Data Release Policy

National Program of Cancer Registries
Cancer Surveillance System (NPCR-CSS)
2015 Data Release Policy
Diagnosis Years 1995–2013
___________________________
Policy Revised June 2015

Cancer Surveillance Branch
Division of Cancer Prevention and Control
NCCDPHP, CDC
4770 Buford Hwy, N.E., Mailstop F-76
Atlanta, GA 30341-3717
E-mail: cancerinfo@cdc.gov (specify “NPCR-CSS” in subject line)

TABLE OF CONTENTS

I.

INTRODUCTION .................................................................................................................. 1
Summary of Changes .......................................................................................................... 1
II. OVERVIEW OF DATA ......................................................................................................... 2
III.
DATA RELEASE ACTIVITIES ........................................................................................ 3
A. Public Web-based Query Systems ...................................................................................... 3
1.
United States Cancer Statistics (USCS) ....................................................................... 4
2.
USCS Expanded Dataset (WONDER) ......................................................................... 4
3.
USCS County Cancer Incidence Dataset (SCP & OWH) ............................................ 4
a)
Age-adjusted rates only............................................................................................. 4
b)
Age-adjusted and crude rates .................................................................................... 4
4.
Environmental Public Health Tracking Network (EPHTN) Dataset............................ 5
a)
EPHTN Unsmoothed Rates. ..................................................................................... 5
b)
EPHTN Smoothed Rates........................................................................................... 5
c)
EPHTN National Portal to State Portal ..................................................................... 5
B. Data Release to Collaborating Partners .............................................................................. 5
1.
Central Brain Tumor Registry of the United States (CBTRUS) .................................. 5
2.
Indian Health Services (IHS) ........................................................................................ 6
3.
International Association of Cancer Registries (IACR) ............................................... 6
a)
CI5............................................................................................................................. 6
b)
CI5plus ...................................................................................................................... 6
c)
IICC .......................................................................................................................... 6
C. Analytic datasets ................................................................................................................. 7
1.
CDC Internal Analytic Data ......................................................................................... 7
a)
USCS Internal Analytic Dataset ............................................................................... 7
b)
NPCR Internal Survival Dataset ............................................................................... 7
2.
USCS SEER*Stat Research Dataset............................................................................. 8
3.
Restricted-Access Research Dataset (RDC) ................................................................. 9
a)
All Variables, Including County at Diagnosis ........................................................ 10
b)
All Variables Except County at Diagnosis ............................................................. 10
D. Data Release Under Controlled Conditions ...................................................................... 10
E. Emergency and Provisional Data Releases ....................................................................... 10
IV.
PROTECTION OF DATA ............................................................................................... 10
A. Assurance of Confidentiality ............................................................................................ 10
B. Suppression of Rates and Counts ...................................................................................... 11
C. Public Release Disclosure Statement ................................................................................ 11
D. Freedom of Information Act (FOIA) Data Requests ........................................................ 12
E. CDC External Data Requests ............................................................................................ 13
V. REFERENCES ..................................................................................................................... 14
A.

TABLE

Comparison of NPCR-CSS Data…………………………………………………….16

APPENDIX A

State and Metro Area Cancer Registries…………………………………………….20
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APPENDIX B

NPCR-CSS Overview of Data Security……………………………….…….............22

APPENDIX C

Data Items for CBTRUS Dataset……………………………………………………24

APPENDIX D

NPCR Analytic Data Use Agreement…….…………………………………………25

APPENDIX E

CDC Nondisclosure Agreement……………………………………………………..27

APPENDIX F

Data Items for USCS Internal Analytic Dataset……………………………………..28

APPENDIX G

Data Items for NPCR Internal Survival Dataset………………...…………………..30

APPENDIX H

NPCR-CSS 308(d) Assurance of Confidentiality………………………………...…31

APPENDIX I

NPCR-CSS 308(d) Assurance of Confidentiality FAQ……………………………..32

APPENDIX J

Data Items for USCS SEER*Stat Research Dataset……………………………...…36

APPENDIX K

NPCR Research Data Use Agreement…………….……………………………...…38

APPENDIX L

NPCR Data at the NCHS RDC Q&A……………………………………………….40

APPENDIX M

Data items for Restricted Access Research Dataset…………………………………45

APPENDIX N

NPCR-CSS Levels of Data Access……………….…………………………………47

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National Program of Cancer Registries
Cancer Surveillance System
2015 Data Release Policy
June 2015
I. INTRODUCTION
This document describes the format and content of data that the Centers for Disease Control and
Prevention’s National Program of Cancer Registries (NPCR) Cancer Surveillance System (CSS)
releases or shares. This multi-year policy updates the May 2014 NPCR-CSS Data Release
Policy. This policy applies to data submitted to the Centers for Disease Control and Prevention
(CDC) for the 2015 NPCR-CSS data submission and for all future data submissions until a new
policy is provided.
The NPCR-CSS Privacy Steward, as authorized by the Chief of the Cancer Surveillance Branch,
clears all releases of State data, ensuring that the data are released according to the terms of the
NPCR-CSS Data Release Policy.
It is possible that, in future years, data release practices or the content and format of released data
may vary from those described in these guidelines. Such changes may occur as a result of
improvements in the quality of the data, changes in information technology, and evolving data
needs. However, if such variations occur, the data release practices will provide comparable
protection (or more protection) for patient confidentiality to what is described in this policy. If it
is anticipated that any data will be released with less protection (as determined by the NPCRCSS Privacy Steward) for patient confidentiality than is described in this policy, NPCR central
registries will be notified and have ample time to respond before the data are released. This
policy is reviewed annually by the NPCR-CSS Privacy Steward and other appropriate CDC staff
members to determine whether revisions are needed.
A.












Summary of Changes
Clarification of unsmoothed and smoothed rates for the Environmental Public
Health Tracking Network dataset, page 5
Information regarding the International Association of Cancer Registries’ Call for
Data returned to the Policy on a permanent basis, page 6
USCS SEER*Stat Restricted Dataset (restricted to NPCR Cancer Registry staff)
replaced with USCS SEER*Stat Research Dataset (open to everyone), page 8
Race/ethnicity combination data presentation added as White Hispanic, White
non-Hispanic, Black Hispanic, Black non-Hispanic (with appropriate cell
suppressions), Table page 18
CDC Nondisclosure Agreement added, Appendix E, page 27
Data items for USCS Internal Analytic Dataset added, Appendix F, page 28
Data items for NPCR Internal Survival Dataset added, Appendix G, page 30
Data Items for USCS SEER*Stat Research Dataset added, Appendix J, page 36
NPCR Research Data Use Agreement added, Appendix K, page 38
Flowchart for NPCR-CSS Levels of Data Access added, Appendix N, page 46
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II. OVERVIEW OF DATA
In 1992 Congress established NPCR by enacting the Cancer Registries Amendment Act, Public
Law 102-515.4 The law authorized CDC to provide funds and technical assistance to States and
territories to improve or enhance existing cancer registries and to plan for and implement
population-based central cancer registries where they did not exist. NPCR’s purpose is to assure
the availability of more complete local, State, regional, and national cancer incidence data for the
planning and evaluation of cancer control interventions and for research. NPCR adopted
reporting requirements and definitions consistent with the National Cancer Institute’s (NCI)
Surveillance, Epidemiology, and End Results Program (SEER);11,12 required the use of uniform
data items, codes, and record layouts as defined by the consensus of members of the North
American Association of Central Cancer Registries (NAACCR);13 and established standards for
data management and data completeness, timeliness, and quality similar to those recommended
by NAACCR.13,14 In 1994, the first 37 States received funding from CDC.15 Currently, 45
States, the District of Columbia, Puerto Rico, and the U.S. Pacific Island Jurisdictions are funded
by NPCR (appendix A).16 NPCR-funded central registries collect data on patient demographics,
primary tumor site, morphology, stage of disease at diagnosis, and first course of treatment. In
addition, NPCR central registries conduct follow-up for vital status by linking with State and
national death files.
Invasive and in situ cancer case reports are submitted to CDC by population-based statewide
central cancer registries in all 45 participating States, the District of Columbia, Puerto Rico, and
the U.S. Pacific Island Jurisdictions. In each State or territory, State laws and regulations
mandate the reporting of cancer cases by facilities and practitioners who diagnose or treat cancer
to the State health department or its designee.4 The central cancer registry receives case reports
from facilities and practitioners throughout the State and processes them according to standard
data management procedures.14 Personal identifiers including the patient’s name, Social Security
number, and street address are removed from the NPCR-CSS submission prior to the encryption
and electronic transmission of these case reports to a contractor acting on behalf of CDC. CDC
and the contractor adhere to strict data security procedures when receiving, processing, and
managing the data (appendix B). For more information on NPCR-CSS data, see the Technical
Notes as posted on the United States Cancer Statistics (USCS) Web site
(http://www.cdc.gov/uscs), which is updated annually. NPCR-CSS received formal approval
(protocol #2594) from CDC’s Institutional Review Board (IRB) in October 1999. The approval
is updated annually. CDC has an Office for Human Research Protections (OHRP)-approved,
Federal-wide assurance of compliance with rules for the protection of human subjects in research
(45 Code of Federal Regulations 46)
(http://www.hhs.gov/ohrp/humansubjects/guidance/45cfr46.htm).
Central cancer registries and Federal agencies routinely publish cancer incidence data 22 months
after the close of each diagnosis year based on data that meet standards for completeness and
quality.16,17 However, other versions of the same data, based on the data file as it exists at
different time periods, are usually available. For example, some central registries have
preliminary data available as soon as 12 months after the close of each diagnosis year. After the
publication of official statistics, central cancer registries (as well as CDC and NCI) continue to
update and republish data with new information incorporated. When cancer incidence data are
published, it is common practice to document either the data submission date (i.e., when the data
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were submitted to CDC or NCI) or the date that the file was prepared. Changes in central cancer
registry incidence data that occur more than 22 months after the close of a diagnosis year are
likely to be small; however, delays in reporting are more likely to impact certain cancer sites and
may be important for some research studies.18
III. DATA RELEASE ACTIVITIES
A. Public Web-based Query Systems
For purposes of this policy, public web-based query systems are defined as datasets that are
comprised of aggregated data (i.e., not individual case-specific data or microdata) that have
been modified according to accepted procedures to block breaches of confidentiality and
prevent disclosure of the patient’s identity or confidential information and have a database
behind a CDC firewall that is case-specific microdata.2, 5–10 Users are able to access only
aggregate counts and rates with all confidentiality protections built in. A combination of
confidentiality protection measures is employed for each public web-based query system (see
table). These systems do not contain information that is identifiable or potentially identifiable
according to currently accepted procedures for reducing disclosure risk.2, 5–10 Before each
system is finalized, the aggregate values are analyzed to determine whether there is a need for
complementary cell suppression.2, 5–10 If appropriate, the analysis includes consultation with a
statistician with specific expertise in statistical disclosure limitation techniques. Following the
analysis, complementary cell suppression is applied as needed.
There are no restrictions on access to public web-based query systems. A public release
disclosure statement (see page 11) cautions users against inappropriate use of the data or
inappropriate disclosure of information. Data are released as delimited ASCII files, a Webbased query system, or possibly through other vehicles (see table). As a convenience to NPCR
central registries, States may request from CDC a copy of their complete State-specific analytic
database that is used to populate each public web-based query system. The following public
web-based query systems are currently being released:





United States Cancer Statistics (USCS)
USCS expanded dataset
USCS county cancer incidence data
Environmental Public Health Tracking Network (EPHTN) data

All NPCR-CSS public web-based query systems consist of cancer incidence data selected from
the NPCR-CSS analytic database. This is the same database that provides cancer incidence
data for the annual publication of USCS.16 Data sources, case definitions, basic registry
eligibility criteria in terms of required data completeness and quality, population denominator
sources, methods for calculating incidence rates, and the rationale for specific cell suppression
thresholds are as described in the Technical Notes for USCS, unless noted in separate
documentation that accompanies the data.
Separate documentation may accompany each system that describes its unique features
(e.g., the data submission date, percentage of the U.S. population covered, diagnosis years and
cancer sites included, variables included, any special data quality criteria required for
inclusion, and any unique statistical methods employed).
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1. United States Cancer Statistics (USCS)
The USCS dataset is a hypertext markup language (HTML) file containing the aggregate
counts and rates for incidence and mortality published annually (see web based report at
www.cdc.gov/uscs), with text documentation. The USCS web-based report is a public
web-based query system which displays the single year and 5-year aggregate counts, ageadjusted rates, and 95-percent confidence intervals at the State, regional, and national
levels. The Web-based query system has the database behind a CDC firewall with pretabulated data using SEER*Stat queries, which allows for the display of counts and rates.
Users are able to access only aggregate counts and rates with all confidentiality
protections built in. Downloadable ASCII or MS Excel files, are available. Male and
female combined counts and rates are also available in the HTML edition, in addition to
the published sex-specific tables.

