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.1 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 I 00 hospi@s of various types and sizes participating in the End Results Evaluation Program. DISTRIBUTION OF CASES The New York Medical College Tumor Registry contains the number of cancer of the cervix in females and of pros- 5,297 malignant tumor cases diagnosed and treated between tate and of the lung-and-bronchus malignancies in mates 1950 and 1964, inclusive. Almost all of the patients were between the two periods. It should be borne in mind that white (96 percent), with little variation in each of the the changes over time represent shifts in the nature of the years. In the aggregate there were about three female to population of cancer patients seen in this hospital and do every two male patients. The Registry accessioned an not necessarily parallel trends in the general population. For average of 353 new cases annually for the fifteen-year example, the incidence of cancer of the large intestine is period, varying from an average of 349 in the five years increasing, but in the Flower and Fifth Avenue Hospitals 1950 through 1954, to an average of 363 in the following the number seen decreased in the periods 1955-59 to 1960- five-year period through 1959, to 348 in the five years end- 64. ing in 1964. The increase in the average number of new Malignancies of the digestive organs and breast constituted cases in the 1955-59 period was due principally to the almost half of all the cases in the Registry over the entire d-bronchus, prostate, spectively). with cancers of the significant increases in rectal, lung-an period (30 and 17 percent, re female genital organs and of the respiratory system follow- leukemia, brain, and non-melanotic skin cases in males, and in cases of the uterine cervix, uterine corpus, ovary, ing with 14 and II percent, respectively (Table I). The eight Hodgkin's disease, and non-melanotic skin cases in females leading sites made up almost two-thirds of all of the cases. with breast cases accounting for more than one of every (Tables 1, 2, and 3). Although the number of cases of the six, and cancers of the large intestine and lung-and-bronchus ovary in the female, and of the stomach, large intestine, and each accounting for one of every ten patients (Figure 1). rectum in both sexes declined markedly between 1950-54 and Nine percent of all the cancers diagnosed were multiple 1960-64, this was made up in large measure by the increase in cancers. PERCENT OF ALL CASES BY LEADING SITES NEWYORK MEDICAL COLLEGE 1950-64 0 5 10 15, 20 BREAST 17 LARGE INTESTINE 10 LUNG & BRONCHUS lo RECTUM 8 STOMACH 6 UTERINE CORPUS UTERINE CERVIX 5 OVARY 4 Fig. 1 In men the six leading sites made up almost two of number of kidney and prostate cases increased 62 and every three malignancies over the fifteen-year period, 37 percent, respectively, between the earliest and latest with considerable variation in their distribution between period. On the other hand, although cancers of the large the time periods (Table 2 and Figure 2). Almost one of intestine, rectum, and stomach represented twelve, ten, every five male patients had cancer of the lung-and- and nine percent, respectively, over the entire period, bronchus, with substantial increases occurring in each five-year period from the preceding period - 19 percent these cases declined by 13, 29, and 25 percent, re- in 1955-59, and 15 percent in 1960-64. Similarly, the spectively, between 1950-54 and 1960-64. PERCENT OF MALE CASES BY LEADING SITES NEW YORK MEDICAL COLLEGE 0 5 10 15 20 25 17 1950-54 LUNG & BRONCHUS 19 1955-59 60 23 1960-64 13 LARGE INTESTINE 12 1 0 1 0 RECTUM 7 STOMACH 9. .m 8 6 PROSTATE 7 8 6 BLADDER 6 8 Fig. 2 9 In women the six