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National Healthcare Quality Report, 2007

Effectiveness of Care: Cancer

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Screening for Breast Cancer
Women age 40 and over who report they had a mammogram within the past 2 years
Rate of breast cancer incidence per 100,000 women age 40 and over diagnosed at advanced stage (regional, distant stage, or local stage with tumor greater than 2 cm)
Screening for Cervical Cancer
Women age 18 and over who report that they had a Pap smear within the past 3 years
Rate of cervical cancer incidence per 100,000 women age 20 and over diagnosed at advanced stage (all invasive tumors)
Screening for Colorectal Cancer
Composite measure: Adults age 50 and over who reported they ever received a colonoscopy, sigmoidoscopy, or proctoscopy, or received fecal occult blood test within the past 2 years
Men and women age 50 and over who reported they ever received a colonoscopy, sigmoidoscopy, or proctoscopy
Men and women age 50 and over who report they had a fecal occult blood test (FOBT) within the past 2 years
Rate of colorectal cancer incidence per 100,000 men and women age 50 and over diagnosed at advanced stage (tumors diagnosed at regional or distant stage)
Cancer Treatment
Cancer deaths per 100,000 persons per year for all cancers
Cancer deaths per 100,000 persons per year for most common cancers: prostate cancer
Cancer deaths per 100,000 persons per year for most common cancers: breast cancer
Cancer deaths per 100,000 persons per year for most common cancers: lung cancer
Cancer deaths per 100,000 persons per year for most common cancers: colorectal cancer
Deaths per 1,000 admissions with esophageal resection for cancer
Deaths per 1,000 admissions with pancreatic resection for cancer
Patients with breast cancer who received recommended treatment: radiation therapy to the breast within 1 year of diagnosis for women under age 70 receiving breast-conserving surgery
Patients with breast cancer who received recommended treatment: axillary node dissection or sentinel lymph node biopsy at the time of surgery (lumpectomy or mastectomy) for women with Stage I-IIb breast cancer
Patients with colon cancer who received recommended treatment: surgical resection of colon cancer that includes at least 12 lymph nodes

Screening for Breast Cancer

Measure Title

Women age 40 and over who report they had a mammogram within the past 2 years.

Measure Source

Healthy People 2010.

National Tables

1.1a Percent of women age 40 and over who report they had a mammogram within the past 2 years, United States, 1999 and 2005.

National Data Source

Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS), National Health Interview Survey (NHIS).

National Denominator

Number of women age 40 and over.

National Numerator

Number of women age 40 and over who report receiving a mammogram within the past 2 years.

State Tables

1.1b Percent of women age 40 and over who reported they had a mammogram within the past 2 years, by State, 2000 and 2005.

State Data Source

CDC, National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), Behavioral Risk Factor Surveillance System (BRFSS).

State Denominator

Number of women age 40 and over.

State Numerator

Number of women age 40 and over who report receiving a mammogram within the past 2 years.

Comments

Data are age adjusted to the 2000 standard population. Age-adjusted rates are weighted sums of age-specific rates. For a discussion of age adjustment, see Part A, Section 5, of Tracking Healthy People 2010.

This measure is referred to as measure 3-13 in Healthy People 2010 documentation.

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Screening for Breast Cancer

Measure Title

Rate of breast cancer incidence per 100,000 women age 40 and over diagnosed at advanced stage (regional, distant stage, or local stage with tumor greater than 2 cm).

Measure Source

National Cancer Institute (NCI), Surveillance, Epidemiology, and End Results Program (SEER).

National Tables

1.2a Rate of breast cancer incidence per 100,000 women age 40 and over diagnosed at advanced stage (regional, distant stage, or local stage with tumor greater than 2 cm), United States, 2000 and 2004.

National Data Source

NCI, SEER.

National Denominator

Women age 40 and over.

National Numerator

Women age 40 and over with new breast cancer diagnosed at advanced stage.

State Tables

1.2b Female breast cancer incidence rate per 100,000 for women age 40 and over diagnosed at advanced stage (regional and distant SEER summary stage), by State, 2002 and 2004.

