SAMC Breast Cancer
1988-2007
20 Year Review
M. Margaret Hadcock, MD, FACS
Ellen Malek, CTR
April 2009
2008 Oncology Servic...
1988-2007 SAMC Analytic Breast Cancer
• There have been 5570 cases of Breast Cancer accessioned into the Saint
Agnes Cance...
Source: SAMC Cancer Registry
1988-2007 SAMC Breast Cancer
Ethnicity
N=5570
Euro-Caucasian, 84.7%
Hispanic, 9.6%
Asian, 3.2...
1988-2007 SAMC Analytic Breast Cancer
• A steady increase in the number of breast cancers diagnosed and/or treated
at the ...
1988-2007 SAMC Breast Cancer
Incidence by Year
N=5570
173
209
283
405
353
0
50
100
150
200
250
300
350
400
450
1988
1989
1...
2007 SAMC Top Ten Analytic Sites
Number of Cases by Site
N=1613
Prostate, 122
Bladder, 36
Non Hodgkin's
Lymphoma, 71
Thyro...
1988-2007 SAMC Breast Cancer
Age at Diagnosis
Comparison to
Lifetime Risk of Developing Breast Cancer (#2)
N=5570
lifetime...
1988-2007 SAMC Breast Cancer
Histology
N=5570
15%
2%
61%
6%
7%
2%
2%
6%
0% 10% 20% 30% 40% 50% 60% 70%
DCIS
LCIS
Infiltrat...
Source: SAMC Cancer Registry
1988-2007 SAMC Breast Cancer
Stage at Diagnosis by 5 Year Intervals
N=5570
12
18 18
20
45
42
...
NCDB Benchmark Comparison
2000-2005 Breast Cancer
Stage at Diagnosis
18%
43%
27%
7%
3%
2% 5%
3%
8%
29%
38%
17%
5%
4%
8%
28...
NCDB Benchmark Comparison~ Comprehensive Community Cancer Centers
2000-2005 Breast Cancer
Breast Conservation by Stage
70
...
2003-2007 SAMC Breast Cancer
Systemic Therapy by Stage
N=1691
220
120
4 3
126
341
116
81
65 66
165
117
11
20
66
35
9 10 14...
2003-2007 SAMC Breast Cancer
Stage by Differentiation
N=1691
8%
33%
12%
6%
4%
36%
38%
32% 33%
29%28%
55%
56%
64%
1% 2%
5% ...
1988-2007 SAMC Breast Cancer
Observed 5 Year Survival
by Stage at Diagnosis
N=5570
92%
87%
82%
58%
19%
82%
0%
10%
20%
30%
...
NCDB 5 Year Observed Survival Comparison
1994-1997 Breast Cancer
by Stage at Diagnosis
91%
88%
59%
87%
90%
79%
53%
16%
81%...
NCDB 5 Year Observed Survival Comparison
1998-2001 Breast Cancer
by Stage at Diagnosis
91% 90%
87%
65%
86%
95%
91%
82%
56%...
Triple Negative Breast Cancer
• Triple-negative breast cancer (#4) refers to a specific subtype of
breast cancer that does...
1998-2007 SAMC Triple Negative Breast Cancer
N=252
• 252 (identified) triple negative breast cancer cases were accessioned...
1998-2007 SAMC Breast Cancer
Comparison Age at Diagnosis
Non-Triple Negative Group to Triple Negative Group
AGE Non-Triple...
1998-2007 SAMC Breast Cancer
Comparison Race
Non-Triple Negative Group to Triple Negative Group
RACE Non-Triple
Negative
T...
1998-2007 SAMC Triple Negative Breast Cancer
Stage by Ethnicity
N=252
STAGE I II III IV NA UNK Total
Euro-
Caucasian
84 78...
1998-2007 SAMC Triple Negative Breast Cancer
Stage by Differentiation
N=252
4% 3% 0%
19%
13%
4%
69%
73%
85%
100%
8% 10% 7%...
1998-2007 SAMC Breast Cancer
Comparison Stage at Diagnosis by Type of Recurrence
Non-Triple Negative Group to Triple Negat...
1998-2007 SAMC Breast Cancer
Comparison Site of Distant Recurrence (#5)
Non-Triple Negative Group to Triple Negative Group...
5 Year Survival Comparison~ Saint Agnes Medical Center
1988-2007 Breast Cancer Cases N=5570
Compared to 1998-2007 Triple N...