leading sites constituted almost seven 1950-54 and 1960-64 the number of stomach and rectum of every ten cancers over the entire period, with varying cases declined about 50 percent, and of the ovary and distributions in each time period (Table 3 and Figure 3). large intestine by 24 and 18 percent, respectively. Con- Three of every ten female patients had breast cancer, and versly,the number of cervical cases increased by more than about one in four had the disease in the genital organs, or in the digestive organs, Although the trend of breast 50 percent, and of non-melanotic skin cancers by more and uterine corpus cases remained almost level, between than 90 percent between the two periods. PERCENT OF FEMALE CASES BY LEADING SITES NEWYORK MEDICAL COLLEGE 0 5 10 15 20 25 30 35 31 1950-54 28 BREAST 1955-59 31 1960-64 10 10 LARGE INTESTINE 8 8 9 UTERINE CORPUS 8 6 8 UTERINE CERVIX 10 8 9 OVARY 6 8 6 RECTUM 4 Fig. 3 10 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 AGE DISTRIBUTION OF CANCER CASES BY SEX NEWYORK MEDICAL COLLEGE 1950-64 35 LE 30 - FEMA 25 20 PERCENT OF CASES 15 10 - 5 - 0 0 10 20 30 40 50 60 70 80+ AGE Fig. 4 The median age at diagnosis of all cases (hidf above genital organs. Seven of every ten breast cases and more and. half below) was 59, ranging from 51 for patients with than six of every ten malignancies of the female genit.al I mphomas and leukeniias,.to 63 years of age for prostate organs were diagnosed in patients under 60 years of age. y cases (Figure 5). On the other hand, three of every four male patients The higher proportion of female casesIbelow the age of with cancer of the genital organs were .60 years of age 60 is due principal to malignancies of the breast and and older (Table 4). IY MEDIAN AGE OF CANCER CASES BY SITE NEWYORKMEDICALCOLLEGE 1950-64 20 40 60 80 ALL SITES 59 L.YMPHOMAS & LEUKEMIAS B,UCDAL CAVITY & PHARYNX :53 FEMALE GENITAL ORGANS 53 BREAST 51 RESPI'RA-tORYORGANS. 60 URINARY ORGANS DIGESTIVE;ORGANS'- MALE GENITAL:ORGANS 63 49 ALL@OTHER SITES (tXtEPT Ski N) Fig. 5 12 METHOD OF DIAGNOSIS Inasmuch as non-white cancer patients constituted only pares favorably with the combined End Results Group four percent of the total number in the Flower and during the ten-year period 1955-64 for which data was Fifth Avenue Hospitals in the fifteen years, 1950 through obtained. A comparison of the levels of microscopic 1964, and to facilitate comparisons with the third report of the End Results Group, the remainder of this analysis confirmation of ten selected sites in the 1955-59 and will deal only with the white cancer cases treated during 1960-64 periods (representing about 70 percent of all this period. of the cases) shows the maintenance of a high level of A measure of the quality of medical care given cancer performance, except for stomach and bladder cases in patients is the proportion of cases treated on the basis of the latest period (Figure 6). More noteworthy, is the microscopic confirmation of the disease. In this respect marked improvement in microscopic confirmation of lung- the performance of the New York Medical College Corn- and bronchus cases from 75 to 89 percent. CASES MICROSCOPICALLY CONFIRMED BY SELECTED SITES NEWYORK MEDICAL COLLEGE PERCENT 0 20 40 60 80 100 STOMACH 1955-59 1960-64 LARGE INTESTINE RECTUM LUNG & BRONCHUS BREAST UTERINE CERVIX 160 UTERINE CORPUS OVARY PROSTATE BLADDER Fig. 6 STAGE OF DISEASE Just as the level of microscopic confirmation of malig- in the patients' medic al charts for 12 percent. of all of the nancies is a measure of the qualitative basis of patient care, cases (one of every eight), and for about one of every the extent of the disease (stage ) at the time of diagnosis five patients with cancers of -the esophagus, prostate, reflects