Effectiveness: Cancer

2010 National Healthcare Quality and Disparities Reports

Effectiveness of Care: Cancer

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

Cervical Cancer
Women age 18 and over who received a Pap smear in the last 3 years
Cervical cancer diagnosed at advanced stage (all invasive tumors) per 100,000 women age 20 and over

Colorectal Cancer
Composite measure: Adults age 50 and over who received colorectal cancer screening (colonoscopy, sigmoidoscopy, proctoscopy, or (in the last 2 years) fecal occult blood test [FOBT])
Adults age 50 and over who ever received a colonoscopy, sigmoidoscopy, or proctoscopy
Adults age 50 and over who received a fecal occult blood test (FOBT) in the last 2 years
Colorectal cancer diagnosed at advanced stage (tumors diagnosed at regional or distant stage) per 100,000 population age 50 and over
Patients with colon cancer who received surgical resection of colon cancer that included at least 12 lymph nodes pathologically examined
Colorectal cancer deaths per 100,000 population

Other Cancers
Cancer deaths per 100,000 population
Prostate cancer deaths per 100,000 male population
Lung cancer deaths per 100,000 population
Men age 75 and over without prostate cancer who had a prostate specific antigen (PSA) test or a digital rectal exam within the past year

Breast Cancer

Measure Title

Women age 40 and over who received a mammogram in the last 2 years.

Measure Source

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

National Tables

1_1_1.1 Women age 40 and over who received a mammogram in the last 2 years, United States, 1999-2008

1_1_1.2a-c Women age 40 and over who received a mammogram in the last 2 years, United States, 2008, by:

• Race.
• Ethnicity.
• Family Income.

National Data Source

CDC, NCHS, NHIS.

National Denominator

Number of women age 40 and over.

National Numerator

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

State Table

1_1_1.3 Women age 40 and over who received a mammogram in the last 2 years, by State, 2000-2008

State Data Source

CDC, Behavioral Risk Factor Surveillance System (BRFSS).

State Denominator

Same as National.

State Numerator

Same as National.

Comments

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

State estimates are age adjusted to the 2000 standard population using four age groups: 40-49, 50-64, 65-74, and 75 and over.

State measure is based on Question 18.2 of the 2008 Behavioral Risk Factor Surveillance System.

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Breast Cancer

Measure Title

Breast cancer diagnosed at advanced stage, per 100,000 women age 40 and over, 2000-2007.

Measure Source

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

National Table

1_1_2.1 Breast cancer diagnosed at advanced stage, per 100,000 women age 40 and over, United States, 2000-2007

National Data Source

NCI, SEER.

Denominator

Women age 40 and over.

Numerator

Subset of denominator with new breast cancer that was diagnosed at an advanced stage.

Comments

Estimates are age-adjusted to the 2000 standard U.S. population, by 5-year age groups.

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

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, has developed a unified dataset that will combine and standardize the information needed to assign stage in the AJCC (TNM), SEER (Extent of Disease [EOD]), and Summary Stage (SS) 1977 and 2000 systems and to derive the T, N, M stage group, EOD, and SS applicable to each cancer site, beginning with cancers diagnosed in 2004.

The 2005 data were adjusted for areas impacted by Hurricanes Katrina and Rita. Hurricanes Katrina and Rita had a huge impact on the populations within Gulf Coast region for the second half of 2005. Katrina also significantly impacted 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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Breast Cancer

Measure Title

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

Measure Source

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

National Tables

1_1_3.1 Women with clinical Stage I-IIb breast cancer who received axillary node dissection or sentinel lymph node biopsy (SLNB) at the time of surgery (lumpectomy or mastectomy), United States, 2001-2007

1_1_3.2a-c Women with clinical Stage I-IIb breast cancer who received axillary node dissection or sentinel lymph node biopsy (SLNB) at the time of surgery (lumpectomy or mastectomy), United States, 2007, by:

• Race.
• Ethnicity
• Family income.

National Data Source

American Cancer Society, American College of Surgeons, CoC, NCDB.

