Changes to The North American Association of Central Cancer Registries (NAACCR) record layout that will affect coding and abstracting for the year 2010 are being developed. Several years ago, national standard setters for cancer surveillance agreed major changes needed to be curtailed to once every 3 years. This was to allow for all the difficulties in making programmatic changes, education to learn new standards, labor costs, etc.

We are now preparing for our first 3-year cycle when major changes can happen. Consequently, we have 3 major changes happening at one time. National Cancer Institute (NCI)/SEER Program is releasing the new Hematopoietic Multiple Primary and Histology (MP/H) database and standards for collecting hematopoietic disease. The AJCC Cancer Staging Manual, 7^th Edition is being published in 2009 and will take effect on Jan. 1, 2010. There will be education for physicians and cancer registrars in the new requirements for staging. The Collaborative Staging (CS) Algorithm uses AJCC requirements for TNM and Stage to output not only the AJCC Stage but SEER Summary Stage 77 and SEER Summary Stage 2000. The new CS guidelines are called CSv2 (Collaborative Stage Version 2).

The process of changing the NAACCR record layout is lengthy and every standard setting organization is in attendance to participate. There are also many different levels of participation for standard setters that goes up to the highest level of authority for the different organizations. NCRA is represented at all levels of participation.

The next steps are to determine what standard setters will require for addition to our current data collection models. People are beginning to get nervous about the possibility of expanding requirements that take more time to collect in an abstract. A lot of thoughtful discussion is taking place on the best ways to collect new requirements, the best ways to educate registrars for the new requirements, as well as what standard setters will require in their documentation.

The changes for CSv2 and AJCC Cancer Staging Manual, 7^th Edition are being driven by the need for cancer data to be relevant to clinicians. The physicians who are developing the 7^th Edition found a greater need for prognostic indicators to be collected in treating patients.

The changes for the collection of hematopoietic disease and the need for the Hematopoietic MP/H are being driven by outdated standards for collection of hematopoietic malignancies. The Hematopoietic Task Force has been working on these changes and uses the WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues, Fourth Edition (Swerdlow, S.H., Campo, E., Harris, N.L., Jaffe, E.S., Pileri, S.A., Stein, H., Thiele, J., Vardiman, J.W; 2008; ISBN-13 9789283224310) as their information resource.

New changes in data collection are always a concern to the National Cancer Registrars Association (NCRA) on behalf of its membership. We want to assure our members as well as all cancer registrars that we have been represented and heard at all levels in regards to an overburdened industry with finite resources. Thought and care is going into making these changes as minimal as possible. Some software will be interactive and software vendors for abstracting are being included in making this effort as easy as possible. The entire cancer surveillance network is working together in a united capacity to make the needed changes in the least time consuming, efficient manor for everyone.

Medicine moves forward. We must move forward as well to remain useful. Let's embrace our new changes with enthusiasm and hope for a good future for cancer surveillance efforts.

Lynda Douglas is president of NCRA.