the effectiveness of a cancer control educational and lung-and-bronchus. Figure 7 shows the distribution program. If the proposition is accepted that early diagnosis by stage of the disease at diagnosis of the ten major and treatment enhances the prospects for patient cure sites which constituted almost 70 percent of the cancer and survival, then the extent of the disease at diagnosis caseload in the Flower and Fifth Avenue Hospitals. is a measure of the discernment of physicans in diag- There was no consistent trend in sfiging the ten nosis, and is indicative of the public's awareness of selected sites (Table 6). While the early diagnosis of the need for regular physical examinations and the con- patients wit@ malignancies of the lung-and-bronchus showed sequences in delaying medical care upon manifestation consistent improvement between the five-year periods, of the "danger signals." The basis of the determination the proportion of patients with localized cancers of the of the stage of the disease at diagnosis is the information large intestine and prostate declined. The decline in available during the first course of medical care, including localized cases of the large intestine may be due to the pathologist's examination of the surgical specimen. increased use of surgery resulting in more accurate staging, During the fifteen years 1950 through 1964, an average while the decrease in prostate cases is obscured by the of 43 percent of the cases (excluding non-melanotic skin, large increase in the proportion of cases for which the lYmPhomas, and leukemias) in the Flower and Fifth extent of the disease was not reported (from five percent Avenue Hospitals were localized, ranging from- a high of in 1950-54 to 30 percent in the latest period. Most 82 percent for patients with cancer of the bladder to a of the other sites followed an erratic course (see par- low of 13 percent for lung-and-bronchus cases ('Table 5), ticularly breast, uter-ine cervix, uterine corpus, and kidney The extent of the disease at diagnosis was not specified cases). STAGE OF CANCER CASES AT DIAGNOSIS BY SELECTED SITES NEW YORK MEDICAL COLLEGE 1950-64 PERCENT 0 20 40 60 80 100 STOMACH LARGE INTESTINE 43 RECTUM 54 LUNG & BRONCHUS BREAST 53 UTERINE CERVIX 53 UTERINE CORPUS 77 2 OVARY 7 PROSTATE 3@ KIDNEY 49, LOCALIZED REGIONAL DISTANT STAGE NOT SPREAD SPREAD SPECIFIED F ig. 7 Survival of Cancer Cases nt groups with different 'normal' mortality The ultimate measure of the effectiveness of the control cancer in patie of cancer by means of improved diagnostic, therapeutic, expectation." It should be borne ift mind that general pop- and follow-up techniques is seen in the survival rates of idation mortality experience may riot be strictly applicable patients. The trend in patient survival will be presented in to the patient population seen at the Flower and Fifth the same terms of relative survival rates as in the third Avenue Hospitals. report of the End Results Group.' As noted in this report "the survival rate observed in a group of The actuarial method of computing the relative survival patients reflects mortality not only from the rates has been employed for this analysis. This permits us disease under study but also deaths due to all to take cognizance of the latest information concerning other causes. The risk of dying from causes the status of each case in the series up to, and including, other than the specific cancer under study the latest year of the study period. (In this study a patient varies with the sex and age characteristics of is considered "lost" to follow-up if no information has the patient group and with calender time. The been received about Mm for two consecutive years, even though the Registrar continues 