Denominator

Women age 18 and over with The American Joint Committee on Cancer (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

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

Includes only women who received all or part of their first course of treatment at a facility with a CoC-approved cancer program. There is not full agreement regarding the appropriate population (denominator) for this measure, addressing lymph node surgery in women with breast cancer. As the measure from the NQF specifies including only women with stage I/II cancer, women classified as having stage III disease during lymph node surgery (based on 4 or more positive nodes) will be 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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Breast Cancer

Measure Title

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

Measure Source

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

National Tables

1_1_4.1 Women under age 70 treated for breast cancer with breast-conserving surgery who received radiation therapy within 1 year of diagnosis, United States, 2001-2007

1_1_4.2a-c Women under age 70 treated for breast cancer with breast-conserving surgery who received radiation therapy to the breast within 1 year of diagnosis, United States, 2007 by:

• Race.
• Ethnicity.
• Family Income.

National Data Source

American Cancer Society, American College of Surgeons, CoC, NCDB.

Denominator

Women ages 18-69 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 (365 days) 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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Breast Cancer

Measure Title

Breast cancer deaths per 100,000 female population, per year.

Measure Source

Healthy People 2010.

National Tables

1_1_5.1 Breast cancer deaths per 100,000 female population, United States, 2004-2007

1_1_5.2 Breast cancer deaths per 100,000 female population, United States, 1999-2003

1_1_5.3a-c Breast cancer deaths per 100,000 female population, United States, 2007 by:

• Race.
• Ethnicity.
• Education.

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 resident population.

National Numerator

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

State Table

1_1_5.4 Breast cancer deaths per 100,000 female population, by State, 1999-2007

State Data Source

CDC, NCHS, NVSS-M.

State Denominator

Female population, by State.

State Numerator

Same as National.

Comments

This measure is referred to as measure 3-3 in Healthy People 2010 documentation. Data are age adjusted to the 2000 standard population, except where indicated. 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. Respondents for which age is not reported are not included in the age adjustment calculations and are excluded from displayed numerators.

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Cervical Cancer

Measure Title

Women age 18 and over who received a Pap smear in the last 3 years.

Measure Source

Healthy People 2010.

National Tables

1_2_1.1 Women age 18 and over who received a Pap smear in the last 3 years, United States, 1999-2008

1_2_1.2a-c Women age 18 and over who received a Pap smear in the last 3 years, United States, 2008, by:

• Race.
• Ethnicity.
• Family Income.

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 civilian noninstitutionalized population age 18 and over.

National Numerator

Subset of denominator who report receiving a Pap test within the last 3 years.

State Table

1_2_1.3 Women age 18 and over who received a Pap smear within the last 3 years, by State, 2000-2008

State Data Source

CDC, Behavioral Risk Factor Surveillance System (BRFSS).

State Denominator

Same as National.

State Numerator

Subset of denominator who report receiving a Pap test within the last 3 years; includes 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

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

Data include women without a uterine cervix.

Data are age adjusted to the 2000 U.S. 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.

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Cervical Cancer

Measure Title

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

Measure Source

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

National Table

1_2_2.1 Cervical cancer incidence per 100,000 women age 20 and over diagnosed at advanced stage, United States, 2000-2007

National Data Source

NCI, SEER.

Denominator

Number of women age 20 and over.

Numerator

Number of women age 20 and over with a new, invasive, cervical cancer diagnosed in the survey years.

Comments

All rates except as noted are adjusted to the 2000 U.S. standard population by 5-year age groups.

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. Estimates include all invasive tumors.

Historically, cancer stage has been collected using three different staging systems having three different purposes, data sets and rules. The American Joint Committee on Cancer (AJCC), in collaboration with North American standard setters, has developed a unified data set that will combine and standardize the information needed to assign stage in the AJCC (TNM), SEER (Extent of Disease, [EOD]) and Summary Stage (SS) 1977 and 2000 systems and to derive the T, N, M stage group, EOD and SS applicable to each cancer site beginning with cancers diagnosed in 2004.

The 2005 data were adjusted for areas impacted by Hurricanes Katrina and Rita. Hurricanes Katrina and Rita had a huge impact on the populations within Gulf Coast region for the second half of 2005. Katrina also significantly impacted 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.

Estimates in this table are adjusted to the 2000 U.S. standard population by 5-year age groups, except where indicated.

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Colorectal Cancer

Measure Title

Composite measure: Adults age 50 and over who received colorectal cancer screening (colonoscopy, sigmoidoscopy, proctoscopy, or (in the last 2 years) fecal occult blood test [FOBT]).

Measure Source

Healthy People 2010.

