Cancer Registry & Cancer Registrars

Like coding, cancer registry is an area of specialization in the health information management field. Many cancer registrars start out as RHIT's or RHIA's (see credentials page). Cancer registrars manage, analyze and maintain clinical cancer information databases that are used in research, quality management, facility planning, program development, and compliance.

Cancer registrars need skills in tumor coding and staging, organization, public speaking, statistics, and technical writing. Core duties involve finding reportable cancer cases (case finding), summarizing and coding cancer related information from medical records (abstracting), and following cancer patients (follow up).

To abstract and code cancer cases, cancer registrars use coding manuals, staging manuals, coding guidelines, and abstracting systems specific to cancer registry. Cancer registrars do not code with ICD-9-CM, but with ICD-O-3.

Data collection, coding, and reporting standards for cancer registries are in a constant state of change. Registrars must continually train and re-train to keep up with the advances in cancer registry.

Cancer registrars work in various settings. According to a recent National Cancer Registrars Association (NCRA) study, over 50% of cancer registrars work in hospitals and 38% work in state or regional central cancer registries. The rest work for consulting companies, vendors, education programs, private practices, or national standard setting organizations. Most work on-site or travel, but telecommuting is an upcoming option for some cancer registrars.

The 2008-09 Occupational Outlook Handbook (OOH) by US Department of Labor states "Medical records and health information technicians also may specialize in cancer registry. Cancer (or tumor) registrars maintain facility, regional, and national databases of cancer patients. Registrars review patient records and pathology reports, and assign codes for the diagnosis and treatment of different cancers and selected benign tumors. Registrars conduct annual followups on all patients in the registry to track their treatment, survival, and recovery. Physicians and public health organizations then use this information to calculate survivor rates and success rates of various types of treatment, locate geographic areas with high incidences of certain cancers, and identify potential participants for clinical drug trials. Public health officials also use cancer registry data to target areas for the allocation of resources to provide intervention and screening. ... Cancer registrars should experience job growth. As the population continues to age, the incidence of cancer may increase."

As you see above, cancer registrars are currently listed under health information technicians in the OOH (see links page). However, cancer registrar's job tasks are significantly different from those of medical records technicians and coders. Thus, NCRA has formally requested a separate occupational classification for cancer registrars. This 2006 request was denied, but NCRA is appealing.

Cancer registries may also be called tumor registries or oncology data centers. Cancer registrars work under many different job titles, including certified cancer registrar, senior cancer registrar, cancer registrar tech specialist, certified oncology data professional, CTR, CTR coordinator, tumor registrar, lead certified tumor registrar, clinical data specialist, abstractor, field abstractor, cancer registry abstractor, quality control medical abstractor, cancer registry specialist, cancer registry assistant, cancer registry analyst, cancer registrar analyst, cancer registry coordinator, cancer registar coordinator, cancer research QA manager, administrative analyst, oncology data technician, oncology data specialist, oncology quality review specialist, oncology data coordinator, quality control specialist, quality control manager, cancer data supervisor, cancer data coordinator, senior coordinator, senior medical information specialist, data collection specialist, data manager, cancer program coordinator, cancer program manager, cancer program data specialist, registry information services director, and clinical registry information services manager.

A list of NCRA accredited formal education programs for cancer registrars can be found on their website. If there are no accredited schools near you, you can choose an online program. When I last looked, six of these cancer registrar programs were offered online:

Note: I am using AS above to indicate the associate degree option. The actual degree could be Associate in Science (AS), Associate in Applied Science (AAS), or Associate in Arts (AA) depending on the school.

All of the NCRA accredited programs qualify you to sit the for the CTR credentialing exam. Eligibility requirements for the CTR exam are currently undergoing changes. Starting in 2010, all candidates for the CTR credentialing exam must have a minimum of an associate’s degree in Cancer Information Management (CIM) or in another allied health field. If you already hold an AS degree, you can just complete a CIM certificate program, otherwise you should complete an AS degree.

Beginning in the fall of 2007, the University of Texas at Brownsville and Texas Southmost College (UTB/TSC) will offer an online bachelor's degree of Applied Arts and Sciences - Interdisciplinary (BAAS-ID) with specialization in tumor registry. Presently, this is the only bachelor's degree program offered in the cancer registry field. For more info, visit the UTB/TSC web site.

Note: Competing the above SEER training modules does not qualify you to sit for the CTR exam. In 2008, you will also need work experience in a cancer registry and have some formal education in CIM, or have completed a NCRA accredited CIM program. Starting in 2010, an associate's degree will be required. Read the CTR exam eligibility rules.

