NAACCR sets the standards behind cancer data for the US and Canada.

Working with Geocodio feels more like a partnership. We can reach out, ask questions, and work together. That relationship has been an unexpected benefit of working with Geocodio.

Who They Are

The North American Association of Central Cancer Registries (NAACCR) is a nonprofit that creates the data collection standards used by every central cancer registry in the United States and Canada. Those standards are what make it possible to compare cancer rates across cities, counties, states, provinces, and the two countries as a whole.

NAACCR also produces the Cancer in North America (CiNA) dataset, which is the data behind the American Cancer Society's Cancer Facts & Figures and many other major cancer publications. NAACCR works closely with the National Cancer Institute, the Centers for Disease Control and Prevention, and the National Center for Health Statistics, and co-authors the Annual Report to the Nation on the Status of Cancer, which uses the CiNA data and has been published for roughly thirty years and is considered the definitive assessment of cancer incidence and mortality trends in the US.

Geocoding is foundational to much of cancer research and control. National and state-level cancer rates are useful, yet to target public health interventions to the populations most at risk, researchers need to go smaller. NAACCR assigns cancer data down to the census tract level so that rates remain comparable across the country while also being precise enough to inform local action.

Tract-level geocoding also makes it possible to append community characteristics to cancer data. Cancer etiology is not just clinical. Social systems, health systems, economic factors, and the physical environment all shape who gets cancer and who survives it. Geocoded data is what allows NAACCR and its member registries to study these impacts.

The Challenge

NAACCR provides geocoding access to its member registries across the US. The registries are the ones geocoding cancer cases, often on tight budgets and with limited staff.

NAACCR's previous geocoder had served the community well for years, but NAACCR needed to find a replacement that could meet, and document, federal security requirements like SOC 2 and HIPAA/HITECH compliance. It also needed to be sustainable in cost across a large network.

Data accuracy, and transparency into how accurate the results are, was a core requirement. Cancer surveillance research requires knowing how confident a geocoder is in each result, beyond the coordinate itself. A geocoder that quietly drops low-confidence matches, or returns low-accuracy results without telegraphing that to the user, doesn't just produce slightly incomplete data. It produces biased data, with the bias running in exactly the direction that hurts cancer surveillance most.

"We don't want to come up with the wrong answer. There's a lot of bias already with the patients that have poorly geocoded data. They tend to be more rural, in poorer communities, and older. Those are also three risk factors for cancer right there," Recinda Sherman, Program Manager, Data Use and Research at NAACCR, explains. "If we don't geocode them correctly, they're out of the analysis. That leads to underestimating what's going on in vulnerable communities and underestimating risk factors and masks important geographic patterns of cancer."

The Solution

NAACCR , in collaboration with the NCI, evaluated multiple geocoders against three criteria: security, accuracy, and cost. Geocodio offered the best balance of the three.

Cancer registries access Geocodio in two ways. Most registries have the API embedded  directly into their registry software, so geocoding happens as cases are processed. Registries also use the Geocodio spreadsheet upload tool for batch jobs, including cancer-related data such as the locations of radiation facilities.

Single sign-on

State cancer registries have access to geocoding through NAACCR, so single sign-on was a hard requirement. SSO was implemented smoothly and on time.

"It went without a hitch so I am not sure I even said thank you. It's just something that we don't think about much because we don’t struggle with it,” said Recinda.

A seamless transition

NAACCR is a small nonprofit operating in a publicly funded environment, which makes careful stewardship of government resources essential. Their members geocode enormous volumes of data on a daily basis. That makes cost, reliability and ease-of-use critical to the success of the geocoding platform they provide to members.

Training members on Geocodio is so straightforward that NAACCR still uses the same one-page documentation it published when registries first onboarded, and ongoing support requirements are low. With Geocodio, the cases run, the data comes back, and it just works. Members rarely run into problems that send them to NAACCR for help.

"The stability and reliability is very much appreciated," Recinda says. "The registries don't really care what product they're using, as long as it provides reliable, accurate results. But they do care if they have to reload something, or something gets hung up, or they can't download it. The fact that we don't hear much from registries about Geocodio is a good thing."

That silence has real budget value for NAACCR. Time not spent fielding support questions is time spent on the research, standards, and partnerships at the heart of NAACCR's work.

Accurate data for cancer surveillance 

The volume of geocoding that cancer registries handle is enormous and funding is limited. Reviewing every borderline match is not feasible, so registries have to prioritize which cases get a human review.

Geocodio provides accuracy information for every result, and worked with NAACCR to incorporate two additional data quality variables that registries have used for decades: census tract certainty and GIS coordinate quality. These metrics have been released to all Geocodio users, not just NAACCR, and are used by other Geocodio customers doing cancer research. 

"The fact that we were able to coordinate with you to get our variables, that was really critical," Recinda says. "We use them heavily."

These quality metrics are what allow registries to determine whether a given result should be used in research or flagged for review.

"A lot of geocoders are a black box. A result comes back, but it’s not in the right location, and they don’t tell you. We've all had that experience using apps for directions," Recinda says. "For cancer research, accuracy is important, and we need to be cautious."

Results with transparent accuracy are key to NAACCR’s future work. The team is developing a CiNA Geographic dataset that would let approved researchers at hospitals and academic centers conduct their own area-based social measure research at the census tract level.

NAACCR data also supports NCI-designated comprehensive cancer centers with sub-county catchment area research, and is used by organizations like the American Cancer Society, the American Lung Association, and the Leukemia & Lymphoma Society for research, as well as cancer control planning and prevention activities.

The Results

Today, the majority of central cancer registry data in the US is geocoded through Geocodio. 

Looking back over the past several years, the transition was smoother than NAACCR expected, both for the central organization and for the registries that use it day to day.

• Accurate, trustworthy data at scale. Accuracy variables on every result let registries decide whether a match is reliable enough for research. 

• A stable, easy-to-use platform. Registries report that the batch upload tool is fast and bug-free with minimal downtime. The most common feedback is the absence of friction: no re-uploading, no restarting hung jobs, no calling NAACCR for support to figure out why something broke.

• Minimal training and support burden. The same one-page documentation has carried registries through the transition with only an SSO update. New users get going and use the platform without much additional help or technical issues, which matters when members and NAACCR have so many demands on their time.

An unexpected level of partnership

Recinda had been happy with NAACCR’s previous geocoder, and changing systems is always challenging. But Recinda now describes herself as very happy with NAACCR’s experience with Geocodio from the initial transition through today.

Geocodio's stability, ease of use, and the relationship NAACCR has been able to build with the Geocodio team have made her a fan.

"If you're working with a big company, who do you call? Knowing a face and not just a name, that wasn't a requirement when we evaluated geocoders,” Recinda explained. “But working with Geocodio feels more like a partnership. We can reach out, ask questions, and work together. That relationship has been an unexpected, but highly valued, benefit.”