Breast Cancer
St. Anthony’s Hospital Cancer Registry Study 1987 - 2005

Breast cancer is the most common cancer seen in the St. Anthony’s Hospital Cancer Registry and accounts for 18.2% of all cases.  This study reviews the experience with all analytic cases of female breast cancer during the period 1987 through the end of 2005. The data was compared with the appropriate national data banks from the National Cancer Data Bank (NCDB) and NCI’s SEER program.

There were 2,476 cases; with 93% white and 6% African-American (nationally these numbers are 83% and 9%). The number of cases has been increasing over the years of the study. The median age was 68 with 15.8% younger than 50 (nationally the median age is 61 and 22.6% of the women are less than 50).

The 5year relative survival was 91% and 10 year relative survival was 82% (nationally the relative 5 year survival is 89%).

The TNM stage and relative survival are as noted below

Breast Cancer Stage and 5 year Relative Survival by TNM System

With increased utilization of mammographic screening the percent of cases diagnosed in the earliest stages (Stage 0 and Stage I) has slowly increased. With more women diagnosed at an earlier stage there has been an increase in women choosing breast conservation.

The American College of Surgeons current quality studies for breast (NCDB electronic quality improvement packet or e-quip) include women who have conservation, and are under the age of 70 to see if they receive postoperative radiation. According the NCCN guidelines women who undergo lumpectomy should receive postOp radiation with some exceptions (NCCN2.2007 “radiation may be omitted in women over 70 with T1N0 cancers that are ERP+ who receive adjuvant hormonal therapy). We reviewed the use of adjuvant radiation in women under 70 with stage 0 and I cancers who were treated with lumpectomy. The percent receiving postOp radiation was 74.7% (72.4% for stage 0 and 80.1% for stage I). This has been stable over the years.

          The second e-quip measure is use of adjuvant chemotherapy for tumors greater than 1cm, NO and all other N+ or T2/T3 that are ER/PR (-). In our group this was 56.8%.

          The third e-Quip measure is for tumors over 1cm N(-)  and all larger sizes or N+ that were ER+ or PR+ to see if they received adjuvant hormone therapy. Our results here was only 34.

Discussion: Breast cancer remains a significant cause of morbidity and is the most common cancer seen at SAH with increasing numbers recorded over the years of the study. With aggressive screening the percent of cases diagnosed in stage 0 or I should increase, but these numbers have remained flat. It was recently reported that there has been a decline is the use of screening mammography (70% in 2000 to only 66% in 2005). SAH is opening a breast imaging center and we will track the stage distribution as a measure of the appropriate use of breast cancer screening.

          The e-quip indicators are designed to evaluate the use of appropriate adjuvant therapies and the numbers were low in all three groups. Nationally only about 70 - 80% of women with conservation receive postOp radiation, so the numbers here are similar.  The low numbers for adjuvant hormonal therapy may reflect the difficulty the tumor registry department has in collecting data after the patient has been discharged from the hospital and may well represent a quality indicator of the tumor registry department as much as a QA indicator for the clinicians. New access to electronic charts may correct for the problems accessing this type of data and will be followed as an ongoing project.