Cancer Surveillance System (CSS)

In 1974, the U.S. National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) program funded the Fred Hutch to establish the Cancer Surveillance System (CSS). Our mission is to provide high quality data on the incidence, treatment and follow-up of all newly-diagnosed cancers (except non-melanoma skin cancers) in 13 western Washington State counties.

When the program began, health care facilities voluntarily reported cancer-related data. In 1992, a newly created state law required cancer diagnoses to be reported to the Washington Department of Health (DOH) for the purposes of understanding, controlling and reducing cancer rates. The DOH designated the CSS as the contractor responsible for receiving abstracts on cancer cases from health care facilities within the CSS reporting region.

Data on cancer cases are obtained by the CSS through hospitals, surgical centers, pathology laboratories, imaging centers, radiotherapy centers, multi-specialty clinics, clinician offices and death certificates. Per DOH policy, we perform quality control and case consolidation on the cancer information, then submit it to the Washington State Cancer Registry for inclusion in the state database.

The collected data helps public health scientists and practitioners:

  • Track trends in the incidence of all forms of cancer (surveillance)
  • Identify and investigate patterns of cancer occurrence (epidemiology)
  • Monitor trends in mortality and survival for specific cancers (end results)

Our reporting area covers Clallam, Grays Harbor, Island, Jefferson, King, Kitsap, Mason, Pierce, San Juan, Skagit, Snohomish, Thurston and Whatcom counties. With a total population of approximately 4.9 million people, over 75% reside in King, Pierce or Snohomish counties. The racial distribution is white: 75%; black: 5%; Asian: 11%; and Native American: 1.6%, with the remaining 7.4% listed as “other.” In addition, 10% self-identify as Hispanic.

The state law is described in R.C.W. 70.54.230, 70.54.250, 70.54.260, 70.54.270. The reporting rules for cancer are described in the Washington Administrative Code (WAC), Chapter 246.102.

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Leadership Team

Stephen M. Schwartz, Ph.D., M.P.H.

Dr. Schwartz is the Principal Investor for the CSS. He is a professor of epidemiology at the University of Washington and member of the Hutch’s Public Health Sciences division. His research focuses on genetic, lifestyle, and environmental determinants of neoplasia and its sequelae.

Christopher I. Li, M.D., Ph.D., M.P.H.

Dr. Li is the Co-Principal Investigator for CSS and a member of the Epidemiology Program in the Hutch’s Public Health Sciences division. Most of his research is on breast cancer etiology and outcomes.

Jennifer Hafterson, CTR

Ms. Hafterson is the Director of Information Services. 

Georgia Green

Ms. Green is the CSS Administrator.

Accessing CSS Data for Research

CSS data provides insight into the patterns, causes and outcomes of cancer. How we release the data depends on the type of information needed for a particular project.

For projects that do not require confidential identifying information, data can be obtained in one of two ways:

  1. Incidence, survival and mortality data (including case counts, rates, and detailed de-identified individual case records) from 1974—2016 can be obtained from the SEER program as limited-use files and from online report generators.
  2. Incidence and mortality data (case counts, rates) from 1974-2018 can be obtained from Cancer Rates.

Projects requiring confidential identifying information must be reviewed and approved by the Hutch’s Institutional Review Board. Email Tiffany Janes, or call her at (206) 667-7902 to discuss your data needs and your IRB application.

The SEER Program

The Surveillance, Epidemiology and End Results (SEER) program has been a trusted source for high quality data since 1973. It currently monitors cancer incidence and survival in approximately 34% of the U.S. population.

SEER registries such as the CSS collect data on cancer incidence, treatment and survival. This information, collected at the population level, is critical for epidemiologic studies designed to determine the causes of cancer, identify strategies to reduce cancer incidence and mortality rates, and improve our understanding of basic mechanisms that lead to the development and progression of cancer. And with over 40 years of cancer incidence and survival data available, SEER enhances the monitoring of temporal trends across the nation. The value of long-term incidence data increases with each passing year, as the ability to perform cohort analyses of time trends becomes greater.

Due to innovations in registration techniques, as well as the high level and quality of data captured in the areas covered, the "SEER-standard" is used as a measure for cancer registries throughout the world. Data are collected and coded using standardized definitions for reportability, site and histology codes and extent of disease at diagnosis.

A unique feature of SEER registries is their connection with strong epidemiologic research units. To be of value, the data must be analyzed and interpreted by knowledgeable individuals. Epidemiologic expertise also helps researchers plan and conduct ancillary studies that use the registry as a case-finding mechanism and source of additional data not routinely collected by registry personnel. SEER has also provided opportunities for training researchers in the uses of data on cancer incidence, treatment and survival.


How many cancer cases are recorded by the CSS each year?


We recorded approximately 27,000 new cancer cases in 2018 — compared to the 9,171 cases from 1974, the first year we collected data. 

How rapidly does the CSS identify new cancer cases?


Washington State law requires institutions and physicians to provide the us with information about each potential new cancer case within 45 days of diagnosis. We complete at least 95% of the case reporting for a given year within 6 months of year-end; for example, by April 30, 2018, we completed over 99% of the reporting for new 2017 diagnoses.