Sources / Footnotes:
# 1. SAMC Cancer Registry database*; www.samc.org.
*Comment: The report is derived from our hospital ...
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CANCER ANNUAL REPORT

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CANCER ANNUAL REPORT

  1. 1. SAMC Breast Cancer 1988-2007 20 Year Review M. Margaret Hadcock, MD, FACS Ellen Malek, CTR April 2009 2008 Oncology Services Annual Report Saint Agnes Medical Center Cancer Registry 1303 East Herndon Avenue Fresno, CA 93720 559 450-3570 www.samc.com ®
  2. 2. 1988-2007 SAMC Analytic Breast Cancer • There have been 5570 cases of Breast Cancer accessioned into the Saint Agnes Cancer Registry (#1) during the 20 year period. • 99.6% were Women and 0.4% were Men. • Median age at diagnosis was 63. • The vast majority of patients were Caucasian, representing 84.7% of the cases with 9.6% Hispanic, 3.2% Asian, 1.9% African American and 0.4% Other/Unknown. • In 2006, the race/ethnicity breakdown of all patients seen at Saint Agnes Medical Center was 72.9% Caucasian, 18.9% Hispanic, 4.43% African American, 3.75% Asian and 0.15% American Indian. Of those, 60.2% were adults age 18-65 and 32.3% were 65 or older.
  3. 3. Source: SAMC Cancer Registry 1988-2007 SAMC Breast Cancer Ethnicity N=5570 Euro-Caucasian, 84.7% Hispanic, 9.6% Asian, 3.2% Other/unk, 0.4% African American, 1.9%
  4. 4. 1988-2007 SAMC Analytic Breast Cancer • A steady increase in the number of breast cancers diagnosed and/or treated at the Saint Agnes Medical Center was observed over this period. • Of note, 65% of the cases were diagnosed at SAMC and received all or part of first course treatment at the medical center. 33% were diagnosed elsewhere and received all or part of their treatment at the facility. Only 2.4% were diagnosed here and seen elsewhere for treatment. • In 2007, Breast Cancer was the number one cancer diagnosed and/or treated at Saint Agnes followed by Colorectal, Lung and Prostate cancers. • Of note, Breast Cancer has been the number one cancer diagnosed at the medical center for the past 14 years! • The commitment and close cooperation of Radiology, Pathology, Surgery, Medical and Radiation Oncology as well as the availability of a dedicated Breast Conference has served our Breast Cancer patients since 1995. • The efforts of our team of breast cancer specialists is reflected in the favorable outcomes displayed in this report.
  5. 5. 1988-2007 SAMC Breast Cancer Incidence by Year N=5570 173 209 283 405 353 0 50 100 150 200 250 300 350 400 450 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 NumberofCases
  6. 6. 2007 SAMC Top Ten Analytic Sites Number of Cases by Site N=1613 Prostate, 122 Bladder, 36 Non Hodgkin's Lymphoma, 71 Thyroid, 72 Pancreas, 46 Melanoma, 55 Kidney/Renal Pelvis, 79 Breast, 353 Colorectal, 179 Lung/Bronchus, 175 Source: SAMC Cancer Registry
  7. 7. 1988-2007 SAMC Breast Cancer Age at Diagnosis Comparison to Lifetime Risk of Developing Breast Cancer (#2) N=5570 lifetime risk     SAMC birth - 39 1/231 <0.5% 4.3% age 40-59 1/25 4.0% 38.0% age 60-79 1/15 7.0% 46.0% age 80 & above 1/10 10.0% 11.4% live to age 90 1/7 14.3%         Sources: SAMC Cancer Registry; BreastCancer.org
  8. 8. 1988-2007 SAMC Breast Cancer Histology N=5570 15% 2% 61% 6% 7% 2% 2% 6% 0% 10% 20% 30% 40% 50% 60% 70% DCIS LCIS Infiltrating Ductal CA Lobular Mixed Mucinous Tubular Other Percent Source: SAMC Cancer Registry
  9. 9. Source: SAMC Cancer Registry 1988-2007 SAMC Breast Cancer Stage at Diagnosis by 5 Year Intervals N=5570 12 18 18 20 45 42 44 42 30 31 29 24 7 5 5 8 4 3 2 23 2 2 3 0 5 10 15 20 25 30 35 40 45 50 1988-1992 N=983 1993-1997 N=1176 1998-2002 N=1725 2003-2007 N=1686 Year Percent Stage 0 I II III IV UNK
