Waikato Breast Cancer Register March 2010
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1 Waikato Breast Cancer Register March 2010
2 Demographics - Population: Total New Waikato Breast Cancers Diagnosed Total Patients Eligible for WBCR 1008 Total Records Entered into WBCR (95% Consented) 998 Gender Total % of Patients Female % Male 3 1% Age Group Total % of Patients % % % % % % Age at Diagnosis: Patients Under 50 Years: 25% Patients Over 65 Years: 34% Family History: A first degree relative with Breast Cancer was reported by 22% of Patients Of these, reported more that one first degree relative
3 Demographics - Ethnicity: Ethnicity % Compared with 2006 Census* WBCR Census European (774) Maori (129) Pacific Islander (18) Other/Not Stated (20) *2006 Census figures not age adjusted
4 Diagnosis Clinical Presentation Method: Detection Method by Year Symptomatic BSA Screening (not BSA) (231) 2006 (246) 2007 (239) 2008 (235) 37% of Cancers were Screen Detected (42% if Non BSA Screening included)
5 Diagnosis Clinical Presentation Method: Detection Method by Ethnicity Symptomatic BSA Screening (Not BSA) 3 1 European (781) Maori (131) Pacific Islander (18) Other (21)
6 Diagnosis Clinical Presentation Method Detection Method by Age Symptomatic BSA Screening (not BSA) 4 29 (5) (44) (190) (262) (237) (132) 80+ (81)
7 Prognostic Indicators Tumour Size & Invasive Grade Pathological Tumour Size Total Cases % Cases T1 (<2cm) % Invasive Cancer Grade Total Cases % Cases T2 (2-5cm) % Grade % T3/T4 (>5cm) 72 7% Tx/To (No Primary/Not Assessable) 46 5% Grade % Grade % Tis %
8 Prognostic Indicators Tumour Size Invasive Tumour Size by Age < 2cm 2-5cm > 5cm Not Assessable 1 29 (5) (41) (154) (218) (201) (119) 80+ (66)
9 Prognostic Indicators Tumour Size Invasive Tumour Size by Ethnicity < 2cm 2-5cm > 5cm Not Assessable 1 European (661) Maori (113) Pacific Islander (18) Other (21)
10 Prognostic Indicators Cancer Grade Invasive Cancer Grade by Age Grade 1 Grade 2 Grade (5) (40) (148) (210) (199) (117) 80+ (66)
11 Prognostic Indicators Cancer Grade Invasive Cancer Grade by Ethnicity Grade 1 Grade 2 Grade 3 1 European (647) Maori (107) Pacific Islander (15) Other (16)
12 Prognostic Indicators Cancer Grade Invasive Cancer Grade by Tumour Size Grade 1 Grade 2 Grade 3 1 < 2cm (217) 2-5cm (401) > 5cm (167)
13 Surgical Treatment Surgical Procedure by Ethnicity Mastectomy WLE No Primary Surgery 1 European (770) Maori (132) Pacific Islander (18) Other (21) Surgical Procedure by Age Mastectomy WLE No Primary Surgery (5) (43) (190) (256) (232) (133) 80+ (82)
14 Surgical Treatment Surgical Procedure by Cancer Type Invasive (774) DCIS (121) Mastectomy WLE Surgical Procedure by Tumour Size Mastectomy WLE <2cm (399) 2-5cm (336) >5cm (39) <2cm (83) 2-5cm (26) >5cm (12) Invasive DCIS
15 Pathology Cancer Type Cancer Type # Cases % Cases Infiltrating Ductal - NST % Invasive Lobular 76 1 Mucinous 17 2% Tubular 8 1% Other 35 5% Invasive Total % Insitu DCIS Alone % Not Assessable 7 0.7% Insitu/Not Assess Total %
16 Invasive Cancer Hormone Receptor Status Hormone Receptor Status # Patients % IHC HER2 Status Result # Patients % ER + PR % IHC HER2 +++ Positive 85 1 ER + PR % ER + No PR Done 62 8% ER - PR + 6 1% IHC HER2 Nil Staining Negative % IHC HER2 + Negative % IHC HER2 ++ Equivocal-no FISH 99 12% FISH HER2 Amplified (+ve) Positive 52 7% ER - PR % FISH HER2 Normal (-ve) Negative % ER - No PR Done 9 1% FISH HER2 Equivocal Equivocal 1 1% Totals Totals
