Breast cancer remains the malignancy seen with the highest frequency at Rice Memorial Hospital (RMH). In the nearly 20 years this data has been collected in our local tumor registry, the overall incidence has always been around 90 cases per year (Figure 1). This represents 20% of our total cases.

Survival rates for five years are quite similar for all stages when Rice (Figure 2) is compared to the NCDB (National Cancer Data Base-Figure 3). As expected, the survival rates for stage 0 and 1 exceeds 95%; whereas, the rates for stage 3 and 4 range from 45-60%.

Treatment for breast cancer usually includes surgery alone or surgery combined with radiation, chemotherapy, and/or hormone therapy. RMH data (Figure 4) again mirrors the NCDB (Figure 5) with only 4-6% receiving a treatment that did not include surgery.

Over the past 20 years, the preferred surgery of breast cancer has evolved from the radical mastectomy to more breast conserving surgery such as lumpectomy. Prior to 1990, most surgery of the breast included a total axillary dissection to stage the cancer. A frequent adverse effect of this procedure is upper arm lymphedema. This can range from a mild nuisance to a crippling disability. In order to decrease the incidence of lymphedema, a sentinel lymph node biopsy of the axilla has become the standard of care. In this procedure, dye is injected into the breast and picked up in the regional lymph nodes, and only those lymph nodes that collect this dye are harvested. If these lymph nodes then show cancer, the remainder of the lymph nodes are removed in a total axillary dissection. If they do not show cancer, the rest of the lymph nodes are left alone, and lymphedema is much decreased. Our data shows that nearly 40% of our surgeries include a sentinel node biopsy (Figure 6). From 2000 to 2003, 114 patients have been spared a total axillary dissection and are spared the associated lymphedema.

Gordon Bos, M.D.
Department of Surgery

figure 1
RMH Number of Breast Cancer Cases
1999 - 2003

figure 2
Five year Survival rates for Breast Cancer Cases Diagnosed
in 1995 and 1996
RMH

figure 3
Five year Survival rates for Breast Cancer Diagnosed
in 1995 and 1996
National Cancer Database

figure 4
Treatment of Breast Cancer Cases Diagnosed in 2001
RMH
93 Cases

figure 5
Treatment of Breast Cancer Cases Diagnosed in 2001
National Cancer Database

figure 6
Breast Sentinel Lymph Node Biopsy Results
Done at RMH
2000 - 2003

Other Breast Comparisons

figure 7
Stage of Breast Cancer Diagnosed in 2001
RMH
83 Cases

figure 8
Stage of Breast Cancer Diagnosed in 2001
National Cancer Database

figure 9
Age at Diagnosis, Breast Cancer 2001
RMH

figure 10
Age at Diagnosis, Breast Cancer 2001
National Cancer Database