State Data Source

Centers for Disease Control and Prevention, National Program of Cancer Registries (NPCR).

State Denominator

Women age 40 and over.

State Numerator

Women age 40 and over with new breast cancer diagnosed at advanced stage.

Comments

All rates except as noted are per 100,000 females age 40 and over and are age adjusted to the 2000 U.S. standard million population by 5-year age groups.

Due to changes in collection of staging data in the State data source, comparisons between 2004 and previous years' data should be interpreted with caution.

Advanced stage is defined as localized tumors in excess of 2 cm and regional or distant staged tumors.

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Screening for Cervical Cancer

Measure Title

Women age 18 and over who report that they had a Pap smear within the past 3 years.

Measure Source

Healthy People 2010.

National Tables

1.3a Percent of women age 18 and over who report they had a Pap smear within the past 3 years, United States, 1999 and 2005.

National Data Source

Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS), National Health Interview Survey (NHIS).

National Denominator

U.S. female population age 18 and over.

National Numerator

Number of women age 18 and over who report receiving a Pap test within the past 3 years.

State Tables

1.3b Percent of women age 18 and over who reported they had a Pap smear within the past 3 years, by State, 2000 and 2005.

State Data Source

CDC, National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), Behavioral Risk Factor Surveillance System (BRFSS).

State Denominator

Female population age 18 and over.

State Numerator

Number of women age 18 and over who report receiving a Pap test within the past 3 years; respondents who answered "Within the past year," "Within the past 2 years," or "Within the past 3 years" to the question "How long has it been since you had your last Pap smear?"

Comments

Data include women without a uterine cervix.

Data are age adjusted to the 2000 standard population. Age-adjusted rates are weighted sums of age-specific rates. For a discussion of age adjustment, see Part A, Section 5, of Tracking Healthy People 2010.

This measure is referred to as measure 3-11b in Healthy People 2010 documentation.

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Screening for Cervical Cancer

Measure Title

Rate of cervical cancer incidence per 100,000 women age 20 and over diagnosed at advanced stage (all invasive tumors).

Measure Source

National Cancer Institute (NCI), Surveillance, Epidemiology, and End Results Program (SEER).

National Tables

1.4a Rate of cervical cancer incidence per 100,000 women age 20 and over diagnosed at advanced stage (all invasive tumors), United States, 2000 and 2004.

National Data Source

NCI, SEER.

National Denominator

Number of women age 20 and over.

National Numerator

Number of women age 20 and over with new cervical cancers diagnosed as invasive in the survey years.

State Tables

1.4b Cervical cancer incidence rate per 100,000 women age 20 and over diagnosed at advanced stage (all invasive tumors), by State, 2002 and 2004.

State Data Source

Centers for Disease Control and Prevention, National Program of Cancer Registries (NPCR).

State Denominator

Number of women age 20 and over with new cervical cancers diagnosed as invasive in the survey years.

State Numerator

Women age 40 and over with new cervical cancer diagnosed at advanced stage.

Comments

All rates except as noted are per 100,000 females age 20 and over and are age adjusted to the 2000 U.S. standard million population by 5-year age groups.

Due to changes in collection of staging data in the State data source, comparisons between 2004 and previous years' data should be interpreted with caution.

Invasive cervical cancer is defined as cancer that has spread from the surface of the cervix to tissue deeper in the cervix or to other parts of the body.

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Screening for Colorectal Cancer

Measure Title

Composite measure: Adults age 50 and over who reported they ever received a colonoscopy, sigmoidoscopy, or proctoscopy, or received fecal occult blood test within the past 2 years.

Measure Source

Healthy People 2010.

Tables

1.5 Percent of men and women age 50 and over who reported they had ever received a colonoscopy, sigmoidoscopy, or proctoscopy, or received a fecal occult blood test within the past 2 years, United States, 2000 and 2005.

Data Source

Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS), National Health Interview Survey (NHIS).

Denominator

U.S. resident population age 50 and over.

Numerator

Number of adults age 50 and over who report ever receiving a colonoscopy, sigmoidoscopy, proctoscopy, or receiving a fecal occult blood test within the past 2 years.