17 Node Positivity by Ethnicity Number of Nodes Positive by Ethnicity Nodes 4-15 Nodes Nodes 30+ Nodes 1 European (269) Maori (53) Pacific Islander (12) Other (6) % Node Positive by Ethnicity Node Positive Node Negative No Axilla Surgery 1 European (763) Maori (131) Pacific Islander (18) Other (21)
18 Nodal Status by Nodal Surgery Nodal Status by Nodal Surgery SNB AND Both 1 Node Negative (443) Node Positive (340)
19 Adjuvant Therapy - Radiotherapy Radiotherapy Treatment for Invasive Cancers Yes No Declined 3 1 Mastectomy (384) WLE (374)
20 Adjuvant Therapy - Chemotherapy Chemotherapy Treatment for Invasive Cancers by Ethnicity Yes No Declined Not Recommended 1 European (647) Maori (107) Pacific Islander (15) Other (16)
21 Areas to Progress Master (National) data dictionary needed to standardise data entry across regions Inter-regional communication- teleconferencing has commenced, and ing/cc ing between all regions by data teams Difficulties of consent for deceased cases audit group - an important clinical group because have had worst outcome.? an inter-regional issue
22 WBCR Team Mary-Ann Hamilton Reg. Nurse Sharee Ellis Data Manager Carol Munt Data Support Shelley Cavanagh Reg. Nurse Paula Palmer Reg. Nurse Team leader 0.75 FTE Data collect., entry and analysis 1.65 FTE (0.437 employed by BCF though 0.85 of these FTE work solely on WBCR {not RACS})
23 Features of Waikato Breast Cancer Register Eligible for WBCR if new cancer post 2005, includes 2 nd primary, excludes recurrence local or distant Eligible for WBCR if residing in the Waikato region at time of diagnosis (even if surgery or work up done out of area) Under resourced in early years resulting in incomplete data In last 2 years, robust systems implemented to avoid this problem, improved documentation, relationships with clinicians, consent, audit of data entry and clean- up of data. WBCR staff attend weekly MDT meetings WBCR staff attend other cancer/breast care related meetings Additional data fields collected (up to 300/case) eg: LCIS cases Breast cancer risk data and presentation info Sentinel node biopsy audit Source of mortality data
24 Features of Waikato Breast Cancer Register Women consented on entry to specialist work-up 95% consented and entered 30 deceased before consent gained 20 declined 2 consent not sought moved overseas, no forwarding address 2 uncertain still chasing consent clarification Online entry to RACS Breast Audit within 2 months of surgery (enables early check of missing data) Virtually 10 complete data for last 2 years Entry into WBCR at 6-8 months post surgery by different person Double data entry a form of data audit One in five cases and all complex cases audited Real time feed back to clinician, both data problems and increasingly data queries WBCR now supervised by Executive Group including representatives from radiation and medical oncology, surgery, pathology, Maori, and population health/clinical School
25 WBCR Ethos Quality data- minimise missing data, question discordant data, mitigate human error, provide support & regular feedback Complete data - setting expectations, actively supporting clinicians to provide complete data, minimise duplication of competing needs (Admin, BSA, RACS ) Facilitate win-win relationships within the users/clinicians supporting the breast cancer care pathway Increase use and promotion of the Register
26 WBCR team would like to express their sincere thanks to: The ABCSG for their development of the database and ongoing support The New Zealand Breast Cancer Foundation for their funding support (Aug Aug 2010)
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