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National Healthcare Quality & National Healthcare Disparities Reports: Measure Specification Appendix, 2013

Effectiveness of Care: Breast Cancer

Measures

Women ages 50-74 who received a mammogram in the last 2 years
Breast cancer diagnosed at advanced stage in women age 40 and over
Women under age 70 treated for breast cancer with breast-conserving surgery who received radiation therapy within 1 year of diagnosis
Women with clinical Stage I-IIb breast cancer who received axillary node dissection or sentinel lymph node biopsy at the time of breast cancer surgery (lumpectomy or mastectomy)
Breast cancer deaths per 100,000 female population per year
 


 

Measure Title

Women ages 50-74 who received a mammogram in the last 2 years

Measure Source

Healthy People 2020

Table Description

Geographic Representation

National, States

Years Available

State: 2000-2010

National: 2000, 2003, 2005, 2008, 2010

Population Subgroups

Activity limitation, age, education, health insurance, income, race/ ethnicity, geographic location (residence)

Data Sources

National

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

State

CDC, Behavioral Risk Factor Surveillance System (BRFSS)

Denominator

Number of women ages 50-74

Numerator

Subset of denominator who report receiving a mammogram within the last 2 years

Comments

National data is referred to as measure C-17 in Healthy People 2020 documentation. Estimates are age adjusted to the 2000 U.S. standard population using two age groups: 50-64 and 50-74.

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Measure Title

Breast cancer diagnosed at advanced stage in women age 40 and over

Measure Source

Centers for Disease Control and Prevention (CDC) and the National Cancer Institute (NCI), National Program of Cancer Registries (NPCR), United States Cancer Statistics.

Tables:

Geographic Representation

National, States

Years Available

States: 2004-2009

National: 2000-2009

Population Subgroups

Age, race, ethnicity

Data Sources

CDC, NCI, NPCR.

Denominator

Women age 40 and over

Numerator

Subset of the denominator with new diagnosis of advanced stage invasive breast cancer; advanced stage is defined as regional, distant or local stage, with a tumor > 2 cm. 

Comments

Advanced stage for this table refers to regional (spread to regional lymph nodes) and distant (cancer has metastasized) Surveillance, Epidemiology, and End Results (SEER) summary stage.

Historically, cancer stage has been collected using three different staging systems, each with a different purpose, dataset, and rules. The American Joint Committee on Cancer (AJCC), in collaboration with North American standard setters, developed a unified dataset that combines and standardizes the information needed to assign stage in the AJCC (Tumor, Node, Metastasis, or TNM), SEER (Extent of Disease, [EOD]), and Summary Stage (SS) 1977 and 2000 systems and to derive the TNM stage group, EOD, and SS applicable to each cancer site beginning with cancers diagnosed in 2004.

The 2005 data were adjusted for areas affected by Hurricanes Katrina and Rita. Hurricanes Katrina and Rita had a huge impact on the populations within the Gulf Coast region for the second half of 2005. Katrina also significantly affected the Louisiana Cancer Registry’s ability to report data for that time period. In an effort to provide the most accurate and complete data and statistics possible, the SEER Program has made several changes for the releases of data and statistics through 2005.

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Measure Title

Women under age 70 treated for breast cancer with breast-conserving surgery who received radiation therapy within 1 year of diagnosis

Measure Source

Commission on Cancer (CoC), American College of Surgeons (ACoS) and American Cancer Society (ACS), National Cancer Data Base (NCDB).

Table Description

Geographic Representation

National, States

Years Available

State: 2004, 2005, 2006, 2007, 2008, 2009, 2010

National: 2004, 2005, 2006, 2007, 2008, 2009, 2010

Population Subgroups

Activity limitation, age, education, health insurance, income, race/ ethnicity, geographic location (residence)

Data Sources

National and State

Commission on Cancer (CoC), American College of Surgeons (ACoS) and American Cancer Society (ACS), National Cancer Data Base (NCDB)

Denominator

Women under age 70 with American Joint Committee on Cancer (AJCC) stage I, II, or III primary invasive epithelial breast cancer that was surgically treated by breast-conserving 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 of date of diagnosis  

Comments

Breast-conserving 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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Measure Title

Women with clinical Stage I-IIb breast cancer who received axillary node dissection or sentinel lymph node biopsy at the time of breast cancer surgery (lumpectomy or mastectomy)

Measure Source

Commission on Cancer (CoC), American College of Surgeons (ACoS) and American Cancer Society (ACS), National Cancer Data Base (NCDB).

Table Description

Geographic Representation

National, States

Years Available

State: 2004-2010

National: 2004-2010

Population Subgroups

Activity limitation, age, education, health insurance, income, race/ ethnicity, geographic location (residence)

Data Sources

National and State

Commission on Cancer (CoC), American College of Surgeons (ACoS) and American Cancer Society (ACS), National Cancer Data Base (NCDB)

Denominator

Women age 18 and over with stage I/IIb breast cancer that was surgically treated by breast-conserving surgery or mastectomy

Numerator

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

Comments

There is not full agreement regarding the appropriate population (denominator) for this measure. In the most current draft form during production of the NHQR and NHDR, the measure specification from the National Quality Forum included only women with stage I/II cancer. Women classified as having stage III disease during lymph node surgery (based on four or more positive nodes) were excluded if their stage prior to surgery (i.e., clinical stage) was not recorded. This may artificially lower the rates for this measure.

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Measure Title

Breast cancer deaths per 100,000 female population per year

Measure Source

Healthy People 2020

Table Description

Geographic Representation

National, State

Years Available

National: 2000-2010

State: 2000-2010

Population Subgroups

Activity limitation, age, education, health insurance, income, race/ ethnicity, geographic location (residence)

Data Sources

National and State

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

Denominator

U.S. female resident population

Numerator

Number of female deaths per year due to breast cancer

Comments

This measure is referred to as measure C-3 in Healthy People 2020 documentation. Respondents for whom age is not reported are excluded from numerators.

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Page last reviewed July 2014
Page originally created July 2014
Internet Citation: National Healthcare Quality & National Healthcare Disparities Reports: Measure Specification Appendix, 2013. Content last reviewed July 2014. Agency for Healthcare Research and Quality, Rockville, MD. https://www.ahrq.gov/research/findings/nhqrdr/nhqrdr13/measurespec/breast-cancer.html

 

The information on this page is archived and provided for reference purposes only.

 

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