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2016 CANCER PROGRAM REPORT
Bay Medical Sacred Heart Health System
615 North Bonita Avenue
Panama City, FL 32401
850.769.1511
www.baymedical.org
2016 Cancer Program Report
Bay Medical Sacred Heart provides comprehensive services and equipment specializing in
the prevention, diagnosis, treatment and management of patients with cancer. The
cancer program at Bay Medical Sacred Heart is designated as a Comprehensive
Community Cancer Program by the American College of Surgeons Commission on Cancer.
As an accredited cancer program, we remain committed to providing outstanding care
and meeting the rigorous standards of quality annually. This program is directed by the
leadership of a multidisciplinary Cancer Committee, and members work diligently to help
provide the best cancer treatment available.
Throughout the year a range of educational events and screenings are also offered to the
community. Multiple platforms are utilized to share information about cancer, including
programs on the air, social and printed media, health fairs, and other public venues. In
2016, Bay Medical Sacred Heart provided and collaborated with others to offer a variety
of programs including the following:

Colon Cancer Educational Seminar

Skin Cancer Screenings

Mammogram Awareness Campaign

Making Strides against Breast Cancer

Tobacco Cessation Classes

Look Good Feel Better
Bay Medical Sacred Heart Health System | 2016 Cancer Program Report
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Bay Medical Sacred Heart Health System | 2016 Cancer Program Report
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Cancer Registry
At Bay Medical Sacred Heart, the Cancer Registry plays an integral role in the
Comprehensive Community Cancer Program. With a Registry Reference year of 1999, the
Registry is responsible for collecting and maintaining data for newly diagnosed cancers
and / or those receiving treatment at this facility. This data assists in determining
incidence, monitoring outcomes, and evaluating cancer care.
The information is collected according to Cancer Program Standards established by the
American College of Surgeons Commission on Cancer, as well as the Florida Cancer Data
System (FCDS), which is the state’s central registry. All analytic1 cases are reported
annually to the American College of Surgeons Commission on Cancer as is stipulated of an
accredited program. Additionally, cases are submitted to FCDS as required by state law.
The data collected is disease specific and standardized to ensure accurate comparisons
with national and state outcomes for all cancer types.
Cancer Registry Data - Summary of 2015 Statistics
The top five cancer sites most frequently diagnosed and / or treated at Bay Medical
Sacred Heart in 2015 were, in order of most to least, Lung, Colorectal, Breast, Bladder,
and Thyroid. For 2015, the Cancer Registry accessioned 700 new cases into the database,
and of those 489 were analytic1 cases and 211 were non-analytic cases. The following data
and graphs reflect the distribution of analytic primary sites seen in 2015 at Bay Medical
Sacred Heart (BMSH).
1Cases
diagnosed and / or received all or part of first course treatment at Bay Medical Sacred Heart.
2015 Gender Distribution
Bay Medical Sacred Heart
2015
Male
49.9%
Female
50.1%
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2015 Analytic Cases
TOTAL
MALE
FEMALE
ORAL CAVITY & PHARYNX
7
6
1
DIGESTIVE SYSTEM
109
64
45
RESPIRATORY SYSTEM
136
77
59
BONE & JOINTS
1
1
0
SOFT TISSUE
3
3
0
SKIN, EXCLUDING BASAL & SQUAMOUS
10
7
3
BREAST
63
0
63
FEMALE GENITAL SYSTEM
11
0
11
MALE GENITAL SYSTEM
9
9
0
URINARY SYSTEM
37
25
12
BRAIN & OTHER NERVOUS SYSTEM
31
15
16
ENDOCRINE SYSTEM
22
6
16
LYMPHOMA
15
7
8
MYELOMA
3
2
1
LEUKEMIA
10
7
3
MESOTHELIOMA
2
2
0
MISCELLANEOUS
20
13
7
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Age at Diagnosis
Bay Medical Sacred Heart
2015
OTHER
6%
AGE 40-49
9%
AGE 50-59
21%
AGE 60-69
27%
AGE 80-89
12%
AGE 70-79
25%
Top Five Cancer Sites by Gender
Bay Medical Sacred Heart
2015
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Male
Lung
54.2%
Colorectal
58.5%
Breast
0.0%
Bladder
80.0%
Thyroid
26.3%
Female
45.8%
41.5%
100.0%
20.0%
73.7%
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Cancer Incidence
Bay Medical Sacred Heart
2015
This chart shows the frequency of the top five primary sites seen at