2. USCS Expanded Dataset (WONDER)
The USCS expanded dataset displays the aggregate counts, rates, and 95-percent
confidence intervals published yearly in USCS, as well as additional aggregate values
created from the same analytic file containing more detailed breakdowns of counts and
rates based on selected variables (see table). These data are available on the Wideranging Online Data for Epidemiologic Research (WONDER) (http://wonder.cdc.gov),
a Web-based query system that has a database behind a CDC firewall with case-specific
microdata. However, users are able to access only aggregate counts and rates with all
confidentiality protections built in. Because this system presents data in more detail than
is presented in USCS, States have the option to notify NPCR if they prefer not to have
their State data included.

3. USCS County Cancer Incidence Dataset (SCP & OWH)
The USCS county cancer incidence dataset consists of aggregate cancer incidence counts,
crude rates, and age-adjusted rates for selected counties in the United States (see table).
These data are available as an ASCII file. Because this dataset presents data at a sub-State
geographic level, States have the option to notify NPCR if they prefer not to have their
county data included. A limited version of this dataset has been released to a small
number of users and states have the option to release age-adjusted rates only:
a) Age-adjusted rates only
Data released to NCI for the State Cancer Profiles (SCP) project
(www.statecancerprofiles.cancer.gov) includes age-adjusted rates only.
b) Age-adjusted and crude rates
Data released to the U.S. Department of Health and Human Services, Office of
Women’s Health (OWH) includes crude and age-adjusted rates.
Future versions may contain more detail about cancer at the county level. Beginning in
2008, CDC began routinely publishing county data averaged over 5 years.
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4. Environmental Public Health Tracking Network (EPHTN) Dataset
The EPHTN dataset for the national EPHTN portal displays the 5-year aggregate counts,
age-adjusted rates, and 95-percent confidence intervals for selected cancer sites at the
State and county level (see table). This dataset is available on the public EPHTN network
(http://www.cdc.gov/nceh/tracking), a Web-based query system that has the database
behind a CDC firewall with case-specific microdata, which allows for the calculation of
locally-weighted smoothed rates or unsmoothed rates, or both:
a) EPHTN Unsmoothed Rates.
Data published are similar to that on State Cancer Profiles.
b) EPHTN Smoothed Rates.
Smoothing is the process of averaging a measure for an area based on information
about that area and areas around it. Please note that the main purpose of
smoothing is to clarify spatial patterns and to improve the stability of rates, not to
prevent disclosure of private information. Back-calculation of case counts from
smoothed rates is sometimes possible when the method of smoothing is made
known and (non-sensitive) denominator data are available from other sources.
Through EPHTN, users are able to access only aggregate counts and rates with all
confidentiality protections built in. Because this system presents data using a locally
weighted smoothing procedure, States have the option to notify NPCR if they prefer not
to have their State and county data included.
c) EPHTN National Portal to State Portal
CDC’s Environmental Health Tracking Branch (EHTB) has grantees in several
NPCR-funded states that are responsible for the state-level public portals. In
collaboration with EHTB, upon request, CDC-NPCR provides the state-level
EPHTN dataset to the EHTB state counterpart. States have the option to notify
NPCR if they prefer not to have their data provided to the EHTB state
counterpart.

B. Data Release to Collaborating Partners

1. Central Brain Tumor Registry of the United States (CBTRUS)
CBTRUS annually publishes the print and Web versions of the statistical report, Primary
Brain Tumors in the United States Statistical Report Supplement; a previous version of
the report is available at: http://www.cbtrus.org/reports/reports.html. The report includes
age-adjusted rates and corresponding 95-percent confidence intervals on brain and other
central nervous system tumors and is presented by State, histology, major histology
grouping, primary site, behavior, gender, race, ethnicity, and age at diagnosis. CDC
provides individual, record-level data to CBTRUS for the publication of this report;
appendix C lists the variables included in this dataset. Only States that agree to
participate and meet the USCS publication criteria are included in the dataset.
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In addition, CBTRUS uses these data to respond to inquiries that are more specific than
those that are provided by the report. For these inquiries, no individual record level data
is released; only aggregated data with the corresponding confidence intervals (if
applicable) and appropriate suppression criteria are provided to data inquirers. Attribution
to the NPCR is provided. CBTRUS signs data use agreements before data are released for
their report and future inquiries. For questions, contact CBTRUS staff at
cbtrus@aol.com.

2. Indian Health Services (IHS)
CDC continues to use the IHS linkage results for analyses related to cancer incidence in
the AI/AN population (e.g., USCS). In addition to improving cancer incidence rates
presented in USCS, an analytic database is maintained by an Albuquerque CSB assignee
for DCPC AI/AN activities, with access limited to approved CDC staff. These activities
include responding to data requests for AI/AN cancer incidence rates from tribal
epidemiology centers and tribal organizations contingent upon permission from the state
registries that comprise the IHS areas of interest. Inclusion in this dataset also includes
an option for IHS to provide the state with the date of death obtained through NDI-IHS
linkage and/or the date the linkage occurred by diagnosis year.

3. International Association of Cancer Registries (IACR)
The International Association of Cancer Registries (IACR) produce the Cancer Incidence
in Five Continents (CI5) and the International Incidence of Childhood Cancer (IICC).
The CI5 series of monographs, published every five years, has become the reference
source of data on the international incidence of cancer. The CI5 databases provide access
to detailed information on the incidence of cancer recorded by cancer registries (regional
or national) worldwide in two formats and the IICC provides access to detailed
information on the incidence of pediatric cancers:
a) CI5
Presents the basic data published in the CI5 volumes.
b) CI5plus
Contains annual incidence for selected cancer registries published in CI5 for the
longest possible period.
c) IICC
Presents basic pediatric data.
When IACR requests data, the formal Call for Data Submission giving information on the
evaluation procedure, likely layout of how data will be presented, and questionnaire on
registry operations will be available from the IACR website. CDC-NPCR will provide
additional information regarding the CI5 Call for Data as it becomes available. There are
two components of the CI5 Call for Data: 1) the questionnaire and 2) data submission. .
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Data submitted for CI5 may also be used for the IICC publication making a separate data
submission unnecessary. This IACR product does require a separate questionnaire to be
completed by the states. An introductory text is required for this publication.
States are responsible for completing the on-line questionnaires and providing an
introductory text, indicating if the CI5 data and introductory text are also used for the
IICC product. States may opt to submit data on their own or have CDC-NPCR to submit
data on their behalf. CDC-NPCR will submit aggregated NPCR data for central cancer
registries that provide permission and meet USCS publication criteria.

C. Analytic datasets

1. CDC Internal Analytic Data
CDC staff members or contractors perform analyses of NPCR program data as needed
utilizing an internal analytic database based on the USCS dataset. This dataset is
available to federal employees in the Division of Cancer Prevention and Control after
signing a NPCR Analytic Data Use Agreement (appendix D) and CDC Nondisclosure
Agreement (appendix E). Analyses include assessment of the completeness, timeliness,
and quality of cancer incidence data and analyses of the cancer burden and survival as
needed for meeting national cancer control objectives. Such analyses of State and
national data are conducted routinely by Federal agencies, including CDC, for
programmatic or statistical purposes, as needed, to achieve the agency’s mandate.
There are two internal analytic datasets routinely analyzed by CDC staff members:
a) USCS Internal Analytic Dataset
Publications or presentations describing the quality of the data or the burden of
cancer are one outcome of such analyses. Examples of topics for such analyses
are descriptive analyses by racial and ethnic populations for specific cancers and
descriptions of cancer incidence trends. Appendix F lists the variables available in
this dataset.
b) NPCR Internal Survival Dataset
Cancer survival data is critical for evaluating the progress and impact of early
detection/screening programs and/or comprehensive cancer control plans as well
as interventions from other sources. CDC’s NPCR-CSS is now poised to
calculate and publish survival rates on this population at the national, state, and
regional levels. Focusing on the entire NPCR-CSS dataset supports analyses of
survival estimates for rare cancers that cannot be addressed otherwise and
provides data for publication on the USCS website as official statistics for the
U.S. Appendix G lists the variables available in this dataset.
In compliance with the 308(d) Assurance of Confidentiality, CDC employees and
contractors conducting these analyses are required to handle the information in
accordance with principles outlined in the CDC Staff Manual on Confidentiality and to
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follow the specific procedures documented in the NPCR-CSS Confidentiality/Security
Statement (appendices B, H, and I).
In addition to adhering to strict requirements for protecting confidentiality, CDC staff
members notify the State cancer registry(ies) in advance whenever they plan to present,
publish, or release State-specific information on cancer incidence or survival that have
not been previously presented, published, or released. This notification includes, when
possible, sending a pre-publication copy of the entire publication or other information to
the specific States. When that is not possible (for example, if the information is
embargoed), the specific State cancer registries receive a summary of the information
before it is published or released. In addition, CDC staff members are required to
acknowledge State cancer registries whenever NPCR-CSS data are presented, released, or
published by CDC by making available the following (or similar) statement:
These data were provided by cancer registries participating in NPCR and
submitted to CDC in the (insert submission date) NPCR-Cancer Surveillance
System data submission.

2. USCS SEER*Stat Research Data
For purposes of this policy, the USCS SEER*Stat Research Dataset is defined as the
version of the full NPCR-CSS microdata (i.e., individual case-specific data) that have
been modified as needed to minimize the potential for disclosure of confidential
information. It consists of a subset of data items published in USCS. This dataset does
not contain personal identifiers such as a patient’s name, street address, or Social Security
number as this information is not transmitted by central cancer registries to CDC as part
of their annual data submission. Certain data items such as date of birth have also been
removed from this research dataset to minimize the potential identification of individuals
with the occurrence of rare cancer in a person of certain age or racial or ethnic group or
living in a specific county. The list of the variables included in this dataset is in appendix
J.
The dataset was previously only available to NPCR Registry Staff and is now available to
anyone after signing an NPCR Research Data Use Agreement (Appendix K). A Public
Release Disclosure Statement cautions users against inappropriate use of the data or
inappropriate disclosure of information. Cell suppression of <16 cases is automatic and
the SEER*Stat case listing function is disabled as additional data protection measures.
This dataset allows the authorized counts, crude rates, age-adjusted rates, and 95-percent
confidence intervals to be generated by the authorized user to meet their specific needs.
Registries have the option to notify NPCR if they prefer to not have their State and
county data included in any research use dataset, or they may choose to limit release of
their data to certain groups.

