AFHSB Case Definition for Breast Cancer: Diagnosis and Surveillance | Lecture notes Radiotherapy

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AFHSB Surveillance Case Definitions

FINAL August 2019

BREAST CANCER

Includes Invasive Cancers Only; Does Not Include Ductal Carcinoma In Situ (DCIS),

Lobular Carcinoma In Situ (LCIS) and Male Breast Cancer

Background

This case definition was developed by the Armed Forces Health Surveillance Branch (AFHSB) for the

purpose of descriptive epidemiological reports on invasive cancers among active duty Service

members.

Clinical Description

Breast cancer forms in the tissues of the breast, most commonly in the ducts and lobules. After skin

cancer, breast cancer is the most common type of cancer among women in the United States and the

second leading cause of cancer deaths (after lung cancer). When the breast cancer tumor is small and is

producing no symptoms, the prospects for successful treatment and cure are highest. For this reason,

early detection through mammography is strongly recommended. A family history of breast cancer and

the presence of certain genetic mutations carry an increased risk, but most women who develop breast

cancer have neither of these factors. Other risk factors for breast cancer include advancing age,

overweight or obesity, use of menopausal hormone therapy, physical inactivity, and alcohol

consumption. Treatment of breast cancer may involve surgery, radiotherapy, chemotherapy, and

hormone therapy.

Armed Forces Health Surveillance Center. Incident diagnoses of cancers and cancer-related deaths,

active component, U.S. Armed Forces, 2005-2014. Medical Surveillance Monthly Report (MSMR).

2016 July; 23(7): 23-31.

American Cancer Society. Cancer Facts & Figures 2019. Atlanta: American Cancer Society; 2019.

https://www.cancer.org/research/cancer-facts-statistics/all-cancer-facts-figures/cancer-facts-figures-

2019.html. Accessed July 2019.

Case Definition and Incidence Rules

For surveillance purposes, a case of breast cancer is defined as:

 One hospitalization with a case defining diagnosis of breast cancer (see ICD9 and

ICD10 code lists below) in the first diagnostic position; or

 One hospitalization with a V or Z-code indicating a radiotherapy, chemotherapy, or

immunotherapy treatment procedure (see ICD9 and ICD10 code lists below) in the first

diagnostic position; AND any case defining diagnosis of breast cancer (see ICD9 and

ICD10 code lists below) in the second diagnostic position; or

 Three or more outpatient medical encounters, occurring within a 90-day period, with

any case defining diagnoses of breast cancer (see ICD9 and ICD10 code lists below) in

the first or second diagnostic position.

Incidence rules:

For individuals who meet the case definition: (continued on next page)

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AFHSB Surveillance Case Definitions

BREAST CANCER

Includes Invasive Cancers Only; Does Not Include Ductal Carcinoma In Situ (DCIS),

Lobular Carcinoma In Situ (LCIS) and Male Breast Cancer

Background

This case definition was developed by the Armed Forces Health Surveillance Branch (AFHSB) for the

purpose of descriptive epidemiological reports on invasive cancers among active duty Service

members.^1

Clinical Description

Breast cancer forms in the tissues of the breast, most commonly in the ducts and lobules. After skin

cancer, breast cancer is the most common type of cancer among women in the United States and the

second leading cause of cancer deaths (after lung cancer). When the breast cancer tumor is small and is

producing no symptoms, the prospects for successful treatment and cure are highest. For this reason,

early detection through mammography is strongly recommended. A family history of breast cancer and

the presence of certain genetic mutations carry an increased risk, but most women who develop breast

cancer have neither of these factors. Other risk factors for breast cancer include advancing age,

overweight or obesity, use of menopausal hormone therapy, physical inactivity, and alcohol

consumption. Treatment of breast cancer may involve surgery, radiotherapy, chemotherapy, and

hormone therapy.^2

1 Armed Forces Health Surveillance Center. Incident diagnoses of cancers and cancer-related deaths,

active component, U.S. Armed Forces, 2005-2014. Medical Surveillance Monthly Report (MSMR).

2016 July; 23(7): 23-31.

2 American Cancer Society. Cancer Facts & Figures 2019. Atlanta: American Cancer Society; 2019.

https://www.cancer.org/research/cancer-facts-statistics/all-cancer-facts-figures/cancer-facts-figures-

2019.html. Accessed July 2019.

