wg (Sis ce _ CANCER EXPERIENCE AT THE NEW YORK MEDICAL COLLEGE FLOWER AND FIFTH AVENUE HOSPITALS, 1950—1964 WALTER L. MERSHEIMER, M. D. * ABRAHAM RINGEL, M. A. ** *Professor and Chairman, Department of Surgery and Director of the Tumor Registry, New York Medical College **Consultant for Cancer Registries ACKNOWLEDGEMENTS The authors wish to extend their appreciation to Miss Helen G. Dixon (RRL) and Mrs. Gloria H. Holt of the Tumor Registry for their conscien- tious work in abstracting and coding the medical records and collating the follow-up information. The operation of the Registry is supported in part by contract no. PH43-66-23 with the National Cancer Institute. Special thanks is due Mrs. Lillian M. Axtell (MA) of the End Results Section, Biometry Branch, NCI for her assistance in preparing special tabulations. The publication of this report was made possible by the McLean Surgical Fund, established by the generosity of Thomas and Eugenia McLean of Pittsburgh, Pennsylvania. INTRODUCTION This report of the Tumor Registry of the New York Medical College, Flower and Fifth Avenue Hospitals is based on special tabulations prepared by the End Results Section, Biometry Branch . of the National Cancer Institute, in addition to tabulations made in conjunction with their pre- paration of the third comprehensive report of the End Results Group.! The End Results Group consists of representatives from three central registries and nine individual hospital registries (one of which is the Tumor Registry of the New York Medical College) and coordinates a national cooperative program for evaluating the end results of cancer therapy. (A detailed description of the program and the manner in which information is collected has been reported by Cutler and Latourette.2) The New York Medical College Tumor Registry has abstracted and submitted punch cards to the End Results Group on all cancer cases diagnosed and treated in the Flower and Fifth Avenue Hospitals between 1950 and 1964, inclusive. The following report is a summary of the most significant data submitted, and a portion of the 400,000 cancer cases reported by over 100 hospitals of various types and sizes participating in the End Results Evaluation Program. DISTRIBUTION OF CASES The New York Medical College Tumor Registry contains 5,297 malignant tumor cases diagnosed and treated between 1950 and 1964, inclusive. Almost all of the patients were white (96 percent), with little variation in each of the years. In the aggregate there were about three female to every two male patients. The Registry accessioned an average of 353 new cases annually for the fifteen-year period, varying from an average of 349 in the five years 1950 through 1954, to an average of 363 in the following five-year period through 1959, to 348 in the five years end- ing in 1964. The increase in the average number of new cases in the 1955-59 period was due principally to the significant increases in rectal, lung-and-bronchus, prostate, leukemia, brain, and non-melanotic skin cases in males, and in cases of the uterine cervix, uterine corpus, ovary, Hodgkin’s disease, and non-melanotic skin cases in females (Tables 1, 2, and 3). Although the number of cases of the ovary in the female, and of the stomach, large intestine, and rectum in both sexes declined markedly between 1950-54and 1960-64, this was made up in large measure by the increase in the number of cancer of the cervix in females and of pros- tate and of the lung-and-bronchus malignancies in males between the two periods. It should be borne in mind that the changes over time represent shifts in the nature of the population of cancer patients seen in this hospital and do not necessarily parallel trends in the general population. For example, the incidence of cancer of the large intestine is increasing, but in the Flower and Fifth Avenue Hospitals the number seen decreased in the periods 1955-59 to 1960- 64. Malignancies of the digestive organs and breast constituted almost half of all the cases in the Registry over the entire period (30 and 17 percent, respectively), with cancers of the female genital organs and of the respiratory system follow- ing with 14 and 11 percent, respectively (Table 1). The eight leading sites made up almost two-thirds of all of the cases. with breast cases accounting for more than one of every six,and cancers of the large intestine and lung-and-bronchus