2012 National Healthcare Quality and Disparities Reports
Effectiveness of Care: Cancer
Breast Cancer
Women who received a mammogram in the last 2 years
Breast cancer diagnosed at advanced stage in women age 40 and over
Women with clinical Stage I-IIb breast cancer who received axillary node dissection or sentinel lymph node biopsy at the time of breast cancer surgery (lumpectomy or mastectomy)
Women under age 70 treated for breast cancer with breast-conserving surgery who received radiation therapy within 1 year of diagnosis
Breast cancer deaths per 100,000 female population per year
Cervical Cancer
Women ages 21-65 who received a Pap smear in the last 3 years
Cervical cancer diagnosed at advanced stage per 100,000 women age 20 and over
Colorectal Cancer
Composite measure: Adults ages 50-75 who report receiving any type of colorectal cancer screening
Adults age 50 and over who ever received a colonoscopy, sigmoidoscopy, or proctoscopy
Adults age 50 and over who received a fecal occult blood test (FOBT) in the last 2 years
Colorectal cancer diagnosed at advanced stage per 100,000 adults age 50 and over
Patients with colon cancer who received surgical resection that included at least 12 lymph nodes pathologically examined
Colorectal cancer deaths per 100,000 population
Other Cancers
Cancer deaths per 100,000 population
Prostate cancer deaths per 100,000 male population
Lung Cancer
Lung cancer deaths per 100,000 population
Breast Cancer
Measure Title
Women who received a mammogram in the last 2 years.
Measure Source
Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS), National Health Interview Survey (NHIS).
National Tables
2_1_1_1.1 Women ages 50-74 who received a mammogram in the last 2 years, United States, 2000, 2003, 2005, 2008 and 2010
2_1_1_1.2a-c Women ages 50-74 who received a mammogram in the last 2 years, United States, 2010, by:
- Race.
- Ethnicity.
- Family income.
National Data Source
CDC, NCHS, NHIS.
National Denominator
Number of women ages 50-74.
National Numerator
Subset of denominator who report receiving a mammogram within the last 2 years.
State Table
2_1_1_1.3 Women ages 50-74 who received a mammogram in the last 2 years, by State, United States, 2000-2010
State Data Source
CDC, Behavioral Risk Factor Surveillance System (BRFSS).
State Denominator
Same as national.
State Numerator
Same as national.
Comments
National data is referred to as measure C-17 in Healthy People 2020 documentation.
Breast Cancer
Measure Title
Breast cancer diagnosed at advanced stage in women age 40 and over.
Measure Source
Centers for Disease Control and Prevention (CDC) and the National Cancer Institute (NCI), National Program of Cancer Registries (NPCR), United States Cancer Statistics.
National Table
2_1_1_2.1 Advanced stage invasive breast cancer incidence, rate per 100,000 women age 40 and over, United States, 2000-2008
National Data Source
CDC, NCI, NPCR.
National Denominator
Women age 40 and over.
National Numerator
Subset of the denominator with new diagnosis of advanced stage invasive breast cancer.
State Table
2_1_1_2.2 Advanced stage invasive breast cancer incidence, rate per 100,000 women age 40 and over, by State, United States, 2004-2008
State Data Source
CDC, NCI, NPCR.
State Denominator
Same as national.
State Numerator
Same as national.
Comments
Advanced stage for this table refers to regional (spread to regional lymph nodes) and distant (cancer has metastasized) Surveillance, Epidemiology, and End Results (SEER) summary stage.
Historically, cancer stage has been collected using three different staging systems, each with a different purpose, dataset, and rules. The American Joint Committee on Cancer (AJCC), in collaboration with North American standard setters, developed a unified dataset that combines and standardizes the information needed to assign stage in the AJCC (Tumor, Node, Metastasis, or TNM), SEER (Extent of Disease, [EOD]), and Summary Stage (SS) 1977 and 2000 systems and to derive the TNM stage group, EOD, and SS applicable to each cancer site beginning with cancers diagnosed in 2004.
