Cancer PathCHART: A Revolution in Cancer Surveillance Standards

• Accessing U.S. Population-Based Cancer Registry Data (SEER, US Cancer Statistics, and NAACCR) (PDF)
• CAP Cancer Protocol Templates
• CAP electronic Cancer Protocols (eCPs)
• For questions, please email us at CancerProtocols@cap.org

Becca Battisfore:

Welcome to the latest edition of the College of American Pathologists' CAPcast. I'm Becca Battisfore, content strategist with the CAP. In this episode, our guest host, Dr. Paner, will be talking with experts about Cancer PathCHART, a vital new resource for cancer registrars, clinicians, pathologists, researchers, and developers.

Cancer PathCHART, short for the Cancer Pathology Coding, Histology, and Registration Terminology is a first of its kind initiative to update cancer surveillance standards for tumor site histology and behavior code combinations and associated terminology. These are among the most important data fields captured from pathology reports. Previously variability in terminology and outdated cancer surveillance standards have led to inconsistencies and inaccuracies in the data captured To address this issue, the National Cancer Institute, the College of American Pathologists and nine other global partners have collaborated to update tumor site morphology standards. The first time in over 15 years through the standardization, cancer surveillance will more accurately reflect medical practice to support cancer research and public health without altering cancer registration workflows.

Before we get into the questions, let's learn more about our guests. Dr. Paner, we'll start with you.

Dr. Gladell Paner:

Thank you, Becca. Good afternoon everyone, and thanks for tuning into CAPcast. My name is Gladell Paner. I am a GU pathologist at the University of Chicago, and in the previous six years I had the pleasure of working for the CAP Cancer Committee and the CAP Pathology Electronic Reporting or the PERT committee. And during this time I had a fantastic, amazing time with our guests.

Dr. Alison Van Dyke:

So I'm Alison Van Dyke. I am dual trained in pathology and cancer epidemiology and work solely in public health with the National Cancer Institute at the National Institutes of Health with the Surveillance Epidemiology and End Results, or SEER, Cancer Registry System.

Dr. Richard Moldwin:

I'm Rich Moldwin and I'm Lead Physician Informaticist in the group of Cancer Protocols and Data Standards at the College of American Pathologists. My clinical background is pediatric hematology/oncology, and I work mostly on data standards for cancer informatics, largely with the registry world, and improving data captured from laboratories to transmit them into registries.

Dr. Kay Washington:

I'm Kay Washington. I'm a GI pathologist at Vanderbilt University Medical Center in Nashville, and I served on the CAP Cancer Committee for a number of years. I've been involved with AJCC for three or four editions now, and currently I'm on the Council for Scientific Affairs for CAP and Chair of the Center Guideline Committee.

Becca Battisfore:

Great. Thank you so much for joining the podcast, Dr. Paner. I'll let you take it from here.

Dr. Gladell Paner:

Thank you, Becca. So for a start, let's have, let's discuss the background about cancer surveillance system. And the first question is for you Alison. So tell us what are the cancer surveillance systems in the us?

Dr. Alison Van Dyke:

There are two sources of funding for cancer registries in the United States. One is from the National Institutes of Health, the other is the Centers for Disease Control and Prevention National Program of Cancer Registries or NPCR program. There is a little overlap in funding by CDC and NCI for some of the registries and in total we cover roughly 98% of the United States population. Just to add a little more context, you can access SEER data, you can also apply to access CDC data, but also CDC aggregates data across both SEER registries and CDC registries funded registries and that's the US Cancer Statistics Database. And then there's a one layer higher and that is the NAACCR or the North American Association for Central Cancer Registries, which combines data across the United States registries and registries covering Canada.

Dr. Gladell Paner:

Thank you, Alison, for that detailed description. So how is this cancer surveillance data used? Tell us why is it so important for pathologists?

Dr. Alison Van Dyke:

So I'll tackle the first question first and that is that the data cancer surveillance data across the globe and especially in the United States and North America, determines research funding, cancer control program planning and prevention planning and funding. But in terms of pathologist use and why it's so important to pathologists is that a lot of pathologists are not aware that they can actually apply to have access to some of the population level data. So if you have a research project in mind that you're interested in doing, using population based data, you can apply to have access to address some of your research questions that are pathology related. We do, for example, for breast cancer, we do capture select data items like biomarkers, ER, PR, HER2 and some others. So I think from an academic standpoint, it's also important for the pathologist because you could actually do some interesting research questions, address interesting research questions with the population-based data. The other thing of why population-based data is why it's so important is that most studies out there are, and especially tissue-based studies, are done in the context of clinical trials and they're not representative of the US population and often are underrepresenting minority populations subpopulations within the us.