each accounting for one of every ten patients (Figure 1). Nine percent of all the cancers diagnosed were multiple cancers. PERCENT OF ALL CASES BY LEADING SITES NEW YORK MEDICAL COLLEGE 1950-64 0 1 BREAST 7 LARGE INTESTINE 10 LUNG & BRONCHUS 10 RECTUM 8 STOMACH & UTERINE CORPUS 5 UTERINE CERVIX 5 OVARY 4 10 15° 20 Fig. 1 In men the six leading sites made up almost two of every three malignancies over the fifteen-year period, with considerable variation in their distribution between the time periods (Table 2 and Figure 2). Almost one of every five male patients had cancer of the lung-and- bronchus, with substantial increases occurring in each five-year period from the preceding period — 19 percent in 1955-59, and 15 percent in 1960-64. Similarly, the number of kidney and prostate cases increased 62 and 37 percent, respectively, between the earliest and latest period. On the other hand, although cancers of the large intestine, rectum, and stomach represented twelve, ten, and nine percent, respectively, over the entire period, these cases declined by 13, 29, and 25 percent, re- spectively, between 1950-54 and 1960-64. PERCENT OF MALE CASES BY LEADING SITES NEW YORK MEDICAL COLLEGE 15 20 25 LUNG & BRONCHUS LARGE INTESTINE RECTUM STOMACH PROSTATE BLADDER | 1955-59 ae 1960-64 Fig. 2 10 In women the six leading sites constituted almost seven of every ten cancers over the entire period, with varying distributions in each time period (Table 3 and Figure 3). Three of every ten female patients had breast cancer, and about one in four had the disease in the genital organs, or in the digestive organs. Although the trend of breast and uterine corpus cases remained almost level, between 1950-54 and 1960-64 the number of stomach and rectum cases declined about 50 percent, and of the ovary and large intestine by 24 and 18 percent, respectively. Con- versly the number of cervical cases increased by more than 50 percent, and of non-melanotic skin cancers by more than 90 percent between the two periods. PERCENT OF FEMALE CASES BY LEADING SITES NEW YORK MEDICAL COLLEGE 0 5 10 15 20 | | | | | 25 30 35 _ LARGE INTESTINE UTERINE CORPUS UTERINE CERVIX OVARY RECTUM 1950-54 1955-59 * 1960-64 BREAST Fig. 3 AGE DISTRIBUTION More women than men were represented in the case load twice that many female cases with cancer in that age below 60 years of age, but there was a marked reversal group. On the other hand, 57 percent of the male cases, thereafter (Figure 4). While only 13 percent of all men as compared with 42 percent of the female cases, were 60 with cancer in the Flower and Fifth Avenue Hospitals years of age and over. were between the ages of 30 and 49, there were more than PERCENT OF CASES AGE DISTRIBUTION OF CANCER CASES BY SEX NEW YORK MEDICAL COLLEGE 1950-64 0 10. 20. 30 50 60 70 80+ AGE Fig. 4 42 The median age at diagnosis of: all cases (half above and. half below) was 59, ranging from 51 for patients with ~ lymphomas and leukemias, to 63 years of age for prostate cases (Figute 5). The higher proportion of female cases below the age of 60 is due principally to malignancies of the breast and genital organs. Seven of every ten breast cases and more than six of every ten malignancies of the female genital organs were diagnosed in patients under 60 years of age. On the other hand, three of every four male patients with cancer of the genital organs were 60 years of age and older (Table 4). "MEDIAN AGE OF CANCER CASES BY SITE NEW YORK MEDICAL COLLEGE 195064 ALL SITES’ LYMPHOMAS & LEUKEMIAS . 51 RSE , “BUCCAL CAVITY & PHARYNX 53 oe FEMALE GENITAL ORGANS 53 ‘BREAST. oe oo "RESPIRATORY ORGANS a) 7 URINARY ORGANS | oo 61 ame DIGESTIVE ORGANS : - 62 MALE GENITAL-ORGANS _ 63] “ALLOTHERSITES > 498 200 | 4 0D (EXCEPT SKIN) ‘Fig. METHOD OF DIAGNOSIS Inasmuch as non-white cancer patients constituted only four percent of the total number in the Flower and Fifth Avenue Hospitals in the fifteen years, 1950 through 1964, and to facilitate comparisons with the third report of the End Results Group, the remainder of this analysis will deal only with the white cancer cases treated during this period. A measure of the quality of medical care given cancer patients is the proportion of cases treated on the basis of microscopic confirmation of the disease. In this respect the performance of the New York Medical College com- pares favorably with the combined End Results Group during