Comments

Data are age adjusted to the 2000 standard population. Age-adjusted rates are weighted sums of age-specific rates. For a discussion of age adjustment, see Part A, Section 5, of Tracking Healthy People 2010.

This measure is referred to as measure 3-12b in Healthy People 2010 documentation.

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Screening for Colorectal Cancer

Measure Title

Men and women age 50 and over who reported they ever received a colonoscopy, sigmoidoscopy, or proctoscopy.

Measure Source

Healthy People 2010.

National Tables

1.6a Percent of men and women age 50 and over who reported they ever received a colonoscopy, sigmoidoscopy, or proctoscopy, United States, 2000 and 2005.

National Data Source

Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS), National Health Interview Survey (NHIS).

National Denominator

Number of adults age 50 and over.

National Numerator

Number of adults age 50 and over who report ever receiving a colonoscopy, sigmoidoscopy, or proctoscopy.

State Tables

1.6b Percent of men and women age 50 and over who reported they ever received a flexible sigmoidoscopy or colonoscopy, by State, 2001 and 2005.

State Data Source

CDC, National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), Behavioral Risk Factor Surveillance System (BRFSS).

State Denominator

Number of adults age 50 and over.

State Numerator

Number of adults age 50 and over who report ever receiving a sigmoidoscopy or colonoscopy.

Comments

Data are age adjusted to the 2000 standard population. Age-adjusted rates are weighted sums of age-specific rates. For a discussion of age adjustment, see Part A, Section 5, of Tracking Healthy People 2010.

This measure is referred to as measure 3-12b in Healthy People 2010 documentation.

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Screening for Colorectal Cancer

Measure Title

Men and women age 50 and over who report they had a fecal occult blood test (FOBT) within the past 2 years.

Measure Source

Healthy People 2010.

National Tables

1.7a Percent of men and women age 50 and over who report they had a fecal occult blood test within the past 2 years, United States, 2000 and 2005.

National Data Source

Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS), National Health Interview Survey (NHIS).

National Denominator

Number of adults age 50 and over.

National Numerator

Number of adults age 50 and over who report receiving fecal occult blood testing within the preceding 2 years.

State Tables

1.7b Percent of men and women age 50 and over who reported they had a fecal occult blood test within the past 2 years, by State, 2001 and 2005.

State Data Source

CDC, National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), Behavioral Risk Factor Surveillance System (BRFSS).

State Denominator

Number of adults age 50 and over.

State Numerator

Number of adults age 50 and over who report receiving fecal occult blood testing within the preceding 2 years.

Comments

Data are age adjusted to the 2000 standard population. Age-adjusted rates are weighted sums of age-specific rates. For a discussion of age adjustment, see Part A, Section 5, of Tracking Healthy People 2010.

This measure is referred to as measure 3-12a in Healthy People 2010 documentation.

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Screening for Colorectal Cancer

Measure Title

Rate of colorectal cancer incidence per 100,000 men and women age 50 and over diagnosed at advanced stage (tumors diagnosed at regional or distant stage).

Measure Source

National Cancer Institute (NCI), Surveillance, Epidemiology, and End Results Program (SEER).

National Tables

1.8a Rate of colorectal cancer incidence per 100,000 men and women age 50 and over diagnosed at advanced stage (tumors diagnosed at regional or distant stage), United States, 2000 and 2004.

National Data Source

NCI, SEER.

National Denominator

U.S. population age 50 and over.

National Numerator

Number of new colorectal cancers diagnosed in the survey years as regional or distant staged cancers.

State Tables

1.8b Colorectal cancer incidence rate per 100,000 for men and women age 50 and over diagnosed at advanced stage (regional and distant SEER summary stage), by State, 2002 and 2004.

State Data Source

Centers for Disease Control and Prevention, National Program of Cancer Registries (NPCR).

State Denominator

Men and women age 50 and over.

State Numerator

Subset of denominator with colorectal cancers diagnosed in the survey years as regional or distant staged cancers.

Comments

All rates except as noted are per 100,000 men and women age 50 and over and are age adjusted to the 2000 U.S. standard million population by 5-year age groups.

