Cancer Registry Report 2011 HRMC Cancer Registry Case Reporting

Cancer Registry Report
The Cancer Registry at Highlands Regional Medical Center continues to collect and maintain data on all
patients diagnosed and/or treated for cancer at our facility. Maintaining our registry ensures that health
officials have accurate and timely information, while ensuring the availability of data for treatment,
research, and educational purposes. Confidentiality of patient identifying information and related
medical data is strictly maintained. Aggregate data are analyzed and published without any patient
identifiers.
Local, state, and national cancer agencies use registry data to make important public health decisions
related to limited public health funds. Registry data is valuable to researchers interested in the etiology,
diagnosis, and treatment of cancer. Current lifetime follow-up maintained by the registry provides
accurate survival information as well as serves as a reminder to physicians and patients to schedule
regular clinical examinations.
2011 HRMC Cancer Registry Case Reporting
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In 2011, a total of 169 cases were reported by the Cancer Registry at HRMC. Of these, 75.15% (127)
patients were diagnosed with their disease at HRMC and received all or part of their first course
treatment here, while 17.75% (30) of patients were initially diagnosed at HRMC but were treated
elsewhere for their disease. Patients who were initially diagnosed and treated elsewhere but received
subsequent treatment at HRMC for recurrent disease accounted for 3.55% (6) of our cases. A total of
2.96% (5) patients were diagnosed elsewhere but received all or part of their first course treatment at
HRMC. And 0.59% (1) of patients were diagnosed and treated elsewhere but had workup or consult at
HRMC.
Newly Diagnosed and/or Treated Cases at HRMC
2001-2011
The number of newly diagnosed and/or treated (analytic) cases reported at HRMC has decreased over
the past couple of years, from 240 in 2009 to 162 in 2011. This decrease may be attributed to the loss of
physicians that were aggressive in the diagnosis of cancer.
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2011 Comparison of Top Five Sites – Male & Female*
HRMC
KY
US
US
KY
HRMC
Breast
33%
29%
30%
14%
19%
27%
Trachea, Bronchus, Lung
Trachea, Bronchus, Lung
27%
15%
14%
29%
20%
18%
Prostate
Colon and Rectum
10%
9%
9%
9%
11%
16%
Colon and Rectum
Thyroid
6%
4%
5%
6%
6%
10%
Bladder
Bladder
5%
2%
2%
1%
1%
4%
Thyroid
All Other Sites
19%
41%
40%
41%
43%
25%
All Other Sites
According to the 2011 American Cancer Society’s Cancer Facts & Figures,
approximately 1,596,670 new cancer cases would be diagnosed in the US in 2011,
excluding carcinoma in situ of any site except urinary bladder and basal and
squamous cell skin cancers. The risk of being diagnosed with cancer increases
with age, with most cases occurring in adults, 78% of all cancers diagnosed in persons 55 years of age or
older. About 571,950 Americans were expected to die of cancer in 2011, more than 1,500 people per
day. Cancer is the second most common cause of death in the US, exceeded only by heart disease, and
cancer accounts for nearly 1 of every 4 deaths.
*Data obtained from the 2011 ACS Cancer Facts & Figures, Kentucky Cancer Registry, and HRMC Cancer
Registry
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5-Year Comparative Analysis of Top Ten Sites at HRMC
2007-2011
2007
2008
2009
2010
2011
Trachea/Bronchus/Lung
53
62
64
54
44
Breast, female & male
34
28
31
32
28
Colon/Rectum/Anus
25
18
26
27
22
Prostate
28
25
21
4
14
Bladder
10
8
11
1
12
Kidney
9
13
11
0
2
Non-Hodgkin's Lymphomas
10
10
8
4
3
Endometrium (corpus uteri)
11
4
10
6
1
Pancreas
4
2
8
2
0
Larynx
1
2
4
6
2
There was a nearly 10% decrease in the number of trachea/bronchus/lung cases reported at HRMC in
2011 in comparison with 2010. This was due to the fact that the community delays seeking health care.
Also, the number of prostate and bladder cases dropped significantly from 2009 to 2010 but rose again
in 2011. These decreases were attributed to the loss of three urologists at HRMC. The numbers began
to rise once another urologist was added the the medical staff.
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2011 Top Five Cancer Sites at HRMC by Best Collaborative/AJCC Stage
Site
Total Cases
Stage 0
Stage I
Stage II
Stage III
Stage IV
Stage Unknown
Trachea/Bronchus/Lung
44
0
5
0
8
26
5
Breast, female & male
28
4
6
10
4
1
3
Colon and Rectum
22
0
8
3
0
3
8
Prostate
14
0
0
10
0
0
4
Bladder
12
5
3
4
0
0
0
Total
120
9
22
27
12
30
20
In 2011, HRMC continued to diagnose the majority of lung cancer cases at late stages: stage III (18.0%)
and stage IV (59.0%). This may be due to patients delaying medical exams until the disease has
progressed so much that symptoms begin to seriously interfere with their lifestyle.
