CANCER PROGRAM Annual Report. Cancer Registry Database 2008 CANCER CASES AND BREAST CANCER SITE OUTCOMES ANALYSIS

Transcription

1 CANCER PROGRAM 2009 Annual Report Cancer Registry Database 2008 CANCER CASES AND BREAST CANCER SITE OUTCOMES ANALYSIS 1

2 2008 Annual Report - Site Table Site Total Class Sex AJCC TNM Collaborative Stage Group Cases Analytic NonAna M F Stage 0 Stage I Stage II Stage III Stage IV N/A Unk ALL SITES HEAD & NECK DIGESTIVE SYSTEM ESOPHAGUS STOMACH COLON/RECTUM ANUS, ANORECTUM LIVER PANCREAS OTHER GI RESPIRATORY SYSTEM NASAL CAVITY,SINUS LARYNX LUNG SMALL CELL LUNG - NON-SMALL CELL PLEURA BONE/SOFT TISSUE BREAST SKIN MELANOMA OTHER SKIN FEMALE GENITAL SYSTEM CERVIX UTERI CORPUS UTERI OVARY OTHER FEMALE MALE GENITAL SYSTEM PROSTATE OTHER MALE URINARY SYSTEM BLADDER KIDNEY/ RENAL PELVIS OTHER URINARY BRAIN & NERVOUS SYSTEM THYROID/ENDOCRINE HEMIC and LYMPHATIC LEUKEMIA MYELOMA OTHER HEMATOPOIETIC HODGKIN S DISEASE NON-HODGKIN'S LYMPH UNKNOWN N/A = Not Applicable Unk = Unknown 2

3 2008 CASES Distribution by Top Primary Sites All Other Sites, 26% n = 743 cases PROSTATE, 18% LEUKEMIA, PANCREAS, 3% BRAIN/NERVOUS SYSTEM, 3% BLADDER, 4% BREAST, NON-HODGKINS, 4% KIDNEY, 5% COLORECTAL, 7% LUNG NON SM CELL, 1 DISTRIBUTION BY GENDER MALE 56% FEMALE 44% CITY AT DIAGNOSIS TOTAL NAPA 382 VALLEJO 69 VACAVILLE 57 YOUNTVILLE 56 AMERICAN CANYON 36 SAINT HELENA 24 CALISTOGA 17 FAIRFIELD 14 BENICIA 12 SONOMA 11 REPRESA 8 LOWER LAKE 5 CLEARLAKE 5 ANGWIN 4 HIDDEN VALLEY LAKE 4 SACRAMENTO 2 SANTA ROSA 3 SAN FRANCISCO 3 SUISUN CITY 2 RUTHERFORD 2 MIDDLETOWN 2 CLEARLAKE OAKS 2 All Cities with 1 Patient 23 TOTAL Dx here rx elsewhere 2008 Class of Case 51% 3 14% Dx & rx here Rx here Rx elsewhere 3

4 Insurance Category 3 n = 743 All Cases 26% 29% 25% 1 1 8% 8% 5% 5% Self pay (not insured) Insurance nos Calif State Prison System Managed care (HMO/PPO) Kaiser Medicaid Medicare Medicare with supplement Distribution by Race/Ethnicity HISPANIC 11% WHITE 79% BLACK 5% AM INDIAN FILIPINO Other ASIAN 1% OTHER 1% UNKNOWN 1% AGE at DIAGNOSIS 2-4 years years years years 9% years 19% years 26% years years years unknown Mean 65 Median 66 n= 743 cases 4