The 2005 data were adjusted for areas affected by Hurricanes Katrina and Rita. Hurricanes Katrina and Rita had a huge impact on the populations within the Gulf Coast region for the second half of 2005. Katrina also significantly affected the Louisiana Cancer Registry’s ability to report data for that time period. In an effort to provide the most accurate and complete data and statistics possible, the SEER Program has made several changes for the releases of data and statistics through 2005.
Breast Cancer
Measure Title
Women with clinical Stage I-IIb breast cancer who received axillary node dissection or sentinel lymph node biopsy at the time of breast cancer surgery (lumpectomy or mastectomy).
Measure Source
Commission on Cancer (CoC), American College of Surgeons (ACoS) and American Cancer Society (ACS), National Cancer Data Base (NCDB).
National Tables
2_1_1_3.1 Women with clinical stage I/IIb breast cancer who received axillary node dissection or sentinel lymph node biopsy at the time of surgery (lumpectomy or mastectomy), United States, 2004-2009
2_1_1_3.2 b-c Women with clinical stage I/IIb breast cancer who received axillary node dissection or sentinel lymph node biopsy at the time of surgery (lumpectomy or mastectomy), United States, 2009, by:
- Ethnicity.
- Family income.
National Data Source
CoC, ACoS and ACS, NCDB.
National Denominator
Women age 18 and over with stage I/IIb breast cancer who were surgically treated by breast-conserving surgery or mastectomy.
National Numerator
The subset of the denominator who received lymph node surgery (axillary node dissection or sentinel lymph node biopsy) at the time of their breast cancer surgery.
State Table
2_1_1_3.3 Women age 18 and over with clinical stage I/IIb breast cancer who received axillary node dissection or sentinel lymph node biopsy at the time of surgery (lumpectomy or mastectomy), by State, United States, 2004-2009
State Data Source
CoC, ACoS; and ACS, NCDB.
State Denominator
Same as national.
State Numerator
Same as national.
Comments
There is not full agreement regarding the appropriate population (denominator) for this measure. In the most current draft form during production of the NHQR and NHDR, the measure specification from the National Quality Forum included only women with stage I/II cancer. Women classified as having stage III disease during lymph node surgery (based on four or more positive nodes) were excluded if their stage prior to surgery (i.e., clinical stage) was not recorded. This may artificially lower the rates for this measure.
Breast Cancer
Women under age 70 treated for breast cancer with breast-conserving surgery who received radiation therapy within 1 year of diagnosis.
Measure Source
Commission on Cancer (CoC), American College of Surgeons (ACoS) and American Cancer Society (ACS), National Cancer Data Base (NCDB).
National Tables
2_1_1_4.1 Women under age 70 treated for breast cancer with breast-conserving surgery who received radiation therapy within 1 year of diagnosis, United States, 2004-2009
2_1_1_4.2b-c Women under age 70 treated for breast cancer with breast-conserving surgery who received radiation therapy to the breast within 1 year of diagnosis, United States, 2009 by:
- Ethnicity.
- Family income.
National Data Source
CoC, ACoS and ACS, NCDB.
National Denominator
Women under age 70 with American Joint Committee on Cancer stage I, II, or III primary invasive epithelial breast cancer that was surgically treated by breast-conserving surgery. Breast cancer diagnoses are known or assumed first or only cancer diagnosis, and patients were known to be alive within 1 year of their diagnosis.
National Numerator
Subset of denominator for whom radiation therapy to the breast was initiated within 1 year of date of diagnosis.
State Table
2_1_1_4.3 Women under age 70 treated for breast cancer with breast-conserving surgery who received radiation therapy to the breast within 1 year of diagnosis, by State, United States, 2004-2009
State Data Source
CoC, ACoS and ACS, NCDB.
State Denominator
Same as national.
State Numerator
Same as national.
Comments
Breast-conserving surgery is defined for this measure as surgical excision less than mastectomy.
Includes only women who received all or part of their first course of treatment at a facility with a CoC-approved cancer program.
Breast Cancer
Measure Title
Breast cancer deaths per 100,000 female population per year.
Measure Source
Healthy People 2020.
National Tables
2_1_1_5.1 Breast cancer deaths per 100,000 female population, United States, 2004-2009
2_1_1_5.2 Breast cancer deaths per 100,000 female population, United States, 2000-2003
2_1_1_5.2a-b Breast cancer deaths per 100,000 female population, United States, 2009, by:
- Race.
