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Enhancements to cancer surveillance systems are needed for meeting increased demands for data and for developing effective program planning, evaluation, and research on cancer prevention and control. Representatives from the American Cancer Society, Centers for Disease Control and Prevention, National Cancer Institute, National Cancer Registrars Association, and North American Association of Central Cancer Registries have worked together on the National Coordinating Council for Cancer Surveillance to develop a national framework for cancer surveillance in the United States. The framework addresses a continuum of disease progression from a healthy state to the end of life and includes primary prevention (factors that increase or decrease cancer occurrence in healthy populations), secondary prevention (screening and diagnosis), and tertiary prevention (factors that affect treatment, survival, quality of life, and palliative care). The framework also addresses cross-cutting information needs, including better data to monitor disparities by measures of socioeconomic status, to assess economic costs and benefits of specific interventions for individuals and for society, and to study the relationship between disease and individual biologic factors, social policies, and the environment. Implementation of the framework will require long-term, extensive coordination and cooperation among these major cancer surveillance organizations.

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The Kentucky Breast Cancer Task Force in conjunction with the Kentucky Cancer Registry and the Kentucky Cancer Program has prepared a Breast Cancer Report Card concerning the incidence and mortality of this disease among Kentucky women for the period of 1995 to 2000. Comparison of Kentucky data with those from the Surveillance, Epidemiology and End Results (SEER) program of the National Cancer Institute reveals that the incidence rate of breast cancer in Kentucky is lower than that for the SEER population. The incidence of "early" stage disease is significantly lower among Kentucky women, but the incidence of "late" stage disease is similar in both data sets. The incidence rate is lower in rural than urban Kentucky, and is lowest in rural Appalachian Kentucky. The ratio of "early" to "late" stage breast cancer is lower for Kentucky women than for the SEER population and lowest in women over age 65, the group in which approximately half of the new cases of breast cancer are detected each year. Mortality rates are similar for Kentucky and for the SEER population. Improving the breast cancer mortality rate in Kentucky will depend on increased case-finding of "early" stage disease and increasing the ratio of "early" to "late" stage incident cases.

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BACKGROUND: This article describes a model used by the Kentucky Breast Cancer Task Force to develop and implement a statewide breast cancer action plan. METHODS: The authors examine the challenges encountered during different phases of plan development and the ways in which these challenges were addressed. CONCLUSIONS: To successfully move from planning to implementation, task forces must have broad-based participation, a "lead organization" to coordinate the planning process, focused work agendas, and firm commitments from cancer-related organizations and groups to spearhead activities in specific implementation areas.

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The pathologist plays a key role in the detection and diagnosis of bladder cancer, as well as in the development of strategies for the clinical management of this disease by the urologist. In order to make appropriate decisions, the urologist needs help from the pathologist in determining: 1) whether or not a bladder tumor is present; 2) if present, its histologic type, grade, depth of invasion and evidence of lymphatic or blood vessel invasion; 3) whether or not there are associated neoplastic lesions elsewhere in the bladder -or elsewhere in the lower urinary tract; and 4) if some therapeutic modality has been directed toward the neoplastic tissue, the completeness of tumor removal or destruction. It is recommended that the WHO classification of bladder tumors be used by pathologists in their reports to facilitate communication among pathologists, urologists, radiation therapists, medical oncologists, and others involved in the management of bladder cancer patients. In addition, the pathologist should make a definite statement regarding the presence or absence of muscle tissue in every bladder biopsy specimen containing tumor. After one or more superficial tumors are identified by the urologist and treated by transurethral means, management of the patient will depend not only on the microscopic evaluation of the resected tumor but also on an accurate assessment of the neoplastic potential of the remaining epithelium. The cytopathologic examination of urine samples or bladder washings aids this assessment.