The purpose of the Washington state cancer registry is to monitor the incidence of cancer in the state and report applicable limited data according to federal requirements. Information collected through the cancer registry system is used by research and public health professionals to understand, control and reduce occurrences of cancer in residents of Washington. This chapter establishes the criteria for identifying and reporting cancer cases. It also defines the standards for access and release of cancer case information.

The definitions in this section apply throughout this chapter unless the context clearly indicates otherwise.

(1) "Cancer case" means:

(a) Any malignant or cancerous neoplasm except basal and squamous cell carcinoma of the skin;

(b) Carcinoma of the external genital organ sites, including those with histology identified as basal or squamous cell type. External genital organ sites include the vulva, labia, clitoris, prepuce, penis and scrotum;

(c) Neoplasms noted as carcinoma in situ or noninvasive carcinomas, except carcinoma in situ of the cervix uteri;

(d) All benign, uncertain, borderline or malignant solid intracranial and central nervous system tumors, including the meninges and intracranial endocrine structures;

(e) All hematopoietic and lymphoid neoplasms including certain potentially malignant hematopoietic conditions;

(f) Other diagnoses that meet the reporting requirements of:

(i) The Center for Disease Control's National Program of Cancer Registries;

(ii) The National Cancer Institute's Surveillance Epidemiology and End Results Program;

(iii) The North American Association of Central Cancer Registries as described by the International Classification of Disease for Oncology, Third Edition (ICD-O-3);

(iv) The North American Association of Central Cancer Registries as described by the WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues, Fourth Edition, Volume 2 published by the World Health Organization.

(2) "Case report" means a complete report, including all items in WAC 246-102-040(3), documenting a cancer case.

(3) "Certified tumor registrar (CTR)" means an individual certified by the National Cancer Registrars Association.

(4) "Department" means the Washington state department of health.

(5) "First course treatment" means all methods of treatment documented in the treatment plan after the original diagnosis and administered to the patient before disease progression or recurrence.

(6) "Health care facility" means any facility or institution which diagnoses, evaluates, provides treatment to patients or provides biomarker or other required prognostic or predictive information to physicians on patients with reportable or potentially reportable cancer cases. Health care facilities include:

(a) Hospitals providing either inpatient or outpatient services;

(b) Free-standing surgical, radiation therapy, imaging, and oncology centers;

(c) Health maintenance organizations;

(d) Multispecialty clinics;

(e) Hospices;

(f) Ambulatory surgical facilities; and

(g) Other outpatient facilities.

(7) "Health care provider" means a person licensed, certified, or registered under RCW 18.130.040 and who diagnoses, evaluates, or provides treatment to patients with reportable or potentially reportable cancer cases.

(8) "Laboratory" means pathology, cytology, biomarker, molecular, genetic and other clinical or reference laboratories, including both hospital laboratories and free-standing laboratories.

(9) "Potentially reportable cancer case" means the reporting of a cancer case based on ambiguous terminology.

(10) "Reporting entity" means any health care facility, laboratory, treatment center, or health care provider.

(11) "Stage of disease" means how far the cancer has spread from the organ or site of origin at the time of diagnosis and treatment planning.

(12) "State cancer registry" means the Washington state cancer registry.

(1) Reporting entities that diagnose, or provide first course treatment to a patient with a cancer case or potentially reportable cancer case shall report the cancer case to the state cancer registry.

(2) If a health care provider refers patients to a health care facility with cancer registry staffing for diagnostic or first course treatment services, then the health care facility is responsible for reporting the case to the state cancer registry.

(3) For purposes of this section "health care facility with cancer registry staffing" means those health care facilities with in-house cancer registries or contracted registry staff services.

The state cancer registry shall:

(1) Publish a reportable list annually.

(2) Publish a recommended case finding list annually.

(3) Publish a list of required data items annually.

(4) Publish recommended reporting guidelines as needed.

(1) Reporting entities shall prepare and submit case reports in a format provided by the state cancer registry.

(2) Reporting entities shall submit completed case reports to the state cancer registry within six months of the date of diagnosis or date patient is first seen for first course treatment, if the diagnosis was made at another health care facility or by another health care provider.