- Ethnicity.
National Data Source
Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS), National Vital Statistics System (NVSS)—Mortality.
National Denominator
U.S. female resident population.
National Numerator
Number of female deaths per year due to breast cancer.
State Table
2_1_1_5.4 Breast cancer deaths per 100,000 female population, by State, United States, 2006-2009
State Data Source
CDC, NCHS, NVSS.
State Denominator
Same as national.
State Numerator
Same as national.
Comments
This measure is referred to as measure C-3 in Healthy People 2020 documentation. Respondents for which age is not reported are excluded from numerators.
Cervical Cancer
Measure Title
Women ages 21-65 who received a Pap smear in the last 3 years.
Measure Source
Healthy People 2020.
National Tables
2_1_2_1.1 Women ages 21-65 who received a Pap smear in the last 3 years, United States, 2000, 2005, 2008, and 2010
2_1_2_1.2a-c Women ages 21-65 who received a Pap smear in the last 3 years, United States, 2010, by:
- Race.
- Ethnicity.
- Family income.
National Data Source
Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS), National Health Interview Survey (NHIS).
National Denominator
U.S. female civilian noninstitutionalized population ages 21-65.
National Numerator
Subset of denominator who report receiving a Pap smear within the last 3 years.
State Table
2_1_2_1.3 Women ages 21-65 who received a Pap smear within the last 3 years, by State, United States, 2000-2010
State Data Source
CDC, Behavioral Risk Factor Surveillance System (BRFSS).
State Denominator
Same as national.
State Numerator
Same as national.
Comments
This measure is referred to as measure C-15 in Healthy People 2020 documentation.
Cervical Cancer
Measure Title
Cervical cancer diagnosed at advanced stage per 100,000 women age 20 and over.
Measure Source
National Cancer Institute (NCI), Surveillance, Epidemiology, and End Results (SEER) Program.
National Tables
2_1_2_2.1 Invasive cervical cancer incidence rate per 100,000 women age 20 and over, United States, 2000-2008
National Data Source
Centers for Disease Control and Prevention (CDC) and NCI, National Program of Cancer Registries (NPCR), United States Cancer Statistics.
National Denominator
Number of women age 20 and over.
National Numerator
Subset of denominator with a new invasive cervical cancer diagnosed in the survey years.
State Table
2_1_2_2.2 Cervical cancer diagnosed at advanced stage per 100,000 women age 20 and over, by State, United States, 2004-2008
State Data Source
CDC, NCI, NPCR.
State Denominator
Same as national.
State Numerator
Same as national.
Comments
Invasive cervical cancer is defined as cancer that has spread from the surface of the cervix to tissue deeper in the cervix or to other parts of the body. Estimates include all invasive tumors.
National estimates are age adjusted to the 2000 U.S. standard population (19 age groups—Census P25-1130). State estimates are age adjusted to the 2000 U.S. standard million population by 5-year age groups.
Historically, cancer stage has been collected using three different staging systems having three different purposes, datasets, and rules. The American Joint Committee on Cancer (AJCC), in collaboration with North American standard setters, has developed a unified dataset that combines and standardizes the information needed to assign stage in the AJCC (Tumor, Node, Metastasis, or TNM), SEER (Extent of Disease, [EOD]), and Summary Stage (SS) 1977 and 2000 systems and to derive the TNM stage group, EOD, and SS applicable to each cancer site beginning with cancers diagnosed in 2004.
The 2005 data were adjusted for areas affected by Hurricanes Katrina and Rita. Hurricanes Katrina and Rita had a huge impact on the populations within the Gulf Coast region for the second half of 2005. Katrina also significantly affected the Louisiana Cancer Registry’s ability to report data for that time period. In an effort to provide the most accurate and complete data and statistics possible, the SEER Program has made several changes for the releases of data and statistics through 2005.
Colorectal Cancer
Measure Title
Composite measure: Adults ages 50-75 who report receiving any type of colorectal cancer screening.
Measure Source
Healthy People 2020.