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3. Restricted-Access Research Dataset (RDC)
For purposes of this policy, the restricted-access dataset is defined as the version of the
full NPCR-CSS analytic dataset, either aggregated data or microdata (i.e., individual
case-specific data) that has been modified as needed to minimize (but may not remove
entirely) the potential for disclosure of confidential information.
CDC uses the National Center for Health Statistics Research Data Center (NCHS RDC)
as a mechanism for researchers outside of the Division of Cancer Prevention and Control
(DCPC) to request and gain access to NPCR data for research purposes. The data is
available through the NCHS RDC only after the standard data quality reviews that occur
as part of the preparation for USCS and State Cancer Profiles. The restricted-access
dataset is released to researchers through the NCHS RDC after CDC authenticates the
requestor’s identity and research intent through an extensive proposal review process and
after the researcher completes the NCHS RDC confidentiality and security requirements.
The requestor must also comply with the confidentiality procedures at and data sharing
agreements with the NCHS RDC.
The NCHS RDC has developed and maintains detailed data sharing agreements and
procedures for user authentication and for logging and monitoring of data releases.
Proposed project proposals are reviewed by staff at central cancer registries, through the
NPCR Central Cancer Registry Council, and by CDC, which includes NPCR and NCHS
RDC staff. User documentation including a data dictionary for every diagnosis year
available at the NCHS RDC is provided.
The use of the NCHS RDC to manage data access provides the highest level of data
security and protection of confidentiality that is available for data analysis. Using the
NCHS RDC allows CDC to comply with the Assurance of Confidentiality [308(d)] that
was obtained for the NPCR-CSS data. The NCHS RDC is also covered by a separate
Assurance of Confidentiality [308(d)].
For further information regarding the NCHS RDC, refer to appendix L of this policy.
The restricted-access dataset at the RDC does not contain personal identifiers such as a
patient’s name, street address, or Social Security number as this information is not
transmitted by central cancer registries to CDC as part of their annual data submission.
However, the dataset may contain information that is potentially identifiable especially
when linked with other datasets, such as the occurrence of a rare cancer in a person of a
certain age or racial or ethnic group or living in a specific county. The list of the
restricted-access dataset variables is in appendix M.
Because this restricted-access dataset may potentially contain identifiable information,
States have the option to notify NPCR if they prefer not to have their data included in this
restricted access dataset. Options for inclusion include:

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a) All Variables, Including County at Diagnosis
County data will only be used in approved analyses and in the following ways: a)
used as a linkage variable (linkage to census data, for example) only by RDC
staff. The county variable will not be available to the researcher, but the RDC
analyst would use it to create a linked dataset and then remove the county
variable; b) included as a confounder or other control variable, but no data are
presented by county. Again, it will be possible for the RDC data analyst to mask
the actual county name and create dummy variables for this purpose; c) used in
geographically aggregated form such as large metropolitan statistical areas (e.g.,
those with a population of 1 million or larger), multi-county regions, or
geographical areas (e.g., Appalachia or IHS Contract Health Services Delivery
Areas (CHSDA) counties). It will be possible for RDC analysts to create these
areas for the researcher.
b) All Variables Except County at Diagnosis
The same file with the county at time of diagnosis removed.

D. Data Release Under Controlled Conditions
CDC-wide policy stipulates that a CDC program may consider release of data that cannot be
released as either a public Web-based system, a research dataset, or restricted-access dataset
under certain controlled conditions.1 These controlled conditions may include a CDCcontrolled data center such as the data center established at National Center for Health
Statistics (NCHS) (http://www.cdc.gov/nchs/r&d/rdc.htm) or through special licensing. NPCRCSS data are available at the NCHS RDC but will not otherwise be released under these
controlled conditions while the current policy is in place. Release of data under controlled
conditions will be considered as part of discussions with partners, and a determination will be
made as to whether such releases of data will be considered for NPCR-CSS data.
E. Emergency and Provisional Data Releases
It is not anticipated that CDC will need to release NPCR-CSS data before the files have been
modified as needed to protect confidentiality as described in this policy. This is prohibited by
the 308(d) Assurance of Confidentiality (appendices B, H, and I).
Provisional data and draft data tables are shared with CDC employees and contractors, NPCR
central registries, and other partners in order to facilitate quality reviews of the data. When
appropriate, individuals who participate in such reviews sign a NPCR Analytic Data Use
Agreement and a CDC Nondisclosure Agreement (when applicable) before accessing the data
or tables.

IV. PROTECTION OF DATA
A. Assurance of Confidentiality
All data collected and maintained by NPCR-CSS must be managed, presented, published, and
released with strict attention to confidentiality and security, consistent with the general
principles and guidelines established by CDC for confidential case data1–3 and specific
NPCR-CSS Data Release Policy
June 2015
1995–2013 Diagnosis Years
10

restrictions imposed on NPCR-CSS data (appendices B, H, and I).4 Special care must be given
to cancer incidence data that are not directly identifiable because geographic and small cell
data may be indirectly identifying when combined with detailed information in case reports,
laboratory reports, medical records, or linkage with other data files.5–10
NPCR-CSS has approval for protection under section 308(d) of the Public Health Services
(PHS) Act (42 U.S.C. 242m(d)) (appendices B, H, and I). The 308(d) confidentiality assurance
protects identifiable and potentially identifiable information from being used for any purpose
other than the purpose for which it was collected (unless the person or establishment from
which it was obtained has consented to such use). This assurance protects against disclosures
under a court order and provides protections that the Privacy Act of 1974 (5 U.S.C. 552a) does
not. For example, the Privacy Act of 1974 protects individual participants, but the 308(d)
confidentiality assurance also protects institutions. Confidentiality protection granted by CDC
promises participants and institutions that their data will be shared only with those individuals
and institutions listed in the project’s consent form or in its specified policies.
B. Suppression of Rates and Counts
When the numbers of cases or deaths used to compute rates are small, those rates tend to have
poor reliability. Another important reason for using a threshold value for suppressing cells is to
protect the confidentiality of patients whose data are included in a report by reducing or
eliminating the risk of disclosing their identity.
Therefore, to discourage misinterpretation or misuse of rates or counts that are unstable
because case or death counts are small, annual incidence and death rates and counts are
suppressed if the case or death counts are below 16. A count of fewer than about 16 results in a
standard error of the rate that is approximately 25% or more as large as the rate itself.
Similarly, a case count below 16 results in the width of the 95% confidence interval around the
rate being at least as large as the rate itself. These relationships were derived under the
assumption of a Poisson process and with the standard population age distribution assumed to
be similar to the observed population age distribution. For aggregated time periods, counts and
rates are suppressed for less than 16 cases. However, average annual rates and counts may not
be suppressed if the total case count for the time period exceeds 16.
The cell suppression threshold value of 16, which was selected to reduce misuse and
misinterpretation of unstable rates and counts, is more than sufficient to protect patient
confidentiality.
Asian/Pacific Islander and American Indian/Alaskan Native data are presented only for the
nation, and states with at least 50,000 population, because of concerns regarding possible
misclassification of race data and the relatively small sizes of these populations in the United
States.
C. Public Release Disclosure Statement
The following (or similar) public release disclosure statement is prominently displayed for
users of all NPCR-CSS public web-based query systems, research datasets, and restrictedaccess datasets:
NPCR-CSS Data Release Policy
June 2015
1995–2013 Diagnosis Years
11

Data Use Restrictions: Read Carefully Before Using
By using these data, you signify your agreement to comply with the following
statutorily based requirements. The National Program of Cancer Registries
(NPCR), Centers for Disease Control and Prevention (CDC), has obtained an
assurance of confidentiality pursuant to Section 308(d) of the Public Health
Service Act, 42 U.S.C. 242m(d). This assurance provides that identifiable or
potentially identifiable data collected by the NPCR may be used only for the
purpose for which they were obtained unless the person or establishment from
which they were obtained has consented to such use. Any effort to determine the
identity of any reported cases, or to use the information for any purpose other
than statistical reporting and analysis, is a violation of the assurance. Therefore
users will:
Use the data for statistical reporting and analysis only.
 Make no attempt to learn the identity of any person or establishment
included in these data.
 Make no disclosure or other use of the identity of any person or
establishment discovered inadvertently, and advise the Associate Director
for Science, Office of Science Policy and Technology Transfer, CDC,
Mailstop D-50, 1600 Clifton Road, N.E., Atlanta, Georgia, 30333, Phone:
404-639-7240) (or NCI’s SEER Program if SEER data) and the relevant
State or metropolitan area cancer registry, of any such discovery.
D. Freedom of Information Act (FOIA) Data Requests
The Freedom of Information Act (FOIA) (http://www.cdc.gov/od/foia/) generally provides
that, upon written request from any person, a Federal agency (i.e., CDC) must release any
agency record unless that record falls (in whole or part) within one of nine exemptions. FOIA
applies to Federal agencies only and covers only records in the possession and control of those
agencies at the time of the FOIA request (except in certain instances involving grantee-held
data). Because State-based data become a Federal record in CDC’s possession, such records
are subject to disclosure in response to a FOIA request. The FOIA exemptions that may be
available to protect some aspects of State data from public disclosures in response to a FOIA
request are:



Exemption 3, which specifically exempts information from disclosure by statute
(in this instance, pursuant to an Assurance of Confidentiality under Section 308(d)
of the Public Health Service Act), and
Exemption 6, which exempts from disclosure personnel and medical files and
similar files, which would constitute an unwarranted invasion of personal privacy.

In general, non-FOIA requests to CDC from the public, media, and other government agencies
for local cancer incidence data are referred to the State health department for a reply. There are
three reasons for this: (1) the State health departments can release cancer incidence data in
accordance with locally established policies and procedures and consistent with provisions of
the Cancer Registries Amendment Act (Public Health Service Act, (42 USC 280e-280e-4), as
amended);4 (2) the relative infrequency of data submission to Federal agencies assures that the
State health department or its designated central cancer registry will have the most complete,
NPCR-CSS Data Release Policy
June 2015
1995–2013 Diagnosis Years
12

accurate, and up-to-date information; and (3) the central registry may be able to provide more
detailed data that can better meet the needs of the requestor. When the request is for data
regarding cancer incidence involving more than one State, CDC will refer the requestor to
published reports or to NPCR-CSS datasets that are released in accordance with practices
described in this document, if relevant.
E. CDC External Data Requests
Individuals, agencies, or organizations outside CDC may request data not available from a
public web-based query system or research dataset. When the requests do not identify a State,
CDC staff members or contractors tabulate the data for the inquirer. For requests that identify a
State, CDC staff members seek States’ permission regarding use. See Appendix N for
additional details.

NPCR-CSS Data Release Policy
June 2015
1995–2013 Diagnosis Years
13

V. REFERENCES
1. Centers for Disease Control and Prevention. CDC/ATSDR Policy on Releasing and Sharing
Data. Atlanta: Centers for Disease Control and Prevention; 2003. Available at
http://www.cdc.gov/maso/Policy/ReleasingData.pdf.
2. Centers for Disease Control and Prevention. CDC/ATSDR/CSTE Data Release Guidelines for
Re-Release of State Data. Atlanta: Centers for Disease Control and Prevention; 2003
(available upon request).
3. Centers for Disease Control and Prevention. CDC Staff Manual on Confidentiality. Atlanta:
Centers for Disease Control and Prevention; 1984 and National Center for Health Statistics.
NCHS Staff Manual on Confidentiality. Hyattsville, MD: National Center for Health
Statistics; 1999.
4. Cancer Registries Amendment Act, Public Law 102-515, Stat. 3312 (October 22, 1992).
Available at http://www.cdc.gov/cancer/npcr/npcrpdfs/publaw.pdf.
5. American Statistical Association. Data Access and Personal Privacy: Appropriate Methods of
Disclosure Control. Alexandria, VA: American Statistical Association; 2008. Available at
http://www.amstat.org/news/statementondataaccess.cfm.
6. Doyle P, Lane JI, Theeuwes JM, Zayatz LM (eds). Confidentiality, Disclosure, and Data
Access: Theory and Practical Application for Statistical Agencies. Amsterdam: Elsevier
Science BV; 2001.
7. Federal Committee on Statistical Methodology. Checklist on Disclosure Potential of
Proposed Data Releases. Available at http://fcsm.sites.usa.gov/committees/cdac/cdacchecklist/.
8. Federal Committee on Statistical Methodology. Report on Statistical Disclosure Limitation
Methodology. (Statistical Working Paper 22). Washington, DC: Office of Management and
Budget; 1994. Available at http://www.fcsm.gov/reports/#fcsm.
9. McLaughlin C. Confidentiality protection in publicly released central cancer registry data.
Journal of Registry Management 2002; 29(3):84–88.
10. Stoto M. Statistical Issues in Interactive Web-Based Public Health Data Dissemination
Systems. Draft report prepared for the National Association of Public Health Statistics and
Information Systems, Rand Corporation; September 2002.
11. Surveillance, Epidemiology, and End Results Program. The SEER Program Code Manual.
3rd ed. Bethesda, MD: National Cancer Institute,1998.
12. Percy C, Van Holten V, Muir C (eds). International Classification of Diseases for Oncology,
2nd edition. Geneva, Switzerland: World Health Organization; 1990.
13. Hultstrom D, editor. Standards for Cancer Registries, vol. II: Data Standards and Data
Dictionary, version 9.1, 6th ed. Springfield, IL: North American Association of Central
Cancer Registries; 2001.
14. North American Association of Central Cancer Registries. Standards for Cancer Registries,
vol. III: Standards for Completeness, Quality, Analysis, and Management of Data.
Springfield, IL: North American Association of Central Cancer Registries; 2000.
15. Hutton MD, Simpson, LD, Miller DS, Weir HK, McDavid K, Hall HI, Progress toward
nationwide cancer surveillance: an evaluation of the National Program of Cancer Registries,
1994–1999. Journal of Registry Management 2001;28(3):113–120.
16. U.S. Cancer Statistics Working Group. U.S. Cancer Statistics Working Group. United States
Cancer Statistics: 1999–2011 Incidence and Mortality Web-based Report, Technical Notes.
NPCR-CSS Data Release Policy
June 2015
1995–2013 Diagnosis Years
14

Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and
Prevention and National Cancer Institute; 2014. Available at: www.cdc.gov/uscs.
17. NAACCR Method to Estimate Completeness. A Data Analysis Tool for Calculations.
Available at: http://www.naaccr.org/Research/DataAnalysisTools.aspx.
18. Clegg LX, Fueur EJ, Midthune DN, Fay MP, Hankey BF. Impact of reporting delay and
reporting error on cancer incidence rates and trends. Journal of the National Cancer Institute
2002; 94(20):1537–45.