  10. 10. NCDB Benchmark Comparison 2000-2005 Breast Cancer Stage at Diagnosis 18% 43% 27% 7% 3% 2% 5% 3% 8% 29% 38% 17% 5% 4% 8% 28% 38% 18% 0 5 10 15 20 25 30 35 40 45 50 0 I II III IV UNK Stage Percent SAMC N=2134 Calif 101 hospitals US 1347 hospitals Sources: SAMC Cancer Registry & National Cancer Data Base Benchmark Reports
  11. 11. NCDB Benchmark Comparison~ Comprehensive Community Cancer Centers 2000-2005 Breast Cancer Breast Conservation by Stage 70 73 72 76 77 72 53 56 51 22 22 20 35 38 38 0% 10% 20% 30% 40% 50% 60% 70% 80% Percent 0 I II III IV Stage SAMC (2000-2007 N=2818) Calif (47 hospitals) US (528 hospitals) Sources: SAMC Cancer Registry & National Cancer Data Base Benchmark Reports
  12. 12. 2003-2007 SAMC Breast Cancer Systemic Therapy by Stage N=1691 220 120 4 3 126 341 116 81 65 66 165 117 11 20 66 35 9 10 14 3 0 50 100 150 200 250 300 350 NumberofCases 0 I II III IV Stage None Horm Chemo Both Prevention of new primary Prevention of distant disease Source: SAMC Cancer Registry *synchronous primary receiving chemo * *
  13. 13. 2003-2007 SAMC Breast Cancer Stage by Differentiation N=1691 8% 33% 12% 6% 4% 36% 38% 32% 33% 29%28% 55% 56% 64% 1% 2% 5% 4% 56% "High Grade" 0% 10% 20% 30% 40% 50% 60% 70% 0 I II III IV Stage Percent Well Moderately Poorly Undifferentiated Source: SAMC Cancer Registry
  14. 14. 1988-2007 SAMC Breast Cancer Observed 5 Year Survival by Stage at Diagnosis N=5570 92% 87% 82% 58% 19% 82% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 0 I II III IV All Stages Stage Percent Source: SAMC Cancer Registry *TNM/CS Mixed Stage; Actuarial Observed method
  15. 15. NCDB 5 Year Observed Survival Comparison 1994-1997 Breast Cancer by Stage at Diagnosis 91% 88% 59% 87% 90% 79% 53% 16% 81% *8% 96% 95% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 0 I II III IV All Stages Stage Percent SAMC N=901 NCDB 1280 Programs Source: National Cancer Data Base Survival Reports (4th Edition AJCC TNM Staging); *SAMC Cancer Registry
  16. 16. NCDB 5 Year Observed Survival Comparison 1998-2001 Breast Cancer by Stage at Diagnosis 91% 90% 87% 65% 86% 95% 91% 82% 56% 19% 84% *33% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 0 I II III IV All Stages Stage Percent SAMC N=1134 NCDB 1318 Programs Source: National Cancer Data Base Survival Reports (5th Edition AJCC TNM Staging); *SAMC Cancer Registry
  17. 17. Triple Negative Breast Cancer • Triple-negative breast cancer (#4) refers to a specific subtype of breast cancer that does not express the genes for estrogen receptor (ER), progesterone receptor (PR) or Her2/neu. • This subtype of breast cancer is clinically characterized as more aggressive and less responsive to standard treatment and associated poorer overall patient prognosis. • It is diagnosed more frequently in younger women, women with BRCA1 mutations, and belong to African-American and Hispanic ethnic groups. • Triple-negative breast cancers are themselves a subgroup of "basal-type" breast cancers.
  18. 18. 1998-2007 SAMC Triple Negative Breast Cancer N=252 • 252 (identified) triple negative breast cancer cases were accessioned into the Saint Agnes Cancer Registry during the 10 year period, 1998-2007. • This number represented 9.6% of the 2615 invasive breast cancers accessioned over this time period. • All reported cases were Female. • Mean age at diagnosis was 57. • The triple negative group did reflect a younger age at diagnosis when compared to all other breast cancer cases (Non-Triple Negative Group N=3330) accessioned during the same time period. • Ethnic distribution of the observation group noted Euro-Caucasians represented 73%, Hispanic 16%, African American 6%, Asian (nos) 4% and Other/unknown less than 1%.