National Tables

1_3_1.1 Adults age 50 and over who received colorectal cancer screening, United States, 2000-2008

1_3_1.2a-c Adults age 50 and over who received colorectal cancer screening, United States, 2008, by:

• Race.
• Ethnicity.
• Family Income.

National Data Source

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

Denominator

U.S. civilian noninstitutionalized population: adults age 50 and over.

Numerator

Number of adults age 50 and over who report receiving a colonoscopy, sigmoidoscopy, proctoscopy, or fecal occult blood test.

Comments

This measure is based on two Healthy People 2010. measures, referred to as 3-12a and 3-12b in Healthy People 2010 documentation. Data are age adjusted to the 2000 standard population, except where indicated. 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.

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Colorectal Cancer

Measure Title

Adults age 50 and over who ever received a colonoscopy, sigmoidoscopy, or proctoscopy.

Measure Source

Healthy People 2010.

National Tables

1_3_2.1 Adults age 50 and over who ever received a colonoscopy, sigmoidoscopy, or proctoscopy, United States, 1998-2008

1_3_2.2a-c Adults age 50 and over who ever received a colonoscopy, sigmoidoscopy, or proctoscopy, United States, 2008, by:

• Race.
• Ethnicity.
• Family Income.

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 civilian noninstitutionalized adults age 50 and over.

National Numerator

Subset of denominator who report ever receiving a sigmoidoscopy, colonoscopy, or proctoscopy.

State Table

1_3_2.3 Adults age 50 and over who ever received a colonoscopy, sigmoidoscopy, or proctoscopy, by State, 2001-2008.

State Data Source

CDC, Behavioral Risk Factor Surveillance System (BRFSS).

State Denominator

Same as National.

State Numerator

Same as National.

Comments

This measure is referred to as measure 3-12b in Healthy People 2010 documentation. Data are age adjusted to the 2000 standard population, except where indicated. 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.

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Colorectal Cancer

Measure Title

Adults age 50 and over who received a fecal occult blood test (FOBT) in the last 2 years.

Measure Source

Healthy People 2010.

National Tables

1_3_3.1 Adults age 50 and over who received a fecal occult blood test (FOBT) in the last 2 years, United States, 1998-2008

1_3_3.2a-c Adults age 50 and over who received a fecal occult blood test (FOBT) in the last 2 years, United States, 2008, by:

• Race.
• Ethnicity.
• Family Income.

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 civilian noninstitutionalized adults age 50 and over.

National Numerator

Subset of denominator who report receiving fecal occult blood testing within the preceding 2 years.

State Table

1_3_3.3 Adults age 50 and over who received a fecal occult blood test in the last 2 years, by State, 2001-2008

State Data Source

CDC, Behavioral Risk Factor Surveillance System (BRFSS).

State Denominator

Same as National.

State Numerator

Same as National.

Comments

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

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Colorectal Cancer

Measure Title

Colorectal cancer diagnosed at advanced stage (tumors diagnosed at regional or distant stage), per 100,000 population age 50 and over.

Measure Source

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

National Table

1_3_4.1 Colorectal cancer diagnosed at advanced stage, per 100,000 population age 50 and over, United States, 2000-2007

National Data Source

NCI, SEER.

Denominator

U.S. population age 50 and over.

Numerator

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

Comments

All rates are age adjusted to the 2000 standard U.S. population by 5-year age groups, except where indicated.

The 2005 data were adjusted for areas impacted by Hurricanes Katrina and Rita.

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.

Cancer stage historically has been collected using three different staging systems having three different purposes, datasets, and rules. The American Joint Committee on Cancer (AJCC), in collaboration with North American standard setters, has developed a unified dataset that will combine and standardize the information needed to assign stage in the AJCC (TNM), SEER (Extent of Disease [EOD]), and Summary Stage (SS) 1977 and 2000 systems and to derive the T, N, M stage group, EOD, and SS applicable to each cancer site beginning with cancers diagnosed in 2004.

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Colorectal Cancer

Measure Title

Patients with colon cancer who received surgical resection that included at least 12 lymph nodes pathologically examined.

Measure Source

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

National Tables

1_3_5.1 Patients with colon cancer who received recommended treatment: resected colon specimen had at least 12 regional lymph nodes pathologically examined, United States, 2003-2007

1_3_5.2a-c Patients with colon cancer who received recommended treatment: resected colon specimen had at least 12 regional lymph nodes pathologically examined, United States, 2007, by:

• Race.
• Ethnicity.
• Family Income.