'to seek information relative survival rate adjusts for 'normal' mor- about him for several more years.) The actuarial method tality and thus makes possible meaningful com- of computing survival rates makes use of every case at parisons of the survival experience of groups each interval following the date of diagnosis, subject- of patients that differ with respect to sex, to the possibility of being alive or dead at the time. age, and calender period of observation. It Thus, for the five-year survivorship computations, all cases is defmed as the ratio of the observed survival rate to the expected rate for a group of people which had the opportunity of surviving five years were in the general population similar to the patient used, irrespective of the date of diagnosis. Thus, the number group with respect to sex, age, -and calender of cases from which computations were made became smaller at each successive yearly interval, with the result period of observation. The relative survival tha .t the data became less reliable as we approached rate is the probability of escaping the mor- the longer time periods. The computation of the survival tality risk due to the specific cancer under rates by this method also has a "built-in" assumption, study." namely, that the living cases, which were dropped from The report presents an illustration of the effect of the computations at each successive yearly interval will adjustment for "normal" mortality and notes that- "com- have the same relative mortality and survival as those parison of relative survival rates provides a measure of the which were kept in the computations at each successive difference in mortality associated with specific forms of time interval. In our groupings of the cancer cases in the New York inclusive, is 42 percent, and 38 percent for those who Medical College Tumor Registry it was possible to com- had the opportunity of surviving ten years. The relative pute with confidence relative survival rates up to ten survival rate remained stable beginning with the eighth years in some instances. Thus, the five-year survival rate year (Table 7). The differences in survival between male for all white cases diagnosed between 1950 and 1964, and female patients is shown in Figure 8. RELATIVE SURVIVAL OF CANCER CASES BY SEX NEW YORK MEDICAL COLLEGE 1950-64 100 90 80 70 60 RELATIVE SURVIVAL 50 - RATE 40 - 30 - 20 -@ ALE 10 - 0 0 2 4 6 8 lo* 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 those treated after the disease invaded adjacent areas-72 treatment of cancer in the Flower and Fifth Avenue percent versus 14 percent, respectively, (Table 7 and Figure Hospitals is apparent when one notes that for all cases 9). The disparity was particularly large in male. cases, 63 more than five times as many patients treated while the percent for localized cases as compared with only five per- disease was localized survived five years, as compared with cent for those with regional spread. RELATIVE SURVIVAL OF CANCER CASES BY STAGE OF DISEASE AT DIAGNOSIS NEWYORK MEDICAL COLLEGE 1950-64 100 90 80 70 - LocALiZED 60 RELATIVE 0 SURVIVAL 5 RATE (%) 40 - 30 - SPREAD 20 - 10 - DISTANT SPREAD 0 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 NEWYORK MEOICAL COLLEGE 1950-64 100 90 80 71i 60 RELATIVE 1960-64 SURVIVAL 50 RATE 40 - 1955-59 1950-54 30 - 20 10 - 0 0 2 4 6 8 lo* 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. 