"Cancer registries throughout the country are just so important for us to understand the incidence of the disease and how we're doing with it," said Dr. Thomas Burke, a professor at the Johns Hopkins University's Bloomberg School of Public Health. "The quality of the data is always important. If you have the wrong reporting, you get the wrong answer."
The Department of Legislative Services produced the audit for a joint committee of the Maryland General Assembly. Bruce A. Myers, an auditor, said the committee is considering whether the problems unearthed at the Family Health Administration deserve more attention. Auditors also found a lack of oversight for several other programs that account for millions in state spending.
"There are some issues here that concern some big dollar amounts," Myers said.
In 2003, when Macro submitted the 2001 cancer database to the North American Association of Central Cancer Registries, it did not receive certification as required under its contract. Auditors faulted the state agency for not taking action, such as terminating the contract.
The next year, Macro did receive certification, but the auditors noted that information was later found to be erroneous. Auditors outlined several red flags that were not raised until years later.
First, the state agency did not review the 2002 data until August 2005, when it found they showed a 90 percent increase in cervical cancer cases and a 70 percent increase in melanoma cases from 1998 to 2002. At the time, auditors said, Macro could not provide an adequate explanation for the staggering rise in cancer incidence.
Around the same time, as part of the state health department's study of breast and cervical cancer diagnosis in Maryland women, about 2,300 patients in the cancer registry were asked to participate in the study. The Family Health Administration later worked with Macro to comb through medical histories, comparing original laboratory reports with data in the cancer registry, and determined that 400 of them did not have cancer. The study was suspended.
Then in May 2006, a former Macro employee informed the state agency that data were deliberately altered. Macro's investigation found that more than 13 percent of all cases in 2002 showed signs of tampering, according to the audit. Macro concluded that the changes were "methodical and were made by one or more persons with broad access to the system," the audit said.