Dr. Gladell Paner:

Thank you, Alison. I'm sure some of our listeners will be interested in using the SEER data and as you hear, it'll be available for use for research.

Dr. Alison Van Dyke:

Yeah, I want to add one thing, Gladell, if that's okay.

Dr. Gladell Paner:

Sure.

Dr. Alison Van Dyke:

We'll be sharing a schematic of figure that explains how you can gain access to the data, how you can explore usually publicly available data visualization tools and exploration tools that are available on the web.

Dr. Gladell Paner:

Thank you Alison. So now let's focus on Cancer PathCHART and I'm pretty amazed how the first letters of the words spelled and fitted into CHART, Cancer PathCHART. So how did the idea for Cancer PathCHART came about, Alison?

Dr. Alison Van Dyke:

This was done at a meeting that Rich Moldwin, my supervisor, Serban Negoita and also Keren Hulkower from the CAP who actually oversees the cancer protocols. We were discussing the big problem in cancer surveillance standards and that there's a long time-lag between when new entities or changed standards for tumor classifications come out in the World Health Organization classification of tumors books and when they get implemented in the cancer registry community. And that creates a lot of data quality issues. Also, there are big differences sometimes between what the standards are and what terminology is actually used in practice and what the registrars actually can code when they're collecting data. That's how it started, it was trying to reduce that gap between biomedical knowledge and practice and the cancer surveillance data that can be captured. Rich, anything to add? Add?

Dr. Richard Moldwin:

Yeah. So yeah, I remember that first meeting we had in Gaithersburg, sometime pre-COVID, I think it was probably 2019, 2018, something like that, when we started talking about this in earnest. I had been working on a variety of NAACCR committees - that's the North American Association of Central Cancer Registries. So I've been in a number of these committees for about almost 20 years now, since 2006. And I noticed a number of places where better collaboration, better data management, better use of standards and improved interoperability - in other words, how we exchange data from pathology systems to registry systems - if we could make some improvements in those areas - that we could reduce certain difficulties in registry operations. Some of those difficulties relate to the time of reporting between when we first know that a [cancer] case is present until the time it gets reported into - let's just say a hospital [cancer] registry - and then eventually into the state central [cancer] registry.

But other difficulties are non-standard terms used for histology, for example, that can create a lot of back and forth to figure out what the pathologist really meant from the point of view of the terms that are used in the registries. They may not match. So, some of the improvements that we would need to do, they would need to reach back into laboratory practice settings, something that NCI or CDC or NAACCR couldn't do on their own, but they would also need to reach back into AP/LIS systems. But these reach backs, they seemed reasonable, at least from the pathology practice and the CAP perspective. And so I thought that there was a way that we could work more closely together to get that to happen. And so one example that we mentioned already is the need to harmonize these frequently updated cancer histology terms. Sometimes new terms come out in a paper or even in a WHO Blue Book and we don't know on either side - of the CAP side or on the registry side - when we should adopt these new terms and new codes.

Sometimes codes undergo some coding changes, codes that we use internally in the software for reasons that are not documented, at least not any documentation that we've seen and they just pop up out of nowhere and we need to keep track of these things and document them and where the changes came from and when they were first applied and so forth, so that we include these new coding systems as they come out with the CAP eCPs, the electronic Cancer Protocols. And then we are trying very hard now to work on the same tables of codes and terms that are used between registry operations and the CAP operations for the cancer protocols, eCPs and registry software.

Dr. Gladell Paner:

Thank you, Rich. My next question is for you, Alison. So why is Cancer PathCHART so critical for cancer surveillance data quality?

Dr. Alison Van Dyke:

Sure. So the major standards for tumor site and morphology combinations had not been overhauled in a very long time. New entities had been added as they came out, but a major cleanup has not happened in quite some time. And so it's focusing on the three most important foundational data items in cancer surveillance. That's tumor site histology and behavior in the histology and behavior together are counted as term as morphology. And so those combinations determine all downstream data captured, especially data like staging site specific data items or what we call SSDIs like the biomarkers and other types of data. Also, if we want to accurately attribute a patient's cancer, we need to make sure that the statistics reflect the disease that patient experienced. So that's why it is so important that we have this massive overhaul and cleanup of the data items.

