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2011 Cancer Registry Report

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Linear Accelerator Upgrade

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High Risk Breast Clinic

NAPBC Accreditation

SonoCine Update

Gynecological Cancer Treatment with the da Vinci Surgical System

Social Workers Provide Comfort to Patients

Community Support and Screenings

Progress in Prediction of Breast Cancer Outcome

From Our Patient

2011 Oncology Peer Review Committee Roster

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Cancer Registry Report on 2010 Activity
Julia Kang, CTR
Manager of Cancer Registry

The Cancer Registry of St. Luke's Hospital is staffed by four Certified Tumor Registrars. All staff members participate in ongoing oncology-related continuing education annually by attending local and regional association meetings and Commission on Cancer sponsored meetings.

In 2010, there were 1,467 cases accessioned to the St. Luke's Hospital Cancer Registry. Of this number, 1,331 were analytic incidences of cancer with initial diagnosis and/or first course of treatment at St. Luke's Hospital, and 136 of these cases were considered non-analytic or cases of recurrent/persistent disease.

The graph below reflects the top five primary sites seen at St. Luke's Hospital in 2010. Based on 1,331 analytic primary cancers accessioned into the Registry's database, the top five primary sites represent 56 percent of the overall cases seen at St. Luke's Hospital.

The Cancer Registry's database has grown to 20,091 diagnosed cases since the reference date in 1995. Of this number, 17,584 were analytic cases, with 10,669 (60.67 percent) known to be living and 6,915 (39.33 percent) expired. Successful follow-up was performed on 86.24 percent of the patients since the reference date. In comparison, follow-up performed on patients in the past five years is 92.67 percent. Both of these percentages are well above the standards set by the Commission on Cancer for successful follow-up.

Breast cancer
According to the American Cancer Society's Breast Cancer Facts & Figures 2009-2010, breast cancer is the most common malignancy among women, excluding cancers of the skin, and accounts for nearly one in four cancers diagnosed in U.S. women. Breast cancer in men is a rare disease. Approximately one percent of breast cancer cases seen in the U.S. are men.

In 2010, there were a total of 298 breast cancers seen at St. Luke's Hospital. Of this number, 297 were female breasts while one was male breast cancer. Over the past five years, there have been a total of 1,305 primary breast cancers diagnosed and/or treated at St. Luke's Hospital. The chart below reflects the number of new breast cancers that have been diagnosed and/or treated at St. Luke's Hospital for the past five years.

Breast Cancer New Cases

Since breast cancer typically produces no symptoms when the tumor is small and most treatable, it is very important for women to follow the recommended screening guidelines by the American Cancer Society for detecting breast cancer at an earlier stage, before symptoms develop. Early detection of breast cancer by mammography may lead to a greater range of treatment options, including less-aggressive surgery and adjuvant therapy. Mammography does have limitations, though. Not all breast cancer will be detected by a mammogram and some breast cancers detected by mammography may still have poor prognosis. Despite these limitations, mammography is the single most effective method of early detection since it can identify cancer several years before physical symptoms develop. Treatment is more successful when cancer is discovered early.

According to the National Cancer Data Base (NCDB), the majority of breast cancer is being diagnosed at much earlier stages. For example, in the state of Missouri, more than 55 percent of the breast cancer patients who were diagnosed from 2000 to 2008 were at an early stage (Stage 0 and I). The national average for diagnosis of breast cancer at an early stage (Stage 0 and I) is 57 percent. For this same time period, St. Luke's had 57 percent of the patients being diagnosed at an early stage (Stage 0 and I).

Stage of Breast Cancer Diagnosed in 2000 to 2008
St. Luke's Hospital, Chesterfield, MO vs. All Types Hospitals in All States All Diagnosed Cases - Data from 1,374 Hospitals

In 2010, St. Luke's Hospital saw patients with the following American Joint Committee on Cancer (AJCC) stages at diagnosis:

This graph reflects an increase in the diagnosis of breast cancer at earlier stages to 66 percent, which is significantly higher over previous years. It is hoped that this increase is a reflection of increased screening mammography and the implementation of improved ultrasound technology. It is anticipated that the number of breast cancers diagnosed at earlier stages will continue to increase over the next few years with the addition of SonoCin� at St. Luke's Hospital.

In addition, St. Luke's Hospital has a strong education and outreach program for patients diagnosed with breast cancer in the St. Louis region. St. Luke's provides free mammograms via the National Breast Cancer Foundation Grant for women who are underinsured or uninsured, as well as referring patients to hospitals that participate in reduced fee mammography programs in the State of Missouri. St. Luke's also provides free treatment for patients diagnosed with breast cancer via the Gateway to Hope Program.

The Breast Care Center at St. Luke's Hospital is dedicated to providing highly specialized diagnostic and therapeutic services for women who are concerned about or diagnosed with breast cancer. Services include physical examinations, diagnostic mammography, breast ultrasound, sentinel node biopsy, fine needle aspiration, core biopsy, supportive counseling, educational materials and instruction in breast selfexam. In 2011, the Breast Care Center was granted a three-year full accreditation designation by the National Accreditation Program for Breast Centers (NAPBC), a program that is administered by the American College of Surgeons.

Treatment decisions are based on stage of disease at diagnosis and a multi-disciplinary team approach. In 2010, a Breast Navigation Program was established for breast cancer patients diagnosed at St. Luke's. The Breast Care Coordinators work closely with a multidisciplinary team of experts in radiology, medical and radiation oncology and surgery to guide women on their journey. They are available to offer valuable support and to answer questions that patients and their loved ones may have during this very difficult time.

Each patient's treatment plan takes into account their tumor size, stage of disease, activity level and other medical conditions, as well as patient preference. The multidisciplinary team bases most of their treatment recommendations on the National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines in Oncology, which are the most comprehensive and most frequently referenced recommendations for care of cancer patients, stage by stage, from diagnosis through lifetime follow-up.

Treatment according to the National Cancer Data Base indicates most breast cancer patients are treated with a multi-modality approach. First course treatment in 2010 reflects 89 percent of the breast cancers treated at St. Luke's Hospital were treated with multi-modality therapies.

According to the American Cancer Society, the five-year relative survival is lower among women with a more advanced stage at diagnosis. Considering all races, five year relative survival is 98 percent for localized disease, 84 percent for regional disease and 23 percent for distant-stage disease. Larger tumor size at diagnosis is associated with decreased survival.

There are many clinical trials available to patients at St. Luke's Hospital who have been diagnosed with breast cancer. Patients receive either the state-of-the-art standard treatment or a new therapy that may offer improved survival and/or fewer side effects. Participation in a clinical trial provides essential information on the effectiveness and risks of a new treatment.

Patients may visit the American Cancer Society Clinical Trials Matching Service at cancer.org/clinicaltrials or call the American Cancer Society Clinical Trials Matching Service at 1-800-303-5691 to identify clinical trials options. This service is free and confidential for patients and their families to help locate a cancer clinical trial most appropriate to the patient's medical and personal situation.

Patients should consult their personal physician and cancer specialists for detailed information about appropriate treatment choices and availability of clinical trials at St. Luke's Hospital.

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