National Tables
2_1_3_1.1 Men and women ages 50-75 who report that they had a blood stool test in the past year, sigmoidoscopy in the past 5 years and blood stool test in the past 3 years, or a colonoscopy in the past 10 years, United States, 2000, 2003, 2005, 2008, and 2010
2_1_3_1.1_2a-c Men and women ages 50-75 who report that they had a blood stool test in the past year, sigmoidoscopy in the past 5 years and blood stool test in the past 3 years, or a colonoscopy in the past 10 years, United States, 2010, by:
- Race.
- Ethnicity.
- Family income.
National Data Source
Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS), National Health Interview Survey (NHIS).
National Denominator
U.S. civilian noninstitutionalized population of adults ages 50-75.
National Numerator
Number of adults ages 50-75 who report receiving a blood stool test in the past year, a sigmoidoscopy in the past 5 years and a blood stool test in the past 3 years, or a colonoscopy in the past 10 years.
State Table
2_1_3_1.3 Men and women ages 50-75 years who reported any colorectal test use, by State, United States, 2010
State Data Source
CDC, Behavioral Risk Factor Surveillance System (BRFSS).
State Denominator
Same as national.
State Numerator
Same as national.
Comments
This measure is based on measure C-16 in Healthy People 2020 documentation. Data are age adjusted to the 2000 U.S. standard population, except where indicated. Age-adjusted rates are weighted sums of age-specific rates.
Colorectal Cancer
Measure Title
Adults age 50 and over who ever received a colonoscopy, sigmoidoscopy, or proctoscopy.
Measure Source
Healthy People 2010.
National Tables
2_1_3_2.1 Adults age 50 and over who ever received a colonoscopy, sigmoidoscopy, or proctoscopy, United States, 2000, 2003, 2005, and 2008
2_1_3_2.2a-c Adults age 50 and over who ever received a colonoscopy, sigmoidoscopy, or proctoscopy, United States, 2008, by:
- Race.
- Ethnicity.
- Family income.
National Data Source
Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS), National Health Interview Survey (NHIS).
National Denominator
Number of civilian noninstitutionalized adults age 50 and over.
National Numerator
Subset of denominator who report ever receiving a sigmoidoscopy, colonoscopy, or proctoscopy.
Comments
This measure is referred to as measure 3-12b in Healthy People 2010 documentation. Data are age adjusted to the 2000 U.S. standard population, except where indicated. Age-adjusted rates are weighted sums of age-specific rates.
Colorectal Cancer
Measure Title
Adults age 50 and over who received a fecal occult blood test (FOBT) in the last 2 years.
Measure Source
Healthy People 2010.
National Tables
2_1_3_3.1 Adults age 50 and over who received a fecal occult blood test in the last 2 years, United States, 2000, 2003, 2005, and 2008
2_1_3_3.2a-c Adults age 50 and over who received a fecal occult blood test in the last 2 years, United States, 2008, by:
- Race.
- Ethnicity.
- Family income.
National Data Source
Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS), National Health Interview Survey (NHIS).
National Denominator
Number of civilian noninstitutionalized adults age 50 and over.
National Numerator
Subset of denominator who report having received a fecal occult blood test within the last 2 years.
Comments
This measure is referred to as measure 3-12a in Healthy People 2010 documentation. Data are age adjusted to the 2000 U.S. standard population. Age-adjusted rates are weighted sums of age-specific rates.
Colorectal Cancer
Measure Title
Colorectal cancer diagnosed at advanced stage per 100,000 adults age 50 and over.
Measure Source
National Cancer Institute (NCI), Surveillance, Epidemiology, and End Results (SEER) Program.
National Table
2_1_3_4.1 Advanced stage invasive colorectal cancer incidence, rate per 100,000 men and women age 50 and over, United States, 2000-2008
National Data Source
Centers for Disease Control and Prevention (CDC) and NCI, National Program of Cancer Registries (NPCR), United States Cancer Statistics.
National Denominator
U.S. population age 50 and over.
National Numerator
Subset of denominator with new colorectal cancers diagnosed as regional or distant staged cancers in the survey years.
