Behind the Numbers:

Xiao-Cheng Wu, MD, MPH, CTR, Professor and LTR Director

Dr. Xiao-Cheng Wu leads LSU Health New Orleans School of Public Health’s Louisiana Tumor Registry (LTR). She has spent almost 30 years working with cancer statistics, both in cancer research, as well as the cancer incidence rates and survival data that guide cancer policy, research funding priorities, targeted interventions and education for the state of Louisiana and the United States of America. It is a hard and demanding job, but work that is crucial to saving lives by preventing or reducing cancer.

Dr. Wu, known affectionately as Wu around the School, was happily doing cancer research in the early 1990s. She analyzed statistical data on the differences between blacks' and whites' cancer survival for a study funded by the National Cancer Institute, among others. She thought she had found her niche, and it was cancer research – until cancer came knocking at her family’s door.

"My mother-in-law, who was in her 60's, was diagnosed with cancer in 1995, and she died a year after," Wu recalls. "We did not know that the cancer had metastasized everywhere. When cancer takes someone you love, it really makes you think about things in a different way, and it motivates you to do what you can to spare others the same tragedy. Cancer affects so many people's lives. As a statistician, I realized how important data is, because without data, where do you start and how do you know where will you have the most impact?"

Everything related to health these days is evidence-based. That means decisions are based on the best information you can get – from the results of well-designed and well-conducted research studies supporting clinical decisions to high-quality, reliable population data supporting policy decisions and more.

“You need to use cancer registry data to identify where you should put efforts to reduce cancer incidence and deaths. Physicians deal with individual patients; a population-based cancer registry monitors cancer occurrence at the population level. Cancer registry data can help policymakers to make good decisions. It can be used for screening, for cancer prevention and education – for lots of things.”

So, Wu began her work with LTR, which not only involved data analysis but then data collection as well.

“I got my certification – I am a certified tumor registrar – because I wanted to understand more about cancer coding and how to best collect data.”

As Wu got more involved with data collection, she realized how critical the quality of the data is. It’s not enough to generate data. It has to be quality data.

“It’s not easy. You have to collect data from all reporting sources, and they are many.”

LTR works with hospitals, freestanding surgical and radiation therapy centers, oncology, urology, and dermatology clinic offices, hospices, nursing homes, pathology labs in- and out-of-state, and other state departments, including vital records, among other sources.

“Gathering information on all newly diagnosed cancers among Louisiana residents no matter where the diagnosis is made is quite involved. There’s a lot more to it than most people realize, and our team is dedicated to going the extra mile. If cases are not reported to us, we go out and find them, using every avenue available to us. You have to ensure that your data is accurate and that it is of the highest quality, so we perform quality assurance activities and audits every step of the way.”

LTR’s hard work continues to benefit not only the citizens of Louisiana, but also national and international cancer efforts. LSU Health New Orleans School of Public Health’s Louisiana Tumor Registry is one of only 18 population-based cancer registries in the US chosen by the National Cancer Institute to join its Surveillance, Epidemiology and End Results (SEER) Program. The data from this program drives national cancer policy and priorities. NCI’s SEER Program has awarded First Place to LTR for the past eight consecutive years for its data. This award is given to registries that meet all the benchmarks for high-quality, timeliness, and completeness of cancer data – exceeding 98% of cases.

LTR also belongs to the Centers for Disease Control and Prevention’s National Program of Cancer Registries (NPCR) and is one of only 10 specialized registries funded by NPCR to collect enhanced data to support comparative effectiveness research. NPCR has recognized LTR as a Registry of Excellence. It is one of only 19 registries nationally to achieve this highest honor. LTR data met all standards for completeness and quality, and the award indicates the high-quality of the data NPCR makes available for cancer prevention and control activities at the local, regional and national levels.

LTR is also invited to submit its data to the North American Association of Central Cancer Registries (NAACCR) for its publications, considered to be the most prestigious publications on cancer incidence worldwide. NAACCR has also recognized the quality of LTR data with awards for quality, completeness and timeliness of its data. LTR data have received Gold Certificates from the North American Association of Central Cancer Registries every year since 1997.

As a testament to Wu’s stature and national regard, she was invited to co-author an Annual Report to the Nation on the Status of Cancer – the first report to the country on the decline in both cancer incidence and death rates.

But the benefit of LTR’s work is felt most immediately at home. It has been estimated more than 40% of cancers are preventable. Colorectal cancer is one of them. LTR produced maps of the areas in Louisiana that have a significantly higher proportion of later-stage diagnoses of colorectal cancer, so education and screening resources could be targeted to those areas. The Louisiana Colorectal Cancer Round Table, a collaborative effort in which LSU Health New Orleans School of Public Health participates, has been working to increase the percentage of people being screened for colorectal cancer to 80% by 2018 using LTR data and maps.

Wu and her team are dedicated to their work. Every single one of them is personally motivated to get it right because they have all been touched by cancer in one way or another. Besides family and close friends, their colleagues have battled cancer. Over the years LTR staff has included cancer survivors and those undergoing treatment, as well as those who lost the fight. Beth Schmidt worked at the Tumor Registry for 20 years. Her work helped visualize LTR data by generating accurate maps. She submitted a proposal to SEER, which was the only one of its kind chosen, to bring in a national geographic information system (GIS) expert. That project created the maps showing the areas of higher incidence of late-stage colorectal cancer used by the Louisiana Colorectal Cancer Round Table. Beth died of ovarian cancer two years ago. The School has created a permanent way to honor and remember her. Beth continues to inspire excellence as each year, the Beth Schmidt Staff Member of the Year Award recognizes the contributions of one employee of the School of Public Health.

“We cannot just stand by and do nothing while our loved ones suffer. We have to do something that makes a difference, and I believe that the Tumor Registry is the foundation of the cancer control continuum – from prevention, early detection, diagnosis and treatment to survivorship care,” says Wu. “I am so proud of the Tumor Registry’s work because our data can be used right now. It’s not like pure research, although that is equally important. Our work is different. Our data can be used directly for cancer control and prevention. Collecting, counting and analyzing data can be tedious, but it is really meaningful. It’s not just numbers. What we do really helps people and saves lives, and that is huge. It is what encourages each of us to do the best work we can do.”