2008 Cancer Committee

Transcription

1 2008 Cancer Committee Breast Cancer Study Stages I-III Ina Stafford, CTR JoAnne Schahuber, RT(R) (T) (M) (QM)

2 Table of Cont ent s Table of Contents... 1 Breast Cancer Facts.. 2 CoxHealth Cancer Committee Study Criteria Item I Patients Diagnosed. 4 Item II Age Distribution Item III Surgical Treatment Item IV Radiation Therapy....6 Item V Imaging Follow-up.7 Item VI Stage Distribution.8 Item VII Recurrence Rates...8 Item VIII Survival Rates...9 Conclusion...10

3 Breast Cancer Facts: In the United States breast cancer is the most common cancer among women. Breast cancer is the second leading cause of cancer death in women. Lung cancer is the first. In the United States it is estimated that 182,460 women will be diagnosed with breast cancer in An estimated 40,480 women will die this year from breast cancer in the United States. 2.5 million women living in the United States are breast cancer survivors. Women have a 1 in 8 chance of developing invasive breast cancer in their lifetime. 1 in 35 women will die from breast cancer. 2

4 Breast Cancer Study Criteria: CoxHealth Cancer Committee In 2008, the Hulston Cancer Committee elected to conduct an outcome and survival analysis of our Stage I-IIIB Breast Cancer Patients who underwent no surgical treatment, breast conservation surgical treatment and those that underwent mastectomy. This study focused upon patients with an initial diagnosis between the time periods of (see criteria below). Members voted unanimously to approve the Breast Cancer study as outlined. Criteria: Study: All patients diagnosed in the years with Breast Cancer in Stage I - III, who had either no surgery, breast conservation surgery or mastectomy. I. Evaluate how many patients were diagnosed with breast cancer. II. Evaluate at what age the patients were diagnosed. III. Identify what percentage of the patients had no surgery, breast conservation surgery and mastectomy. Evaluate surgical intervention by stage of disease. IV. Identify what percentage of patients having breast conservation surgery also had radiation therapy. V. Evaluate how many patients having breast conservation surgery were compliant with imaging follow-up within 6-12 months. VI. Evaluate the stage distribution from Stage I through Stage III, benchmark to national data resources. VII. Evaluate the recurrence. VIII. Evaluate the 5 year survival rate. 3

5 2008 Breast Cancer Study Details: Item I -- Patients Diagnosed with Breast Cancer During the years 1998 through 2002, 879 patients were diagnosed with breast cancers in Stages I-IIIB. Of those 879 patients, 205 patients had other cancers in addition to breast cancer. Item II Age Distribution at Time of Diagnosis Age Number of Patients Percent of Total Breast Cancers <30 5 1% % % % % % % > % AGE DISTRIBUTION AT TIME OF DIAGNOSIS Number of Patients < > Age (Source: CoxHealth Cancer Registry Database) 4

6 Item III Surgical Treatment 13 patients did not have surgery 260 had breast conserving surgery 606 had mastectomies Of the 13 patients that did not have surgery the reasons included: 2 patients refused, 1 patient had a contraindication, 8 of the patients had progression of the disease, 1 patient had lung cancer and expired, and in 1 patient the breast primary could not be located. Number of Patients Percent of Patients No Surgery 13 1% Breast Conservation % Mastectomy % Stage Breast Conservation Mastectomy I IIA IIB IIIA 1 14 IIIB 1 31 Surgical Intervention by Stage Number of Patients Stage I Stage IIA Stage IIB Stage IIIA Stage IIIB Stage Breast Conservation Mastectomy (Source: CoxHealth Cancer Registry Database) 5

7 Item IV Radiation Therapy 260 Patients had breast conservation surgery. 238 Of those patients had radiation therapy within 1 year. 22 Of those patients did not have radiation therapy within 1 year. After review of records: 11 refused radiation and 11 unknown reason. American Society of Clinical Oncology and the National Comprehensive Cancer Network Quality Measure recommends local-regional radiation therapy treatment within 1 year of diagnosis for stage I - III breast cancer patients undergoing breast conserving surgery. Radiation Therapy after Breast Conserving Surgery Number of Patients Yes Radiation Therapy within 1 Year No (Source: CoxHealth Cancer Registry Database) 6

8 Item V Imaging Follow-up National Comprehensive Cancer Network Clinical Practice Guidelines recommend imaging follow-up at 12 months for patients undergoing breast conservation surgery for breast cancer. American College of Radiology practice guideline for imaging, following Breast Conservation Therapy, is to perform a baseline mammogram for comparison 6 to 12 months after tumor excision and completion of radiation therapy. (Source: ACR Practice Guideline, Practice Guideline for Breast Conservation Therapy in the Management of Invasive Breast Carcinoma, Revised 2006(Res20)) Patients with Breast Conserving Surgery Imaging Follow-up (6-12 Months) Number of Patients Yes Imaging Follow-up No (Source: CoxHealth Registry Database and CoxHealth Mammography Reporting System Database) 7

9 Item VI - Stage Distribution Number of Patients by Stage COX CIRF Stage I 60% 53% Stage II 34% 39% Stage III 6% 8% Number of Patients by Stage COX NCDB Stage I 60% 51% Stage II 34% 41% Stage III 6% 8% Item VI- Recurrence Rates The overall recurrence rate was 12.7%. Stage Number of Recurrences Recurrence Percentage I 31 6% IIA 33 16% IIB 25 26% IIIA 8 50% IIIB 15 42% TYPE OF RECURRENCES BY STAGE Stage Local Regional Distant Never Disease Free Unknown Type Total I IIA IIB IIIA IIIB (Source: CoxHealth Cancer Registry Database) 8

10 Item VII Survival Rates Breast Cancer Survival 5-Year Observed Survival CoxHealth vs CIRF Combined Stages Percent Surviving Years Surviving Cox CIRF Breast Cancer Survival 5-Year Observed Survival CoxHealth vs National Combined Stages Percent Surviving Years Surviving Cox NCDB 9

11 Conclusion: I. During the years 1998 through 2002, 879patients were diagnosed with breast cancers in Stages I-IIIB. Of those 879 patients, 205 patients had other cancers in addition to breast cancer (23%). II. The patients diagnosed with breast cancer were predominately between the ages of 50 and 80 (71%). Slightly more than one half (53%), of the breast cancers occurred in women aged 50 to 70 years. III. Of the patients in this study, 1% of these patients had no surgery, 30% had breast conservation surgery and 69% had a mastectomy. IV. 91.5% of patients having breast conservation surgery and received post-op radiation therapy. V. 84% of patients having breast conservation surgery were compliant with imaging 6-12 month imaging follow-up studies. (NCCN Guidelines). VI. The stage distribution evaluation demonstrated that 60% of patients were diagnosed in Stage I. At CoxHealth, 94% of the patients diagnosed with breast cancer from 1998 through 2002 where in Stage I, IIA or IIB. VII. The overall recurrence rate was 12.7%. 50% of the recurrences occurred in patients with stage IIIA breast cancer. 92% of the recurrences occurred in patients with stage IIIA and IIIB breast cancer. VIII.. CoxHealth five year survival rate is in line with NCDB & CIRF survival for all stages. Works Cited: a. American Cancer Society b. National Comprehensive Community Cancer Network, Clinical Practice Guidelines V

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