How accurate are the data CSS collects?


In annual assessments of data quality, we’re the only SEER registry to be ranked in the top three in each of the more than 20 assessments.

What are the most common cancers CSS records?


In 2018, the 10 most common cancers recorded in the CSS for males and females and the number of cases diagnosed (in parentheses), were as follows:













Breast (4333)

Lung (1581)

Colon/Rectum (935)

Uterus (874)

Non-Hodgkin Lymphoma (553)

 Melanoma (742)

Thyroid (495)

Pancreas (383)

Leukemia (337)

Kidney/Renal Pelvis (306)













Prostate (3463)

Lung (1405)

Colon/Rectum (1076)

Melanoma (944)

Bladder (902)

Non-Hodgkin Lymphoma (698)

Kidney/Renal Pelvis (594)

Leukemia (456)

Pancreas (448)

Liver (337)


How many CSS patients have more than one reportable diagnosis?


Of the 844,739 patients recorded by the CSS between 1974 and 2017, 110,922 (15.1%) had more than one reportable diagnosis.


We post bi-monthly newsletters for hospital registrars in Washington State with process improvement pointers (PIPs). If you have topics you would like to suggest, please email us at



May 2023 How to Use Audit Results to Improve Data Quality

March 2023 The RAS Initiative

January 2023 Making a Good First Impression with Data – Part Two

November 2022 Making a Good First Impression with Data – Part One

September 2022 Will Improved Timeliness Enhance Productivity and Data Usage?

July 2022 Unknowns: An Opportunity for Improvement Just Waiting to Happen

May 2022 What is More Important than Collecting Cancer Data?

March 2022 NCI Childhood Cancer Data Initiative

January 2022 Dx 2022 Updates for ICD-O-3.2 and STR

November 2021 The Future: A One Stop Shop for Primary Site and Histology Coding

September 2021 Improving the Quality of Histology Coding

July 2021 Targeted Disease Index Processing

May 2021 Does Neoadjuvant Therapy Improve Disease Free Survival?

March 2021 Are We Missing 2020 Cases?  Maybe...But Probably Not

January 2021 Coding Tips for EOD and Summary Stage: Urinary System

November 2020 Coding Tips for EOD and Summary Stage: Prostate and Melanoma

September 2020 Coding Tips for EOD and Summary Stage: Breast, Colorectal and Lung

July 2020a COVID-19 Abstracting Instructions Excel for Copy/Paste

July 2020b COVID-19 Data Collection Introduction

July 2020c COVID-19 Abstraction Guidance from SEER - updated 08-10-2020

July 2020d COVID-19 SEER Q&A - August 2020

May 2020 COVID-19 Impact on Cancer Diagnosis and Treatment

March 2020 Coding Breast Histology - a "Do Better" Plan

January 2020 Clinical Grade for CNS Primaries, Mary Trimble

November 2019 Treatment Options vs Treatment Refusal, Mercedi Smalley

September 2019 Coding Primary Site for Lymphoma Primaries, Shalini Sahni, Coding Clinical Size for Breast Primaries, Jessica Liang

July 2019  Circumferential Resection Margin, Shalini Sahni

May 2019  Grade for 2018+ Cases - Carolyn Callaghan

May 2019  Practice Exercises (PowerPoint) - Carolyn Callaghan

March 2019  Are LCIS, GIST and Pseudomyxoma Peritonei Cases Reportable?- Mary Zimny

January 2019  Treatment Traps: Melanoma Surgery and Systemic Treatment/Surgery Sequence for All Sites- Melissa Rook

November 2018  Correctly Applying Diagnostic Confirmation for Hematopoietic and Lymphoid Primaries - Shalini Sahni

September 2018  Stage Cases Multiple Times - Carolyn Callaghan

July 2018  Imaging Findings - Seana Pierce

May 2018  Surgery of Primary Site - Melissa Rook

March 2018 TNM - Katie Fidgeon; Lab Values - Cristina Guerrero

January 2018 Grade (multiple sites) - Carolyn Callaghan; Prostate Grade - Tiffany Janes

Contact Us

Mailing Address

Fred Hutchinson Cancer Center
Cancer Surveillance System
Mail Stop MD-B706
P.O. Box 19024
Seattle, WA 98109-1024

Scientific Leadership

Stephen M. Schwartz, Ph.D.

Principal Investigator, Program in Epidemiology
Phone: 206.667.4660
Fax: 206.667.5948
Work Location: M4-C308

Christopher I. Li, M.D., Ph.D., M.P.H.

Co-Principal Investigator, Cancer Epidemiology Research Cooperative
Phone: 206.667.7444
Work Location: M4-C308

Information Services

Jennifer Hafterson, CTR

Operations Supervisor, Cancer Surveillance System
Phone: 206.667.4719
Fax: 206.667.4870
Work Location: MD-B706

Data Inquiries

Tiffany Janes, CTR

Cancer Surveillance System

Phone: 206.667.7902
Fax: 206.667.4870
Work Location: MD-B706