Focus on Breast Cancer
According to the American Cancer Society, an estimated 214,640 new cases of invasive breast cancer and 61,980 cases of in situ breast cancer are expected to occur among women in the US in 2006. Nationally, breast cancer ranks second among cancer deaths in women (after lung cancer), with an estimated 41,430 deaths expected in 2006. Death rates from breast cancer have continued to decline by an average of 2.3% per year from 1990 to 2002, presumably due to increased awareness, earlier detection through screening, and improved treatment.
Incidence
Breast cancer age at diagnosis comparison shows that Shady Grove has a lower percentage of elderly patients (18% >age 70), while NCDB > age 70 is at 30%. Highest incidence for both SGAH and the National Cancer Database (NCDB) is in the 50-59 age group.
Breast cancer stage at diagnosis comparison shows SGAH has a slightly lower incidence of Stage III and Stage IV patients when compared to NCDB. As demonstrated, SGAH has a higher incidence of non-invasive breast cancer compared to NCDB, presumably due to availability and use of mammography screening.
Treatment
Surgery
Shady Grove mastectomy rates continue to decline. In 2005, 38.6% of women underwent mastectomy as compared with 5 years ago, (2000) when 46% of women underwent total removal of the breast. Conversely, patients undergoing breast conservation surgery rose from 54% 5 years ago to 61.4% in 2005. The most recent data available from NCDB (2003) shows the national breast conserving surgery rate at 58%.
Systemic Therapy
NCCN (National Comprehensive Cancer Network) treatment guidelines, widely accepted as representing the best of care, recommend that breast cancers that are estrogen receptor positive should be offered anti-hormonal therapy such as Tamoxifen or Arimidex. A study of ER+ invasive breast cancer patients at SGAH for 2003/2004 shows 79% (2003) and 83% (2004) of patients received anti-hormonal therapy. This is compared with only 43.5% (2003) of NCDB ER+ invasive breast cancer cases getting anti-hormone treatment.
NOTE: This low percentage is thought to be more likely due to hospital registries across the country collecting inadequate treatment information about treatment delivered outside the hospital setting.
Outcomes
The most recent 5-year survival data from NCDB (1998) is compared to SGAH for same time period (1998) and shows SGAH with equivalent Stage 0 survival (both NCDB and SGAH at 94%). Superior survival rates are demonstrated in SGAH patients with Stage I, II and IV breast cancer. More favorable NCDB rates for Stage III can be attributed to SGAH small number of Stage III cases (13). Please note that these are observed survival rates and do not take into account cause of death, i.e. patients may have been cancer free but expired from other causes.
Long term survival: Based on the most recent data from the American Cancer Society, survival after a diagnosis of breast cancer continues to decline beyond 5 years. Superior survival outcomes are seen long term in SGAH breast cancer patients with 1995-1996 breast cancer cases demonstrating 86% relative survival for combined stages at 10 years, compared with national 10 year relative survival at 80%. Caution should be used when interpreting 10 year survival rates because they reflect the experience of women using past therapies and don’t reflect recent trends in early detection or advances in treatment since that time frame.
Progress in the treatment of breast cancer continues and Shady Grove Adventist Hospital is proud to offer the most up to date, and beneficial treatments available today, and to support the many efforts toward progress against breast cancer.