Certified Tumor Registrar (CTR) is the credential for cancer registrars. Most cancer registries prefer to hire experienced and credentialed (or CTR eligible) cancer registrars. NCRA has offered the CTR credential since 1983. Today there are over 4,000 CTR's.

The CTR exam covers registry organization and operations, A&P related to cancer, histology, cancer coding and abstracting, cancer staging, data analysis and interpretation, statistics, patient follow-up, and computerized data management. Total time for the exam is 4.5 hours. It has two parts. Part 1 is closed-book and part two is open-book. Part 2 requires three reference manuals for coding and staging: AJCC staging manual, ICD-O-3 book, and the CS manual (see books below). Read the CTR exam content outline.

The 2008 CTR exams are offered in March and September. These computerized exams are administered by the Professional Testing Corporation. Search for a LaserGrade testing center near you.

	Cancer Registry Management Principles and Practice by Herman R. Menck Kendall Hunt, 2nd edition, 2004 THE cancer registry handbook and textbook used by cancer registrar training programs also used in preparing the CTR exams ISBN-10: 0757501923 ISBN-13: 978-0757501920
	Central Cancer Registries: Design, Management and Use by National Cancer Registrars Association, Herman Menck, Dennis Deapen, Jerri Linn Phillips, Thomas C. Tucker Kendall Hunt, 2nd edition, 2007 also used in preparing the CTR exams ISBN-10: 0757531202 ISBN-13: 978-0757531200
	ICD-O-3 * International Classification of Diseases for Oncology by April G. Fritz, Constance Percy, Andrew Jack, L. H. Sobin, Max D. Parkin World Health Organization (WHO) 3rd edition, 2000 for coding the site (topography) and the histology (morphology) of neoplasms also used in preparing the CTR exams needed in the open book part of the CTR exam ISBN-10: 9241545348 ISBN-13: 978-9241545341
	AJCC Cancer Staging Manual * by Frederick L. Greene, David L. Page, Irvin D. Fleming, April Fritz, Charles M. Balch, Daniel G. Haller, Monica Morrow American Joint Committee on Cancer 6th edition, 2002 needed in the open book part of the CTR exam ISBN-10: 0387952713 ISBN-13: 978-0387952710 Also available as: AJCC Cancer Staging Handbook - same book as above but w/o staging forms and CD-ROM, pocket size AJCC Cancer Staging Atlas - use alone or with the AJCC Manual, over 400 illustrations help visualize the TNM components AJCC Cancer Staging Atlas - Kindle version with instant wireless delivery, see ebooks page
	Basic Statistics for the Health Sciences by Jan W. Kuzma, Steve Bohnenblust McGraw-Hill 5th edition, 2004 introductory statistics text that assumes no prerequisites other than high school algebra we used this book in my CIM statistics class ISBN-10: 0072985437 ISBN-13: 978-0072985436
	Statistics for the Utterly Confused by Lloyd R. Jaisingh McGraw-Hill, 2nd edition, Dec 2005 Confused in your statistics class? buy this as a companion book to your main statistics textbook ISBN-10: 0071461930 ISBN-13: 978-0071461931
	Cancer Dictionary by Michael J. Sarg, Ann D. Gross Checkmark Books 3rd edition, Mar 2007 over 2,500 alphabetical entries ISBN-10: 0816064121 ISBN-13: 978-0816064120
	Clinical Oncology: A Multi- Disciplinary Approach for Physicians & Students by Phillip Rubin, Jacqueline P. Williams Saunders 8th edition, Jun 2001 over 900 pages, incl. a CD-ROM we used this book in my pathophysiology of cancer class ISBN-10: 0721674968 ISBN-13: 978-0721674964
	American Cancer Society's Clinical Oncology by Raymond E. Lenhard, Robert T. Osteen, Ted Gansler Blackwell Publishing 3rd edition, Nov 2000 heavy book with over 900 pages b/w photos & illustrations, incl. a CD-ROM we used this book in my CIM classes also used in preparation of CTR exams ISBN-10: 0944235158 ISBN-13: 978-0944235157

* The following books are needed in the open book portion of the CTR exam: ICD-O-3 (above), AJCC Cancer Staging Manual (above), and Collaborative Staging Manual (buy from NCRA or download from AJCC).

References:
Advance http://www.advanceweb.com/
AHIMA http://www.ahima.org/
NCRA http://www.ncra-usa.org/index.html
NCRA's Council on Certification http://www.ctrexam.org/index.html
OOH http://www.bls.gov/oco/home.htm