Dr. Gladell Paner:

I would like to shift to Dr. Kay. So Kay, I have a question for you, and this is regarding the pathologist involvement in this initiative. So how did pathologists and registers work together to create the Cancer PathCHART standards?

Dr. Kay Washington:

Pathologists and registrars work together at every step of this process. Basically, the first thing we did, the content work group pulled the new WHO terms and the historical terms as well, and compared the histology and site combinations; sometimes there were dozens if not hundreds of terms to look at and determined whether they were biologically valid, biologically unlikely or biologically impossible. And the registrars really had a lot of input all along the way because they're dealing with whatever the pathologist is diagnosing and trying to fit it into their list of terms. So they were involved early on, but then at the end of the review process, after a group of subject matter expert pathologists had looked at these terms and come to a consensus on them, then the registrars looked at that list again to make sure it wasn't in conflict with some of their important registry rules such as their solid tumor rules.

Dr. Gladell Paner:

Thank you. Okay. I'm sure when you're going through that review of the terminologies, the tons of terminology, there will be surprises. So let me ask you, what surprised you the most in conducting the reviews of site morphology combinations?

Dr. Kay Washington:

Well, starting out you think, well, it's just going to be a matter of incorporating new WHO terms, and that was far from it. That was the easiest part of it. I think what really surprised me was this huge list of vague or archaic legacy terms that the registrars were struggling with. I mean, you would not believe these things epithelial [epithelioma], I mean, what is that? I have no idea. After practicing surgical pathology for 30 plus years, how does that apply to a colon cancer? So those have been retained for good reason because we need to stage as many cases as possible. So they were retained for legacy purposes, but we need to, one of the goals here is to try to clean these things up. The other thing that surprised me, and I think we can address this going forward with pathologists’ input, is there are a lot of almost identical non-standard terms that pathologists love to use because we're attuned to the nuances of our diagnoses. So we tend to be consummate splitters, but I think that is not in many cases helping either the patient, the clinicians treating the patient or the registry world. So we need to take a good look at our WHO list and try whenever possible to use standard terminology when we're diagnosing cancers. It's just a matter of some of these don't add value and they're complicating the registrar's work. So that was a big surprise as well. How many of those almost identical terms are included in these lists?

Dr. Alison Van Dyke:

There was one example, concrete example of soundalike terms that we found by going through this process and looking at how many cases were diagnosed or coded recorded by the registrar in the last five years of data. We looked at, for example, instead of adenocarcinoma of the prostate code, some of them were coding acinar cell carcinoma. And so that is an example of now acinar cell carcinoma is impossible in the prostate and the adenocarcinoma of the prostate is that code is actually the valid code to use. So in the process of doing cancer PathCHART, we found some concrete examples that will change things.

Dr. Gladell Paner:

Thank you, Alison. That was supposed to be my question. So there were biologically impossible terms, but as you mentioned, although not many, there were cases that were coded under those terms.

Dr. Alison Van Dyke:

I will say to add to what you mentioned, the vast majority of newly impossible terms are codes that we determined through the cancer pass chart review process. Most of them had had zero case counts in the last five years of diagnosis. So that's reassuring.

Dr. Gladell Paner:

Thank you, Alison. Kay, I have a side question for you. You mentioned that basically our standard for terminology is the WHO. Can you comment on those classification that are not the WHO classification?

Dr. Kay Washington:

Sometimes those are in conflict with WHO classification. Sometimes there's overlap or sometimes expansion of the terms and pathologists we recognize are going to use those terms. And I think Cancer PathCHART will offer a framework for mapping those terms to the correct histology code. I mean the WHO is a starting point. Certainly not everybody uses strictly the WHO list. There are additions, et cetera to it, and the Blue Books are updated, what about every five years? So it makes sense that every now and then something is going to emerge as an accepted entity in between revisions of the Blue Books.

Dr. Gladell Paner:

Thank you. Kay. And I would like to shift to you, Rich. So how is CAP using the standards in the Cancer Protocols?

