Adapting Natural Language Processing Models Across Jurisdictions: A pilot Study in Canadian Cancer Registries

TL;DR

This study evaluates the cross-jurisdiction adaptability of transformer-based NLP models for Canadian cancer registries, demonstrating high performance with modest fine-tuning and ensemble methods to reduce missed cases.

Contribution

First cross-provincial evaluation of transformer models for cancer registry NLP, showing effective adaptation and ensemble strategies to improve sensitivity across jurisdictions.

Findings

Models maintained high performance after cross-jurisdiction adaptation.

Ensemble approach achieved 0.99 recall, reducing missed cancers.

Privacy-preserving workflow enables interoperable NLP infrastructure.

Abstract

Population-based cancer registries depend on pathology reports as their primary diagnostic source, yet manual abstraction is resource-intensive and contributes to delays in cancer data. While transformer-based NLP systems have improved registry workflows, their ability to generalize across jurisdictions with differing reporting conventions remains poorly understood. We present the first cross-provincial evaluation of adapting BCCRTron, a domain-adapted transformer model developed at the British Columbia Cancer Registry, alongside GatorTron, a biomedical transformer model, for cancer surveillance in Canada. Our training dataset consisted of approximately 104,000 and 22,000 de-identified pathology reports from the Newfoundland & Labrador Cancer Registry (NLCR) for Tier 1 (cancer vs. non-cancer) and Tier 2 (reportable vs. non-reportable) tasks, respectively. Both models were fine-tuned using complementary synoptic and diagnosis focused report section input pipelines. Across NLCR test sets, the adapted models maintained high performance, demonstrating transformers pretrained in one jurisdiction can be localized to another with modest fine-tuning. To improve sensitivity, we combined the two models using a conservative OR-ensemble achieving a Tier 1 recall of 0.99 and reduced missed cancers to 24, compared with 48 and 54 for the standalone models. For Tier 2, the ensemble achieved 0.99 recall and reduced missed reportable cancers to 33, compared with 54 and 46 for the individual models. These findings demonstrate that an ensemble combining complementary text representations substantially reduce missed cancers and improve error coverage in cancer-registry NLP. We implement a privacy-preserving workflow in which only model weights are shared between provinces, supporting interoperable NLP infrastructure and a future pan-Canadian foundation model for cancer pathology and registry workflows.