NPCR-CSS Data Release Policy
June 2015
1995–2013 Diagnosis Years
15

TABLE
Comparison of the NPCR-CSS Datasets
Overview
Public Web-Based Query Systems
USCS Expanded
USCS County

USCS

EPHTN

Format

Database of
aggregate counts
and rates, with text
documentation

Database of
aggregate counts
and rates, with text
documentation.
The database
behind the CDC
firewall is casespecific microdata.

Database of
aggregate counts and
rates, with text
documentation

Database of
aggregate counts and
rates, with text
documentation. The
database behind the
CDC firewall is casespecific microdata.

Mode of Access

Web-based query
system with
downloadable
ASCII files, MS
Excel files, and
SAS datasets
USCS Web site
www.cdc.gov/uscs

Web-based query
system

Flat ASCII file and
Web-based query
system and separate
brief text
documentation

Web-based query
system

CDC WONDER
http://wonder.cdc.g
ov

Request from
cancerinfo@cdc.gov
(specify “USCS
County” in subject
line)

Web Address or Contact
Information

Contains Potentially
Identifiable Information
Registry Eligibility Criteria
for Data Completeness and
Quality
When Available

No

No

National
Environmental Public
Health Tracking
http://www.cdc.gov/n
ceh/
tracking
No

USCS
publication criteria

USCS publication
criteria;
data meet criteria for
unknown county
Updated 2015

USCS publication
criteria;
data meet criteria for
unknown county
Updated 2015

Updated 2015

NPCR-CSS Data Release Policy
June 2015
1995–2013 Diagnosis Years
16

Analytic datasets
USCS SEER*Stat
USCS RestrictedResearch Dataset
Access Dataset
Customized, analytic Customized, analytic
database. The
database available
database behind the
through the National
SEER*Stat firewall is
Center for Health
case-specific
Statistics Research
microdata with
Data Center (NCHS
enforced cell
RDC)
suppression and case
listing disabled.
SEER*Stat clientOn-site at NCHS
server mode only
RDC, on-site at a
after receipt of signed
Census Research
Data Use Agreement
Data Center (RDC),
remotely or staffassisted
Online request form
Application process
available at
www.cdc.gov/rdc

No

Yes

USCS publication
criteria

USCS
publication criteria;
data meet criteria for
unknown county
Updated 2015

Updated 2015

TABLE
Comparison of the National Program of Cancer Registries-Cancer Surveillance System Datasets

USCS
States/ Territories

Diagnosis Years

Cancer Sites

Cases Included
Public Web-Based Query Systems
USCS Expanded
USCS County

NPCR and SEER States that meet
eligibility criteria

1999; 2000; 2001;
2002; 2003; 2004;
2005; 2006; 2007;
2008; 2009; 2010;
2011; 2012; 2013;
2009–2013

1999; 2000; 2001;
2002; 2003; 2004;
2005; 2006; 2007;
2008; 2009; 2010;
2011; 2012; 2013

All reportable invasive cancers; in situ female
breast, and benign and borderline primary
intracranial and central nervous system tumors
(diagnosis year 2004)

EPHTN

Analytic datasets
USCS SEER*Stat
USCS RestrictedResearch Dataset
Access Dataset
Registries that meet
NPCR States that
USCS publication
meet eligibility
criteria
criteria

NPCR States that
meet eligibility
criteria*

NPCR States that
meet eligibility
criteria

2009–2013

Individual years for
2001 through 2013for
State level; 20012005, 2002-2006,
2003-2007, 2004–
2008; 2005-2009;
2006-2010; 20072011; 2008-2012;
2009-2013 for county
level

1999; 2000; 2001;
2002; 2003; 2004;
2005; 2006; 2007;
2008; 2009; 2010;
2011; 2012; 2013
2009-2013

1999; 2000; 2001;
2002; 2003; 2004;
2005; 2006; 2007;
2008; 2009; 2010;
2011; 2012; 2013

All reportable cancer
sites combined; female
breast; in situ female
breast; cervix uteri;
colon and rectum; lung
and bronchus;
melanoma; bladder;
prostate; oral cavity and
pharynx; brain and
other nervous system;
thyroid; kidney;
stomach; ovary; corpus
and uterus, NOS;
leukemias;
non-Hodgkin
lymphoma; liver and
intrahepatic bile duct;
pancreas, esophagus;
and childhood cancers

Female breast; lung and
bronchus; bladder; brain
and other nervous
system; thyroid;
leukemias; nonHodgkin lymphoma; all
childhood cancers (state
level only); childhood
leukemias (state level
only); childhood CNS
and miscellaneous
intercranial and
intraspinal neoplasms
(state level only);
mesothelioma (state
level only); kidney and
renal pelvis; prostate;
melanoma of skin; liver
and intrahepatic bile
duct; pancreas;
oral/pharynx;
esophagus, larynx

All reportable invasive
cancers; in situ female
breast, and benign and
borderline primary
intracranial and central
nervous system tumors
(diagnosis year 2004)

All reportable invasive
and in situ cancers and
benign and borderline
primary intracranial and
central nervous system
tumors (diagnosis year
2004)

* Future plans may include the addition of SEER data similar to the USCS dataset.
NPCR-CSS Data Release Policy
June 2015
1995–2013 Diagnosis Years
17

TABLE
Comparison of the National Program of Cancer Registries-Cancer Surveillance System Datasets
Variables Included
Public Web-Based Query Systems
USCS Expanded
USCS County

USCS

Geographic Levels

Race

All areas combined;
U.S. census region
and division; NPCR
and SEER State or
territory; SEER
metropolitan area

All areas combined;
NPCR and SEER
State or territory;
MSA for cities of
>500,000 (additional
levels may be
added)*
All races combined; white; black;
Asian/Pacific Islander (API) ; American
Indian/Alaska Native (AI/AN); white nonHispanic; black non-Hispanic

Yes

Ethnicity (Hispanic)
Age Groups

Summary Stage
Histology

All ages combined
and standard 5-year
age groups for adults
and <15 and <20 for
childhood cancers

All ages combined
and standard 5-year
age groups that can
be combined by the
user

EPHTN

Analytic datasets
USCS SEER*Stat
USCS RestrictedResearch Dataset
Access Dataset

NPCR State;
county*

NPCR State;
county

All areas combined;
U.S. census region and
division; NPCR and
SEER State or territory

NPCR State or territory;
county for approved
data sets only†

All races combined;
white; black; AI/AN;
API (with appropriate
50,000 population
suppression and State
permission for AI/AN
and A/PI); white/black
non-Hispanic
Yes for State Profiles
only (with State
permission)
Childhood cancers: <15
and <20; all other
cancers: <50, 50–64,
65+

All races combined;
white; black; AI/AN;
API (with appropriate
50,000 population
suppression and State
permission for AI/AN
and A/PI)

All races combined;
white; black;
Asian/Pacific Islander
(API) ; American
Indian/Alaska Native
(AI/AN)

All races reported

Yes (with State
permission)

Yes

Yes

Childhood cancers: <15
and <20
Breast cancer: <50, 50+

All ages combined,
standard 5-year age
groups

No

No

No

Yes

Standard 5-year age
groups and individual
ages (Month and day of
birth not provided for
confidentiality reasons.
If the age at diagnosis
>99, then grouped into
one category. Year of
birth is also grouped.)
Yes

International Classification of Childhood
Cancers, Third Revision (all geographic areas
combined),
Mesothelioma (national and State level),
Kaposi Sarcoma (national and State level),
Consensus Conf on Cancer Registration of
Brain, and CNS Tumors (all geographic areas
combined)

No

No

Same as USCS

Yes

* Pending further data quality investigation and discussion with the NPCR Central Cancer Registry Council.
† County data used as a: a) linkage variable only by the NCHS RDC analyst; b) confounder or other control variable, no data presented by county; c) geographically
aggregated form; e.g., large MSA (population >1 million), multi-county regions, or geographical areas (Appalachia, IHS CHSDA counties).
NPCR-CSS Data Release Policy
June 2015
1995–2013 Diagnosis Years
18

TABLE
Comparison of the National Program of Cancer Registries-Cancer Surveillance System Datasets

USCS

Confidentiality Protection/Disclosure Limitation Measures Employed
Public Web-Based Query Systems
USCS Expanded
USCS County
EPHTN
No

No

Analytic datasets
USCS SEER*Stat
USCS RestrictedResearch Dataset
Access Dataset
No
Yes, but not in output

Direct or Record-Level
Identifiers?

No

Aggregation

Yes

Yes

Yes

No

No

Limited Number of
Variables

Yes

Yes

Yes

Yes

Yes

Grouping/Collapsing of
Variables or Response Codes
(1) Average Annual Counts
Rounded to the Nearest
Whole Number
(2) Average Annual Rates
(3) Annual Averages Are
Based on At Least 5 Years
of Data
Cell Suppression

Yes

No

Yes

No

Yes

No

Yes

Yes

No

No

which will be reviewed
by NCHS RDC staff for
confidentiality

Yes

Yes

Yes

Yes

Yes (output will be

Counts and rates: count of <16

Counts and rates: 5 year
total count of <16

Counts and unsmoothed
rates: count of <16
Smoothed rates: RSE
>25%

Counts and rates: count
of <16 enforced
Case listing disabled

reviewed by NCHS
RDC analyst to ensure
that small cell sizes are
suppressed)

Complementary Cell
Suppression
Public Release Disclosure
Statement
Data Sharing Agreement
and/or IRB Approval
User Authentication

As needed

As needed

As needed

As needed

No

Yes

Yes

Yes

Yes

Yes

No

No

No

Yes

Yes

No

No

No

Yes

Yes

Logging and Monitoring

Limited

Limited

Limited

Yes, monitoring
databases used,
session type and date
only

Yes

NPCR-CSS Data Release Policy
June 2015
1995–2013 Diagnosis Years
19

APPENDIX A
State, Metropolitan Area, and Territory Cancer Registries by Federal Funding Source, and First
Diagnosis Year* for Which Cancer Cases Were Reportable to CDC’s NPCR or NCI’s
SEER Program
First Diagnosis Year for
Which Cancer Cases
State, Metropolitan Area, or
Were Reportable to
Territory
NPCR or SEER*
Alabama
1996
Alaska
1996
Arizona
1995
Arkansas
1996
California
1995/2000
Los Angeles
1992
San Francisco-Oakland
1973
San Jose-Monterey
1992
Colorado
1995
Connecticut
1973
Delaware
1997
District of Columbia
1996
Florida
1995
Georgia
1995/2010
Atlanta
1975
Hawaii
1973
Idaho
1995
Illinois
1995
Indiana
1995
Iowa
1973
Kansas
1995
Kentucky
1995/2000
Louisiana
1995/2000
Maine
1995
Maryland
1996
Massachusetts
1995
Michigan
1995
Detroit
1973
Minnesota
1995
Mississippi
1996
Missouri
1996
Montana
1995
Nebraska
1995
Nevada
1995
New Hampshire
1995
New Jersey
1995/2000
NPCR-CSS Data Release Policy
June 2015
1995–2013 Diagnosis Years
20

Federal Funding Source
NPCR
NPCR
NPCR
NPCR
NPCR/SEER
SEER
SEER
SEER
NPCR
SEER
NPCR
NPCR
NPCR
NPCR/SEER
SEER
SEER
NPCR
NPCR
NPCR
SEER
NPCR
NPCR/SEER
NPCR/SEER
NPCR
NPCR
NPCR
NPCR
SEER
NPCR
NPCR
NPCR
NPCR
NPCR
NPCR
NPCR
NPCR/SEER

