weiss with the Washington Post. Please go ahead

QUESTION: Hi. You know, everything I'm hearing so far sounds like the story here is that you've released these data which are going to be useful for people who want to start looking more closely at causes and so on of various cancers by smaller region and locality.

I cannot put my finger on what the news story is, in terms of what the data actually show, and I wonder if someone there could tell me what you think the headline ought to be, if there were to be a news story really about the data themselves, and not about the fact that the report exists now.

DR. WEIR: I think the significance of the report is the fact that now we have cancer registries operating in all 50 states, these 6 metropolitan areas, the District of Columbia, the 3 territories. This does show considerable progress in having a nationwide cancer surveillance system.

QUESTION: Right, but I mean what is the news about the actual content of those data, though?

DR. WEIR: Now we're actually able to start to identify the geographic variability in incidence rates in the United States and that being able to start to identify the reasons for this variability will help us to better focus our cancer prevention and control activities so that we can actually begin to reduce, to plan for the reduction in the burden of cancer.

AT&T OPERATOR: We have a question now from Chris Barrish with the News Journal at Wilmington. Please go ahead.

QUESTION: So what will this do eventually to the SEER Program as the baseline for cancer statistics? Are you looking down the road 10 years from now that this report will become the baseline that you measure the U.S. average by and you measure all the states against?

DR. EDWARDS: This is Brenda Edwards. I think we pointed out that we've been working together as organizations to produce other reports, where we put together the SEER data and data from the National Program of Cancer Registries, and that's been facilitated, in large part, with the North American Association of Central Cancer Registries. So for about three years now we've actually published a variety of cancer statistics that do include data, putting together information from SEER and the NPCR.

So, no, I don't think--I think what it is, is our two programs complement one another in ways that would not have been possible before.

AT&T OPERATOR: Next, a follow-up question from Maggie Fox, once again, with Reuters. Please go ahead.

QUESTION: Thanks. I want to follow up on Rick's question, and I want to ask who was it who answered his question, was that Dr. Weir?

But what struck you in the actual data, in the cancer incidence data, as something that was new or different that we didn't know before? Is there a geographical area that it surprised you had more or less cancer? Was there a group that you found that surprised you?

And could you please make sure that we know who is speaking. Thanks.

DR. WEIR: This is Hannah Weir at CDC.

These findings, as Brenda mentioned, do confirm findings that have been presented before, but in addition, they start to get at identifying the geographic variability in cancer that has been missing in the past. So, as she said, the combination of the data from the two programs put together gives us a picture of cancer both at the national level for the United States, but also then starting to look at the regional variation and the state variations.

AT&T OPERATOR: We have a follow-question from Tim Friend with USA Today. Please go ahead.

QUESTION: Yes. My question is you're saying that we're making a lot of progress, and we have 78-percent coverage now. What's different about 2002 than 1992 that we didn't have this information before?

DR. EDWARDS: I think in 1992 we had registries with high-quality data covering between 10 and 14 percent of the U.S. population. Today, for the year, cancers diagnosed in 1999, we are showing a report that covers 78 percent of the population, and that is expected to increase.

So, for any single year or even five years, we have seen an increase in the amount of information.

DR. WEIR: And in 1992, Congress passed the Cancer Registries Amendment Act, which authorized CDC to establish the National Program of Cancer Registries so that we could ensure that all registries would have high-quality and complete data so that they could do their own local cancer control planning.

AT&T OPERATOR: We do go back to Maggie Fox now for a follow-up. Please go ahead, ma'am.

QUESTION: I'm sorry to harp on this, but otherwise we're all going to go through the numbers and try to find our own clusters, which is probably not a very good thing, and you probably don't want journalists doing it.

But when we're asking for something out of the data that has struck you that is descriptive, not just the fact that, yes, we've got geographic variability, what geographic variability do we have? Is cancer higher in the South, in the Northeast? Is it, you know, can you give us a little bit more detail than we've had?

DR. WEIR: Well, again, I would caution trying to identify areas with particularly high rates. Again, we don't have--there are 13 states that are not included in this report. I think that, again, it's a wealth of information. You can look at individual cancers and identify it. There are certain geographic variations for particular cancers, you know, for all sites combined, and I just caution trying to identify clusters of cancers from this report.

It's more the case of trying to identify the variability in it that would allow us then to do the follow-up research to answer the questions as to why there might be variability and is there anything that we can do, as a result of that follow-up research, to reduce the burden of cancer.

DR. EDWARDS: This is Brenda Edwards at NCI.

I also would probably caution you, in using the word "cluster," because rates for cancer incidence, when you have screening, can be higher when you've actually had screening occur more prominently in one period of time versus another. So sometimes a high increase in incidence may actually reflect something being done to try to control cancer.

The other thing I would also say is that looking for cancer clusters, by looking at the patterns, is actually a rather complicated and sophisticated activity, and while simply looking at the numbers and finding the top ones is something we all do, and we're interested in, actually trying to understand whether there is an area with high rates, and those rates have persisted over time, which may lead one to talking about a cluster, is a much larger effort. And so I would like to dispel your interest in trying to identify clusters by simply looking at this set of data.

Perhaps you can help your readers understand that high cancer rates for one point in time don't really define a cluster. It is something that takes more evidence than that.

AT&T OPERATOR: Thank you, Ms. Fox.

We go to Seth Borenstein for our next follow-up. Please go ahead.

QUESTION: I think you get, hopefully, an understanding of the frustration levels that are here.

We are talking about these as possible clusters only because we have asked you numerous ways to try to help us define what is unusual here, and you keep weaseling out here. This is why, as Maggie pointed out, if you don't do it, we'll do it, and you don't want us doing it.

So I look at this, for example, and I want to know where then are you going to be looking and saying this is unusual--you are saying you will use this to help you figure out the geographic variability. What geographic variability are you going to be looking at from this data, to say this is something unusually high, this is something unusually low, this is where we're going to start to study further? Where are you studying further? Is it perhaps looking, I looked at lung and bronchus cancer rates there, and I see dramatically higher rates among the Midwest and the South and the Northeast areas you would see with a lot of a coal power plants. Obviously, what you're telling me is I shouldn't draw that conclusion. Are you going to look into that?

CDC MODERATOR: Seth, this is Kathy Harben, the Public Affairs officer. I think you're taking this beyond what we were intending this telebriefing to be about. This is new information. We were really intending to focus on the fact that this is a greater percentage of the U.S. population than we have been able to report on in the past. The data do confirm some things we have known for some time.

There is new information, but another important thing to remember is that CDC, and the National Cancer Institute, and the North American Association of Central Cancer Registries is interested in getting this data out there to the states so they can look at it. Researchers at the state, and local, and Federal levels, as you can tell, will be looking at this more closely.

We don't have a laundry list of new findings at this point. At this point, we're running way over the time we have budgeted, and some of our speakers do need to move on to other commitments.

Please call the CDC Press Office at 404-639-3286, and we'll be happy to arrange interviews with Dr. Weir at CDC or Dr. Edwards at the National Cancer Institute in order to try and get answers to your questions.

AT&T OPERATOR: Thank you, Ms. Harben.

Ladies and gentlemen, that does conclude your press briefing for today. Thank you very much for your participation, as well as for using AT&T's Executive Teleconference Service. You may now disconnect.

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