Dr. Richard Moldwin:

Before getting into that, I just sort of want to mention that one of the things that Cancer PathCHART has done is really increased, I think, the communication between the various groups that are participating in Cancer PathCHART. And because of the communication, we can much more easily work on our timeline. So, we release things at approximately the same time. We try not to release terms - new histologic terms - for example, or new data elements, before the registry data standards can get in sync with that. We are not always successful with keeping things completely in sync, but at least we know when we're out of sync and we can have then a timeline and a plan for implementing the latest and greatest that comes out of our collaborative work. The CAP works closely with AJCC and NAACCR. And NAACCR sort of includes all of us, including the NCI and the CDC and the AJCC and everybody else interested in registry processes and registry data.

So, we work and we share our implementation timelines and we work on common sources of truth like histology and AJCC stage details, which turn out to be very, very important, and harmonizing [the updates]. We have a lot of other data elements in the eCPs beyond histologic type and primary tumor site. And in the registry world we have these other data elements called SSDIs or “Site-Specific Data Items” that are similar but not exactly the same as the data elements you have in the CAP protocols. And we work very hard to try to make sure that the data can flow from the CAP eCPs into the registry SSDI data elements. And so that requires a lot of collaborative work on a bunch of different committees that aren't necessarily Cancer PathCHART committees. So that just sort of gets into the collaboration we have to do and that's kind of like the underpinnings of what we're doing in Cancer PathCHART.

Now to get back to your question - How is the CAP using these standards? Well, we produce these lists of ICD-O-3 vetted terms and codes. We find abnormalities sometimes, let me say, I don't know, “mistakes” or legacy terms that are in there that we need to remove. We find differences in spellings, differences in parentheses and commas - and little things like that that make it crazy to do searches [on histology terms], to find the right terms, which are, some of which are very similar. And especially for cancer registrars searching on the term, we really need to be using the term pretty much exactly as it comes out of the Blue Books and/or ICD-O. One of the challenges we have is sometimes the Blue Books and ICD-O aren't in one hundred percent sync. Sometimes the IARC, which manages ICD-O, makes some little subtle changes to it, which changes how you can search for things that can drive you crazy.

Sometimes they [the ICD-O committee members] don't include synonyms that you think really ought to be there. And so, we bring that information back into the eCP, (into) the cancer protocol development process, and we try to use a standard, the most commonly used terms as we can. And then behind the scenes we develop maps to those terms so you can use the code rather than the letters and the commas and the dashes and the parentheses and the semicolons between translocations and things like that that drive you crazy when you're doing term searches. So, we try to make all those things standardized and release those as separate [code to term] maps and we'll be doing some of that. We were a little bit delayed on our latest map. It should be coming out in Q1 2025 to have some of those ICD-O-4maps. We're also working to, we've been doing some work with SNOMED CT on mapping terms that are in the cancer protocols, including histologic types to SNOMED CT terms in addition to ICD-O. So, we'll be releasing those [SNOMED codes] in the near future also.

So, it goes both ways. It's not just “how are we taking the information from Cancer PathCHART into the cancer protocols,” but there's a large part of coordinating how we all do things together at the same time. And so, we work on shared standards and thereby improving interoperability and decrease the effort and the errors made on the registry side.

Dr. Gladell Paner:

Thank you Rich. And just to inform our audience that the CAP protocols basically used the WHO terminology as its standard, I like to go back to the Cancer PathCHART and this is for pathologist Alison. So how can pathologists access Cancer PathCHART?

Dr. Alison Van Dyke:

Sure, and we can provide the link and the resources for this podcast, but if you just Google Cancer PathCHART, we have a website that comes up in our products and downloads page. There are standards for 2024 and 2025. We reviewed approximately a third, the total number of tumor sites and updated the standards for those for 2024 and about another third for 2025. So those standards can be downloaded. We have 'em in the format, four different formats including Excel and JSON and XML and CSV. So that's how you can access those standards if you're interested.

Dr. Gladell Paner:

Thank you, Alison. So now let's talk about CPC search. So Alison and Kay, what is CPC search and how is it being used today? Can pathologists use this CPC search?

Dr. Alison Van Dyke:

Sure. CPC search, it's a web tool that's accessible on our Cancer PathCHART website that allows users to search the validity status if it's a valid, impossible or unlikely site morphology combination. And so that you can enter the tumor site and then the tumor histology you're interested in, you can enter either for each, you can enter either a code or a term and it will bring up all of the psych morphology combinations that meet that combination and tell you if it's valid, unlikely, or impossible.