APPENDIX A
State, Metropolitan Area, and Territory Cancer Registries by Federal Funding Source, and First
Diagnosis Year* for Which Cancer Cases Were Reportable to CDC’s NPCR or NCI’s
SEER Program
First Diagnosis Year for
Which Cancer Cases
State, Metropolitan Area, or
Were Reportable to
Territory
NPCR or SEER*
New Mexico
1973
New York
1996
North Carolina
1995
North Dakota
1997
Ohio
1996
Oklahoma
1997
Oregon
1996
Pennsylvania
1995
Puerto Rico
1998
Rhode Island
1995
South Carolina
1996
South Dakota
2000
Tennessee
1999
Texas
1995
United States Pacific Island
Jurisdictions
2007
Utah
1973
Vermont
1996
Virginia
1996
Washington
1995
Seattle-Puget Sound
1974
West Virginia
1995
Wisconsin
1995
Wyoming
1996

Federal Funding Source
SEER
NPCR
NPCR
NPCR
NPCR
NPCR
NPCR
NPCR
NPCR
NPCR
NPCR
NPCR
NPCR
NPCR
NPCR
SEER
NPCR
NPCR
NPCR
SEER
NPCR
NPCR
NPCR

* Diagnosis year is the year during which a reported cancer case was first diagnosed.
CDC = Centers for Disease Control and Prevention
NCI = National Cancer Institute
NPCR = National Program of Cancer Registries
SEER = Surveillance, Epidemiology, and End Results Program

NPCR-CSS Data Release Policy
June 2015
1995–2013 Diagnosis Years
21

APPENDIX B
NPCR-CSS Overview of Data Security

The NPCR-CSS project data reside on a dedicated server maintained by ICF International. To
ensure the security and confidentiality of project data, the following provisions have been
incorporated into the ICF International NPCR-CSS Security Plan in accordance with the
requirements of the Assurance of Confidentiality.
The NPCR-CSS server is housed in a secure facility at Terremark, Culpeper, VA with a guard on
duty 24 hours a day. Only authorized staff is allowed to access the facility. Support people are
escorted by an authorized staff member if needed. The server resides on its own local area
network (LAN) behind ICF International’s firewall. ICF International project staff access the
server via VPN from ICF International office located at Rockville, MD. Elevator and stairwell
access to Rockville office is controlled by card key 24 hours. During business hours, an attendant
is always present at the reception desk to guide visitors.










Access to the NPCR-CSS server is limited to authorized ICF International project staff
(see below). It is password-protected on its own security domain. No one, including nonproject staff at ICF International, is allowed access to the NPCR-CSS data.
All ICF International project staff must sign a confidentiality agreement before
passwords and keys are assigned. All staff must pass background checks appropriate to
their responsibilities for a public trust position.
NPCR-CSS data that are submitted electronically are encrypted during transmission from
the States. They arrive on a document server behind ICF International’s firewall. Each
State has its own directory location so that no State has access to another State’s data.
The data are moved automatically from the document server to the NPCR-CSS server.
Receipt and processing logs are maintained to document data receipt, file processing, and
report production. All reports and electronic storage media containing NPCR-CSS data
are stored under lock and key when not in use and will be destroyed once they are no
longer needed.
A comprehensive security plan has been developed by ICF International’s security team.
The security team consists of Kevin Zhang, Project Director; Shailendra Bhavsar,
Systems Lead and Security Officer; and Gretchen Stanton, Database Administrator and
LAN/WAN Security Steward. All project staff receive annual security awareness training
covering security procedures. The ICF International project security team oversees
operations to prevent unauthorized disclosure of the NPCR-CSS data.
Periodic (currently quarterly, but no less than once per year) reviews and updates of ICF
International security processes will be conducted to adjust for rapid changes in computer
technology and to incorporate advances in security approaches. The Security Plan will be
amended as needed to maintain the continued security and confidentiality of NPCR-CSS
data.

NPCR-CSS Data Release Policy
June 2015
1995–2013 Diagnosis Years
22

APPENDIX B
NPCR-CSS Overview of Data Security
ICF International
Authorized Project Staff
Staff Member
NPCR-CSS Team
Kevin Zhang, Ph.D.
Yuan Ren, Ph.D.
Gretchen Stanton
Olga Galin, M.S
Shailendra Bhavsar, B.S
Xing Dong, M.S.
David Radune, B.A.
Jonathan Stanger, M.P.A.
Jing Guo, B.S.
Haoping Jiang, M.S.
Ping Huang
Alternate Staff
Nicholas Kelsch
Metin Sisman
Carlos Birdsong
Scott Gimsley
Tom Sauer
Gregory Hicks

Position

Project Director
Project Manager/Sr. Statistical Programmer
System Administrator and LAN/WAN Security Steward
Sr. SAS Programmer/QA Specialist
Security Officer/Development Manager
Sr. Statistical Programmer
Sr. Developer
Database Administrator
Programmer Analyst
Data Analyst
Developer/Database Administrator

These staff will assist the ICF System Administrator and
LAN/WAN Security Steward on an as-needed basis to provide
support for the NPCR-CSS network, servers, virtual private
network (VPN), data and system backup, and NPCR-CSS
Websites. Access to the NPCR-CSS record-level datasets is
not included in the planned support activities.

NPCR-CSS Data Release Policy
June 2015
1995–2013 Diagnosis Years
23

Appendix C
Data Items for Central Brain Tumor Registry of the United States Dataset
The dataset for CBTRUS includes individual case-specific data from the NPCR-CSS dataset.
The data items to be included are listed below.
*Diagnosis Years 1995-2003 invasive cases only, 2004-2012 invasive, benign, and borderline cases
Item Name

NAACCR Data Item Number

Patient ID (unique)

20

NAACCR Record Version

50

State of Residence at Diagnosis

80

Rural/Urban Continuum/Beale Code 1993

3300

Rural/Urban Continuum/Beale Code 2003

3310

NPCR Race Recode

Derived based on [160], [161], and [192] Same as race for USCS

NHIAv2 Derived Hispanic Origin

191

(Results of NAACCR Hispanic/Latino
NAPIIA
Identification Algorithm)

193

Sex

220

Age at Diagnosis

230

Sequence Number—Central

380

Date of Diagnosis (YEAR portion only)

390

Primary Site

400

Laterality

410

Grade

440

Diagnostic Confirmation

490

Type of Reporting Source

500

Histologic Type (ICD-O-3)

522

Behavior (ICD-O-3)

523

Derived Summary Stage 2000

3020

EDITS overrides

1990–2074

CS Site-Specific Factor 1

2880

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24

Comments

Single year up to age 84; 85+
grouped into one category

Day and month of diagnosis not
requested

WHO Grade

APPENDIX D
NPCR Analytic Data Use Agreement

NPCR+SEER Analytic Data
Submitted [Month,Year] (diagnosis years 1998-xxxx)
To protect the confidentiality of the individuals represented within the National Program of
Cancer Registries – Cancer Surveillance System (NPCR-CSS) data, the Centers for Disease
Control and Prevention (CDC) has obtained an Assurance of Confidentiality under Section
308(d) of the Public Health Service Act (42 U.S.C. 242m(d)), which provides that these data can
only be used for the purpose for which they were obtained.
When using NPCR+SEER Analytic Data for research purposes, it is absolutely necessary to
ensure, to the extent possible, that use of the data will be limited to research or public health
purposes. Any person who attempts to determine the identity of individuals represented by
reported cases, or to use the information for any purpose other than for health statistical reporting
and analysis, will be prosecuted to the full extent of the law.
CDC’s Division of Cancer Prevention and Control (DCPC) takes every possible measure to
ensure that the identity of data subjects cannot be determined. All direct identifiers, as well as
characteristics that might lead to identification of individuals, are omitted from the dataset.
Nevertheless, in rare instances, through complex analysis and with outside information, it may be
possible to ascertain from the dataset the identity of particular persons. Considerable harm can
ensue if this occurs.
Data users must agree to the following provisions prior to receiving access to NPCR+SEER
Analytic Data:

I understand that all NPCR and SEER data are owned by the states and territories.
As the recipient of the NPCR+SEER Analytic Data, I will:
 Not use or permit others to use the datasets in any way other than for statistical reporting and
analysis.
 Not release or permit others to release the datasets or any part of them to any person except
with DCPC’S written approval.
 Not attempt to link or permit others to link the datasets with individually identifiable records
from any other dataset without DCPC’s approval.
 Not attempt to use the datasets or permit others to use them to learn the identity of any person
or establishment included in any dataset.
 Take the following actions if the identity of any person or establishment is discovered
inadvertently:
o Make no use of this knowledge.
o Notify DCPC’s Cancer Surveillance Branch Chief.
o As requested by DCPC, safeguard or destroy the information that identifies an individual
or establishment.
o Inform no one else of the discovered identity.
In addition, I will make every effort to release all statistical information in such a way as to
avoid inadvertent disclosure. I will:
NPCR-CSS Data Release Policy
June 2015
1995–2013 Diagnosis Years
25

APPENDIX D
NPCR Analytic Data Use Agreement




Ensure that no data on an identifiable case can be derived through subtraction or other
calculation from the combination of tables in the given publication.
Ensure that no data permit disclosure when used in combination with other known data.
Acknowledge central cancer registries whenever data are presented, released, or
published by including the following (or similar) statement:
These data were provided by central cancer registries participating in the National
Program of Cancer Registries (NPCR) and submitted to CDC in [Month, Year], and/or
the Surveillance, Epidemiology and End Results (SEER) program and submitted to NCI
in [Month, Year]. The dataset includes data for diagnosis years 1998-xxxx (excluding
SEER-Metro Registry data).

My signature below indicates that:
 I will adhere to the requirements of the Data Use Agreement and understand that my
access to the data will be revoked if these requirements are violated.
 I understand that the NPCR+SEER Analytic Data belong to the states and territories. The
states’ and territories’ agreement to use of the data is obtained through the activities
outlined in the general NPCR-CSS Data Release Policy and by specific requests to the
states and territories through the CSB management team.
 I am familiar with the use of SEER*Stat in analyzing data or will complete the needed
training.
 I have submitted an analysis proposal describing the intended data use to the NPCR
Internal Data users Group, who will review the proposal and forward it to the
Applications, Statistics, and Informatics Support Team (ASIST) when the proposal is
approved.
 I will provide a courtesy copy of draft papers or abstracts to the NPCR Internal Data
Users Group at npcridug@cdc.gov as they are entered into Documentum for clearance.

__________________________________________________________________
Signature
Date
Name:____________________________________________________________
Title/ Organization__________________________________________________
CDC campus/building/room/mailstop___________________________________
Telephone____________________

E-mail:_______________________

Please return completed form to the NPCR Internal Data Users Group at npcridug@cdc.gov.

NPCR-CSS Data Release Policy
June 2015
1995–2013 Diagnosis Years
26

Appendix E
CDC Non-Disclosure Agreement
The success of CDC's operations depends upon the voluntary cooperation of States, of
establishments, and of individuals who provide the information required by CDC programs
under an assurance that such information will be kept confidential and be used only for
epidemiological or statistical purposes.
When confidentiality is authorized, CDC operates under the restrictions of Section 308(d) of the
Public Health Service Act which provides in summary that no information obtained in the course
of its activities may be used for any purpose other than the purpose for which it was supplied,
and that such information may not be published or released in a manner in which the
establishment or person supplying the information or described in it is identifiable unless such
establishment or person has consented.
''I am aware that unauthorized disclosure of confidential information is punishable under Title
18, Section 1905 of the U.S. Code, which reads:
'Whoever, being an officer or employee of the United States or of any department or agency
thereof, publishes, divulges, discloses, or makes known in any manner or to any extent not
authorized by law any information coming to him in the course of his employment or official
duties or by reason of any examination or investigation made by, or return, report or record made
to or filed with, such department or agency or officer or employee thereof, which information
concerns or relates to the trade secrets, processes, operations, style of work, or apparatus, or to
the identity, confidential statistical data, amount or source of any income, profits, losses, or
expenditures of any person, firm, partnership, corporation, or association; or permits any income
return or copy thereof or any book containing any abstract or particulars thereof to be seen or
examined by any person except as provided by law; shall be fined not more than $1,000, or
imprisoned not more than one year, or both; and shall be removed from office or employment.'
''I understand that unauthorized disclosure of confidential information is also punishable under
the Privacy Act of 1974, Subsection 552a (i) (1), which reads:
'Any officer or employee of an agency, who by virtue of his employment or official position, has
possession of, or access to, agency records which contain individually identifiable information
the disclosure of which is prohibited by this section or by rules or regulations established
thereunder, and who knowing that disclosure of the specific material is so prohibited, willfully
discloses the material in any manner to any person or agency not entitled to receive it, shall be
guilty of a misdemeanor and fined not more than $5,000.'
''My signature below indicates that I have read, understood, and agreed to comply with the
above statements.''