State Table
2_1_3_4.2 Colorectal cancer diagnosed at advanced stage, per 100,000 population age 50 and over, by State, United States, 2004-2008
State Data Source
CDC and NCI, NPCR, United States Cancer Statistics.
State Denominator
Same as national.
State Numerator
Same as national.
Comments
All rates are age adjusted to the 2000 standard U.S. population by 5-year age groups, except where indicated. State estimates are per 100,000 population age 50 and over and are age adjusted to the 2000 U.S. standard million population by 5-year age groups.
The 2005 data were adjusted for areas affected by Hurricanes Katrina and Rita. Hurricanes Katrina and Rita had a huge impact on the populations within the Gulf Coast region for the second half of 2005. Katrina also significantly affected the Louisiana Cancer Registry’s ability to report data for that time period. In an effort to provide the most accurate and complete data and statistics possible, the SEER Program has made several changes for the releases of data and statistics through 2005.
Advanced stage refers to tumors diagnosed at regional or distant stage. Regional stage is defined as a neoplasm that has extended beyond the limits of the organ of origin, either directly into surrounding organs or tissues or into regional lymph nodes. Distant stage is defined as a neoplasm that has spread to parts of the body remote from the primary tumor, either by direct extension or by discontinuous metastasis.
Cancer stage historically has been collected using three different staging systems having three different purposes, datasets, and rules. The American Joint Committee on Cancer (AJCC), in collaboration with North American standard setters, has developed a unified dataset that combines and standardizes the information needed to assign stage in the AJCC (Tumor, Node, Metastasis, or TNM), SEER (Extent of Disease, [EOD]), and Summary Stage (SS) 1977 and 2000 systems and to derive the TNM stage group, EOD, and SS applicable to each cancer site beginning with cancers diagnosed in 2004.
Colorectal Cancer
Measure Title
Patients with colon cancer who received surgical resection that included at least 12 lymph nodes pathologically examined.
Measure Source
Commission on Cancer (CoC), American College of Surgeons (ACoS) and American Cancer Society (ACS), National Cancer Data Base (NCDB).
National Tables
2_1_3_5.1 Patients with colon cancer who received recommended treatment: resected colon specimen had at least 12 regional lymph nodes pathologically examined, United States, 2004-2009
2_1_3_5.2b-c Patients with colon cancer who received recommended treatment: resected colon specimen had at least 12 regional lymph nodes pathologically examined, 2009, by:
- Ethnicity.
- Family income.
National Data Source
CoC, ACoS and ACS, NCDB.
National Denominator
People age 18 and over with AJCC stage I, II, or III primary invasive epithelial colon cancer that underwent surgical resection (surgery more than local excision). Colon cancer diagnoses are known or assumed first or only cancer diagnosis.
National Numerator
Subset of denominator with 12 or more regional lymph nodes pathologically examined.
State Table
2_1_3_5.3 Patients with colon cancer who received recommended treatment: resected colon specimen had at least 12 regional lymph nodes pathologically examined, by State, United States, 2004-2009
State Data Source
CoC, ACoS and ACS, NCDB.
State Denominator
Same as national.
State Numerator
Same as national.
Comments
Staging describes the severity of a person’s cancer based on the extent of the original (primary) tumor and whether cancer has spread in the body. Higher numbers indicate more extensive disease. Stage I, II, and III cancers indicate a larger tumor size or spread of the cancer beyond the organ in which it first developed to nearby lymph nodes or organs adjacent to the location of the primary tumor.
Colorectal Cancer
Measure Title
Colorectal cancer deaths per 100,000 population.
Measure Source
Healthy People 2020.
National Tables
2_1_3_6.1 Colorectal cancer deaths per 100,000 population per year, United States, 2004-2009
2_1_3_6.2 Colorectal cancer deaths per 100,000 population per year, United States, 2000-2003
2_1_3_6.2a-b Colorectal cancer deaths per 100,000 population, United States, 2009, by:
- Race.
- Ethnicity.
National Data Source
Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS), National Vital Statistics System—Mortality (NVSS-M).
National Denominator
U.S. resident population.
National Numerator
Number of deaths per year due to colorectal cancer.