the ten-year period 1955-64 for which data was obtained. A comparison of the levels of microscopic confirmation of ten selected sites in the 1955-59 and 1960-64 periods (representing about 70 percent of all of the cases) shows the maintenance of a high level of performance, except for stomach and bladder cases in the latest period (Figure 6). More noteworthy, is the marked improvement in microscopic confirmation of lung- and bronchus cases from 75 to 89 percent. CASES MICROSCOPICALLY CONFIRMED BY SELECTED SITES NEW YORK MEDICAL COLLEGE PERCENT 0 20 40 | STOMACH LARGE INTESTINE RECTUM LUNG & BRONCHUS BREAST UTERINE CERVIX UTERINE CORPUS OVARY PROSTATE BLADDER 60 80 100 | | 1960-64 Fig. 6 STAGE OF DISEASE Just as the level of microscopic confirmation of malig- nancies is a measure of the qualitative basis of patient care, the extent of the disease (stage) at the time of diagnosis reflects the effectiveness of a cancer control educational program. If the proposition is accepted that early diagnosis and treatment enhances the prospects for patient cure and survival, then the extent of the disease at diagnosis is a measure of the discernment of physicans in diag- nosis, and is indicative of the public’s awareness of the need for regular physical examinations and the con- sequences in delaying medical care upon manifestation of the “danger signals.” The basis of the determination of the stage of the disease at diagnosis is the information available during the first course of medical care, including the pathologist’s examination of the surgical specimen. During the fifteen years 1950 through 1964, an average of 43 percent of the cases (excluding non-melanotic skin, lymphomas, and leukemias) in the Flower and Fifth Avenue Hospitals were localized, ranging from-a high of 82 percent for patients with cancer of the bladder to a low of 13 percent for lung-and-bronchus cases (Table 5), The extent of the disease at diagnosis was not specified in the patients’ medical charts for 12 percent.of all of the cases (one of every eight), and for about one of every five patients with cancers of the esophagus, prostate, and lung-and-bronchus. Figure 7 shows the distribution by stage of the disease at diagnosis of the ten major sites which constituted almost 70 percent of the cancer caseload in the Flower and Fifth Avenue Hospitals. There was no consistent trend in staging the ten selected sites (Table 6). While the early diagnosis of patients with malignancies of the lung-and-bronchus showed consistent improvement between the five-year periods, the proportion of patients with localized cancers of the large intestine and prostate declined. The decline in localized cases of the large intestine may be due to increased use of surgery resulting in more accurate staging, while the decrease in prostate cases is obscured by the large increase in the proportion of cases for which the extent of the disease was not reported (from five percent in 1950-54 to 30 percent in the latest period. Most of the other sites followed an erratic course (see par- ticularly breast, uterine cervix, uterine corpus, and kidney cases), STAGE OF CANCER CASES AT DIAGNOSIS BY SELECTED SITES NEW YORK MEDICAL COLLEGE 1950-64 PERCENT 0 20 40 60 80 100 i 1 l I I I ! I | STOMACH 15 ro a LARGE INTESTINE a3 5 RECTUM 54. fog LUNG & BRONCHUS ; oe BREAST 53 UTERINE CERVIX 63 UTERINE CORPUS" 77 OVARY a. 97 ; es PROSTATE are KIDNEY 2 49, LOCALIZED REGIONAL DISTANT STAGE NOT SPREAD SPREAD SPECIFIED Fig. 7 Survival of Cancer Cases The ultimate measure of the effectiveness of the control of cancer by means of improved diagnostic, therapeutic, and follow-up techniques is seen in the survival rates of patients. The trend in patient survival will be presented in the same terms of relative survival rates as in the third report of the End Results Group.! As noted in this report “the survival rate observed in a group of patients reflects mortality not only from the disease under study but also deaths due to all other causes. The risk of dying from causes other than the specific cancer under study varies with the sex and age characteristics of the patient group and with calender time. The relative survival rate adjusts for ‘normal’ mor- tality and thus makes possible meaningful com- parisons of the survival experience of groups of patients that differ with respect to sex, age, and calender period of observation. It is