Typed/Printed Name

Signature

Center/Institute/Office
NPCR-CSS Data Release Policy
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27

Date

Appendix F
Data Items for USCS Internal Analytic Dataset
Record ID and Demographic Data Items [NAACCR Data Item Number]
Patient ID Number [20]
Address at DX – State [80]
NHIA [191]*
Sex [220]
Age at Diagnosis [230]
Birth Date [240] - year only
Cancer Identification Data Items
Sequence Number--Central [380]
Date of Diagnosis [390] - month and year only
Primary Site [400]
Laterality [410]
Grade [440]
Diagnostic confirmation [490]
Type of Reporting Source [500]
Histologic Type ICD-O-3 [522]
Behavior Code ICD-O-3 [523]
Stage/Prognostic Factors Data Items
SEER Summary Stage 2000 [759]
SEER Summary Stage 1977 [760]
Derived Summary Stage 2000 [3020]
Geographic locations
Rural-urban continuum 2003 [3310]
Over-ride Flags
Over-ride Age/Site/Morph [1990]
Over-ride SeqNo/DxConf [2000]
Over-ride Site/Lat/Sequence Number [2010]
Over-ride Site/Type [2030]
Over-ride Histology [2040]
Over-ride Report Source [2050]
Over-ride Ill-define Site [2060]
Over-ride Leuk,Lymphoma [2070]
Over-ride Site/Behavior [2071]
Over-ride Site/Lat/Morph [2074]
Over-ride CS 20 [3769]
Derived Fields
Site recode ICD-O-3/WHO 2008
ICCC site recode ICD-0-3/WHO 2008
Behavior Recode for Analysis
Behavior Recode for Analysis Derived
SEER-modified ICCC Recode
Standard 5-year age recode
Race Recode for USCS (W, B, AI/AN, API, O,Unk)
User-specified fields
USCS standard
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Appendix F
Data Items for USCS Internal Analytic Dataset
uscs9812
uscs9912
uscs0312
uscs0812
US Census Region
US Census Division
Econ status
* Since the NHIA algorithm continues to be refined, states may choose not to provide data for
NHIA in this file.

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1995–2013 Diagnosis Years
29

Appendix G
Data Items for NPCR Internal Survival Dataset
Demographic Data Items
Alternate Patient ID Number
Address at Diagnosis – State
Race 1
Race Recode
Sex
Age at Diagnosis
Age Recode with <1 Year Olds
Age Recode
Year of Birth
Cancer Identification Data Items
Sequence Number – Central
Day of Diagnosis
Month of Diagnosis
Year of Diagnosis
Primary Site
Laterality
Grade
Diagnostic Confirmation
Type of Reporting Source
Histologic Type ICD-O-3
Behavior Code ICD-O-3
Behavior Recode for Analysis Derived/WHO 2008
Site Recode ICD-O-3/WHO 2008
ICCC Recode ICD-O-3/WHO 2008
Stage/Prognostic Factors Data Items
SEER Summary Stage 2000
Derived SS2000
NPCR Cancer Stage
Follow-up/Death Data Items
Original Day of Last Contact
Original Month of Last Contact
Original Year of Last Contact
Survival Months-Presumed Alive
Survival Flag-Presumed Alive
Presumed Alive Day of Last Contact Recode
Presumed Alive Month of Last Contact Recode
Presumed Alive Year of Last Contact Recode
Original Day of Diagnosis Recode
Original Month of Diagnosis Recode
Original Year of Diagnosis Recode
Vital Status
Vital Status Recode
Follow-up Source Central
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1995–2013 Diagnosis Years
30

Appendix H
NPCR-CSS 308(d) Assurance of Confidentiality Statement
A surveillance system of population-based cancer incidence data received from cooperative
agreement holders for the National Program of Cancer Registries is being conducted by the
National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP) of the
Centers for Disease Control and Prevention (CDC), an agency of the U.S. Department of Health
and Human Services, and ICF International, a contractor of CDC. The information to be received
by CDC is a subset of a standard set of data items that the State central cancer registry routinely
receives from hospitals, pathology labs, clinics, and private physicians on all cancer patients
diagnosed in the State. This information includes patient demographics and cancer diagnosis and
treatment data. Each August, CDC requests cumulative data from central cancer registries. The
variables reported to CDC may vary from year to year. The cancer registries maintain these data
permanently in longitudinal databases that are used for public health surveillance, program
planning and evaluation, and research. CDC will update its longitudinal database each year with
data received from the States. These data are used by CDC scientists for routine cancer
surveillance, program planning and evaluation, and to provide data for research. NCCDPHP,
recognizing the sensitivity of the data being furnished by the States, has applied for and obtained
an Assurance of Confidentiality to provide a greater level of protection for the data while at CDC
and at the contractor site.
Information received by CDC or its contractors as part of this surveillance system that could lead
to direct or indirect identification of cancer patients is collected and maintained at CDC under
Section 306 of the Public Health Service (PHS) Act (42 U.S.C. 242k) with an assurance that it
will be held in strict confidence in accordance with Section 308(d) of the PHS Act (42 U.S.C.
242m). It will be used only for purposes stated in this assurance and will not otherwise be
disclosed or released, even following the death of cancer patients in this surveillance system.
Information collected by CDC will be used without personal identifiers for publication in
statistical and analytic summaries and for release in restricted release datasets for research.
Information that could lead to direct or indirect identification of cancer patients will not be made
available to any group or individual. In particular, such information will not be disclosed to:
insurance companies; any party involved in civil, criminal, or administrative litigation; agencies
of Federal, State, or local government; or any other member of the public.
Collected information that could lead to direct or indirect identification of cancer patients will be
kept confidential and—with the exception of CDC employees, their contractors, and qualified
researchers—no one will be allowed to see or have access to the information. CDC employees
and contractors will be required to handle the information in accordance with principles outlined
in the CDC Staff Manual on Confidentiality and to follow the specific procedures documented in
the Confidentiality Security Statement for this project. Qualified researchers will be required to
sign the NCHS RDC data sharing agreements and abide by the NCHS RDC confidentiality
procedures. Organizations (e.g., the North American Association of Central Cancer Registries,
American Cancer Society, and National Cancer Institute) will be required to sign a detailed data
release agreement to have access to restricted release data.

NPCR-CSS Data Release Policy
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1995–2013 Diagnosis Years
31

Appendix I
NPCR-CSS 308(d) Assurance of Confidentiality FAQ
Background
The Centers for Disease Control and Prevention (CDC) is responsible for public health
surveillance in the United States. CDC collects, compiles, and publishes a large volume of
personal, medical, epidemiologic, and statistical data. The success of CDC’s operations depends,
in part, on the agency’s ability to protect the confidentiality of these data. While it is a matter of
principle for CDC to guard sensitive information and Federal statutes such as the Privacy Act of
1974 provide a degree of protection for personally identifiable data, Section 308(d) of the Public
Health Service Act (42 U.S.C. 242m(d)) enables CDC to provide the highest level of
confidentiality protection for sensitive and mission-significant research and surveillance data.
CDC received a formal delegation of authority from the National Center for Health Statistics
(NCHS) (formally a separate agency) to grant 308(d) confidentiality protection in 1983. Section
308(d) of the Public Health Service Act ensures the confidentiality of data collected under
Sections 304 and 306 of the Public Health Service Act. These special legislative authorities were
the provisions under which NCHS collects and safeguards most of its survey data, along with the
mortality data within the National Death Index. CDC was required to establish a stringent
application process and continues to use the authority sparingly. The agency has granted
confidentiality assurances to projects deemed significant to CDC’s mission, such as surveillance
of hospital infections, AIDS and HIV infections, pregnancy-related mortality, and congenital
defects. Fewer than 50 projects have received 308(d) protection since CDC received this
authority, and currently there are approximately 25 active projects with 308(d) confidentiality
assurances. As a testament to the importance of this project to the mission of CDC, the National
Program of Cancer Registries (NPCR) has been afforded this special data protection.
What is stated in Public Health Service Act, Section 308(d)?
The first clause of Section 308(d) states that CDC must explain the purpose for collecting data to
persons or agencies supplying information, and it guarantees that CDC will be limited to those
specified uses unless an additional consent is obtained. Moreover, the information obtained may
be used only by CDC staff or CDC’s contractors in the pursuit of such stated purposes. The
second clause states that CDC may never release identifiable information without the advance,
explicit approval of the person or establishment supplying the information or by the person or
establishment described in the information.

What process did NPCR undertake to obtain 308(d) confidentiality protection?
NPCR staff worked with the CDC Office of General Counsel and the CDC Confidentiality and
Privacy Officer to prepare the application for the NPCR Cancer Surveillance System (CSS)
project. The application contained the following four components:


A Justification Statement summarizing the NPCR-CSS project’s programmatic purpose,
the type of data to be collected, and the uses to be made of the information. This
statement also included an assurance that a) the requested data would not be furnished
without the guarantee of a confidentiality assurance, b) confidentiality assurance is
important to protect the individuals described in the data and to reassure the institutions
submitting data, c) the information cannot reliably be obtained from other sources, d) the
NPCR-CSS Data Release Policy
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1995–2013 Diagnosis Years
32





Appendix I
NPCR-CSS 308(d) Assurance of Confidentiality FAQ
information is essential to the project’s success, e) granting the confidentiality assurance
would not prohibit CDC from fulfilling its responsibilities, and f) the advantages of
assuring confidentiality outweigh the disadvantages.
An Assurance of Confidentiality Statement delineating anticipated data uses and those
with whom identifiable data would be shared, along with general advisements regarding
the confidentiality protection.
A Confidentiality Security Statement detailing the stringent safeguarding measures in
place to ensure that the promise of confidentiality would not be jeopardized by practices
of staff handling the data.
An Institutional Review Board (IRB) Review Status Statement verifying NPCR-CSS’s
exemption from CDC IRB approval. (The Human Subjects Administrator at the National
Center for Chronic Disease Prevention and Health Promotion determined that NPCRCSS activities are routine surveillance and not research on human subjects. Therefore,
protocol review by CDC IRB was deemed unnecessary.)

The application was submitted to the CDC Confidentiality Officer for review and modification,
prepared for presentation to the CDC Confidentiality Review Group (CRG), and in May 2000
NPCR received 308(d) confidentiality protection approval for NPCR-CSS data, including
authorization for retroactive confidentiality protection beginning with diagnosis year 1995.
NPCR must file for continuation every 5 years to maintain the assurance. In 2006 and 2010,
NPCR filed and received approval for continuation.
What makes 308(d) confidentiality assurance the best protection for NPCR-CSS data?
The 308(d) confidentiality assurance is the only confidentiality protection that covers routine
surveillance activities, such as those conducted by NPCR-CSS. The assurance specifies that data
protected by 308(d) may be used only for statistical or epidemiological purposes and not released
further in identifiable form without consent. Another exclusive advantage of 308(d) is that it also
protects indirectly identifiable data. Operationally, this means that NPCR may never release a
directly identifiable variable (e.g., Social Security number) or any combination of variables that
could be used to indirectly identify an individual. Finally, 308(d) provides protection for
information on both living and deceased individuals.
Are there any disadvantages to individuals or institutions protected by the 308(d)
confidentiality assurances?
A 308(d) confidentiality assurance does not pose a disadvantage for individuals or institutions
submitting data to CDC. In fact, 308(d) provides an added benefit because it prevents CDC from
freely releasing data to researchers and any other persons or entities that could request access to
the data. With the confidentiality assurance protecting NPCR-CSS data, NPCR staff members
are prohibited from sharing data except for the purposes stated at the time of data collection,
unless consent from those who provided the assurance is obtained.
Does NPCR’s 308(d) confidentiality assurance protect the data from subpoena and
Freedom of Information Act (FOIA) requests?

