Emory Report

April 12, 1999

 Volume 51, No. 27

Steven Roffers helps document U.S. cancer statistics

Steven Roffers' office is crowded. Clogging the already narrow passage between door and desk are several boxes of thick books, hefty spiral-ringed tomes of cancer data that for at least one April afternoon had no other home. "I told the Fed Ex guy to just put them in here," Roffers sighed. "I don't know where else they can go."

Of course, Roffers can place part of the blame on himself, since his work with several cancer registry organizations--including the National Cancer Registrars Association, of which he is currently president--makes up a goodly portion of what is contained within the reports. In fact, NCRA has declared April 11-17 "National Cancer Registrars Week" to recognize the people who are helping define the problem of cancer so that others may then find causes and cures.

"Richard Nixon declared war on cancer in 1971, and yet here we are in 1999 without a cure," Roffers said. "The problem is we still don't really have a good feel for what it is, who's getting it, where they live and when they get it, that kind of information."

Cancer registries are data systems at various levels that collect, manage and analyze data on people who have been diagnosed with cancer. Many hospitals have their own in-house registries, but there are also organizations at the regional and state levels, and seven years ago Congress authorized the Centers for Disease Control and Prevention to develop a national network of cancer registries. These groups provide the foundation for cancer research, tracing patterns for all types of cancers across many different at-risk populations.

Roffers has been involved in cancer registry work for nearly 13 years and was hired at Emory just nine months ago to work for the Georgia Center for Cancer Statistics, run out of the School of Public Health and directed by Professor John Young. Young was a colleague of Roffers' when the two were in California working for the North American Assocation of Central Cancer Registries. Emory recruited Young and shortly after recruited Roffers, who initially had no desire to leave Northern California but slowly became convinced of his karmic imperative.

"Emory flew me here for an interview, and around the same time I had an interview with the American Cancer Society, so they flew me here," Roffers said. "Then the CDC had a position I also applied for, so they flew me out, and then the Council of State and Territorial Epidemiologists, a branch of the CDC, also flew me out. So I had all these paid househunting trips, and I thought, 'Wow, God's trying to tell me something.'"

Roffers finally listened, and he's spent his time at Emory working on cancer registry training programs and flying to sites all over the world to help local agencies set up their own cancer registries. He's been to Bolivia, India, China, Jordan and Egypt, to name just a few. In the United States studies have shown that half of men and a third of women are diagnosed with cancer at some point in their lifetimes; the absence of cancer registries makes it impossible to determine statistics like these in some other countries, but Roffers has formed his own firsthand conclusions.

"The reality is, in places like India they're living longer over there only to get really funky cancers, different cell types, different sites on the body," he said, brandishing a series of snapshots he took while in Thiruvananthapuram. Roffers described a local vice called paan, a mishmash of all sorts of ingredients, including betel nut, crushed and rolled up in a leaf and placed between cheek and gum á la chewing tobacco. In one particular gruesome photo, Roffers pointed out an Indian woman with an oral tumor the size of a golf ball.

"This woman's tumor was so big she couldn't even close her mouth," he winced. "The problem was, before I opened her mouth wide enough so that I could take a picture, I had to take out the paan that was in there-she's still doing it. Some of them are walking around with their mandibles falling off."

Roffers then pointed to a somewhat familiar building in the background of one of the photos. "And then you've got the Taj Mahal, so there's this tremendous dichotomy [between poverty and extravagance]. If you survive the communicable diseases, you end up getting the cancers just like we do here."

Not surprisingly, Roffers has his own personal experiences with cancer; his brother died of Karposi's sarcoma, his grandmother of breast cancer and his grandfather of skin, stomach and lung cancer. Though he doesn't attribute his getting involved in cancer research to these personal factors, he does indeed credit his staying involved to them. "It's kind of corny to say, but people ask why you get out of bed in the morning," he said. "As soon as I no longer care about this is when I'll no longer get out of bed.

"I would like to think my goal is to put ourselves out of business--I would like to live to see the day when there's no longer an NCRA, when there's no need for one," he said, glancing at the boxes of thick books cluttering his office. "But I don't see that day on the horizon."

--Michael Terrazas

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