defined as the ratio of the observed survival rate to the expected rate for a group of people in the general population similar to the patient group with respect to sex, age, and calender period of observation. The relative survival rate is the probability of escaping the mor- tality risk due to the specific cancer under study.” The report presents an illustration of the effect of adjustment for “normal” mortality and notes that: “com- parison of relative survival rates provides a measure of the difference in mortality associated with specific forms of cancer in patient groups with different ‘normal’ mortality expectation.” It should be borne ih mind that general pop- ulation mortality experience may not be strictly applicable to the patient population seen at the Flower and Fifth Avenue Hospitals. The actuarial method of computing the relative survival rates has been employed for this analysis. This permits us to take cognizance of the latest information concerning the status of each case in the series up to, and including, the latest year of the study period. (In this study a patient is considered “lost” to follow-up if no information has been received about him for two consecutive years, even though the Registrar continues to seek information about him for several more years.) The actuarial method of computing survival rates makes use of every case at each interval following the date of diagnosis, subject- to the possibility of being alive or dead at the time. Thus, for the five-year survivorship computations, all cases which had the opportunity of surviving five years were used, irrespective of the date of diagnosis. Thus, the number of cases from which computations were made became smaller at each successive yearly interval, with the result that the data became less reliable as we approached the longer time periods. The computation of the survival rates by this method also has a “built-in” assumption, namely, that the living cases, which were dropped from the computations at each successive yearly interval will have the same relative mortality and survival as those which were kept in the computations at each successive time. interval. In our groupings of the cancer cases in the New York Medical College Tumor Registry it was possible to com- pute with confidence relative survival rates up to ten years in some instances. Thus, the five-year survival rate for all white cases diagnosed between 1950 and 1964, inclusive, is 42 percent, and 38 percent for. those who had the opportunity of surviving ten years. The relative survival rate remained stable beginning with the eighth year (Table 7). The differences in survival between male and female patients is shown in Figure 8. RELATIVE SURVIVAL OF CANCER CASES BY SEX NEW YORK MEDICAL COLLEGE 1950-64 100 90 80 RELATIVE SURVIVAL 50 RATE (%) 40 30 + 20. 10+ “BOTH SEXES MALE 8 10* 12 14 16 YEARS *Survival rates beyond this point should be interpreted with caution because of the limited number of patients remaining under follow-up. Fig. 8 The significance of early diagnosis in the successful treatment of cancer in the Flower and Fifth Avenue Hospitals is apparent when one notes that for all cases more than five times as many patients treated while the disease was localized survived five years, as compared with those treated after the disease invaded adjacent areas—72 percent versus 14 percent, respectively, (Table 7 and Figure 9). The disparity was particularly large in male cases, 63 percent for localized cases as compared with only five per- cent for those with regional spread. RELATIVE SURVIVAL RATE (%) 100 90 80 70 40 30 20 10 RELATIVE SURVIVAL OF CANCER CASES BY STAGE OF DISEASE AT DIAGNOSIS NEW YORK MEDICAL COLLEGE 1950-64 DISTANT SPREAD LOCALIZED REGIONAL SPREAD i 1 a ! l ! ! 