NPCR-CSS Data Release Policy
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1995–2013 Diagnosis Years
33

Appendix I
NPCR-CSS 308(d) Assurance of Confidentiality FAQ
The 308(d) assurance is the strongest protection against compulsory legal disclosure that CDC
can offer. Although CDC receives FOIA requests, the FOIA (b)(6) exemption enables CDC to
withhold sensitive, individually identified data that would constitute a “clearly unwarranted
invasion of personal privacy.” It is CDC’s firm position that all projects covered by a 308(d)
confidentiality assurance, including NPCR-CSS, meet this exemption.
Has a case involving 308(d) been tested in court?
Yes. CDC’s ability to protect data submitted to the agency was upheld in court. The case
involved a National Institute for Occupational Safety and Health project collecting death
certificate information, which is widely accepted as the least sensitive data protected by 308(d).
The court’s ruling in favor of the non-release of these data establishes an effective precedent for
restricting access to more sensitive data, such as that collected by a cancer registry.
How long are confidential data submitted to NPCR-CSS protected?
NPCR-CSS data are covered by the 308(d) confidentiality assurance forever. Individual records
in the NPCR-CSS surveillance system are protected even following the death of the cancer
patients.
Will NPCR release CSS data to persons or agencies outside of CDC?
An assurance of confidentiality protects NPCR-CSS data held at CDC and by its contractor, ICF
International. The 308(d) confidentiality protection does not go with the data whether released
publically or through restricted means, and any data released to qualified researchers by CDC are
subject to the limits of any coverage afforded by the requesting agency. However, it is important
to note that NPCR’s confidentiality assurance prohibits the release of any data that are directly or
indirectly identifiable. Therefore, CDC would not release highly sensitive NPCR-CSS data.
Restricted access data that are released to external researchers are done so in accordance with the
NCHS RDC proposal process and confidentiality procedures, prohibiting attempts to identify
subjects within the record system. Under the 308(d), NPCR is permitted to release NPCR-CSS
data to qualified researchers and organizations, such as the North American Association of
Central Cancer Registries (NAACCR), American Cancer Society (ACS), and National Cancer
Institute (NCI). This is so because these entities were specifically mentioned in the NPCR-CSS
confidentiality assurance as anticipated recipients of identifiable data. Prior to the restricted
release of NPCR-CSS data to qualified organizations, a detailed data use agreement must be
signed by the requesting party (attachment I). Information that could lead to the identification of
cancer patients, through direct or indirect methods, cannot be made available to any other group
or individual. In particular, NPCR cannot disclose information to insurance companies; any party
involved in civil, criminal, or administrative litigation; agencies of Federal, State, or local
government; or any other member of the public.
Are there penalties for violating the confidentiality assurance?
NPCR employees and contractors at ICF International working on the NPCR-CSS project may
be subject to fine, imprisonment, and termination of employment for unauthorized disclosure of
confidential information. To assure that all NPCR employees are aware of their responsibilities
to maintain and protect NPCR-CSS records and the penalties for failing to comply, CDC
NPCR-CSS Data Release Policy
June 2015
1995–2013 Diagnosis Years
34

Appendix I
NPCR-CSS 308(d) Assurance of Confidentiality FAQ
employees must read and sign a data use agreement. Contract employees at ICF International
with access to NPCR-CSS data are required to sign a confidentiality agreement.

NPCR-CSS Data Release Policy
June 2015
1995–2013 Diagnosis Years
35

Appendix J
Data Items for USCS SEER*Stat Research Dataset
The research use USCS dataset contains individual case-specific data from the USCS dataset
with enforced <16 cell suppression and case listing disabled.
Status [NAACCR
Name
Data Item number
Notes
listed in brackets]
Demographic Data Items
Address at Diagnosis—State

[80]

Race Recode

Derived based on [160],
[161] and [192]

NHIA Derived Hispanic Origin

[191]

Sex

[220]

Age Recode

Derived based upon [230]

Recoded to 5-year age groups.
Age over 99 recoded to 95-99
age group.

Cancer Identification Data Items
Sequence Number—Central

[380]

Date of Diagnosis

Derived based upon [390]

Primary Site

[400]

Laterality

[410]

Grade

[440]

Diagnostic Confirmation

[490]

Type of Reporting Source

[500]

Histologic Type ICD-O-3

[522]

Behavior Code ICD-O-3

[523]

Behavior Recode for Analysis
Primary Site Recode
Primary Site Recode with Mesothelioma
and Kaposi Sarcoma
SEER-Modified International
Classification of Childhood Cancer
(ICCC) Recode

Day of diagnosis will not be
provided.

Derived based upon
[400], [522], and [523]
Derived based upon [400]
and [522]
Derived based upon [400]
and [522]
Derived based upon
[400], [522], and [523]

Stage/Prognostic Factors Data Items
SEER Summary Stage 2000

[759]

SEER Summary Stage 1977

[760]

Derived SS2000

[3020]

User-Defined Data Items
USCS Standard

USCS standard for single years of analysis at the national
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1995–2013 Diagnosis Years
36

Appendix J
Data Items for USCS SEER*Stat Research Dataset
level.
uscs9913

USCS standard for diagnosis years 1999-2013 total.

uscs0913

USCS standard for diagnosis years 2009-2013 total.
US Census Regions are Northeast, Midwest, South, and
West.
US Census Regions are further divided into Divisions:
Northeast region consists of New England and Middle
Atlantic divisions; Midwest region consists of East North
Central and West North Central divisions; South region
consists of South Atlantic, East South Central, and West
South Central divisions; and West region consists of
Mountain and Pacific divisions

U.S. Census Region

U.S. Census Division

NPCR-CSS Data Release Policy
June 2015
1995–2013 Diagnosis Years
37

Appendix K
NPCR Research Data Use Agreement
National Program of Cancer Registries (NPCR)
Research Data Use Agreement
For data submitted November, 2015
The Centers for Disease Control and Prevention (CDC) makes NPCR data available to the public and
researchers through various data release activities. The NPCR Research Data is an unrestricted subset of
data submitted to CDC made available only through the SEER*Stat statistical software.
The CDC has obtained an assurance of confidentiality for NPCR pursuant to Section 308(d) of the Public
Health Service Act, 42 U.S.C. 242m(d). Any effort to determine the identity of any reported cases, or to
use the information for any purpose other than statistical reporting and analysis, is a violation of the
assurance. All direct identifiers, as well as characteristics that might easily lead to identification of
individuals, are omitted from NPCR Research Data. Certain demographic information has been included
for research purposes; thus, all SEER*Stat results must be presented or published in a manner that ensures
that no individual can be identified. In addition, there must be no attempt to identify individuals from any
computer file or to link with a computer file containing patient identifiers.
Data users must agree to the following provisions prior to receiving access to the NPCR Research Data.
As the recipient of access to NPCR Research Data through SEER*Stat, I will:
 Not use or permit others to use the analytic results in any way other than for statistical reporting
and analysis.
 Use appropriate safeguards to prevent use or disclosure of the information other than as provided
for by this data-use agreement.


Ensure all members of the research team who have access to the NPCR Research Data through
SEER*Stat have signed this data-use agreement.



Not attempt to link or permit others to link NPCR Research Data with individually identifiable
records from any other dataset without CDC approval.



Not attempt to use the analytic results or permit others to use them to learn the identity of any
person or establishment included in any dataset.



Take the following actions if the identity of any person or establishment is discovered
inadvertently:
o
o
o
o

Make no use of this knowledge.
Notify CDC.
As requested by CDC, safeguard or destroy the information that identifies an individual
or establishment.
Inform no one else of the discovered identity.

In addition, I will make every effort to release all statistical information in such a way as to avoid
inadvertent disclosure. I will:
 Ensure that no data on an identifiable case can be derived through subtraction or other calculation
from the combination of tables in the given publication.
 Ensure that no data permit disclosure when used in combination with other known data.
 I will not disclose or otherwise make public data on any unit smaller than 16. If the total number
of cases in a cell is <16, the cell data will be suppressed in oral and written presentations.
My signature below indicates that:
NPCR-CSS Data Release Policy
June 2015
1995–2013 Diagnosis Years
38

Appendix K
NPCR Research Data Use Agreement


I will adhere to the requirements of this Data Use Agreement and understand that my access to
the data will be revoked if these requirements are violated.



I am familiar with the use of SEER*Stat in analyzing data or will complete the needed training.



I understand that all NPCR data are owned by the states and territories. The states’ and territories’
have established agreements with CDC on the use and dissemination of the data.



I understand that I am responsible for the results of my own analysis. The findings and
conclusions resulting from the analysis of these data are those of the authors and do not
necessarily represent the official position of the CDC.



I will acknowledge central cancer registries whenever data are presented, released, or
published by including the following (or similar) statement:
These data were provided by central cancer registries participating in the National Program of
Cancer Registries (NPCR) and submitted to CDC in November 2015, and/or the Surveillance,
Epidemiology and End Results (SEER) program and submitted to NCI in November 2015.

Click here to enter a date.
Date

Signature
Name: Click here to enter text.
Title/organization: Click here to enter text.
CDC campus/building/room/mailstop: Click here to enter text.
Telephone: Click here to enter text.

E-Mail: Click here to enter text.

Please print, sign, and date the agreement. Send the form to CDC (or authorized contractor):
 By fax to xxx.xxx.xxxx
 Or, e-mail a scanned form to xxxxxx@xxxxx.xxx

Research Data Use Agreement (November 2015 Submission)
NPCR-CSS Data Release Policy
June 2015
1995–2013 Diagnosis Years
39

Updated 12/2014

Appendix L
NPCR Data at the NCHS RDC Q&A
Can you summarize what CDC is planning to do?
CDC uses the National Center for Health Statistics (NCHS) Research Data Center (RDC) as a
mechanism for researchers outside of the Division of Cancer Prevention and Control (DCPC) to
request and gain access to the Restricted-Access NPCR data for research purposes. The data
will be available through the NCHS RDC only after the standard data quality reviews that occur
as part of the preparation for USCS and State Cancer Profiles.
The use of the NCHS RDC to manage data access will provide the highest level of data security
and protection of confidentiality that is available for analysis of data. Any researcher must
submit a proposal which will be reviewed and approved by CDC and representatives from the
participating central cancer registries (CCRs) before any data analysis begins. Trained data
analysts at the NCHS RDC create a dataset that is customized to each analysis. The researcher
can run his or her own statistical analysis or have the NCHS RDC analyst run the analysis. The
NCHS RDC analyst reviews all output from statistical analysis to ensure that the researcher only
conducts analyses relevant to the approved protocol and that small cell sizes are suppressed.
Absolutely no individual level data will leave the NCHS RDC facilities.

What is National Center for Health Statistics (NCHS)?
NCHS is one of the national centers at CDC and is located in Hyattsville, Maryland. As the
Nation's principal health statistics agency, staff at NCHS compile statistical information to guide
actions and policies to improve the health of our people. More information about NCHS is
available at: http://www.cdc.gov/nchs/about.htm.

What is the Research Data Center (RDC)?
The NCHS RDC began in 1998 and has a long-standing history of managing access to health and
vital statistics data through a rigorous proposal review process as well as review of the statistical
output. The NCHS RDC mission is to give public access to the full range of health and vital
statistics data, while protecting the confidentiality of the respondents and institutions that
collected the information. There have been no breeches of confidentiality for data access through
the NCHS RDC.
The NCHS RDC houses sensitive, but not classified, data. It allows access to individual data
without the possibility of disclosure of identifying information. The NCHS RDC offers
statistical, programming, and consulting expertise to facilitate the data analysis for research.
The NCHS RDC is a data hosting center, not a data repository. The data extracts that are hosted
on the NCHS RDC are tailored specifically to the proposal and have a research life cycle. Once
the analysis is completed, the data extract is archived for 2 years and then destroyed.
There are currently three modes of access through the NCHS RDC, each with specific
restrictions. Access is available on-site at two locations (Hyattsville, MD and Atlanta, GA), nine
Census RDCs, or through remote electronic access. More information about the NCHS RDC is
available at: http://www.cdc.gov/rdc/
NPCR-CSS Data Release Policy
June 2015
1995–2013 Diagnosis Years
40

Appendix L
NPCR Data at the NCHS RDC Q&A
Why does CDC use the NCHS RDC?
Maintaining confidentiality is the primary objective of the NCHS RDC. Staff at NCHS RDC
have statistical expertise to address confidentiality and disclosure risk. Using the NCHS RDC
will allow CDC to comply with the Assurance of Confidentiality [308(d)] that was obtained for
the NPCR-CSS data. All researchers must take confidentiality orientation, complete
confidentiality forms, and review the disclosure manual, all of which outline practices that are
essential to protecting the data and preventing disclosure of confidential information.
Additionally, data housed at the NCHS RDC are not subject to the Freedom of Information Act
(FOIA). More information about confidentiality is available at:
http://www.cdc.gov/rdc/B4ConfiDisc/CfD400.htm.