The majority of breast cancer cases were diagnosed at early stage: stages I (21.4%) and II (35.7%). This
is felt to be attributed to strong public awareness of early diagnosis & self exams.
The majority of colorectal cases were diagnosed at stage I (36.3%). This may be due in part to aggressive
colon screening by PCP’s & HRMC’s gastroenterologist.
Nearly three-fourths of prostate cases were diagnosed at stage II (71.4%). This is true because of
aggressive screening by PCP’s & HRMC’s urologists.
And a significant of bladder cases were diagnosed at stage 0 (41.6%), most likely due to aggressive
screening by PCP’s & HRMC’s urologists.
Analysis of Prostate Cancer Care at HRMC Using Cancer Registry Data
Goal: HRMC will increase the number of cases diagnosed with aggressive screening by the urology
department.
Criteria: Data includes records of newly diagnosed and/or treated patients at HRMC. Comparative
analyses utilizing NCDB data.
Sources: HRMC Cancer Registry Data, National Cancer Data Base, American Cancer Society 2011 Cancer
Facts & Figures
Reviewer: Terry Hall, MD
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Prostate Cases Diagnosed and/or Treated at HRMC
2001-2011
New Cases: According to the ACS Facts & Figures, approximately 240,890 new cases of prostate cancer
would be diagnosed in the US in 2011. Prostate cancer is the most frequently diagnosed cancer in men.
For reasons that remain unclear, incidence rates are significantly higher in African Americans than in
Caucasians. Incidence rates for prostate cancer changed substantially between the mid-1980s and mid1990s, in large part reflecting changes in prostate cancer screening with the prostate-specific antigen
(PSA) blood test. Since 1998 incidence rates have remained relatively stable.
At HRMC, the number of prostate cases diagnosed and/or treated have peaked in 2002 and 2004 and
then gradually declined after 2006. This could be attributed to the fact that there were three urologists
on staff at HRMC from 2002-2004. Then, all three ceased services offered at HRMC one at a time. There
was a significant decrease in 2010 due to all three urologists were gone & had not yet been replaced,
but our cases began to increase again in 2011 due to the hiring of a new urologist.
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Risk Factors: The only well-established risk factors for prostate cancer are age, race/ethnicity, and
family history of the disease. About 62% of all prostate cancer cases are diagnosed in men 65 years of
age and older, and 97% occur in men 50 and older.
At HRMC, 83% of patients were diagnosed at age 60 years of age or older, and 99% of patients were
diagnosed at age 50 or older. These findings are consistent with the NCDB data.
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Early Detection/Stage: At this time, there are insufficient data to recommend for or against routine
testing for early prostate cancer detection with the PSA test. The ACS recommends that beginning at
age 50, men who are at average risk of prostate cancer and have a life expectancy of at least 10 years
receive information about the potential benefits and known limitations of testing for early prostate
cancer detection and have an opportunity to make an informed decision about testing.
At HRMC, 77% of patients are diagnosed at stage II, fairly consistent with the NCDB data. This is a result
of proper screening by the urology department.
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Treatment: Treatment options vary depending on age, stage, and grade of the cancer as well as other
medical conditions and should be discussed with the individual’s physician. Surgery (open, laparoscopic,
or robotic-assisted), external beam radiation, or radioactive seed implants (brachytherapy) may be used
to treat early stage disease, and hormonal therapy may be added in some cases.
At HRMC, more patients were treated with other specified therapy, in comparison to the NCDB data
showing more patients were treated with surgery only. This may be due to diagnosis at an early stage.
The number of patients treated with radiation only and radiation/hormone therapy is consistent with
NCDB data.
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Stage of Disease
ENTER
0.0 yr
Stage 0
4
Insufficient cases to display survival information
Stage I
4601
100.0
96.8
93.3
90.1
86.6
82.7
81.5 - 83.9
Stage II
261076
100.0
98.7
97.1
95.1
93.0
90.5
90.4 - 90.7
Stage III
26358
100.0
99.0
97.5
95.5
93.4
90.9
90.5 - 91.2
Stage IV
16696
100.0
77.4
60.5
49.9
42.5
37.1
36.3 - 37.8
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1.0 yr
2.0 yr
3.0 yr
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4.0 yr
5.0 yr
95% Confidence Interval
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Stage of Disease
ENTER
0.0 yr
1.0 yr
Stage I
4
Insufficient cases to display survival information
Stage II
55
100.0
Stage III
5
Insufficient cases to display survival information
Stage IV
11
Insufficient cases to display survival information
90.5
2.0 yr
88.5
3.0 yr
4.0 yr
81.8
79.4
5.0 yr
73.4
95% Confidence Interval
60.1 - 86.6
Survival: Comparison of 5-year cumulative survival rates for stage II prostate cases shows lower survival
rates at HRMC (73.4%) than for NCDB data (90.5%).
CONCLUSION: Although there was a sharp decline in the number of cases of prostate cancer & many
late stage lung cancer diagnosis’s, HRMC will continue to be aggressive in screening & educating our
community the importance of early detection.
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