Due to changes in collection of staging data in the State data source, comparisons between 2004 and previous years' data should be interpreted with caution.

Regional stage is defined as a neoplasm that has extended beyond the limits of the organ of origin, either directly into surrounding organs or tissues or into regional lymph nodes. Distant stage is defined as a neoplasm that has spread to parts of the body remote from the primary tumor, either by direct extension or by discontinuous metastasis. For more information on staging, see Ries LAG, Harkins D, Krapcho M, Mariotto A, Miller BA, Feuer EJ, Clegg L, Eisner MP, Horner MJ, Howlader N, Hayat M, Hankey BF, Edwards BK (eds). SEER Cancer Statistics Review, 1975-2003. National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2003/, based on November 2005 SEER data submission, posted to the SEER Web site, 2006.

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Cancer Treatment

Measure Title

Cancer deaths per 100,000 persons per year for all cancers.

Measure Source

Healthy People 2010.

National Tables

1.9a Cancer deaths per 100,000 population per year for all cancers, United States, 1999 and 2004.

National Data Source

Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS), National Vital Statistics System-Mortality (NVSS-M).

National Denominator

U.S. population.

National Numerator

Number of deaths per year due to cancer (ICD-10-CM codes C00-C97).

State Tables

1.9b Cancer deaths per 100,000 population per year for all cancers, by State, 1999 and 2004.

State Data Source

CDC, NCHS, NVSS-M.

State Denominator

Population by State.

State Numerator

Same as national.

Comments

Data are age adjusted to the 2000 standard population. Age-adjusted rates are weighted sums of age-specific rates. For a discussion of age adjustment, see Part A, Section 5, of Tracking Healthy People 2010.

This measure is referred to as measure 3-1 in Healthy People 2010 documentation.

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Cancer Treatment

Measure Title

Cancer deaths per 100,000 persons per year for most common cancers: prostate cancer.

Measure Source

Healthy People 2010.

National Tables

1.10a Cancer deaths per 100,000 male population per year for prostate cancer, United States, 1999 and 2004.

National Data Source

Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS), National Vital Statistics System-Mortality (NVSS-M).

National Denominator

U.S. male population.

National Numerator

Number of male deaths per year due to prostate cancer (ICD-10-CM code C61).

State Tables

1.10b Cancer deaths per 100,000 male population per year for prostate cancer, by State, 1999 and 2004.

State Data Source

CDC, NCHS, NVSS-M.

State Denominator

Population by State.

State Numerator

Same as national.

Comments

Data are age adjusted to the 2000 standard population. Age-adjusted rates are weighted sums of age-specific rates. For a discussion of age adjustment, see Part A, Section 5, of Tracking Healthy People 2010.

This measure is referred to as measure 3-7 in Healthy People 2010 documentation.

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Cancer Treatment

Measure Title

Cancer deaths per 100,000 persons per year for most common cancers: breast cancer.

Measure Source

Healthy People 2010.

National Tables

1.11a Cancer deaths per 100,000 female population per year for breast cancer, United States, 1999 and 2004.

National Data Source

Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS), National Vital Statistics System-Mortality (NVSS-M).

National Denominator

U.S. female population.

National Numerator

Number of female deaths per year due to breast cancer (ICD-10-CM code C50).

State Tables

1.11b Cancer deaths per 100,000 female population per year for breast cancer, by State, 1999 and 2004.

State Data Source

CDC, NCHS, NVSS-M.

State Denominator

Population by State.

State Numerator

Same as national.

Comments

Data are age adjusted to the 2000 standard population. Age-adjusted rates are weighted sums of age-specific rates. For a discussion of age adjustment, see Part A, Section 5, of Tracking Healthy People 2010.

This measure is referred to as measure 3-3 in Healthy People 2010 documentation.

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Cancer Treatment

Measure Title

Cancer deaths per 100,000 persons per year for most common cancers: lung cancer.

Measure Source

Healthy People 2010.

National Tables

1.12a Cancer deaths per 100,000 population per year for lung cancer, United States, 1999 and 2004.

National Data Source

Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS), National Vital Statistics System-Mortality (NVSS-M).

National Denominator

U.S. population.