Dr. Kay Washington:

Yeah, pathologists are welcome to use it. I think for rare tumors, they may want to take a look at it to see if that particular combination has been reported in the registry before, for instance, and is considered most likely it would be considered biologically unlikely if it's extra rare, but it could keep you from making a diagnosis that's really implausible. It gives you a basis for thinking about research projects as well.

Dr. Gladell Paner:

I agree. Kay. Those are good points. This may not happen, but it may happen that say pathologists use a term that probably it's maybe invalid or some really old term in his diagnosis line. And then the registrar will search the term and it'll come back as a biologically invalid. Then we'll say, oh, okay. So the registrar will call back as the pathologist and the opposed, Hey, this is correct. This is my diagnosis. How do you handle those cases?

Dr. Alison Van Dyke:

The registrar can submit a question about cancer pastorate standards through Ask A SEER Registrar. This is an online form that they can fill out and ask questions that sends the questions directly to me and to the Cancer PathCHART team at NCI. And then we take those to what we call our seer clin core. This is a group of subspecialty matter. I call 'em them subspecialty matter SMEs because they're really uber subspecialized and Dr. Washington is our GI pathologist for who we go to for those organ system question. And we can go to our expert and present this question, should our standards change or is it really an issue of this is outdated terminology. During the review process, we also generate or captured a lot of comments about site morphology, combinations from the pathologist who reviewed the site morphology combinations to determine if they're valid, unlikely, or impossible. And that's a gold mine of information that we can then reply with justification for why something was valid, unlikely, or impossible.

Dr. Kay Washington:

Yeah, I want to second that comment by Alison. Many of the biologically impossible combinations have a note that point you to the correct diagnosis,

Dr. Alison Van Dyke:

And we don't have those comments yet, those consensus comments or those reviewer comments yet in the CPC search tool, but that is a goal in the future.

Dr. Gladell Paner:

Thank you. I like what Kate pointed out for pathologists to use this tool, especially for rare tumors because for rare tumors, some who discover this entity or describe this entity at the beginning may use a different terminology from another group who would describe this tumor. And if we go to a standard term like in the WHO, there may be an official term for this, so maybe it's a good idea for those who making a diagnosis of rare tumors to please check the appropriate terminology in CPC search. The next question is, what are the plans for cancer patch art and CPC search in the next few years?

Dr. Alison Van Dyke:

Sure. We're interested in the issue of changing terminology over time and changing codes within cancer surveillance over time, recite morphology combinations, and this is especially true for bone and soft tissue and the hemato lymphoid malignancies. This is a big issue. We all know that the classification terminologies have changed over time. So this presents a big question mark and issue for the registrars who are trying to code the right site morphology. So one of the things that we're hoping to do is to map, say the WHO term from a given organ system in the third, fourth, fifth, and in the future, the sixth additions to indicate if it was in ICD-O-3.2 or ICD-O-4 and what the code was in that classification. So those are just some of the things that we're hoping to do. The CAP is hosting and working with us on the cancer pass chart database that Rich Moldwin oversees, and so we'll be working closely together to create this more sophisticated search capability in a search tool. But that's the golden vision down the line is that you'll be able to have more than just CPC search. You'll be able to search the consensus comments, you'll be able to search for that site-morphology combination, whether it existed under ICD-O-3, 3.2, ICD-O-4, et cetera.

Dr. Gladell Paner:

I'm sure there will be thousands of terminologies that will undergo clean up. In terms of timeline currently, how far are you with cleaning up the terms?

Dr. Alison Van Dyke:

Sure. So as I mentioned, for cases diagnosed 2024 and forward, we've done about a third of the cases, an additional third we're done for cases diagnosed 2025 and forward. And we are working on head and neck at this point for 2026. The trigger point for us to begin the review process is when the latest edition WHO comes out in print. And so we are waiting for the skin iron orbit and endocrine books to come out in print before we start the review process for those sites and morphologies.

Dr. Gladell Paner:

Thank you, Alison. So it seems like there's something bigger on the way, so I would switch to your rich and also Alison can comment. So what is the larger mapping effort underway and when will the more powerful search web tool mapping tumor types over time be available?