10 18 T'he five-year relative survival rate of nine major selected relative survival for all cases improved from 45 percent to sites ranged from a high of 75 percent for patients with 52 percent between 1950-54 and 1960-64 (Table 9). Also, cancer of the uterine corpus to seven percent for those significant improvement is evident for patients with cancer with malignancies of the lung-and-bronchus (Table 8 and of the urinary organs, and of the genital organs (both male Figures 11 and 12). Sufficient data was not avaflable and female). Of the specific sites where- data was avafl- to compute five-year rates for each of the major site able breast cases and those with cancer of the bladder groups diagnosed in each time period. The three-year showed significant improvement (Table 10). RELATIVE SURVIVAL OF CANCER CASES BY SELECTED SITES NEWYORK MEDICAL COLLEGE 1950-64 100 90 80 70 60 RELATIVE PROSTATE SURVIVAL 50 - RECTUM Fig. 11 RATE (%) F@: 40 - 30 - LARGE INTESTINE 20 - 10 - 01 0 2 4 6 8 10, 12 14 16 YEARS Sumival rates beyond this point should be interpreted with caution because of the limited number of patients remaining under follo@up. RELATIVE SURVIVAL OF CANCER CASES BY SELECTED SITES NEWYORK MEDICAL COLLEGE 1950@ 100 90 80 UTERINE CORPUS 70- 60- NE CERVIX RELATIVE SURVIVAL 50 - Fig. 12 RATE(%) 40 30 - 20 - OVARY AND FALLOPIAN TUBE 10 01 I I I I I I I I I I i I 0 2 4 6 8 lo' 12 14 YEARS 'Survival rates beyond this point should be interpreted with caution because of the limited number of patients remaining under follow-up. Table 1 Number and Percent Distribution of All Cancer Cases New York Medical College, 1950-54, 1955-59, 1960-64 SITE OF CANCER 1950-64 1950-54 1955-59 1960-64 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 1.5 Buccal Cavity 1.0 17 1.0 13 .7 25 1.4 Pharynx 2 2 .1 5 .3 2 .1 Digestive Organs 29.8 576 33.0 567 31.3 436 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 10.7 171 9.8 186 10.3 210 12.0 Larynx .4 12 .7 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 4.9 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 @l 2.3 50 2.8 56 @2 All Other Male Genital .7 12 .7 11 .6 13 .8 Urinary Organs 5.3 85 4.9 85 4.7 ill 6.4 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 5.6 Lymphosarcoma .9 12 .7 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 11 .6 13 .7 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 SITE OF CANCER 1950-64 195D-54 - 1955-59 1960-64 NUMBER PERCENT NUMBER PERCENT NUMBER PERCENT All Sites 2,216 699 100.0 774 100.0 743 100.0 Buccal Cavity & Pharynx 1.6 10 1.4 1 2 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 37.7 294 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 11.8 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 0 0.0 2 .3 4 .5 Male Genital Organs 8.2 53 7.6 61 .7.9 69 9.3 Prostate 6.6 41 5.9 50 6.5 56, 7.5 All Other Male Genital 1.6 12 1.7 1 1 1.4 13 1.8 Urinary Organs 8.8 53 7.6 63 8.1 79 10.6 Kidney 2.4 13 1.9 @9 2-.4 21 2.8 Bladder 6.4 40 5.7 44 5.7 58 7.8 Lymphati c & Hematopoietic Tissues 7.5 54 7.7 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 1.5 9 1.2 10 1.3 Leukemia & Aleukemia 19 2.7 33 4.3 23 3.1 3.3 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 14on-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 .7 Connective Tissue 1.2 12 1.7 7 .9 7 .9 Al I 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 SITE OF CANCER 1950-64 1950-54 1955-59 1960-64 NUMBER PERCENT NUMBER PEWCE-NT NUMBER PERCENT' All Sites 3,081 1,044 ioo.o 1,039 100.0 998 100.0 Buccal Cavity & Pharynx .9 9 .9 6 .6 14 1.4 Buccal Cavity .8 8 .8 3 .3 @3 @3 Pharynx i 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 4o 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 -T8 @7 -T2 @2 All Other Respiratory .2 2 .2 2 .2 2 .2 Breast 29.7 319 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 3.2 Kidney 1.1 13 1.3 @o -. 