National Numerator

Number of deaths per year due to lung cancer (ICD-10-CM code C33-C34).

State Tables

1.12b Cancer deaths per 100,000 population per year for lung cancer, by State, 1999 and 2004.

State Data Source

CDC, NCHS, NVSS-M.

State Denominator

Population by State.

State Numerator

Same as national.

Comments

Data are age adjusted to the 2000 standard population. Age-adjusted rates are weighted sums of age-specific rates. For a discussion of age adjustment, see Part A, Section 5, of Tracking Healthy People 2010.

This measure is referred to as measure 3-2 in Healthy People 2010 documentation.

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Cancer Treatment

Measure Title

Cancer deaths per 100,000 persons per year for most common cancers: colorectal cancer.

Measure Source

Healthy People 2010.

National Tables

1.13a Cancer deaths per 100,000 population per year for colorectal cancer, United States, 1999 and 2004.

National Data Source

Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS), National Vital Statistics System-Mortality (NVSS-M).

National Denominator

U.S. population.

National Numerator

Number of deaths per year due to colorectal cancer (ICD-10-CM code C18-C21).

State Tables

1.13b Cancer deaths per 100,000 population per year for colorectal cancer, by State, 1999 and 2004.

State Data Source

CDC, NCHS, NVSS-M.

State Denominator

Population by State.

State Numerator

Same as national.

Comments

Data are age adjusted to the 2000 standard population. Age-adjusted rates are weighted sums of age-specific rates. For a discussion of age adjustment, see Part A, Section 5, of Tracking Healthy People 2010.

This measure is referred to as measure 3-5 in Healthy People 2010 documentation.

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Cancer Treatment

Measure Title

Deaths per 1,000 admissions with esophageal resection for cancer.

Measure Source

Agency for Healthcare Research and Quality (AHRQ), Inpatient Quality Indicators (IQI).

Tables

1.14 Deaths per 1,000 admissions with esophageal resection for cancer (excluding obstetric and neonatal admissions and transfers to another hospital), age 18 and over, United States, 2003 and 2004.

Data Source

AHRQ, Center for Delivery, Organization, and Markets (CDOM), Healthcare Cost and Utilization Project (HCUP), Nationwide Inpatient Sample (NIS).

Denominator

Hospital inpatient discharges with an esophageal resection (ICD-9-CM code 42.40-42.42) in any procedure field and a diagnosis code of esophageal cancer in any field (ICD-9-CM 150.0-150.5, 150.8, 150.9), excluding obstetric and neonatal admissions and transfers to another hospital.

Numerator

Number of deaths with a code of esophageal resection in any procedure field.

Comments

Rates are adjusted by age, gender, age-gender interactions, and APR-DRG risk of mortality score. When reporting is by age, the adjustment is by gender and APR-DRG risk of mortality score; when reporting is by gender, the adjustment is by age and APR-DRG risk of mortality score.

Although not all States participate in the HCUP database, the Nationwide Inpatient Sample is weighted to give national estimates using weights based on all U.S. community, non-rehabilitation hospitals in the American Hospital Association Annual Survey of Hospitals.

This table was created using version 2.1, revision 3, of the AHRQ IQI software. This measure is referred to as indicator 8 in the software documentation. More information about the AHRQ Quality Indicators is available at http://www.qualityindicators.ahrq.gov.

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Cancer Treatment

Measure Title

Deaths per 1,000 admissions with pancreatic resection for cancer.

Measure Source

Agency for Healthcare Research and Quality (AHRQ), Inpatient Quality Indicators (IQI).

Tables

1.15 Deaths per 1,000 admissions with pancreatic resection for cancer (excluding obstetric and neonatal admissions and transfers to another hospital), age 18 and over, United States, 2003 and 2004.

Data Source

AHRQ, Center for Delivery, Organization, and Markets (CDOM), Healthcare Cost and Utilization Project (HCUP), Nationwide Inpatient Sample (NIS).

Denominator

Hospital inpatient discharges with a pancreatic resection (ICD-9-CM codes of 52.6 or 52.7) in any procedure field and a diagnosis code of pancreatic cancer in any field (ICD-9-CM 152.0, 156.1, 156.2, 157.0-157.4, 157.8, 157.9), excluding patients transferring to another short-term hospital and obstetric and neonatal admissions.