State Tables
2_1_3_6.4 Colorectal cancer deaths per 100,000 population per year, by State, United States, 2006-2009
2_1_3_6.5 Colorectal cancer deaths per 100,000 population per year, by State, United States, 2000-2005
State Data Source
CDC, NCHS, NVSS.
State Numerator
Same as national.
State Denominator
Same as national.
Comments
This measure is referred to as measure C-5 in Healthy People 2020 documentation. Estimates are age adjusted to the 2000 U.S. standard population. Respondents for which age is not reported are not included in the age adjustment calculations and are excluded from numerators.
Other Cancers
Measure Title
Cancer deaths per 100,000 population.
Measure Source
Healthy People 2020.
National Tables
2_1_4_1.1 All cancer deaths per 100,000 population per year, United States, 2004-2009
2_1_4_1.2 All cancer deaths per 100,000 population per year, United States, 2000-2003
2_1_4_1.2a-b All cancer deaths per 100,000 population per year, United States, 2009, by:
- Race.
- Ethnicity.
National Data Source
Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS), National Vital Statistics System—Mortality (NVSS-M).
National Denominator
U.S. resident population.
National Numerator
Number of deaths per year due to cancer.
State Tables
2_1_4_1.4 All cancer deaths per 100,000 population, by State, United States, 2006-2009
2_1_4_1.5 All cancer deaths per 100,000 population, by State, United States, 2000-2005
State Data Source
CDC, NCHS, NVSS.
State Denominator
Same as national.
State Numerator
Same as national.
Comments
This measure is referred to as measure C-1 in Healthy People 2020 documentation. Estimates are age adjusted to the 2000 U.S. standard population. Age data are unadjusted. Respondents for which age is not reported are not included in the age adjustment calculations and are excluded from numerators.
Other Cancers
Measure Title
Prostate cancer deaths per 100,000 male population.
Measure Source
Healthy People 2020.
National Tables
2_1_4_2.1 Prostate cancer deaths per 100,000 male population per year, United States, 2004-2009
2_1_4_2.2 Prostate cancer deaths per 100,000 male population per year, United States, 2000-2003
2_1_4_2.2a-b Prostate cancer deaths per 100,000 male population per year, United States, 2009, by:
- Race.
- Ethnicity.
National Data Source
Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS), National Vital Statistics System—Mortality (NVSS-M).
National Denominator
U.S. male resident population.
National Numerator
Number of deaths due to prostate cancer.
State Tables
2_1_4_2.4 Prostate cancer deaths per 100,000 male population, by State, United States, 2006-2009
2_1_4_2.5 Prostate cancer deaths per 100,000 male population, by State, United States, 2000-2005
State Data Source
CDC, NCHS, NVSS.
State Denominator
Same as national.
State Numerator
Same as national.
Comments
This measure is referred to as measure C-7 in Healthy People 2020 documentation. Estimates are age adjusted to the 2000 U.S. standard population. Age data are unadjusted. Respondents for which age is not reported are not included in the age adjustment calculations and are excluded from numerators.
Lung Cancer
Measure Title
Lung cancer deaths per 100,000 population.
Measure Source
Healthy People 2020.
National Tables
2_1_4_3.1 Lung cancer deaths per 100,000 population per year, United States, 2004-2009
2_1_4_3.2 Lung cancer deaths per 100,000 population per year, United States, 2000-2003
2_1_4_3.2a-b Lung cancer deaths per 100,000 population per year, United States, 2009, by:
- Race.
- Ethnicity.
National Data Source
Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS), National Vital Statistics System—Mortality (NVSS-M).
National Denominator
U.S. resident population.
National Numerator
Number of deaths per year due to lung cancer.
State Tables
2_1_4_3.4 Lung cancer deaths per 100,000 population, by State, United States, 2006-2009
2_1_4_3.5 Lung cancer deaths per 100,000 population, by State, United States, 2000-2005
State Data Source
CDC, NCHS, NVSS.
State Denominator
Same as national.
State Numerator
Same as national.
Comments
This measure is referred to as measure C-2 in Healthy People 2020 documentation. Estimates are age adjusted to the 2000 U.S. standard population. Age data are unadjusted. Respondents for which age is not reported are not included in the age adjustment calculations and are excluded from numerators.
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