0 @l 1.1 Bladder 1.7 19 1.8 12 1.1 21 2.1 Lymphatic & Hematopoletic Tissues 4.8 43 4.1 57 5.5 47 4.7 Lymphosarcoma .7 4 .4 8 .8 8 ..8 Hodgkin's Disease 1.1 7 .7 17 1.6 11 1.1 Leukemia & Afeukemia 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 .9 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 0 - 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 4.9 1.6 1.9 1.2 7.3 4.3 2.3 1.0 Table 5 Percent Distribution of White Cancer Cases, By Stage At Diagnosis, By Site (Exclusive of Skin, Lymphomas, and Leukemias) 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 (i 00.0%) (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 Esopha 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 4.7 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 56.2 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 2.4 2.4 All Other Sites 32. 34.4 21.9 25.0 0.0 18.7 Table 6 Percent Distribution of White Cancer Cases, By Stage At Diagnosis,* By Selected Sites New York Medical College, 1950-54,1955-59,1960-64 Localized Regional Spread Distant Spread Unspecified 1950- 1955- 196G- 1950- 1955- 1960- 1950- 1955- 1960- 1950- 1955- 1960- Site of Cancer 1954 1959 1964 1954 1959 1964 1954 1959 1964 1954 1959 1964 Stomach 12 18 16 24 25 26 56 41 44 7 14 11 Large Intestine 46 43 39 is 16 29 27 29 28 9 12 3 Rectum 50 58 53 17 9 23 23 22 16 9 11 8 Lung & Bronchus 7 12 19 36 27 28 35 32 37 21 24 14 Breast 54 51 54 27 18 39 3 6 5 16 25 1 Uterine Cervix 59 41 59 1 1 13 26 25 28 2 5 17 10 Uterine Corpus 80 73 80 5 3 13 8 1 7 15 5 Ovary & Fallopian Tube 27 24 32 .9 8 21 60 60 46 5 .7 2 Prostate 39 31 3 0 25 15 21 32 27 18 5 27 30 Kidney 54 35 59 8 10 13 27 41 16 12 14 9 Excludes cases no longer localized, but extent of spread unknown 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 19- Groups of Cases Cases Yr. Yrs. Yrs. Yrs. Yrs. Yrs Yrs. Yrs. Yrs Yrs. Yrs. Yrs. r@s. 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 E 28 27 26 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 JA 1 1 9 5 All Distant Spread 1,367 29 18 13 1 1 -R 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 76 73 71 70 70* 70 71 70 67 66 Regional Spread - Male 380 47 26 17 1 1 Female 544 70 49 37 27 20 15 13 5 Distant Spread - Male 717 23 15 11 10 -R 7 6 6 Female 650 35 22 14 12 M 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 ll* 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.remainkl under follow-up. Table 8 Relative Survival Rates of White Cancer Cases, By Site Groups and Selected Sites New York Medical College, 1950-64 Number Relative Survival Rate (Percent) of 1 2 3 4 5 6 7 8 9 10 1 1 12 13 14 15 Site of Cancer Cases Yr. Yrs. Yrs. Yrs. Yrs. Yrs. Yrs. Yrs. Yrs. @rs. Y-M Yr$ Yrs Yrs Yrs All Sites 5,075 65 54 48 45 42 41 40 38 38 38- 38 38 39 38 38 BucGal Cavity & Pharynx 62 75 65 62 63 62 63 65 61 Digestive Organs 1,509 53 41 34 30 27 26 25 25 25 25' 26 26 27 27 27 Stomach 302 33 21 16 14 11 11 11 10 11 Large Intestine 536 64 53 48 42 TO 38 36 35 32 34- 34 34 35 34 32 Rectum 386 74 60 49 44 3-9 38 37 38 38 40- 42 42 45 43 Respiratory Organs 553 28 17 12 10 9 8 7 Lung & Bronchus 505 27 15 10 9 7 8 6 B reast 890 93 82 76 69 66 63 60 56 54 53' 51 50 48 47 48 Female Genital Organs 716 81 69 62 59 5-7 56 55 54 53 53* 54 54 56 57 52 Uterine Cervix 222 90 80 77 73 67 68 67 63 61 62- 63 64 65 67 Uterine Corpus 251 91 84 77 75 75 74 74 75 75 72* 74 72 74 Ovary & Fallopian Tube 218 58 40 32 27 IL 26 26 26 24 Male Genital Organs 172 84 78 65 59 55 54 47 43 42 40 Prostate 141 84 77 63 56 51 48 41 36 Urinary Organs 271 73 64 59 55 51 51 51 48 48 51* 53 56 53 Melanoma of Skin 48 88 82 75 65 63 60 56 51 Non-melanotic Skin 187 96 93 89 91 87 90 87 87 86 78* 81 Lymphatic & Hemato- poletic Tissues 295 51 40 31 29 26 21 20 19 19 Other & Unspecified Sites 372 48 39 36 35 3-3 34 33 34 35 35* 34 35 37 Srvival 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 Medical College, 1950-54,1955-59,1960-64 Years Number Relative Survival Rate (Percent) of of 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 .Site of Cancer Dia Cases yr yrs yrs yrs yrs yrs yrs yr-S yr-S yrs yrs yrs yrs yrs yrs All Sites 19@54 1,693 63 51 45 42 39 37 36 35 34 34* 34 34 35 34 34 1955-59 1,735 65 55 48 44 42* 41 39 38 37 37 1960-64 1,647 67 57 52 Buccal Cavity & Pharynx 1950-54 19 70 49 1955-59 18 80 70 58 1960-64 25 76 77 78 Digestive Organs 1950-54 559 53 40 33 30 26 26 24 24 24 24* 25 25 25 25 25 1955-59 537 54 43 37 32 @O 28 28 27 26 26 1960-64 413 51 38 31 Respiratory Organs 1950-54 165 25 12 7 6 1955-59 181 25 17 13 10 9* 9 1960-64 207 34 21 15 Breast 1950-54 314 90 77 71 65 63 59 57 53 51 50* 48 46 44 43 44 1955-59 286 95 83 75 68 @3* 59 55 52 50 50 1960-64 290 95 87 83 Female Genital Organs 1950-54 232 78 66 59 55 53 52 52 49 49 49* 50 50 51 53 48 1955-59 261 79 66 60 57 54* 54 53 54 53 50 1960-64 223 86 75 67 Male Genital Organs 1950-54 49 85 69 47 41 38 37 1955-59 59 85 81 71 67 641 64 64 60 1960-64 64 82 83 76 UrinM Organs 1950-54 83 70 54 51 48 45 44 44 42 44 46* 48 50 47 1955-59 83 70 65 58 55 48 48 42 1960-64 105 0 Melanoma of Skin 1950-54 13 86 79 80 73 1955-59 16 83 84 72 58 1960-64 19 95 82 74 Non-melanotic Skin 1950-54 46 96 96 91 94 BZ 90 83 81 79 69, 72 1955-59 63 99 91 85 88 BE* 88 87 90 1960-64 78 94 93 93 Lymphatic & Hemato- poietic Tissues 1950-54 92 42 33 25 23 19 14 13 1955-59 ill 58 42 31 31 2Z* 24 23 23 24 1960-64 92 50 44 41 Other & U nspecif led Sites 1950-54 121 53 42 40 39 35 36 35 34 35 35- 34 35 36 1955-59 120 47 39 34 34 33* 34 35 36 37 1960-64 131 44 36 33 Survtval rites beyond this point should be interpreted with caution because of the limited number of patients remaining under follow-up. Table 10 Relative Survival Rates of White Cancer Cases By Selected Sites New York Medical College, 1950-54, 1955-59, 1960-64 Years Number of of 1 2 3 4 5 6 7 8 1 Site of Cancer iagnosis Cases yr. yrs yrs yrs yrs yrs. yrs. yrs. yr, Xrs. yr, yrs yrs. yrs. yrs. Stomach 1950-54 133 28 17 15 13 10 10 10 1955-59 107 41 28 19 15 13-' 11 1960-64 80 29 20 Large Intestine 1950-54 185 64 52 45 40 38 j6 33 34 32 33' 32 33 33 32 30 1955-59 188 65 57 53 45 42* 43 38 36 31 33 1960-64 158 63 47 45 Rectum 1950-54 150 72 57 46 42 35 40 32 34 33 34- 36 36 38 36 '1955-59 146 72 59 51 45 44- 40 41 41 43 45 1960-64 88 78 65 48 Lung & Bronchus 1950-54 147 21 9 4 1955-59 165 23 16 12 9 9 1960-64 192 34 20 16 Breast 1950-54 314 90 77 71 65 63 59 57 53 51 50* 48 46 44 43 44 1955-59 286 95 83 75 68 C3' 59 55 52 50 50 1960-64 287 95 87 83 Uterine Cervix 1950-54 62 88 75 67 61 58 59 57 50 47 48* 49 50 51 1955-59 50 83 69 69 65 50* 51 52 1960-64 41 90 70 65 Uterine Corpus 1950-54 83 89 80 74 74 74 69 71 70 72 71* 73 70 72 1955-59 90 92 84 77 74 @4 75 75 77 73 1960-64 76 92 88 78 Ovary 1950-54 76 56 40 33 26 25 24 22 1955-59 85 56 38 27 22 Y2- 1960-64 57 65 45 42 Prostate 1950-54 41 82 62 41 37 33 1955-59 47 83 80 68 63 59* 58 56 1960-64 51 85 87 78 Bladder 1950-54 58 73 60 56 54 49 49 49 45 47 49* 52 55 1955-59 53 81 77 70 67 @* 59 57 60 1960-64 73 80 70 70 Survival nms 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 work4oad improvements and on-dssic;ns in the reporting of necessary and quality of care in this institution. The accomplish- patient information. It may, therefore, point the way ments and shortcomings reflected by the data in the for additional professional and public education and in- Tumor Registry may be likened to a continuous corn- tensified research to save more patients from this disease. 40 40 - - - - - - - - - - - - REFERENCES 1. End Results in Cancer, Report No. 3. End Results Section Biometry Branch, National Cancer Institute, Bethesda, 1968. 2. 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. 40 Layout and Lithography by American Litho-Craft Corp., New York City, 1969 k