Numerator

Number of deaths with a code of pancreatic resection in any procedure field.

Comments

Rates are adjusted by age, gender, age-gender interactions, and APR-DRG risk of mortality score. When reporting is by age, the adjustment is by gender and APR-DRG risk of mortality score; when reporting is by gender, the adjustment is by age and APR-DRG risk of mortality score.

Although not all States participate in the HCUP database, the Nationwide Inpatient Sample is weighted to give national estimates using weights based on all U.S. community, non-rehabilitation hospitals in the American Hospital Association Annual Survey of Hospitals.

This table was created using version 2.1, revision 3, of the AHRQ IQI software. This measure is referred to as indicator 9 in the software documentation. More information about the AHRQ Quality Indicators is available at http://www.qualityindicators.ahrq.gov.

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Cancer Treatment

Measure Title

Patients with breast cancer who received recommended treatment: radiation therapy to the breast within 1 year of diagnosis for women under age 70 receiving breast-conserving surgery.

Measure Source

American College of Surgeons (ACS), Commission on Cancer (CoC), National Cancer Database (NCDB).

Tables

1.16 Patients with breast cancer who received recommended treatment: radiation therapy to the breast within 1 year of diagnosis for women under age 70 receiving breast-conserving surgery, United States, 1999 and 2004.

Data Source

ACS, CoC, NCDB.

Denominator

Women age 18-69 with AJCC Stage I, II, or III primary invasive epithelial breast cancer that was surgically treated by breast conservation surgery. Breast cancer diagnoses are known or assumed first or only cancer diagnosis, and patients were known to be alive within 1 year of their diagnosis.

Numerator

Subset of denominator for whom radiation therapy to the breast was initiated within 1 year (365 days) of date of diagnosis.

Comments

Breast conservation surgery is defined for this measure as surgical excision less than mastectomy.

Includes only women who received all or part of their first course of treatment at a facility with a CoC-approved cancer program.

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Cancer Treatment

Measure Title

Patients with breast cancer who received recommended treatment: axillary node dissection or sentinel lymph node biopsy at the time of surgery (lumpectomy or mastectomy) for women with Stage I-IIb breast cancer.

Measure Source

American College of Surgeons (ACS), Commission on Cancer (CoC), National Cancer Database (NCDB).

Tables

1.17 Patients with breast cancer who received recommended treatment: axillary node dissection or sentinel lymph node biopsy at the time of surgery (lumpectomy or mastectomy) for women with Stage I-IIb breast cancer, United States, 1999 and 2004.

Data Source

ACS, CoC, NCDB.

Denominator

Women age 18 and over with AJCC Stage I or IIA primary invasive epithelial breast cancer that was surgically treated by breast conservation surgery or mastectomy. Breast cancer diagnoses are known or assumed first or only cancer diagnosis.

Numerator

Subset of denominator who received lymph node surgery (axillary node dissection or sentinel lymph node biopsy) at the time of their breast cancer surgery.

Comments

Includes only women who received all or part of their first course of treatment at a facility with a CoC-approved cancer program.

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Cancer Treatment

Measure Title

Patients with colon cancer who received recommended treatment: surgical resection of colon cancer that includes at least 12 lymph nodes.

Measure Source

American College of Surgeons (ACS), Commission on Cancer (CoC), National Cancer Database (NCDB).

Tables

1.18 Patients with colon cancer who received recommended treatment: resected colon specimen had at least 12 regional lymph nodes pathologically examined, United States, 2003 and 2004.

Data Source

ACS, CoC, NCDB.

Denominator

Persons age 18 and over with AJCC Stage I, II, or III primary invasive epithelial colon cancer that underwent surgical resection (surgery more than local excision). Colon cancer diagnoses are known or assumed first or only cancer diagnosis.

Numerator

Subset of denominator with 12 or more regional lymph nodes pathologically examined.

Comments

Includes only adults who received all or part of their first course of treatment at a facility with a CoC-approved cancer program.

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