1 1 poo yp 0 2 4 6 8 10* 12 14: 16 YEARS * Survival rates beyond this point should be interpreted with caution because of the limited number of patients remaining under follow-up. Fig. 9 Between the three periods, the overall relative survival rates from 77 to 79 percent, the rate for cases with regional show small increases (Figure 10). However, although the spread more than doubled (from 20 percent to 48 percent) three-year survival rate of localized cases improved slightly, (Table 7). RELATIVE SURVIVAL OF CANCER CASES BY YEARS OF DIAGNOSIS NEW YORK MEDICAL COLLEGE 1950-64 100 90 ‘ 80 76 60k RELATIVE SURVIVAL 50 RATE (%) 1856-59 1950-54 307 20 10- 0 to eee ! i I 1 pope po YEARS * Survival rates beyond this point should be interpreted with caution because of the limited number of patients remaining under follow-up. Fig. 10 18 The five-year relative survival rate of nine major selected sites ranged from a high of 75 percent for patients with cancer of the uterine corpus to seven percent for those with malignancies of the lung-and-bronchus (Table 8 and Figures 11 and 12). Sufficient data was not available to compute five-year rates for each of the major site groups diagnosed in each time period. The three-year relative survival for all cases improved from 45 percent to 52 percent between 1950-54 and 1960-64 (Table 9). Also, significant iniprovement is evident for patients with cancer of the urinary organs, and of the genital organs (both male and female). Of the specific sites where’ data was avail- able breast cases and those with cancer of the bladder showed significant improvement (Table 10). RELATIVE SURVIVAL OF CANCER CASES BY SELECTED SITES NEW YORK MEDICAL COLLEGE 1950~64 100 90 80 70 60 RELATIVE PROSTATE SURVIVAL 50 |- RECTUM Fig. 11 RATE (%) 3s 40 |- seis! ae ee sR TT 30 j- LARGE INTESTINE 20 |- . STOMACH 10 |- LUNG & BRONCHUS : 0 1 L i 4 L J 4. I t L al. 1 t J 0 2 4 6 8 10* 12 14 16 YEARS * Survival rates beyond this point should be interpreted with caution because of the limited number of patients remaining under follow-up. RELATIVE SURVIVAL OF CANCER CASES BY SELECTED SITES NEW YORK MEDICAL COLLEGE 1950-64 100 90 80 a, -s UTERINE CORPUS Nag 2 Rat seensciert re A AE MAREE IO EET RTT a : er . . ° 70 eer : Paes 60F UTERINE CERVIX RELATIVE BIE SURVIVAL 50|- Fig. 12 RATE (%) . . BREAST 40F PURE SG 30P 20 10F 0 ! i : i ve 0 2 4 6 8 10° 12 14 YEARS “Survival rates beyond this point shouid be interpreted with caution because of the limited number of patients ramalning under follow-up. Table 1 Number and Percent Distribution of All Cancer Cases New York Medical College, 1950-54, 1955-59, 1960-64 1950-54 1955-59 1960—64 SITE OF cance 1980-84 NUMBER PERCENT | NUMBER PERCENT NUMBER PERCENT All Sites 5,297 1,743 100.0 1,813 100.0 1,741 100.0 Buccal Cavity & Pharynx 1,2. 19 1.1 18 1.0 27 15 Buccal Cavity 1.0 17 1.0 13 7 25 1.4 Pharynx 2 2 1 5 3 2 J Digestive Organs 29.8 576 33.0 567 31.3 436 25.1 Esophagus 8 14 8 17 9 9 5 Stomach 6.4 139 8.0 . 112 6.2 88 5.1 Large Intestine 10.4 191 10.9 201 11.1 161 9.3 Rectum 7.5 151 8.7 153 8.5 92 5.3 All Other Digestive 4.7 81 4.6 84 4.6 86 4.9 Respiratory Organs 10.7 A7t 9.8 186 10.3 210 12.0 Larynx 4 12 Jf 5 3 7 4 Lung & Bronchus 9.9 151 8.7 163 9.6 169 11.4 All Other Respiratory 4 8 4 8 4 4 2 Breast 17.4 319 18.3 294 16.1 308 17.7 Female’ Genital. Organs 14.4 240 13.8 277 15.4 247 14.2 Uterine Cervix 4,7 65 3.7 85 4,7 98 5.6 Uterine Corpus 49 85 4.9 94 5.2 80 4.6 Ovary & Fallopian Tube 4.3 79 4.6 91 5.0 60 3.5 All Other Female Genital 5 11 6 7 5 9 5 Male Genital Organs 3.5 53 3.0 61 3.4 69 4.0, Prostate 2.8 4 2.3 50 2.8 56 2 All Other Male Genital 7 12 7 11 6 13 8 Urinary Organs 5.3 85 49 85 4,7 111 A Kidney 1.6 26 1.5 29 1.6 32 1.8 Bladder 3.7 59 3.4 ' 56 3.1 79 4.6 Lymphatic & Hematopoietic Tissues 5.9 97 5.6 119 6.5 98 — BG Lymphosarcoma 9 12 J 20 1.1 18 1.0 Hodgkin‘s Disease 1.2 18 1.0 26 1.4 21 1.2 Leukemia & Aleukemia 2.6 38 2.2 57 3.1 42 2.4 All Other Lymphatic & Hematopoietic Tissues 1.2 29 1,7 16 9 17 1.0 Other & Unspecified Sites 11.8 183 10.5 206 11.3 235 13.5 Melanoma of Skin 9 14 8 16 9 19 1.1 Non-melanotic Skin 3.6 46 2.6 66 3.6 80 4.6 ~ Brain & Other Nervous System 1.5 14 . 8 27 1.8 39 2.5 Thyroid 1.3 25 1.4 26 1.4 17 1.0 Connective Tissue — 8 17 1.0 1 6 13 JZ - All Other & Unspecified Sites 3.7 67 3.9 60 3.0 67 3.6 Table 2 Number and Percent Distribution of Male Cancer Cases New York Medical College, 1950-54, 1955-59, 1960-64 1950-54 1955-59 _1960—64 SITE OF CANCER 1980-64 NUMBER PERCENT NUMBER PERCENT NUMBER PERCENT All Sites 2,216 699 100.0 774 100.0 743 100.0 Buccal Cavity & Pharynx 16 10 14 12. 1.6_ 13 1.7 Buccal Cavity 1.4 9 1.3 10 1.3 12 1.6 Pharynx 2 1 1 2 — 3 1 1 Digestive Organs 7.7 294 42.1 306 39.5 235 31.7 Esophagus 1.1 9 1.3 8 1.0 8 1.1 Stomach - 9.2 76 10.9 70 9.0 57 7.7 Large Intestine 1.8 | 88 12.6 96 12.4 77 10.4 Rectum 9.6 73 10.4 88 11.4 52 7.0 All Other Digestive 6.0 48. ' 6.9 44 5.7 41 5.5 Respiratory Organs 21.3 140 20.0 156 20.2 - 176 23.8 Larynx 1.1 12 1.7 5 7 7 1.0 Lung & Bronchus 19.6 122 17.4 145 18,7 167 22.5 All Other Respiratory 6 6 9 6 8 2 3 Breast 3 o. 0.0. 