Bay Medical Sacred Heart in 2015. Lung cancer remains the leading
primary site, representing 26.8% of cancer cases.
Lung 26.8%
Colorectal 13.3%
Breast 12.9%
Bladder 4.1%
Thyroid 3.9%
Other Cancers 39.0%
Cancer Frequency Comparison
National, State and Bay Medical Sacred Heart
30%
2015
This graph displays the comparison of Bay Medical Sacred Heart's
2015 cases to Florida and national estimates. State and national
figures are taken from the American Cancer Society's Facts and
Figures 2015. BMSH has a higher occurrence rate of lung and
colorectal cancer when compared to the national and state data.
BMSH has implemented lung cancer education and screenings
and has provided colorectal cancer seminars
and community educational offerings in response to this.
25%
20%
15%
10%
5%
0%
BMSH
Lung
26.8%
Colorectal
13.3%
Breast
12.9%
Bladder
4.1%
Thyroid
3.9%
FL
14.7%
8.2%
13.6%
5.0%
USA
13.3%
8.0%
14.1%
4.5%
NA
3.8%
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Triple Negative Breast Cancer
2016 Study
It is estimated that in 2016 there will be approximately 246,660 women and 2,600 men
diagnosed with invasive breast cancer, and 61,000 additional women will be diagnosed
with in-situ breast cancer. Breast cancer remains the most commonly diagnosed cancer in
women and the second leading cause of death in women in the United States. From
2009-2013, breast cancer was the most commonly diagnosed cancer in the state of
Florida.
When the diagnosis of breast cancer has been confirmed, the samples of cancer tissue are
evaluated by lab tests to determine the presence or absence of receptors (proteins),
specifically estrogen, progesterone and HER2/neu (human epidermal growth factor
receptor 2) receptors. The results of these tests assist in determining which treatments
are likely to be more effective.
If the tumor tests positive, this indicates that there are many receptors. If the tumor tests
negative, then this means that there are few or no receptors. The presence of these
receptors is known to support the growth of most breast cancers. There are more
treatment options for tumors that test positive. Hormonal therapies and the HER2targeted therapies interfere with the effects of hormones and the HER2 receptors on the
breast cancer cells.
When all three of these receptors test negative it is known as triple negative breast cancer
(TNBC). In the United States, about 10-20% of all breast cancers are triple negative
cancers. Of the reviewed breast cancer cases at Bay Medical Sacred Heart from 2011
through 2015, 10 percent were triple negative breast cancers. Most breast cancers are
diagnosed after the age of 55, and although TNBC can occur in anyone, it is more likely to
occur in those who are younger, African American and Hispanic women, or those who
have the BRCA 1 gene mutations. The graph below reflects the TNBC age distribution at
Bay Medical Sacred Heart for the same time period of 2011 through 2015.
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Age Distribution
Bay Medical Sacred Heart
> 60 yo = 46%
< 60 yo = 54%
Additionally, when testing the tumor tissue, the pathologist determines the grade of the
cancer tissue on a scale of 1 to 3. The higher the grade, the less the cancer cells resemble
normal cells in their appearance and growth pattern. The triple negative breast cancers
tend to be a higher grade than other types of breast cancer. Of the reviewed triple
negative breast cancer cases at Bay Medical Sacred Heart, 75% were Grade 3.
Tumor Grade Distribution
Bay Medical Sacred Heart
Grade 2: 25%
Grade 3:
75%
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Triple negative breast cancer is typically treated with a combination of surgery,
chemotherapy, and radiation.
The chemotherapy with radiation is often adjuvant
therapy, being given after surgery. According to the National Comprehensive Cancer
Network (NCCN) clinical practice guidelines, surgery with or without chemotherapy and
radiation is the standard for locoregional triple negative breast cancer. Although TNBC is
not treated with hormone or targeted therapy, some studies have shown that TNBC may
respond better to chemotherapy than the breast cancers that are hormone-receptor
positive.
Bay Medical Sacred Heart manages triple negative breast cancer in concordance with
current NCCN guidelines.
For the cases reviewed with TNBC diagnosed from 2011
through 2015, in those with small tumor size AJCC Stage I disease, surgery alone was the