Dr. Richard Moldwin:

As Kay mentioned, we're currently working on harmonizing the WHO Blue Book terms and codes with the primary sites where they may occur. It actually turns out to be quite a technically intensive process to do the cross maps to every single site that's present in the ICDO {International Classification of Diseases for Oncology) site list. There are about 300 something terms in there, sites in there that have to map to each histologic type for a yes or no kind of response. So that's a very big production. It takes place, it'll take a few years. I think before, as Alison mentioned - we don't have all the blue books completed, so that's ongoing. We map also to alternative terms that are occasionally found in the eCPs. Sometimes the CAP has terms that are ahead of the Blue Books. And then we have what comes in with the ICD-O-4 beta, which was just released a few weeks ago, which has its own twist on some of the terms that may match the eCPs.

They may match the Blue Books or they may not, and they could be subtly different or sometimes more-than-subtly different. So all those things need to be mapped to have common codes and have code corrections applied and documented when the codes were changed. We've also made some progress mapping eCP histologies and data elements to SNOMED CT and in many cases we've created hundreds of new SNOMED CT terms to match the things in the eCPs. They haven't been officially released yet, but we hope we're hoping for Q1 2025. As I mentioned before, future mapping work will involve, for example, harmonizing terminology systems from hematologic malignancies and mapping eCP data elements to the NAACCR data elements, the SSDIs that I mentioned before, so that they can be automatically coded and rather than manually abstracted - and you can't use something like natural language processing for these things. They really require manual effort. And even though some people are trying to use some AI techniques for this, it's really an uphill battle right now and they really need to be mapped from the get-go. So we can get the data flowing directly from one data element on the CAP side on the laboratory side to the registry side. And we're also, on the CAP side, we're doing another set of mappings, which are mapping each of the eCP, the histologies that you see in your computer systems. We're mapping those to the appropriate, if you have a subscription to the Blue Book webpages, you'll be able to just click on the histology and pull up the webpage over there. That's on the CAP side. That's closely related to what we're doing on the Cancer PathCHART side. On the clinical oncology side, we're also looking at, just talking now, about the possibility of incorporating some mCODE data elements into the NAACCR data set and then we'll have to support them in Cancer PathCHART as well.

mCODE is the “minimal Clinical Oncology Data Elements” initiative. It has to do with FHIR and another set of national standards on the clinical oncology side. So we may be looking at incorporating those as well. I want to kind of stick to the pathology discussion here, but we are looking a little bit ahead to what we can do with more clinical oncology data elements. Some of them include pathology data elements, but they also include clinical data elements like mixing, pathology and radiology. So there are some other things going on, but that's just an overview of where we're at right now with the mapping efforts.

Dr. Gladell Paner:

Thank you, Rich. Those are promising, but there's got to be a lot of work there. I could see you mentioned something of that minimal clinical data. Right now we've been, when we were discussing the PathCHART, we're talking about basically cytomorphology. And you mentioned a little bit about the elements in the eCP. Is part of that bigger mapping, project mapping, will it also cover the other elements like important elements for oncologists like grade or stage of the tumor beyond morphology and tumor site?

Dr. Richard Moldwin:

Yeah. Well, it's very complicated and the answer really has to be provided on a data element by data element basis because data elements are “controlled” in quotes by different groups. So for grade it's mostly pathological grading. However, some types of grading systems, are not completely pathological, they may include radiologic factors or patient factors, performance scales and things like that that get beyond where we have data on the pathology side. So we have to find ways of combining those data sets. So we're not really doing that right now with Cancer PathCHART, which is pathology focused. The other up and coming data elements, for example, mCODE is making quite a splash now in the EHR and data exchange area. And we do talk about these on the registry side, but right now we're really focused on the pathology side of things. It would be nice if we could include these other data elements. Also, some of the mCode data elements, just for example, are already present in a somewhat different format as SSDIs and in the NAACCR data dictionary and some of them are not. And so if they're felt to be important for the oncology leaders that are developing these data elements, probably we should be collecting them on the registry side. And so we need to look at these things in much more detail and - we'll get there. We have a lot of work to do on the pathology side, but eventually we hope to get there.