(3) Case reports shall include the following information from the patient's medical records:

(a) Patient information:

(i) Name (last, first, middle);

(ii) Address at time of diagnosis;

(iii) Sex;

(iv) Race(s);

(v) Spanish/hispanic origin;

(vi) Birthdate;

(vii) Age at time of diagnosis;

(viii) Social Security number;

(ix) State or country of birth;

(x) Usual occupation, or if retired, primary occupation before retirement;

(xi) Primary payor;

(b) Diagnostic information:

(i) Date of patient's first contact with the reporting entity for the diagnosis or treatment of the cancer;

(ii) Date diagnosis made;

(iii) Primary site of originating tumor;

(iv) Laterality (if applicable);

(v) Histology type or types, behavior and grade of tumor;

(vi) Documentation, including dates, of pertinent diagnostic or evaluation studies, and biopsies;

(vii) Written documentation that describes the stage of disease at diagnosis, including Collaborative Staging coding used;

(viii) Sequence number;

(c) First course of treatment information:

(i) Date initial treatment began or the date the decision for no treatment was made;

(ii) Description of all treatment given as part of the first course treatment including, but not limited to, surgery, radiation, chemotherapy, BRM/immunotherapy, hormone or other therapies, or a statement as to why no treatment was given;

(d) Other information:

(i) Date of last contact;

(ii) Vital status at time of last contact;

(iii) Identification of reporting entity providing information:

(A) Name and address; or

(B) National Provider Identification number; and

(iv) Other items necessary to meet the reporting requirements of the state cancer registry as provided annually.

(4) For the purpose of assuring high quality data, the state cancer registry will publish reporting guidelines for assistance in completing the requirements in subsections (2) and (3) of this section, which will be available on the registry's website.

(5) All laboratories shall provide:

(a) Report files within ten days of the close of each month or on a schedule determined by the volume of reports acquired daily and approved by the state cancer registry;

(b) Updated information made to reports resulting in addendums and amendments; and

(c) Patient demographic information.

(1) To assure accurate monitoring of the incidence of cancer in Washington, the state cancer registry shall review the overall quality of all cases received using national guidelines.

(2) The state cancer registry shall follow up with reporting entities for additional case information as needed to ensure the completeness and quality of a case report.

(3) The state cancer registry shall provide education and training related to identifying and reporting cases. The state cancer registry shall:

(a) Offer education and training opportunities to certified tumor registrars on staff at health care facilities.

(b) Offer education and training opportunities to individuals not certified as a certified tumor registrar, but who report cancer cases to the state.

(4) The state cancer registry shall provide technical assistance to reporting entities.

(5) The state cancer registry shall perform audits of reporting entities to ensure accurate and complete reporting.

(6) The state cancer registry will provide thirty days notice of an audit.

(7) The state cancer registry shall request the following documents, as appropriate from the reporting entity, as part of the audit process:

(a) Disease and operations indices files;

(b) Pathology, cytology, and autopsy reports or files;

(c) Report files providing results of specialized testing, such as biomarker results or results of any other tests providing prognostic or predictive information;

(d) Report files providing imaging results;

(e) Radiation therapy new patient or summary treatment files;

(f) Medical oncology new patient or summary treatment files;

(g) Office visit logs; and

(h) Other alternative reports or electronic files necessary to identify and provide information on reportable or potentially reportable cancer cases.

(1) Information collected by the state cancer registry shall be used only for statistical, scientific, medical research and public health purposes.

(2) The department may release state cancer registry information for research purposes:

(a) After the research project has been reviewed and approved by the Washington state institutional review board; and

(b) After a written agreement between the department and the researcher is in place regarding state cancer registry information accessed, used or disclosed. Written agreements shall incorporate:

(i) The confidentiality requirements in RCW 42.48.020; and

(ii) The department's data security requirements.

(3) The department may release state cancer registry information for projects to assess threats to public health or improve public health practice after the project has been reviewed and approved by the department and a data-sharing agreement is in place.

(4) The state cancer registry shall publish an annual report that includes:

(a) Age-adjusted incidence rates;

(b) Age-adjusted mortality rates; and

(c) Age-adjusted incidence and mortality rates by sex, race, ethnicity, and county at diagnosis subject to confidentially requirements.

(5) The state cancer registry shall make available to health care facilities and health care providers:

(a) Information for patients and their families that describes the purpose of the state cancer registry;

(b) The statutory requirements;

(c) The intended use of case information;

(d) The circumstances under which cancer registry information is disclosed.

(6) The state cancer registry shall exchange data with states that have a data exchange agreement in place. The data provided to other states shall only include cancer cases with an address at the time of diagnosis outside the borders of Washington state.