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CANCER ANNUAL REPORT

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  • 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. 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. Source: SAMC Cancer Registry
  • 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.  
  • 6. Source: SAMC Cancer Registry
  • 7. 1988-2007 SAMC Breast Cancer Age at Diagnosis Comparison to Lifetime Risk of Developing Breast Cancer (#2) N=5570 Sources: SAMC Cancer Registry; BreastCancer.org         14.3% 1/7 live to age 90 11.4% 10.0% 1/10 age 80 & above 46.0% 7.0% 1/15 age 60-79 38.0% 4.0% 1/25 age 40-59 4.3% <0.5% 1/231 birth - 39 SAMC     lifetime risk
  • 8.  
  • 9. Source: SAMC Cancer Registry
  • 10.  
  • 11. NCDB Benchmark Comparison ~ Comprehensive Community Cancer Centers 2000-2005 Breast Cancer Breast Conservation by Stage Sources: SAMC Cancer Registry & National Cancer Data Base Benchmark Reports
  • 12. 2003-2007 SAMC Breast Cancer Systemic Therapy by Stage N=1691 Prevention of new primary Prevention of distant disease Source: SAMC Cancer Registry *synchronous primary receiving chemo * *
  • 13.  
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  • 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 &quot;basal-type&quot; breast cancers.
  • 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. 1998-2007 SAMC Breast Cancer Comparison Age at Diagnosis Non-Triple Negative Group to Triple Negative Group Source: SAMC Cancer Registry 6% 12% 80 & over 39% 45% 60-79 24% 24% 50-59 19% 16% 40-49 12% 3% 39 & under Triple Negative Non-Triple Negative AGE
  • 20. 1998-2007 SAMC Breast Cancer Comparison Race Non-Triple Negative Group to Triple Negative Group Source: SAMC Cancer Registry 0.7% 0.2% Other/Unk 4% 4% Asian (nos) 6% 2% African-American 16% 11% Hispanic 73% 83% Euro-Caucasian Triple Negative Non-Triple Negative RACE
  • 21. 1998-2007 SAMC Triple Negative Breast Cancer Stage by Ethnicity N=252 Source: SAMC Cancer Registry *4 th & 5 th Edition AJCC TNM Staging 0.7% 4% 6% 16% 73% 252 2 11 15 41 183 Total 1 1 6 27 105 112 Total 0.3% 0.3% 2.3% 11% 42% 44% 0 0 0 0 2 0 Other/Unk 0 0 0 1 6 4 Asian 0 0 1 2 4 8 African- American 0 0 1 9 15 16 Hispanic 1 1 4 15 78 84 Euro-Caucasian UNK NA IV III II I STAGE
  • 22. Source: SAMC Cancer Registry
  • 23. 1998-2007 SAMC Breast Cancer Comparison Stage at Diagnosis by Type of Recurrence Non-Triple Negative Group to Triple Negative Group Source: SAMC Cancer Registry Type of Recurrence 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 unk Never Free Distant Regional Local None
  • 24. 1998-2007 SAMC Breast Cancer Comparison Site of Distant Recurrence (#5) Non-Triple Negative Group to Triple Negative Group Source: SAMC Cancer Registry 3% 8% Liver 17% 15% Multi Sites* 22% 15% Other 8% 9% CNS 31% 15% Lung 19% 38% Bone Triple Negative Non-Triple Negative SITE
  • 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 Source: SAMC Cancer Registry 58% 70% 82% All Stages 0% 0% 19% IV 31% 43% 58% III 58% 66% 82% II 71% 84% 87% I Triple Negative (5YR) (10YR) All Patients STAGE
  • 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.