2007 Oncology Services Annual Report

Li Liu, MD Ellen Malek, CTR

July 2008

1987-2006 SAMC

Esophagus & Stomach Cancers

20 Year Review

Saint Agnes Medical CenterCancer Registry

1303 East Herndon AvenueFresno, CA 93720

559 450-3570www.samc.com

®

1987-2006 SAMC Analytic Stomach Cancer

There were 544 cases of Stomach Cancer diagnosed and/or treated at Saint Agnes Medical Center during the 20 year period.

97% were diagnosed by positive histology. 58% were Men and 42% were Women. Median age at diagnosis was 72. The most common site of Stomach Cancer diagnosed for Men was Stomach

Cardia (29%) and the most common site for Women was Gastric Antrum (21%). An overall 5% increase incidence of Stomach Cancer was observed at SAMC

(#1). Although, SEER data show historical rate trends (1975-2005) for Stomach Cancer Nationally are falling (minus 1.6%) (#2).

For the years 2000-2004 CDC National Cancer Institute data (#3) showed an average annual count of 61 cases of Stomach Cancer diagnosed in Fresno County. SAMC Cancer Registry data (#1) indicated that close to half (28) of that average annual number of Stomach Cancer were seen at SAMC.

In California, cancer rates are considerably lower for persons of Asian/Pacific Inlanders and Hispanic ethnicity; however, both these group have a substantially higher rate of Stomach Cancer (#4) which appears to be reflected in our data and, noted in particular contrast to our data seen further in this report for Cancer of the Esophagus.

1987-2006 Analytic Stomach CancerIncidence by 5 Year Interval N=544

73 70

86 86

5262

5065

125132 136

151

0

20

40

60

80

100

120

140

160

1987-1991 1992-1996 1997-2001 2002-2006

Year

nu

mb

er

of c

ase

s

Male Female Overall

1987-2006 SAMC Analytic Stomach CancerEthnicity by SexN=544

66%

54%

61%

22%

9.5%

16%12%

1.5%

8%

4%0.9 0.4 1%

0

10

20

30

40

50

60

70

perc

ent

White Hispanic Asian Black Other

Male Female Overall

1987-2006 SAMC Analytic Stomach Cancer Histology by 5 Year Intervals N=544

0

20

40

60

80

100

120

140

num

ber

of c

ases

1987-1991 1992-1996 1997-2001 2002-2006

Year

Carcinoma in-situ

Squamous Cell CA

Adenocarcinoma

signet ring

Sarcoma

Carcinoid

Neuroendocrine

Other

1987-2006 SAMC Analytic Stomach Cancer Personal History of Multiple Primaries N=544

83.5%Stomach Cancer

only

80% Stomach Cancer

only

20% 2 or more primaries

16.5% 2 or more primaries

Male Female

1987-2006 SAMC Analytic Stomach CancerStage by Combined Treatment ModalitiesN=544

5% 3%

26%

100%

75%

50%44% 46%

21%

30%25%

14%7%

23%25%

6%

0%

20%

40%

60%

80%

100%

120%

Stage 0 Stage I Stage II Stage III Stage IV

None Single Bi Tri

N=8 N=81 N=65 N=105 N=191

1987-2006 SAMC Stomach Cancer Treatment ~ Surgery Only

23%

29%

25%

34%

25%

17%

27%

20%

1987-1991 1992-1996 1997-2001 2002-2006

Year

Stage I Stage II/III

N=125 N=132 N=136 N=151

1998-2000 Analytic Stomach CancerNational Cancer Data Base 5 Year Survival Comparison ~ All Stages

SAMC25%N=64

NCDB18%

N=29,490(1337 facilities)

Analytic Stomach CancerNational Cancer Data Base5 Year Survival Comparison ~ Stage II/III Combined

SAMC, 32%1998-2002

N=32

NCDB, 20%1998-2000

N=10,081

1987-2006 SAMC Analytic Esophagus Cancer

244 cases of esophageal cancer were accessioned into the Saint Agnes Cancer Registry over the 20 year period.

98% were diagnosed by positive histology. 74% were Men and 26% were Women. Median age at diagnosis was 70. Data showed a 10.7% observed overall increased incidence of esophageal

cancer diagnosed and/or treated at the medical center (#1). Of these, 54% were diagnosed and/or treated at SAMC. 38.5% received all or

part of first course treatment at our facility. 7.8% were diagnosed here and seen elsewhere for treatment.