Case Definition and Incidence Rules

For surveillance purposes, a case of breast cancer is defined as:

 One hospitalization with a case defining diagnosis of breast cancer (see ICD9 and

ICD10 code lists below) in the first diagnostic position; or

 One hospitalization with a V or Z-code indicating a radiotherapy, chemotherapy, or

immunotherapy treatment procedure (see ICD9 and ICD10 code lists below) in the first

diagnostic position; AND any case defining diagnosis of breast cancer (see ICD9 and

ICD10 code lists below) in the second diagnostic position; or

 Three or more outpatient medical encounters , occurring within a 90-day period , with

any case defining diagnoses of breast cancer (see ICD9 and ICD10 code lists below) in

the first or second diagnostic position.

Incidence rules:

For individuals who meet the case definition:

(continued on next page)

AFHSB Surveillance Case Definitions

Codes

The following ICD9 and ICD10 codes are included in the case definition:

Condition ICD-10-CM Codes ICD-9-CM Codes

Breast cancer C50 (malignant neoplasm of breast) 174 (malignant neoplasm of female breast) C50.01 (malignant neoplasm of nipple and areola, female)

1. 174.0 (malignant neoplasm of nipple and

areola, female breast)

C50.011 (malignant neoplasm of nipple and areola, right female breast)
C50.012 (malignant neoplasm of nipple and areola, left female breast)
C50.019 (malignant neoplasm of nipple and areola, unspecified female breast) C50.11 (malignant neoplasm of central portion of breast, female)

2. 174.1 (malignant neoplasm of central

portion of female breast)

C50.111 (malignant neoplasm of central portion of right female breast)
C50.112 (malignant neoplasm of central portion of left female breast)
C50.119 (malignant neoplasm of central portion of unspecified female breast) C50.21 (malignant neoplasm of upper-inner quadrant of breast, female)

3. 174.2 (malignant neoplasm of upper-inner

quadrant) (continued on next page)

C50.211 (malignant neoplasm of upper- inner quadrant of right female breast)
C50.212 (malignant neoplasm of upper- inner quadrant of left female breast)

Case Definition and Incidence Rules (continued)

 The incidence date is considered the date of the first hospitalization or the first of the

three or more outpatient medical encounters occurring within a 90-day period that

includes a case defining diagnosis of breast cancer (see Case Definition and Incidence

Rule Rationale ).

 An individual is considered an incident case only once per lifetime.

Exclusions:

 None

AFHSB Surveillance Case Definitions

C50.812 (malignant neoplasm of overlapping sites of left female breast)
C50.819 (malignant neoplasm of overlapping sites of unspecified female breast) C50.91 (malignant neoplasm of breast of unspecified site, female)

9. 174.9 (malignant neoplasm of breast,

female, unspecified)

C50.9 11 (malignant neoplasm of unspecified site of right female breast)
C50.9 12 (malignant neoplasm of unspecified site of left female breast)
C50.919 (malignant neoplasm of unspecified site of unspecified female breast)

Procedures ICD-10-CM Codes ICD-9-CM Codes

Related treatment procedures (Radiotherapy, chemotherapy, immunotherapy) Z51.0 (encounter for antineoplastic radiation therapy) V58.0 (radiotherapy) Z51/1 (encounter for antineoplastic chemotherapy and immunotherapy) V58.1 (encounter for chemotherapy and immunotherapy for neoplastic conditions)

Z51.11 (encounter for antineoplastic chemotherapy) V58.11 (encounter for antineoplastic chemotherapy)
Z51.12 (encounter for antineoplastic immunotherapy) V58.12 (encounter for antineoplastic immunotherapy)

Development and Revisions

 In September of 2015 the case definition was updated to include ICD10 codes.

 This case definition was developed in 2010 by the Armed Forces Health Surveillance Center

(AFHSC) in collaboration with a working group of subject matter experts from the Office of the

Assistant Secretary of Defense for Health Affairs (ASDHA), the United States Army Public

Health Command (USAPHC) and the United States Military Cancer Institute. The case definition

was developed based on reviews of the ICD9 codes, the scientific literature, and previous AFHSC

analyses.

 This case definition was developed for a report on ten different invasive cancers. As such, the

same case finding criteria are used for all types of cancer in the report. This broad application of a

single case definition may affect the sensitivity and specificity in varying ways for the individual

cancers. Furthermore, surgical treatment procedures such as hysterectomy, mastectomy,

prostatectomy, and other procedures unique to certain types of cancer are not included in the code

sets for individual cancers.

AFHSB Surveillance Case Definitions

AFHSB Case Definition for Breast Cancer: Diagnosis and Surveillance, Lecture notes of Radiotherapy

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Partial preview of the text

Download AFHSB Case Definition for Breast Cancer: Diagnosis and Surveillance and more Lecture notes Radiotherapy in PDF only on Docsity!