2. a 4 5. Male Genital Organs 8.2 53 7.6 61 79 69 9.3 Prostate 6.6 41 5.9 50 6.5 56 7.5 All Other Male Genital ~ 1.6 12 1.7 11 1.4 13 1.8 Urinary Organs Se 88 53. 76 63 8.1 79 10.6 Kidney , 2.4 13 1.9 19 2.4 21 2:8 Bladder ; 6.4 40 5,7 44 5.7 58 7.8 Lymphatic & Hematopoietic Tissues | _7.5 54 27 62 8.0 51 6.8 -* Lymphosarcoma 1.4 8 1,1 12 1.5 10 1.3 Hodgkin's Disease _- 1.4 1 1.5 9 1.2 10 1.3 _ Leukemia & Aleukemia 3.3 19 2.7 | 33 4,3 23 . 3.1 All Other Lymphatic & Hematopoietic Tissues - 1.4 16 2.4 8. 1.0 8 1.1 _ Other & Unspecified Sites 14.6 _95 13.6 112 14.4 116 15.6 Melanoma of Skin 9 5 7 6 8 9 1.2 Non-melanotic Skin 4.2... 23 3.3 33 4.3 36 4.8 Brain & Other Nervous System 2.3 7 1.0 19 2.4 25 ' 3.4 Thyroid 1.0 © - 10 1.4 8 1.0 5 J Connective Tissue 1.2 12 1.7 7 9 ‘7 9 All Other & Unspecified Sites 5,0 - 38 5.5 39 5.0 34 4.6 Table 3 Number and Percent Distribution of Female Cancer Cases New York Medical College, 1950-54, 1955-59, 1960-64 1950-54 1955-59 1960—64 elaine 1950-64 | NomBeR PERCENT | NUMBER PERCENT | NUMBER PERCENT All Sites 3,081 1,044 100.0 1,039 100.0 998 100.0 Buccal Cavity & Pharynx 2 2 2 6 6 414 1.4 Buccal Cavity 8 8 8 . 3 3 13 1.3 Pharynx 1 1 1 3 3 1 1 Digestive Organs 24.1 282 27.0 261 25.0 201 20.1 Esophagus 5 5 5 9 9 1 1 Stomach 4.4 63 6.0 42 4.0 - 31 3.1 Large Intestine , 9.5 103 9.9 105 10.1 84 8.4 Rectum 5.9 78 7.5 65 6.2 40 4.0 All Other Digestive 3.8 33 3.1 40 3.8 45 4,5 Respiratory Organs 3.1 31 3.0 _30 2.9 34 3.4 Lung & Bronchus 2.9 29 2.8 28 2.7 32 3.2 All Other Respiratory 2 2 2 2 2 2 2 Breast 29.7 19 30.5 292 27.9 304 30,5 Female Genital Organs 24.8 240 23.0 277 26.9 247 24.8 Uterine Cervix 8.0 65 6.2 85 8.2 98 9.9 Uterine Corpus . 8.4 85 8,1 94 9.0 80 8.0 Ovary & Fallopian Tube 7.5 79 7.6 91 8.8 60 6.0 All Other Female Genital 9 11 1.1 7 9 9 9 Urinary Organs 2.8 32 3.1 22 2.1 32 2 Kidney 1.1 13 1.3 10 1.0 11 1.1 Bladder 17 19 1.8 12 1.1 21 2.1 Lymphatic & Hematopoietic Tissues 4.8 43 4.1 57 5.5 AT 4.7 Lymphosarcoma a 4 4 8 8 8 8 Hodgkin’s Disease 1.1 7 7 17 1.6 11 1.1 Leukemia & Aleukemia 2.0 19 1.8 24 2.3 19 1.9 All Other Lymphatic & Hematopoietic Tissues 1.0 13 1.2 8 8 9 9 Other & Unspecified Sites 9.8 88 8.4 94 9.1 119 11.9 Melanoma of Skin 9 9 9 10 1.0 10 1.0 Non-melanotic Skin 3.3 23 2.2 33 3.2 44 4.4 Brain & Other Nervous System 1.5 7 7 8 8 14 1.4 Thyroid 5 15 1.4 18 1.7 12 1.2 Connective Tissue 2.7 5 5 4 4 6 6 All Other & Unspecified Sites 29 29 2.7 21 2.0 33 3.3 Table 4 Percent Distribution of White Cancer Cases, By Site and Age Groups New York Medical College, 1950-64 Buccal Lymphatic Total Cavity Female Male and Hemato-|. Other and Age At All and Digestive | Respiratory Genital Genital Urinary poietic Unspecified Diagnosis Sites - Pharynx Organs Organs Breast Organs Organs Organs Tissues (except Skin) All Ages, Number 4,791 64 1,559 545 907 673 177 276 305 285 Oo- 9 1.4 0.0 0.3 0.0 0.0 0.3 0.0 1.5 12.8 6.0 10~— 19 0.8 0.0 0.1 0.0 0.0 0.0 1.7 0.0 6.2 5.3 20 — 29 1.8 4.7 0.6 0.4 0.9 2.2 4,0 0.4 7.2 6.7 30 — 39 5.4 7.8 1.9 2.4 9.9 7.3 2.8 4.3 7.2 12.3 40 — 49 15.7 17.2 9.6 11.4 29.0 21.7 2.8 10.9 10.8 17.5 50 — 59 26.8 34.4 24.6 32.1 29.9 29.9 13.6 27.9 18.4 26.3 60 — 69 29.3 23.4 34.3 40.7 20.2 27.0 41.2 29.7 23.3 15.4 70—79 15.7 9.4 23.9 11.4 8.2 10.4 26.6 21.0 11.8 9.5 80 & Over 3.1 3.1 49 1.6 1.9 1.2 74.3 4.3 2.3 1.0 9a Percent Distribution of White Cancer Cases, By Stage At Diagnosis, By Site (Exclusive of Skin, Lymphomas, and Leukemias) Table 5 New York Medical College, 1950-64 Not Total Localized Number But Extent of - Regional Distant of Spread Site of Cancer Cases Localized Spread Spread Unknown Unspecified All Sites, Number 4,486 1,918 921 ' 1,056 48 543 Percent (100.0%) (42.8%) (20.5%) (23.5%) (1.1%) (12.1%) Buccal Cavity & Pharynx 64 59.4 26.5 1.6 1.6 | 10.9 Buccal Cavity 53 67.9 26.4 0.0 1.9 3.8 Pharynx 11 18.2 27.3 9.1 0.0 45.4 Digestive Organs 1,559 35.2 19.4 34.8 0.8 9.8 Esophagus 40 22.5 20.0 35.0 0.0 22.5 Stomach 339 15.0 24.8 48.1 1.5 10.6 Large Intestine 550 42.9 20.6 27.8 0.5 8.2 Rectum 396 53.8 15.4 21.2 0.3 9.3 All Other Digestive 234 17.1 15.8 54,7 1.3 11.1 Respiratory Organs 545 14.5 30.3 33.6 2.8 18.9 Larynx 24 37.5 37.5 12.5 0.0 12.5 Lung & Bronchus 515 13.0 29.9 35.0 2.9 19.2 All Other Respiratory 6 50.0 33.3 0.0 - 0.0 1.7 Breast 907 52.7 28.1 47 0.7 13.8 Female Genital Organs 673 53.6 11.2 26.0 1.0 8.2 Uterine Cervix 170 52.9 15.9 18.8 2.4 10.0 Uterine Corpus 255 77.2 6.7 6.3, 0.4 9.4 Ovary & Fallopian Tube 226 27.0 11.5 66.2 0.4 4.9 Other Female Genital 22 59.1 22.7 0.0 4.6 13.6 Male Genital Organs 177 37.3 19.8 23.7 0.6 18.6 Prostate 148 33.1 20.3 25.0 0.0 21.6 Other Male Genital 29 58.6 17.2 17.2 3.5 3.5 Urinary Organs 276 71.4 9.4 11.6 0.7 6.9. _ Kidney 87 49.4 10.3 27.6 1.2 11.5 Bladder 189 81.5 9.0 4.2 0.5 4.8 Other & Unspecified Sites ‘(except Skin) 285 52.6 15.8 13.3 1.4 16.9 Melanoma of Skin 49 71.4 8.2 10.2 4.1 6.1 Brain ~ 95 42.1 21.0 10.5 1.1 -25.3 Thyroid 68 60.3 10.3 8.8 0.0 20.6 Connective Tissue 41 56.1 17.1 22.0 . 