treatment option for a very few patients. One patient with Stage I disease refused
chemotherapy, and surgery and radiation alone was the treatment in this case.
Chemotherapy was administered appropriately and withheld only upon refusal by the
patient. Surgery with chemotherapy and radiation therapy were the treatment modalities
for all those with Stage III disease. As per guidelines, anti-hormone therapy was not
prescribed for these patients. Trastuzumab (Herceptin), an immunotherapy that targets
the HER2 receptor / protein, was not utilized in any of these cases.
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AJCC Staging
Triple Negative Breast Cancer
50%
45%
40%
35%
30%
25%
20%
15%
10%
5%
0%
Triple Negative Cases
Stage I
33%
Stage II
50%
Stage III
17%
Treatment for BMSH TNBC 2011-2015
Surgery, Chemotherapy, & Radiation Therapy
Surgery and Chemotherapy
Surgery Alone
Surgery and Radiation Therapy (Refused Chemotherapy)
50.0%
37.5%
8.3%
4.2%
References:
The American Cancer Society
The American Cancer Society Facts and Figures 2016
Breastcancer.org
Susan G. Komen Foundation
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Accountability and Quality Improvement Measures
Bay Medical Sacred Heart continues to participate in the Rapid Quality Reporting System
(RQRS) of the American College of Surgeons. RQRS is a reporting and quality tool used to
provide real time assessment of the program’s adherence to quality cancer measures for
various types of cancer. This allows physicians to track clinical performance on national
quality indicators. Participating in this activity on a monthly basis provides a method to
evaluate care in a timely manner and develop appropriate quality improvements.
Another way care is evaluated is by reviewing the performance rates of care received by
patients with breast, colon, gastric, lung, and rectal cancer who have documentation of
treatment according to standard of care. The goals for the standards are established by
the American College of Surgeons Commission on Cancer (CoC).
Bay Medical Sacred Heart Performance: All measures with applicable cases were
compliant for the most recent year evaluated, being either above the established standard
(goal) percentage or with an upper limit of the 95% confidence interval above the set
benchmark.
Breast
Standard: Radiation is administered within 1 year (365 days) of diagnosis for women under
age 70 receiving breast conservation surgery for breast cancer.
CoC Standard: 90%
Standard: Tamoxifen or third generation aromatase inhibitor is recommended or
administered within 1 year (365 days) of diagnosis for women with AJCC T1c, or Stage IB-III
hormone receptor positive breast cancer.
CoC Standard: 90%
Standard: Radiation therapy is recommended or administered following any mastectomy
within 1 year (365 days) of diagnosis of breast cancer for women with > = 4 positive
regional lymph nodes.
CoC Standard: 90%
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Standard: Image or palpation-guided needle biopsy to the primary site is performed to
establish diagnosis of breast cancer.
CoC Standard: 80%
Colon
Standard: At least 12 regional lymph nodes are removed and pathologically examined for
resected colon cancer.
CoC Standard: 85%
Gastric
Standard: At least 15 regional lymph nodes are removed and pathologically examined for
resected gastric cancer.
CoC Standard: 80%
Lung
Standard: Systemic chemotherapy is administered within 4 months to day pre-operatively
or day of surgery to 6 months postoperatively, or it is recommended for surgically resected
cases with pathologic lymph node-positive (pN1) and (pN2) NSCLC.
CoC Standard: 85%
Standard: Surgery is not the first course of treatment for cN2, M0 lung cases.
CoC Standard: 85%
Rectum
Standard: Preoperative chemo and radiation are administered for clinical AJCC T3N0,
T4N0, or Stage III; or postoperative chemo and radiation are administered within 180 days
of diagnosis for clinical AJCC T1-2N0 with pathologic AJCC T3N0, T4N0, or Stage III; or
treatment is recommended; for patients under the age of 80 receiving resection for rectal
cancer.
CoC Standard: 85%
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The Healing Garden
615 North Bonita Avenue
Panama City, FL 32401
Bay Medical Sacred Heart Health System | 2016 Cancer Program Report
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