BREAST CANCER

Includes Invasive Cancers Only; Does Not Include Ductal Carcinoma In Situ (DCIS),

Lobular Carcinoma In Situ (LCIS) and Male Breast Cancer

Background

This case definition was developed by the Armed Forces Health Surveillance Branch (AFHSB) for the

purpose of descriptive epidemiological reports on invasive cancers among active duty Service

members.^1

Clinical Description

Breast cancer forms in the tissues of the breast, most commonly in the ducts and lobules. After skin

cancer, breast cancer is the most common type of cancer among women in the United States and the

second leading cause of cancer deaths (after lung cancer). When the breast cancer tumor is small and is

producing no symptoms, the prospects for successful treatment and cure are highest. For this reason,

early detection through mammography is strongly recommended. A family history of breast cancer and

the presence of certain genetic mutations carry an increased risk, but most women who develop breast

cancer have neither of these factors. Other risk factors for breast cancer include advancing age,

overweight or obesity, use of menopausal hormone therapy, physical inactivity, and alcohol

consumption. Treatment of breast cancer may involve surgery, radiotherapy, chemotherapy, and

hormone therapy.^2

1 Armed Forces Health Surveillance Center. Incident diagnoses of cancers and cancer-related deaths,

active component, U.S. Armed Forces, 2005-2014. Medical Surveillance Monthly Report (MSMR).

2016 July; 23(7): 23-31.

2 American Cancer Society. Cancer Facts & Figures 2019. Atlanta: American Cancer Society; 2019.

https://www.cancer.org/research/cancer-facts-statistics/all-cancer-facts-figures/cancer-facts-figures-

2019.html. Accessed July 2019.

Case Definition and Incidence Rules

For surveillance purposes, a case of breast cancer is defined as:

 One hospitalization with a case defining diagnosis of breast cancer (see ICD9 and

ICD10 code lists below) in the first diagnostic position; or

 One hospitalization with a V or Z-code indicating a radiotherapy, chemotherapy, or

immunotherapy treatment procedure (see ICD9 and ICD10 code lists below) in the first

diagnostic position; AND any case defining diagnosis of breast cancer (see ICD9 and

ICD10 code lists below) in the second diagnostic position; or

 Three or more outpatient medical encounters , occurring within a 90-day period , with

any case defining diagnoses of breast cancer (see ICD9 and ICD10 code lists below) in

the first or second diagnostic position.

Incidence rules:

For individuals who meet the case definition:

(continued on next page)

Codes

The following ICD9 and ICD10 codes are included in the case definition:

Condition ICD-10-CM Codes ICD-9-CM Codes

1. 174.0 (malignant neoplasm of nipple and

2. 174.1 (malignant neoplasm of central

3. 174.2 (malignant neoplasm of upper-inner

Case Definition and Incidence Rules (continued)

 The incidence date is considered the date of the first hospitalization or the first of the

three or more outpatient medical encounters occurring within a 90-day period that

includes a case defining diagnosis of breast cancer (see Case Definition and Incidence

Rule Rationale ).

 An individual is considered an incident case only once per lifetime.

Exclusions:

 None

9. 174.9 (malignant neoplasm of breast,

Procedures ICD-10-CM Codes ICD-9-CM Codes

Development and Revisions

 In September of 2015 the case definition was updated to include ICD10 codes.

 This case definition was developed in 2010 by the Armed Forces Health Surveillance Center

(AFHSC) in collaboration with a working group of subject matter experts from the Office of the

Assistant Secretary of Defense for Health Affairs (ASDHA), the United States Army Public

Health Command (USAPHC) and the United States Military Cancer Institute. The case definition

was developed based on reviews of the ICD9 codes, the scientific literature, and previous AFHSC

analyses.

 This case definition was developed for a report on ten different invasive cancers. As such, the

same case finding criteria are used for all types of cancer in the report. This broad application of a

single case definition may affect the sensitivity and specificity in varying ways for the individual

cancers. Furthermore, surgical treatment procedures such as hysterectomy, mastectomy,

prostatectomy, and other procedures unique to certain types of cancer are not included in the code

sets for individual cancers.

Case Definition and Incidence Rule Rationale

 This case definition is designed to capture cases of invasive female breast cancer only. Codes

ICD9 233.0 (carcinoma in situ of breast and genitourinary system) / ICD10 D05.90 (unspecified

type of carcinoma in situ of unspecified breast) which includes ductal carcinoma in situ (DCIS)

and lobular carcinoma in situ (LCIS) are not included in the code set. Carcinoma in situ represents

approximately 20% of new breast cancer cases and has different prognoses and treatments than

invasive breast cancer.^2 Because DCIS and LCIS can progress to invasive cancer, women with

these diagnoses should be carefully monitored for progression.^2