  19. 19. 1998-2007 SAMC Breast Cancer Comparison Age at Diagnosis Non-Triple Negative Group to Triple Negative Group AGE Non-Triple Negative Triple Negative 39 & under 3% 12% 40-49 16% 19% 50-59 24% 24% 60-79 45% 39% 80 & over 12% 6% Source: SAMC Cancer Registry
  20. 20. 1998-2007 SAMC Breast Cancer Comparison Race Non-Triple Negative Group to Triple Negative Group RACE Non-Triple Negative Triple Negative Euro-Caucasian 83% 73% Hispanic 11% 16% African-American 2% 6% Asian (nos) 4% 4% Other/Unk 0.2% 0.7% Source: SAMC Cancer Registry
  21. 21. 1998-2007 SAMC Triple Negative Breast Cancer Stage by Ethnicity N=252 STAGE I II III IV NA UNK Total Euro- Caucasian 84 78 15 4 1 1 183 73% Hispanic 16 15 9 1 0 0 41 16% African- American 8 4 2 1 0 0 15 6% Asian 4 6 1 0 0 0 11 4% Other/Unk 0 2 0 0 0 0 2 0.7% Total 112 105 27 6 1 1 252 44% 42% 11% 2.3% 0.3% 0.3% Source: SAMC Cancer Registry *4th & 5th Edition AJCC TNM Staging
  22. 22. 1998-2007 SAMC Triple Negative Breast Cancer Stage by Differentiation N=252 4% 3% 0% 19% 13% 4% 69% 73% 85% 100% 8% 10% 7% 0% 20% 40% 60% 80% 100% 120% I II III IV Stage Percent Well Mod Poorly Undifferentiated Source: SAMC Cancer Registry
  23. 23. 1998-2007 SAMC Breast Cancer Comparison Stage at Diagnosis by Type of Recurrence Non-Triple Negative Group to Triple Negative Group 4%3%15%7%41%15%4%4%0%3%37%66%III 4%2%3%2%15%6%1%1.5%1%2%75%85%II 3%1%0%1%8%2%3%1%2%1%85%94%I Triple Neg Non- triple Neg Triple Neg Non- triple Neg Triple Neg Non- triple Neg Triple Neg Non- triple Neg Triple Neg Non- triple Neg Triple Neg Non- triple Neg Stage Recur, type unkNever FreeDistantRegionalLocalNone Source: SAMC Cancer Registry Type of Recurrence
  24. 24. 1998-2007 SAMC Breast Cancer Comparison Site of Distant Recurrence (#5) Non-Triple Negative Group to Triple Negative Group SITE Non-Triple Negative Triple Negative Bone 38% 19% Lung 15% 31% CNS 9% 8% Liver 8% 3% Multi Sites* 15% 17% Other 15% 22% Source: SAMC Cancer Registry
  25. 25. 5 Year Survival Comparison~ Saint Agnes Medical Center 1988-2007 Breast Cancer Cases N=5570 Compared to 1998-2007 Triple Negative Group N=252 STAGE All Patients Triple Negative (5YR) (10YR) I 87% 84% 71% II 82% 66% 58% III 58% 43% 31% IV 19% 0% 0% All Stages 82% 70% 58% Source: SAMC Cancer Registry
  26. 26. Sources / Footnotes: # 1. SAMC Cancer Registry database*; www.samc.org. *Comment: The report is derived from our hospital based registry experience which is not ‘population based’ data. # 2. Lifetime Risk of Developing Breast Cancer www.breastcancer.org. # 3. National Cancer Data Base: Benchmark/Survival Comparison Reports ©Commission on Cancer, American College of Surgeons. NCDB Benchmark Reports, v1.1. Chicago, IL, 2002. The content reproduced from the applications remains the full and exclusive copyrighted property of the American College of Surgeons. The American College of Surgeons is not responsible for any ancillary or derivative works based on the original Text, Tables, or Figures. # 4. Triple Negative Breast Cancer www.wikipedia.org. # 5. Until recently, cancer registry software did not allow data collection of multiple sites of distant recurrence occurring simultaneously to be captured as one occurrence. Therefore, categories may not be an accurate representation of incidence.
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