• ity, predictive value) in a community setting is being evaluated in eight sites across the country as part of a congressionally mandated study under the Mammography Quality Standards Act of 1992. The major objectives of the consortium are to enhance understanding of the accuracy, cost, and quality of breast cancer screening; to foster collaborative research among consortium participants; to assess factors associated with variations in mammography practice, accuracy, and subsequent diagnostic evaluation; and to provide a foundation for the conduct of clinical and basic science research that can improve understanding of breast cancer etiology and prognosis. By the year 2000, the consortium will have data on nearly 3.2 million screening mammographic examinations and more than 24,000 breast cancer cases. Through 1999, total funding for the consortium is $17.2 million (NCI provides 85-90 percent of the total funding, with the remainder coming from CDC and the DoD). An additional $31 million for the period FY 2000 through FY 2004 will support the extramural research effort.
  • The SEER-Medicare database: This is a collaborative effort of the NCI, the SEER registries, and HCFA to create a large population-based source of information for cancer-related epidemiologic and health services research. The database links cases in SEER cancer registries to claims records in Medicare's administrative database. The currently available linked file includes all Medicare data through 1994 for persons diagnosed with cancer through 1993. An update of the linkage, which will incorporate SEER cancer cases diagnosed in 1994-1996, will be completed in 1999.

The SEER-Medicare data offer an opportunity to examine patterns of care prior to the diagnosis of cancer, during the period of initial diagnosis, and during long-term follow-up. Topics that can be addressed with the linked database include patterns of care for specific cancers, the use of health services, and the costs of treatment. There is also the potential for longitudinal surveillance of the health care of persons with cancer. These data can be used to assess health care directed toward the prevention of disease or disability, as well as the restoration or maintenance of health (Edwards, 1997). Active projects using the linked SEER-Medicare database include analyses of

  • trends in treatment of in situ breast cancer;
  • total lifetime payments for elderly cancer patients;
  • differences in patterns of care and cancer survival between health maintenance organizations (HMOs) and fee-for-service (FFS) providers;
  • breast cancer treatment patterns and trends;
  • prostate cancer detection practices; and
  • trends and variations in initial treatment for early-stage prostate cancer.

HMO Cancer Research Network. The purpose of the Cancer Research Network (CRN) is to encourage the expansion of collaborative cancer research among health care provider organizations that are oriented to community care; have access to large, stable, and diverse patient populations; and are able to take advantage of existing integrated databases that can provide patient-level information relevant to research studies on cancer control and to cancer-related population studies. Beginning in 1999, NCI will fund the first CRN project—a consortium of 10 large, not-for-profit, research-oriented HMOs. The CRN will conduct four main projects (Martin Brown, Head, Health Services and Economics Section, Applied Research Branch, Cancer Surveillance Re-

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