National Data Source

American Cancer Society (ACS), American College of Surgeons (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

Family income is based on median ZIP Code income as of the 2000 U.S. Census.

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Colorectal Cancer

Measure Title

Colorectal cancer deaths per 100,000 population.

Measure Source

Healthy People 2010.

National Tables

1_3_6.1 Colorectal cancer deaths per 100,000 population, United States, 2004- 2007.

1_3_6.2 Colorectal cancer deaths per 100,000 population, United States, 1999-2003.

1_3_6.3a-c Colorectal cancer deaths per 100,000 population, United States, 2007, by:

• Race.
• Ethnicity.
• Education.

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. resident population.

National Numerator

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

State Table

1_3_6.4 Colorectal cancer deaths per 100,000 population, by State, 1999- 2007

State Data Source

CDC, NCHS, NVSS-M.

State Denominator

Population, by State.

State Numerator

Same as National.

Comments

This measure is referred to as measure 3-5 in Healthy People 2010 documentation. Data are age adjusted to the 2000 U.S. 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.

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Other Cancers

Measure Title

Cancer deaths per 100,000 population.

Measure Source

Healthy People 2010.

National Tables

1_4_1.1 All cancer deaths per 100,000 population, United States, 2004-2007

1_4_1.2 All cancer deaths per 100,000 population, United States, 1999-2003

1_4_1.3a-c All cancer deaths per 100,000 population, United States, 2007, by:

• Race.
• Ethnicity.
• Education.

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. resident population.

National Numerator

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

State Table

1_4_1.4 All cancer deaths per 100,000 population, by State, 1999-2007

State Data Source

CDC, NCHS, NVSS-M.

State Denominator

Population, by State.

State Numerator

Same as National.

Comments

This measure is referred to as measure 3-1 in Healthy People 2010 documentation. Data are age adjusted to the 2000 U.S. 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.

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Other Cancers

Measure Title

Prostate cancer deaths per 100,000 male population.

Measure Source

Healthy People 2010.

National Tables

1_4_2.1 Prostate cancer deaths per 100,000 male population, United States, 2004-2007

1_4_2.2 Prostate cancer deaths per 100,000 male population, United States, 1999-2003

1_4_2.3a-c Prostate cancer deaths per 100,000 male population, United States, 2007, by:

• Race.
• Ethnicity.
• Education.

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 resident population.

National Numerator

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

State Table

1_4_2.4 Prostate cancer deaths per 100,000 male population, by State, 1999-2007

State Data Source

CDC, NCHS, NVSS-M.

State Denominator

Population, by State.

State Numerator

Same as National.

Comments

This measure is referred to as measure 3-7 in Healthy People 2010 documentation. Data are age adjusted to the 2000 U.S. 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.

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Lung Cancer

Measure Title

Lung cancer deaths per 100,000 population.

Measure Source

Healthy People 2010.

National Tables

1_4_3.1 Lung cancer deaths per 100,000 population, United States, 2004-2007.

1_4_3.2 Lung cancer deaths per 100,000 population, United States, 1999-2003.

1_4_3.3a-c Lung cancer deaths per 100,000 population, United States, 2007, by:

• Race.
• Ethnicity.
• Education.

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. resident population.

National Numerator

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

State Table

1_4_3.5 Lung cancer deaths per 100,000 population, by State, 1999-2007

State Data Source

CDC, NCHS, NVSS-M.

State Denominator

Population, by State.

State Numerator

Same as National.

Comments

This measure is referred to as measure 3-2 in Healthy People 2010 documentation. Data are age adjusted to the 2000 U.S. 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.

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Prostate Cancer

Measure Title

Men age 75 and over without prostate cancer who had a prostate specific antigen (PSA) test or a digital rectal exam within the past year.

Measure Source

Centers for Disease Control and Prevention (CDC), Behavioral Risk Factor Surveillance System (BRFSS).

National Table

1_4_1.1. Men age 75 and over without prostate cancer who had a PSA test or a digital rectal exam for prostate cancer screening within the past year, United States, 2004, 2006 and 2008

National Data Source

CDC, BRFSS.

Denominator

Adult males age 75 and over without history of prostate cancer.

Numerator

Subset of denominator who had a PSA test or a digital rectal exam within the past year.

Comments

This measure is based on Question 19.1 and 19.4 of the Behavioral Risk Factor Surveillance Survey.

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