5 2008 Analytic Cases Stage at Diagnosis Not Applicable, 11% Unknown, 3% Stage 0, 5% Stage I, 25% Stage IV, Stage III, 13% Stage II, 28% n=637 Analytic Cases Top 15 Histology/Grades ADENOCARCINOMA(42.1%) 199 INFILTRATING DUCT CA(14.) 67 SQ CELL CA(12.7%) 60 RENAL CELL CA(3.8%) 18 MALIGNANCY NOS(3.6%) 17 MENINGIOMA NOS(3.4%) 16 PAP TRANS CELL CA NON-INV(3%) 14 CARCINOMA NON-SMALL CELL(2.7%) 13 DUCTAL & LOBULAR CA(2.5%) 12 CARCINOMA NOS(2.5%) 12 LYMPHOMA LG B-CLL DIF NOS(2.3%) 11 PAPILLARY ADENOCA(1.9%) 9 LOBULAR CA(1.9%) 9 ENDOMETRIOID CA(1.7%) 8 TRANS CELL CA(1.7%) 8 Diagnostic Confirmation POS HISTOL (88.) 562 CYTOLOGY (2.) 14 POS LAB/MARKER (0.) 1 VISUALIZATION (0.) 1 RADIOGR ONLY (8.6%) 55 CLINICAL ONLY (0.6%) 4 TNM/CS Mixed by 1st Course Rx Summary Analytic Cases Stage Stage I Stage Stage Stage Not Unknown TOTAL 0 II III IV Applicable None S Only R Only C Only H Only O Only S+R S+C S+H R+C R+H C+H C+O S+R+C S+R+H S+C+H R+C+H S+R+C+H S+R+H+T R+C+H+O TOTAL

6 CANCER PROGRAM 2009 Annual Report Site Specific Breast Cancer Study 2008 Breast Cancer Overview 6

7 Introduction: This overview provides an analysis of 102 new breast cancer cases seen in 2008 at Queen of the Valley Medical Center (QVMC) and the facility s experience compared to the National Cancer Data Base breast cancer data in TNM Staging and survival patterns. An overview of 2008 Cancer Statistics was provided to the Cancer Committee at their December 9, 2009 meeting. The Committee asked for an in-depth detailed analysis of breast cancer data including comparison of the number of patients receiving lumpectomy vs. mastectomy treatment by stage. This analysis was presented back to the Committee and included the following graphs for discussion on race-ethnicity, age at diagnosis, stage at diagnosis, histology, and first course of treatment. The Committee was pleased that 9 of the 2008 breast cancer patients were diagnosed at early stage disease (Stages 0-II) at QVMC and treated with breast conserving surgery. They noted that this has remained true since the previous breast cancer study several years ago. Overview: One of the most startling facts in understanding breast cancer is that an estimated 182,460 new cases of invasive breast cancer will be identified in women in the year 2008 in the United States. Breast cancer has continued to grow in incidence; however, incidence rates declined by 3.5 % from 2001 to This may be reflective of the reduced use of hormone replacement therapy (HRT) following the publication of results from Women s Health Initiative in 2002, which linked HRT use to increased risk of heart diseases and breast cancers. 1 At QVMC, breast cancer is the leading primary site for women where 47% are diagnosed and treated here and an additional 53% of women sought ongoing treatment at QVMC. The overall median age group is 61 years of age at diagnosis with 55% of patients between the ages of years. Ninety-eight percent were female and two percent male breast cancers. The breast population was Caucasian at 75%, 15 % Hispanic and another 1 of the cases accounted for other races/ethnicities. Early cancer detection plays an important role in reducing the impact of breast cancer disease. Mammography is especially valuable as an early detection tool because it can identify breast cancer at an early stage, usually before physical symptoms develop. Numerous studies have shown that early detection saves lives and increases options for treatment according to the ACS Cancer Facts and Figures. Sixty-one percent of breast cancer patients diagnosed at QVMC are infiltrating ductal carcinomas, which corresponds to national histology types. For breast cancer patients diagnosed and treated (Class 1 only) at QVMC, 83% of women were seen at early stage diagnosis (Stage 0 to II) compared to NCDB at 84%. Only of QVMC patients were diagnosed with evidence of Stage III disease. Primary treatments for breast cancer include the standard surgery and surgery plus radiation plus or minus hormone therapy for early stage disease, as well as including chemotherapy, and radiation therapy being added for late stage disease as evidenced in the treatment table of patients seen at QVMC. Surgery alone is no longer the treatment of choice. Combined modalities of Surgery + Radiation and/or Hormones, or Surgery plus Radiation, Chemotherapy and/or Hormones accounted for 8 of the patients treated at QVMC. Surgery plus chemotherapy and/or Hormones was also prescribed treatment modalities for 13% of the patients. Five-year survival outcomes for QVMC breast cancer can be found on page 7. Observed survival comparison is made to NCDB All states/us from 1,340 hospitals and California data from 102 hospitals versus 543 QVMC breast cancer patients. The five-year observed survival rates by stage ( ) show that for all stages combined; QVMC is at 83% and comparable to NCDB at 84%. Stage III was slightly lower (QVMC=48%, NCDB, all programs = 56%). This was felt to be due to the low volume of QVMC cases for Stage III, twenty seven (27) patients. According to the American Cancer Society 2008 Facts and Figures on page 11, the 5-year relative survival for localized breast cancer (malignant cancer that has not spread to lymph nodes or other locations outside the breast) has increased from 8 in the 1950s to 98% today which is great news for breast cancer patients American Cancer Society Facts and Figures, 2009,

