BACKGROUND Practice volume may affect the outcome of patients with breast carcinoma. Defining factors that influence the relation of volume and outcome for the diagnosis and treatment of breast carcinoma is important, because breast carcinoma is common, and care is decentralized. METHODS Community‐wide diagnosis and treatment of mammogram‐detected breast carcinoma was examined using claims data from a single insurer representing 25% of the regional population. Among 1001 mammogram‐directed breast biopsies, the rate of breast carcinoma diagnosed by stereotactic core needle biopsy (SCNB) or excisional biopsy with needle localization (EBNL) and the rate at which breast‐conserving surgery (BCS) was used were analyzed. Outcome and practice volume were examined for surgeons, radiologists, and medical centers. RESULTS Two hundred twenty‐four tumors were diagnosed by EBNL (604 diagnoses) and SCNB (397 tumors), for a 22.4% positive biopsy rate. The median number of procedures per physician was one. Positive biopsy rates for radiologists, surgeons, and medical centers did not correlate with practice volume. Positive biopsy rates for high‐volume physician providers and medical centers ranged from 9% to 46%. The BCS rate was 45% and 64% for surgeons treating one or more than one claim, respectively. Tumor stage and surgeon case volume were the only independent predictors of BCS (P < 0.05). CONCLUSIONS There is wide variation in diagnosis and treatment outcomes for patients with mammogram‐detected breast carcinoma. Overall, practice volume was correlated with the use of BCS but not with the rate of positive biopsy. A wide variation in the positive biopsy rate among high‐volume providers and medical centers suggests that volume of practice is not a surrogate for quality in the diagnosis of breast carcinoma. Cancer 2002;95:704–12. © 2002 American Cancer Society. DOI 10.1002/cncr.10737
The NCDB can be matched with private payer claims using available identifiers. Registry data in this convenience sample of hospitals did not include a substantial fraction of outpatient data identified by claims. Private payer claims may help enhance the completeness of NCDB treatment information.
#1135 Background:
 Anti-hormonal therapy (AHT) is a key component of therapy that improves survival in breast cancer. However, many women do not complete the prescribed treatment course. There is currently limited reliable information regarding long-term adherence to AHT. We hypothesize that health payer administrative claims for prescription benefits may allow more reliable monitoring of AHT use.
 Methods:
 Claims for women diagnosed with breast cancer between 2001 and 2003 from a single insurance carrier covering about 1/3 of the regional population were matched to disease stage and treatment information from the National Cancer Data Base (NCDB) for women treated at NCDB hospitals in Western New York. Claims were searched for AHT drugs identified by National Drug Codes (NDC). Start date, end date, type of agent, switch in drugs, patterns of discontinuation, and dates of insurance coverage eligibility were recorded. A compliance index was attributed to each patient, reflecting the ratio of AHT claims identified, over the ideal number of claims that should have been recorded based on treatment start date.
 Results: 
 AHT was initiated in 230 women at a median of 165 days from breast cancer diagnosis. Stage was 0: 3.5%; I: 54.3%; II: 33.4%; III: 7%; unknown: <2%. Tamoxifen was the first AHT agent in 66.5% of cases. A switch in agents occurred in 36.1% women. There was a gap in prescription renewal in 57% of patients. The average gap length was 5.9 months. The maximum gap duration was 1 month in 27% of cases; however 16% of patients had a treatment gap of 6 months or more. The annual compliance rate for the study population was 79.6%, 60.9%, 52.7%, 24.1% and 6.9% for each of the 5 consecutive years of treatment. After adjusting for time from start of AHT, the compliance index was ≤0.66 in 50% of women. Less than 20% of patients had an index of 1.0 .
 Discussion: 
 Administrative claims data combined with cancer stage data proved to be effective at defining gaps in use of AHT among breast cancer patients. By applying this strategy, we found that over 50% of women treated with AHT had gaps in treatment averaging 6 months. The annual compliance rate to AHT decreased steadily over each of the 5 years of treatment. Real time monitoring of administrative claims for patients who start AHT can identify those who discontinue treatment and may allow counseling on side effects and benefits and improve treatment compliance and outcome. Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 1135.
6565 Background: The National Quality Forum (NQF) recently approved quality measures for cancer care. These are intended for application through cancer registries. Variably complete cancer registry data on outpatient care may limit application of these measures. Administrative claims matched to registries may provide more complete data. This study tested the ability to match claims with the National Cancer Data Base (NCDB) registry and to apply NQF breast cancer measures in a limited pilot in one region. Methods: Claims data from one regional payer in Western New York (WNY) were matched with registry data from the 3 WNY hospitals participating in the NCDB for 2001–2003. NQF measures for hormone therapy (HT), radiation (RT) with breast conserving surgery (BCS) and chemotherapy (CT) were applied independently using registry and claims data. Results: 480 women with this payer had claims for breast cancer surgery at the NCDB hospitals and 439 (91%) matched NCDB based on birth date, date of treatment and reporting hospital. Among these, 17 had duplicate or incomplete records. Among 422 analytic cases the median age was 54 and stage was 0 –9%; I –49%; II –33%; III –7%; IV –2%. Claims identified CT, HT and RT in substantially more cases than identified by the registry ( Table 1 ). Claims also provided information not collected by registry including specific drugs used and duration of therapy. Conclusions: Matching NCDB with payer claims is possible based on limited identifiers, and quality measures can be applied using claims. Registry data in WNY NCDB hospitals did not capture some RT, HT and CT identified by claims. Though in aggregate the registries in WNY shows substantially lower treatment rates than national NCDB averages, this study demonstrates that claims enhance registry data. Linkage of claims with NCDB may be a robust tool to apply quality measures of cancer care. No significant financial relationships to disclose. [Table: see text]
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