Improvements

• Quality Management/ Performance Improvements 1999
• Breast Cancer PCE Project
• Melanoma PCE Project with Skin Cancer Screening

Year 2000 Study on 1999 Breast Cancer Cases

A special breast cancer study was chosen for one of the 1998 Patient Care Evaluation studies by the ACoS. It was designed to document current methods of diagnosis, staging, treatment, disease control and survival in three areas of breast cancer: (1) all male breast cancer (of any histology and any stage); (2) female ductal carcinoma in-situ (DCIS); and (3) female breast cancer of any histology with a tumor size of T1mic (microscopic invasion) or T1a (tumor size 0.5 cm or less). However, the Cancer Registry at Del Sol Medical Center was not formally organized until 1/2000. Since it was not possible to do the 1999 PCE on 1998 cases, the Cancer Committee decided to do this study as one of the year 2000 PCE studies on 1999 data because of the importance of early breast cancer among our patient population.

The study will primarily address: (1) radiographic, pathologic, and clinical factors in treatment choices for DCIS and T1mic or T1a tumors; (2) the risk factors for local recurrence in DCIS, T1mic and T1a cancers; (3) current radiotherapeutic practice for DCIS; (4) guidelines for pathological assessment of margins, grade, and size of tumor; and (5) disease presentations, trends, and treatment of male breast cancer, with a particular focus on adjuvant therapy. We have developed some preliminary answers to these questions and on that basis we provided information that will contribute to the NCDB collection of data on these issues. Some of the relevant facts are briefly referred to below.

We were able to submit the additional PCE information (specialized and detailed data not included on the normal cancer abstract) for eight eligible cases: one Stage IV male breast cancer patient, three cases of ductal carcinoma in-situ, two cases with the tumor stage of T1mic, and two cases with a tumor stage of T1a. (A ninth case was not eligible because there was no histological confirmation.) Only one of these patients had a second primary maligancy, and that was also a breast cancer. Most cases had ductal and/or intraductal histologies, although one case of ductal with tubular carcinoma was reported. In two cases, the pathology reported comedo patterns (an indicator for local recurrence). Ethnographically, study patients mirror the El Paso population in being 80% Hispanic and 20% Non-Hispanic. All patients were reported as White. Age at diagnosis: one patient in her 30's, one in her 40's, one in her 50's, one in her 60's, and four patients in the 70's.

Although we will compare our data to national trends when it is returned by the NCDB, we have done one study comparing the figures on breast conservation therapy vs. mastectomy with the data in our corporate database. We found that our lumpectomy/mastectomy ratio was superior to both national and corporate figures. However, a more refined study is being undertaken by our pathologist in collaboration with a radiation oncologist. Although an initial view of the data gathered above indicates treatment that meets current clinical pathway standards, we are refining and specifying our data to the highest degree possible to provide the detailed knowledge required for this study and thus to obtain an accurate picture of early-stage breast cancer management here.

We will also develop recommendations for the improvement of care for patients with early-stage breast cancer. Current activities for education and prevention have been distribution of materials at four health fairs, at cancer screenings at the Del Sol Regional Oncology Center, and at the hospital for the observance of Breast Cancer Awareness Month in October.