What is the research proposal process?
The NCHS RDC has a rigorous review process for analyses proposed by any researchers wanting
to use RADS data. All proposals will be evaluated by a Review Committee consisting of: the
NCHS RDC Director, the Confidentiality Officer, the assigned NCHS RDC analyst, and NPCR
representatives. The iterative review and comment process may take 6 to 8 weeks.
Through this process, the NCHS RDC staff, the NPCR staff, and the CCR staff will fully
understand the intended analysis and will be able to provide any needed direction or restrictions
on the analysis and describe any limitations in what is proposed. It will be possible for CDC
and participating registries to disapprove a proposal. However, guidance and re-direction as
needed should be the norm. More information about the review process is available at:
http://www.cdc.gov/rdc/B3Prosal/PP300.htm.
Once a proposal has been approved, the NCHS RDC offers a secure environment for data
analyses and has processes in place to review data output for small cell sizes. This will ensure
that the NPCR suppression rules are properly applied. Through the NCHS RDC, the user can
conduct analyses and have remote access to data but cannot download the individual record level
data or obtain counts for inappropriately small cell sizes.
The use of the NCHS RDC to host the NPCR data is a win-win opportunity because of the
confidence in knowing that the data are being used correctly and safely, while at the same time
making the data available for external researchers in an appropriate way. In addition, this
approach will not overtax resources here in the Branch or in the CCRs. The NCHS RDC
provides a level of data control beyond that of any other data access system used for registry
data.

If a CCR agrees to participate, who has access to the data and at what level?
The NCHS RDC analysts will have access to the individual record level data since it is easier to
create an analytic dataset using these data. The NCHS RDC analysts will be bound by the same
data use agreements that CDC staff sign on an annual basis. Researchers with approved
proposals will be able to conduct analyses through the NCHS RDC on the created dataset or have
the NCHS RDC analyst do the analysis for them. However, they will not be able to download
NPCR-CSS Data Release Policy
June 2015
1995–2013 Diagnosis Years
41

Appendix L
NPCR Data at the NCHS RDC Q&A
any part of the data from the NCHS RDC. Any additional variables that were not included in the
original analysis proposal will need a separate approval process.
Note that this is different from the process that NPCR has used in the past where researchers
with approved proposals would have direct access to the dataset itself including the ability to
download the data and create a listing of individual record level data and all variables in the
RADS.
Researchers have several possible modes of access to the data set created for their specific
research proposal. More information is available at:
http://www.cdc.gov/rdc/B2AccessMod/ACs200.htm.

When a researcher conducts an analysis, what type of output will he or she get?
If a researcher is on-site at the NCHS RDC, he or she can save the results on the hard drive of the
NCHS RDC computer. The NCHS RDC analyst will review the output for disclosure then either
load the output onto a flash drive supplied by the researcher or e-mail the output files to the
researcher. If a researcher is accessing the NCHS RDC remotely, he or she will send program by
e-mail and, after disclosure review by the NCHS RDC analyst, will receive the output files by email. No individual record level data are released to the researcher.

Will the CCRs be able to decide whether their data will be available through the NCHS
RDC?
Yes. However, given the protection provided to the data and the review process the CCRs are
expected to participate. Data use is important to NPCR and for continued support of the
registries.

Will the CCRs be able to decide if their county-identifying variable (County at Dx
[NAACCR#90]) is to be available for use in the NCHS RDC?
Yes. CCRs will be able to decide if county data are used by the NCHS RDC. County data will
be used only in approved analyses and in the following ways:


Used as a linkage variable (linkage to census data, for example) only by the NCHS RDC
analyst. The county variable will not be available to the researcher but the NCHS RDC
analyst would use it to create a linked dataset and then remove the county variable.



Included as a confounder or other control variable, but no data are presented by county.
The NCHS RDC analyst will create dummy variables to mask the actual county name.



Used in geographically aggregated form such as large metropolitan statistical areas (e.g.,
those with a population of 1 million or larger), multi-county regions, or geographical
areas (e.g., Appalachia or IHS Contract Health Services Delivery Areas (CHSDA)
counties). It will be possible for the NCHS RDC analyst to create these areas for the
researcher.
NPCR-CSS Data Release Policy
June 2015
1995–2013 Diagnosis Years
42

Appendix L
NPCR Data at the NCHS RDC Q&A
Previous data release policies indicate that the project proposals for RADS would be reviewed by
the RADS working group, facilitated by CDC with representation by the CCRs. Does this
procedure change now that the NCHS RDC is used?
The CCRs will still have input on the RADS proposals. The NCHS RDC review process also
includes the NCHS RDC analyst and the confidentiality officer, who will be responsible mainly
for disclosure review to ensure that we abide by the 308(d) assurance of confidentiality obtained
for NPCR-CSS. More information about the NCHS RDC review process is available at:
http://www.cdc.gov/rdc/B3Prosal/PP340.htm.
NPCR will obtain comments on each proposal from multiple CCRs whose data are included in
the NCHS RDC analysis.

Will SEER data be included for analysis or will the data be limited to NPCR data?
Yes. Both NPCR and SEER data may be accessed through the NCHS RDC.

Will the NCHS RDC staff have access to SEER*Prep and SEER*Stat?
Yes. NPCR staff are working with NCHS RDC staff to provide appropriate training for these
data preparation and analysis tools.

Will researchers have access to SEER*Stat?
Yes. It is expected that researchers will know the basics of the analyses that they wish to carry
out. NCHS RDC staff will be available for limited consultation. Since cell phones or access to
the Internet are not available inside the NCHS RDC, all SEER*Stat tutorials
(http://seer.cancer.gov/seerstat/tutorials/) would need to be completed beforehand.

What suppression rules will be used for the RADS?
The same suppression rules that are used for United States Cancer Statistics. More detailed
information is available at:
http://www.cdc.gov/cancer/npcr/uscs/2006/technical_notes/stat_methods/suppression.htm.

In addition, the suppression rules for Asians/Pacific Islanders (A/PI) and American
Indians/Alaska Natives (AI/AN) will also apply. The data for A/PI and AI/AN will be presented
only for states or counties with at least 50,000 population because of concerns regarding possible
misclassification of race data and the relatively small sizes of these populations in the United
States.
Wouldn’t it be better for researchers to contact CCRs directly for linkage studies?
CDC doesn’t collect personal identifiers like name or social security number.
NPCR-CSS Data Release Policy
June 2015
1995–2013 Diagnosis Years
43

Appendix L
NPCR Data at the NCHS RDC Q&A
Yes, it would be best for researchers to contact CCRs directly for linkage studies that require
individual identifiers. However, valuable public health research can be conducted with access to
county-level data. Examples include linkage with U.S. Census data for socioeconomic analyses,
or to examine regional differences in the prevalence of a specific cancer

Will IRB review be required for each proposal? If not, will NCHS require the researcher to
obtain IRB approval before they submit their proposal?
The NCHS RDC has an umbrella ethics review board (ERB) protocol that covers CDC
employees and can be extended to external researchers. The principal investigator and all
research team members who come in contact with the data must take the confidentiality
orientation and complete the confidentiality forms. One of the confidentiality forms is the
designated agent form (http://www.cdc.gov/rdc/Data/B4/DesignatedAgent.pdf), which extends
the ERB to cover external researchers.
Note that the ERB protocol serves the same function as an institutional review board (IRB)
protocol. At CDC, there is one office that coordinates the submission and tracking of human
research protocols. However, other centers such as NCHS and the National Institute of
Occupational Safety and Health, have different names for these review boards: Research Ethics
Review Board (ERB) at NCHS and Human Subjects Review Board (HSRB) at NIOSH.
Researchers may choose to obtain an IRB from their own institution, but it will not be a
requirement in the application process given the ERB extension that the NCHS RDC provides.

Does access to the RADS cost anything?
No. CDC covers the cost of analyzing RADS through the NCHS RDC.

As more researchers become aware of the RADS, they may want access to additional
variables that CCRs submit to CDC. How will this process be handled?
The addition of new variables in RADS will be discussed with CCRs prior to their inclusion in
the data release policy, which is updated annually.

How is access to the comparative effectiveness research (CER) dataset managed?
Access to the CER dataset are managed through the same NCHS RDC process. The proposal
process will not differ except that staff from the Specialized Registries funded for CER data
collection will review these proposals.

NPCR-CSS Data Release Policy
June 2015
1995–2013 Diagnosis Years
44

Appendix M
Data Items for Restricted-Access Dataset (RDC)
The restricted access datasets are individual case-specific data from the NPCR-CSS
dataset. The data items to be included are listed below.
Status [NAACCR Data
Item number listed
in brackets]

Name
Demographic Data Items
Patient ID Number
Address at Diagnosis—State

[20]
[80]

Address at Diagnosis—County

[90]

Address at Diagnosis—Census Region

Spanish/Hispanic Origin
NHIA Derived Hispanic Origin
Sex

Derived based upon [80]
Derived based on [160],
[161] and [192]
[190]
[191]
[220]

NPCR Age at Diagnosis

Derived based upon [230]

NPCR Age Recode

Derived based upon [230]

NPCR Race Recode

NPCR Birth Date

Derived based upon [240]

Cancer Identification Data Items
Sequence Number—Central

[380]

NPCR Date of Diagnosis

Derived based upon [390]

Primary Site
Laterality
Grade
Diagnostic Confirmation
Type of Reporting Source
Histologic Type ICD-O-3
Behavior Code ICD-O-3

[400]
[410]
[440]
[490]
[500]
[522]
[523]
Derived based upon [400],
[522], and [523]
Derived based upon [400]
and [522]
Derived based upon [400]
and [522]
Derived based upon [400],

NPCR Behavior Recode for Analysis
SEER Incidence Site Recode
SEER Incidence Site Recode with
Mesothelioma and Kaposi Sarcoma
SEER International Classification of

NPCR-CSS Data Release Policy
June 2015
1995–2013 Diagnosis Years
45

Notes

Only used in approved
analyses.*

Age over 99 will be
recoded.
Only year will be
provided; if age is
over 99, then year of
birth will be recoded.

Day of diagnosis will
not be provided.

Appendix M
Data Items for Restricted-Access Dataset (RDC)
Name
Childhood Cancer (ICCC) Recode

Status [NAACCR Data
Item number listed
in brackets]
[522], and [523]

Notes

Stage/Prognostic Factors Data Items
SEER Summary Stage 2000
[759]
SEER Summary Stage 1977
[760]
CS Extension
[2810]
CS Lymph Nodes
[2830]
CS Mets at DX
[2850]
CS Site-Specific Factor 1
[2880]
CS Site-Specific Factor 2
[2890]
CS Site-Specific Factor 3
[2900]
CS Site-Specific Factor 15
[2879]
CS Site-Specific Factor 25
[2879]
CS Version Input Original
[2935]
CS Version Derived
[2936]
CS Version Input Current
[2937]
Derived SS2000
[3020]
Over-ride Flags
Over-ride Age/Site/Morph
[1990]
Over-ride SeqNo/DxConf
[2000]
Over-ride Site/Lat/Sequence Number
[2010]
Over-ride Site/Type
[2030]
Over-ride Histology
[2040]
Over-ride Report Source
[2050]
Over-ride Ill-define Site
[2060]
Over-ride Leuk, Lymphoma
[2070]
Over-ride Site/Behavior
[2071]
Over-ride Site/Lat/Morph
[2074]
* County data will be used only in approved analyses and in the following ways: a) used as a linkage
variable (linkage to census data, for example) only by the NCHS RDC analyst; b) included as a
confounder or other control variable, but no data are presented by county; c) used in geographically
aggregated form such as large metropolitan statistical areas (e.g., those with a population of 1 million or
larger), multi-county regions, or geographical areas (e.g., Appalachia or IHS Contract Health Services
Delivery Areas (CHSDA) counties)

NPCR-CSS Data Release Policy
June 2015
1995–2013 Diagnosis Years
46

Appendix N
NPCR-CSS Levels of Data Access

NPCR-CSS Data Release Policy
June 2015
1995–2013 Diagnosis Years
47

Appendix N
NPCR-CSS Levels of Data Access

NPCR-CSS Data Release Policy
June 2015
1995–2013 Diagnosis Years
48