8 2008 Breast Cancer Cases Class of Case Class 2 = Rx Here 53% Class 1 = Dx & Rx Here 47% n = 102 Histology TOTAL Percentage Infiltrating Ductal Carcinoma 62 61% Intraducal Carcinoma 15 Ductal & Lobular Carcinoma 12 1 Lobular Carcinoma 9 9% Mucinous Adenocarcinoma 2 1% Tubular Adenocarcinoma 1 1% Infiltrating Ductal Mixed with Other Carcinomas 1 1% Total Breast Cancer Gender 10 98% 5 Males Females n = 102 8

9 2008 Breast Cancer Age at Diagnosis years years years years 11% Median Age: 61 24% years 31% years 16% years 5% 1 25% 3 35% 2008 Breast Breakdown by Race/Ethnicity HAWAIIAN 1% OTHER ASIAN 3% FILIPINO 6% WHITE 75% HISPANIC n = 102 analytic cases 9

10 2008 Breast Cancer TNM Stage at Diagnosis 5 47% 45% 4 35% 3 27% 25% 16% 1 5% 9% Stage 0 Stage I Stage II Stage III Unknown n = 102 First Course Treatment Summary None Chemotherapy/Hormone 1% Surgery 5% Surgery/Hormone 7% Surgery/Chemotherapy 3% Surgery/Chemotherapy/Hormone 3% Surgery/Radiation 18% Surgery/Radiation/Hormone 29% Surgery/Radiation Hormone/Transplant 1% Surgery/Radiation/Chemotherapy Surgery/Radiation/Chemotherapy/Hormone 17% Total 10 10

11 2008 Breast Cancer - Class 1 Only Early Stage Diagnosis ( Stage 0-II) Breast Conserving Surgery Rate = 83% % 9 No Surgery BCS Mastectomy 83% % % 25% Stage 0 Stage I Stage II Total Stage 0 - II No Surgery: 1 BCS: 34 Mastectomy: 6 Total: Breast Cancer - Class 1 Only Breast Conserving Surgery Vs Mastectomy % 9 No Surgery BCS Mastectomy % % 25% Stage 0 Stage I Stage II Stage III Stage IV Unknown Early Detection Stage 0 - II No Surgery: 1 BCS: 34 83% Mastectomy: 6 Total: All Stages Stage 0 thru IV No Surgery: 3 6% BCS: 35 73% Mastectomy: 10 21% TOTAL:

12 % 97% 95% 91% Breast Cancer Five Year Observed Survival Rate by AJCC Stage All Stages Ending at Five Years 87% 91% 84% 8 81% QVMC NCDB - CA - CoC Approved Programs NCDB- All States- CoC Approved Programs 48% 56% 25% 21% 19% Stage 0 Stage I Stage II Stage III Stage IV QVMC: n = 543 Cases, excludes unknown stages NCDB Data: California: n = 47,453 Cases from 102 hospitals NCDB Data: All States/US: n = 554,904 Cases from 1340 hospitals Stage 0 = 91 with 88 alive over 5 years Stage I = 263 with 227 alive over 5 years Stage II = 143 with 116 alive over 5 years Stage III = 27 with 13 alive over 5 years Stage IV = 12 with 3 alive over 5 years 12