1987-2006 SAMC Analytic Esophagus Cancer Incidence by 5 Year IntervalN=244

29.5%27.5%

26%

17%

0%

5%

10%

15%

20%

25%

30%

35%

1987-1991 1992-1996 1997-2001 2002-2006

Year

pe

rce

nt

N=41 N=64 N=72 N=67

2001-2005 Analytic Esophagus Cancer SEER Comparison Age at Diagnosis

0%

5%

10%

15%

20%

25%

30%

35%

35-44 45-54 55-64 65-74 75-84 85+

Age at Diagnosis

perc

ent

SAMC SEER

1987-2006 SAMC Analytic Esophagus Cancer Histology by 5 Year Interval N=244

0

5

10

15

20

25

30

35

40

45

50

1987-1991 1992-1996 1997-2001 2002-2006

Year

nu

mbe

r o

f ca

ses

Carcinoma In-situ

Squamous Cell CA

Adenocarcinoma

Small Cell CA

Other

1987-2006 SAMC Analytic Esophagus Cancer Site by 5 Year Interval N=244

Site 1987-1991N=41

1992-1996N=64

1997-2001N=72

2002-2006N=67

total244

Upper 3rd 12.1% 12.5% 9.7% 8.9% 11%

Middle3rd

34.1% 23.4% 25.0% 16.4% 24%

Lower3rd

51.2% 51.5% 58.3% 65.6% 57%

Overlapping & NOS

2.3% 12.5% 6.9% 8.9% 8%

1987-2006 SAMC Analytic Esophagus Cancer Site by Sex N=244

8.8%

19.3%

62.4%

9.3%

15.8%

36.5%

4.7%

42.8%

Upper 3rd Middle 3rd Lower 3rd Overlapping/NOS

Site

Male Female

1987-2006 SAMC Analytic Esophagus Cancer Ethnicity by Sex N=244

1%2%3%

12%

83%

0%2%3%

13%

83%

White Hispanic Black Asian Other

Male Female

1987-2006 SAMC Analytic Esophagus CancerPersonal History of Multiple PrimariesN=244

78% Esophageal

Canceronly

79% Esophageal

Canceronly

22% with 2 or more

primaries

21% with 2 or more

primaries

Male Female

1987-2006 SAMC Analytic Esophagus CancerTreatment by Stage at DiagnosisN=244

1%4.0%

20.3%

50%

77%

59% 61%

40%

15%20.5%

38.5%

60%

3.3%

20.5%18.0%11.5%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

Stage 0 Stage I Stage II Stage III Stage IV

pe

rce

nt

None Single Bi Tri

N=5 N=26 N=90 N=34 N=59

Year

1998-2000 Analytic Esophagus CancerNational Cancer Data Base5 Year Survival Comparison ~ All Stages

24.0%SAMC

N=25

15.3%NCDBN=21,169

Analytic Esophagus CancerNational Cancer Data Base5 Year Survival Comparison ~ Stage II/III Combined

16.6%NCDB

1998-2000N=10,471

29.4% SAMC

1998-2002N=34

Sources:

# 1. SAMC Cancer Registry database*; www.samc.org. Comment: The report is developed from our hospital based registry experience which is not ‘population based’ data.

# 2. SEER Fact Sheet, Cancer of the Stomach; www.seer.cancer.gov/statfacts# 3. Centers for Disease Control, National Cancer Institute, State Cancer Profiles, Incidence Rate

Report for California by Count, All Races, Both Sexes, Stomach, All Ages; www.statecancerprofiles.cancer.gov/recenttrend

# 4. California, Cancer Facts & Figures, 2008; www.ccrcal.org/publications# 5. Fresno County demographics, www.factfinders.census.gov. Comment: Fresno County statistics breaks out Hispanic or Latino which, they note can be of any race, comprises

47.6% of the county demographic.

# 6. National Cancer Data Base: ©Commission on Cancer, American College of Surgeons. NCDB Benchmark Reports, v1.1. Chicago, IL, 2002. The content reproduced from the applications remains the full and exclusive copyrighted property of the American College of Surgeons. The American College of Surgeons is not responsible for any ancillary or derivative works based

on the original Text, Tables, or Figures.