24 2.4 Alf Other Sites 32 34.4 21.9 25.0 ° 0.0 © 18.7 Percent Distribution of White Cancer Cases, By Stage At Diagnosis,* By Selected Sites Table 6 New York Medical College, 1950-54, 1955-59, 1960-64 Site of Cancer Stomach Large Intestine Rectum Lung & Bronchus Breast Uterine Cervix Uterine Corpus Ovary & Fallopian Tube Prostate Kidney Localized 12 18 16 46 43 39 50 58 53 54 51 54 59 41 59 80 =. 73 80 27 24 32 39 31 «30 54 35 59 Regional Spread Distant Spread 1950- 1955- 1960- 1954 1959 1964 1950- 1955- 1960- 1954 1959 1964 24 25 26 18 16 29 7 9 23 36 27 28 27 18 39 4 13 26 25 15 21 1950- 1955- 1960- 1954. 1959 1964 56 41 44 27 29 28 23 22 16 35 32 37 25 28 2 60 60 46 32 27 18 _ 27 41 16 Unspecified 1950- 1955- 1960- 1954 1959 1964 7 14 11 9 12 3 9 11 8 21 24 14 16 25 1 5 17 10 7 15 5 5 7 2 5 27 30 12 14 9 * Excludes cases no longer localized, but extent of spread unknown 9B . Table 7 Relative Survival Rates of White Cancer Cases By Sex, Stage, and Years of Diagnosis New York Medical College, 1950-64 Number Relative Survival Rate (Percent) of 1 2 3 4 5 6 7 8 9 10 #11 #12 #13 «14~«% Groups of Cases Cases Yr. Yrs. Yes. Yrs, Yrs. Yrs, Yrs. Yrs. Yrs. Yrs. Yrs. Yes. Yrs. Yrs. Yrs. All Cases 5,075 65 54 48 45 42 41 “39 38 #38 #38" #38 #38 39 38 38 All Male Cases 2,121 52 41 35 32 29 28 27 #2 25 25* 25 26 27 28 27 All Female Cases —- 2,954 74 64 #57 #53 51 49 47 #46 #45 45% 45 45 45 43 =. 43 All Localized 2,061 90 83 78 74 72 71 #68 67 66 65* 66 67 67. 66 64 All Regional Spread 924 61 40 29 21 14 #11 9 5 All Distant Spread 1,367 29 18 #+%13 «#11 «2 8 7 7 7 7* 7 Localized - Male 723 83 74 68 65 63 61 58 58 55 55* 55 56 60 63 60 Female 1,338 94° 87 #83 #78 77 j%27 73 +=#71 «70 %70* #%70 #%71 #70 67 66 Regional Spread - Male 380 47 26 17 #11 8 Female 544 70 #49 37 #27 «20 «615—~=«618 5 Distant Spread - Male 717 23 #15 #+«11 #10 8 7 6 6 Female 650 35 22 14 +12 «10 8 8 8 8 Localized - 1950-54 676 90 82 77 72 71 69 66 65 63 63* 63 64 64 63 61 1955-59 691 90 82 77 74 70* 69 66 65 63 62 1960-64 694 89 84 79 Regional Spread - 1950-54 322 56 32 20 15 _9 6 5 2 1955-59 238 50 30 17 7 3 1960-64 364 72 «#54 48 Distant Spread - 1950-54 490 28 #17) «12 «11°: «8 6 6 6 6 1955-59 482 32 22 14 #13 «11% #10 9 10 9 1960-64 395 26 #17—=«12 * Survival rates beyond this point should be interpreted with caution because of the limited number of patients remaining under follow-up. ' Table 8 Relative Survival Rates of White Cancer Cases, By Site Groups and Selected Sites New York Medical College, 1950-64 Site of Cancer All Sites Buccal Cavity & Pharynx Digestive Organs Stomach Large Intestine Rectum Respiratory Organs Lung & Bronchus Breast Female Genital Organs Uterine Cervix Uterine Corpus Ovary. & Fallopian Tube Male Genital Organs Prostate Urinary Organs Melanoma of Skin Non-melanotic Skin Lymphatic & Hemato- poietic Tissues ‘Other & Unspecified Sites Number of 5,075 62 1,509 302 536 386 553 505 890 716 222 251 218 172 141 271 48 187 295 372 Cases Relative Survival Rate (Percent) T 2 oS 4 5 6 7 8 9 0 1 #12 #13 #14 ~« 15 Yr. Yes, Yrs. Yrs. Yrs. Yrs. Yrs. Yrs. Yrs. Yes. Yes. Yrs. Yes. Yrs. Yes. 65 54 48 45 42 47 #40 38 38 38 38 38 #39 38 «38 75 65 62 63 62 63 65: 61 53 41 34 30 27 26 2 2 25 25 26 26 27 #27 2 33 21 16 #14 #W so #1 «100611 64 53 48 42 40 38 36 35 32 34* 34 34 #35 34 32 74 60 49 44 39 38 37 38 38 40% #42 #42 «#45 «43 28417 «12 #10 9 8 7 277615 «10 «9 2 8 6 93 82 76 69 66 63 60 56 54 53* 51 50 48 47 48 8t 69 62 59 57 56 55 54 53 53* 54 54 56 57 52 90 80 77 73 67 68 67 63 61 G62* 63 64 65 67 91 84 77 75 35 74 74 75 75 72% 74 72 74 58 40 32 27 22 26 26 26 24 84 78 65 59 55 54 47 43 42 40 8 #77 63 56 51 48 41 36 73 64 #59 #55 54 51 51 48 48 5S1* 53. 