Dr. Gladell Paner:

Thank you, Rich. And Alison, Rich wants you to ask the second part of the question, when will this more powerful search web tool be

Dr. Alison Van Dyke:

Available? Sure. So what I envision is that we will probably have it available for select sites as we develop the content, but I'm envisioning it could be 2027 January 2027, because we want to incorporate ICD-O-4 this, as you can imagine, especially for bone and soft tissue and heme path, this is going to be a huge undertaking. So yeah, I think January 2027 is a more realistic timeline

Dr. Gladell Paner:

And for you, Kay. So how can pathologists get involved in the review process?

Dr. Kay Washington:

Well, we're always looking for subject matter experts, and as Alison said, we still have skin and orbit and endocrine to do, and endocrine will have multiple sites within it. So we'll need multiple groups to look at that. So if anybody is an expert or has a particular interest in these sites, contact me or Alison as we start to put together those review groups. And I'm sure Alison would welcome any feedback on the website and the search tools as well. Absolutely,

Dr. Alison Van Dyke:

Absolutely. And currently we're doing reviewing head and neck sites, so if you are an expert in those sites, please do reach out.

Dr. Gladell Paner:

You need at least three reviewers, I believe.

Dr. Alison Van Dyke:

Yeah, so it's the clin core reviewer does the first pass. That's our one subspecialist expert who does the first pass review, and then we do independent reviews by two to three additional pathologists. And then there's a consensus conference to review the discrepancies.

Dr. Gladell Paner:

Thank you, Alison. So this is for you, Rich. So what are the ways other than Cancer PathCHART, that CAP collaborates with public health to advance interoperability and data standards for cancer surveillance and research?

Dr. Richard Moldwin:

First of all, the development of the CAP Cancer Protocols and the electronic Cancer Protocols, they promote best practices, standards, accuracy and consistency in cancer diagnostics and also in informatics. The eCPs are the best way to get standardized, discreet coded data into pathology systems for subsequent use for downstream uses in searching, quality measures, and transmitting the data to registries. There's nothing like them - otherwise you’re on your own. So that's why we really encourage the use of the eCPs and it's a big initiative at the CAP, through our group - Cancer Protocols and Data Standards. With our marketing team, we also produce these initiatives called “Cancer Data Champions,” which includes videos and podcasts like this. And we have a Cancer Data Summit at the CAP meeting where we talk about a whole bunch of different issues. And really in cancer pathology informatics at CAP, CAP works with many other cancer organizations to promote data standards and including groups like ASCO and federal agencies like CDC and NCI, but also ONC, which is now called ASTP, and others.

And we work on data transmissions with groups like HL7, just standardize the way pathology data is exchanged. And one project we're doing, for example, with the CDC and also the NCI, there is this very collaborative project we work on called the NAACCR Annotated List, and it's sort of like a microcosm of Cancer PathCHART. It's been going on for years, and I think Alison alluded to it, or maybe Kay alluded to it about all the legacy terms and rearranged terms – we call them “transformed terms” – that we have in this list of something like 5,000 terms that has never been cleaned up. So one of the things we're doing is trying to clean up that standardized list of terms and legacy terms. Mark the legacy terms as legacy, put their start date, stop date on there, the start ICD-O version, the stop ICD-O version. This has never been done before. And these are all derived from old, faxed ICD-O lists and PDF documents. So we're trying to get as much as possible standardized in there to say, these are old terms. You may see this still, you may see them used, but you shouldn't be using them. You should pick a better term. So that's the NAACCR annotated list that we're working on, we're very far along with that right now.

Dr. Alison Van Dyke:

I just want to add one quick thing, and that is there's a lot of interest in making cancer surveillance data available in a more timely fashion instead of the two plus year timeline between a cancer diagnosis and case creation and when the data are actually released for statistics, we are now really advocating the use of synoptic reporting because using the synoptics allows us to build an abstract off of electronically transmitted data like Rich was saying, and starting that abstract in a much more timely fashion rather than waiting for a manual abstraction process.

Dr. Gladell Paner:

Thank you, Alison, and thank you, Rich, and thank you, Kay. Unfortunately, this is all the time that we have. So I would like to thank the three of you for giving us your expertise and insights and explainings to us the Cancer PathCHART and how will it impact pathologists. And I would like to pass this to you, Becca.

Becca Battisfore:

Thank you all for joining the podcast to talk about this important topic. And I want to thank you all for listening to this CAPcast Cancer PathCHART is a free resource available at seer.cancer.gov. We'll have a link to that in the episode description and for more information about the CAP, visit cap.org.

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