56 53 88 82 75 65 63 60 56 51 96 93 89 91 87 90 87 87 86 78* 81 51 40 31 29 26 21 20 #19 #19 48 39 36 35 33 34 33 34 #35 35% 34 35 37 * Survival rates beyond this point should be interpreted with caution because of the limited number of patients remaining under follow-up. Table 9 Relative Survival Rates of White Cancer Cases By Site Groups New York Medica! College, 1950-54, 1955-59, 1960-64 Site of Cancer All Sites Buccal Cavity & Pharynx Digestive Organs Respiratory Organs Breast Female Genital Organs Male Genital Organs Urinary Organs Melanoma of Skin Non-melanotic Skin Lymphatic & Hemato- poietic Tissues Other & Unspecified Sites Years of Diagnosis 1950-54 1955-59 1960-64 1950-54 1955-59 1960-64 1950-54 1955-59 1960-64 1950-54 1955-59 1960-64 1950-54 1955-59 1960-64 1950-54 1955-59 1960-64 1950-54 1955-59 1960-64 1950-54 1955-59 1960-64 1950-54 1955-59 1960-64 1950-54 1955-59 1960-64 1950-54 1955-59 1960-64 1950-54 1955-59 1960-64 Number of Cases 1,693 1,735 1,647 19 18 25 559 537 413 165 181 207 314 286 290 232 261 223 49 59 64 83 83 105 13 16 19 46 63 78 92 WW 92 121 120 131 1 63 65 67 70 80 76 53 54 51 25 25 34 90 95 95 78 79 86 85 85 82 70 70 80 86 83 95 96 99 94 42 58 50 53 47 2 51 55 57 49 70 77 40 43 38 12 7 21 77 83 87 66 66 75 69 81 83 54 65 72 79 84 82 96 91 93 33 42 44 42 39 36 3 45 48 52 58 78 33 37 31 13 16 71 75 83 59 60 67 47 71 76 51 58 68 80 72 74 91 85 93 25 31 41 40 34 33 4 yr. yrs. yrs. yrs. 42 44 30 32 65 68 55 57 41 67 48 55 73 58 94 88 23 31 Relative Survive | Rate (Percent) 5 66 yrs. yrs. yrs. vis yrs. 39 37 42" 41 26 26 30° 28 59 * 59 53 52 54* 54 38 37 64* 64 45 44 53* 48 85" 88 19 14 27* 24 7 9 10 11 12 13 «14 #15 36 39 24 28 57 55 52 53 64 44 48 83 87 13 23 35 35 35 38 24 27 53 52 49 54 60 42 42 81 90 23 34 36 34 37 24 26 51 50 49 53 44 79 24 35 37 34* 34 34 35 34 HM 37 24* 25 25 25 25 25 26 50* 48 46 44 43 44 50 49* 50.50 51 53 48 50 46* 48 50 47 69* 72 35* 34 35 36 * Survival rates beyond this point should be interpreted with caution because of the limited number of patients remaining under follow-up. Relative Survival Rates of White Cancer Cases By Selected Sites New York Medical College, 1950-54, 1955-59, 1960-64 Table 10 Years of Site of Cancer Diagnosis Stomach 1950-54 1955-59 1960-64 Large Intestine 1950-54 1955-59 1960-64 Rectum 1950-54 °1955-59 1960-64 Lung & Bronchus 1950-54 1955-59 1960-64 Breast 1950-54 1955-59 1960-64 Uterine Cervix 1950-54 1955-59 1960-64 Uterine Corpus * 1950-54 1955-59 1960-64 Ovary 1950-54 1955-59 1960-64 Prostate 1950-54 1955-59 1960-64 Bladder 1950-54 1955-59 1960-64 Number of Cases 133 107 80 185 188 158 150 146 88 147 165 192 314 286 287 62 50 41 83 90 76 76 85 57 41 47 51 58 53 73 1 yr. 28 41 29 64 65 63 72 72 78 21 23 34 90 95 95 88 83 90 89 92 92 56 56 65 82 83 85 73 81 80 17 28 20 52 57 47 57 59 65 16 20 77 83 87 75 69 70 80 88 40 38 45 62 80 87 60 77 70 15 19 45 53 45 46 51 48 12 16 71 75 83 67 69 65 74 77 78 33 27 42 41 68 78 56 70 70 13 15 40 45 42 45 65 68 61 65 74 74 26 22 37 63 54 67 a 8 42* 35 [= 74* Iz BI * 49 10 11 36 43 40 40 59 59 59 51 69 75 24 58 49 59 10 33 38 32 41 57 55 57 52 71 75 22 56 34 36 34 41 53 52 50 70 77 Relative Survival B (P. j 3 4 9 10 11 12 13 14 15 32 31 33 43 51 50 47 72 73 33* 32 33 33 32 30 33 34* 36 36 38 36 45 50* 48 46 44 43 44 50 48* 49 50 51 71* 73° «70 72 49 45 47 49* 52 55 57 60 * Survival rates beyond this point should be interpreted with caution because of the limited number of patients remaining under follow-up. The foregoing descriptive analysis of the cancer ex- mercial “profit and loss” statement. As such it high- perience in the New York Medical College, Flower and lights successes and deficiencies in patient care, and Fifth Avenue Hospitals is a measure of the work-load improvements and omissions in the reporting of necessary and quality of care in this institution. The accomplish- patient information. It may, therefore, point the way ments and short-comings reflected by the data in the for additional professional and public education and in- Tumor Registry may be likened to a continuous com- tensified research to save more patients from this disease. REFERENCES End Results in Cancer, Report No. 3. End Results Section Biometry Branch, National Cancer Institute, Bethesda, 1968. Cutler, S. J. and Latourette, H. B.: A National Cooperative Program for the Evaluation of End Results in Cancer. J. Nat. Cancer Inst. 22:633-646, 1959. Layout and Lithography by American Litho-Craft Corp., New York City, 1969