JULY / AUGUST 1999

As of July 1, 1999 FCDS was 94% complete for the 1998 reporting year. We have been able to do this for the last two years. This could have not been done without the hard work each of you has put forth over the past several years.

Since early 1998, Eli Lilly, the No. 6 U.S. drug maker, has sold Evista (Raloxifene) for prevention of the bone-thinning disease osteoporosis in postmenopausal women. But studies have indicated that the drug may have the potential to prevent breast cancer as well. On July 19, 1999, a U.S. federal court temporarily barred Eli Lilly and Co. from making promotional claims that its osteoporosis drug Evista (Raloxifene) has been shown to reduce the risk of breast cancer.

STAR, a new study on Tamoxifen and Raloxifene, is now recruiting volunteers at more than 400 centers across the United States, Puerto Rico, and Canada. The trial will include 22,000 postmenopausal women at increased risk of breast cancer to determine whether the osteoporosis prevention drug raloxifene (Evista®) is as effective in reducing the chance of developing breast cancer as Tamoxifen (Nolvadex®) has proven to be.

STAR is a study conducted by the National Surgical Adjuvant Breast and Bowel Project (NSABP), a network of research professionals, and is supported by the National Cancer Institute (NCI). Call the National Cancer Institute's Cancer Information Service at 1-800-4-CANCER

(1-800-422-6237) for information in English or Spanish. The number for callers with TTY equipment is 1-800-332-8615.

On April 30, 1999, The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and the American College of Surgeons' Commission on Cancer (CoC) announced the initiation of a cooperative agreement that will reduce duplicative onsite evaluations of cancer treatment facilities.

Effective immediately, the Joint Commission will accept Commission on Cancer (CoC) accreditation decisions for cancer treatment facilities or cancer hospitals that are affiliated with health plans and health systems applying for accreditation under the Joint Commission's Network Program. It is anticipated that Joint Commission recognition of CoC accredited cancer treatment programs will be expanded to include all Joint Commission accreditation programs during the next year.

The Joint Commission's acceptance of CoC accreditation decisions was based upon a detailed assessment of the Commission on Cancer's standards and standards development process; survey process; surveyor selection, training and monitoring processes; accreditation decision-making process; and approach to public disclosure of organization-specific findings.

The intent of the assessment is to assure a strong fit with corresponding Joint Commission standards, processes, and procedures.

The CoC accredits approximately 1,500 cancer programs located in hospitals, outpatient centers, and freestanding cancer treatment facilities across the country.

Approved programs will benefit from increased visibility for the program within the institution and in the local community, improved ability to benchmark cancer program compliance with standards, affirmation of the cancer program's value, and reduced duplication of survey processes.

The Approved programs will benefit from increased visibility for the program within the institution and in the local community, improved ability to benchmark cancer program compliance with standards, affirmation of the cancer program's value, and reduced duplication of survey processes.

For more information about the Joint Commission and CoC cooperative agreement, please contact Millie Perich, associate director, Cooperative Accreditation Initiative, Joint Commission, at 630-792-5932 or Jo Anne Sylvester, Administrative Director, Commission on Cancer at 312-202-5298.

http://www.facs.org/news/coc_jcaho.html

A letter from the FL Cancer Liason to the Commission on Cancer stated that capturing physician office cases, Class 6, is important. Implementation progress to date showed a mixed experience, with some programs reporting significant obstacles beyond their immediate control. The CoC is interested in those approved cancer programs that have successfully implemented this program and would like these facilities to share their findings.

The standard for reporting physician office Class 6 cases has been postponed until the special committee presents recommendations to the Committee on Approvals in April 2000.

Florida statutes require that all physicians report cancer cases to FCDS. However, at this time physician office cases are only being reported through the hospitals, freestanding facilities and pathology labs. For those approved cancer programs reporting physician office cases, Class 6 cases, you must submit a complete abstract with a report source = 4 and a class of case = 6.

In July, FCDS mailed the quarterly death match to all hospital based registries. This report is used to identify expired patient’s matched with Florida’s Bureau of Vital Statistics Records.

The deadline to have the Death Certificate Notification (DCN) completed by the facilities is

August 31, 1999.

NAACCR WebPages –Questions & Answers on Histology-

Q. Are the terms "light-chain disease" and "multiple myeloma" synonymous? Both are coded to 203.0, but light chain disease is not mentioned in the ICD-O-2.

A. No, the terms are not synonymous. Multiple myeloma is present in about 60% of patients with light chain disease. Each record coded 203.0 should be reviewed. If multiple myeloma is not mentioned, do not include the case.

Q. Do we code the higher histology or the high grade histology when pathology is malignant lymphoma, follicular, small non-cleaved, B cell type?

A. Code follicular non-cleaved, NOS (9698/3). 1) Follicular and follicular non-cleaved cell are the same histology, first 3 digits are identical (969), higher code used. 2) No combination code for follicular non-cleaved and small cell (9686), use higher code.

Q. If a case is not confirmed pathologically, should a specific histology be coded? For example, if the case is diagnosed as a hepatoma based only on MRI findings, should the histology code be hepatoma or malignancy, NOS?

A. Code hepatoma (8170/3). Specific histology codes can be used for cases that are not confirmed microscopically because current imaging techniques can identify certain histologies

Q. Pt is dx with papillary urothelial carcinoma of the urinary bladder. Should we code histology to papillary transitional cell CA (8130/3)?

A. Yes. In the numerical ICD-O-2 listing, urothelial carcinoma is indented under the bold type heading "Transitional Cell Carcinoma," which means the terms are synonymous.

Q. What histology code should be assigned for fibromyosarcoma, and what hierarchy should be used? Using the "more than one adjective" rule, we see 8895/3 (myosarcoma) as acceptable, but should we use a combination code (8890/3)?

A. Code myosarcoma (8895/3). Leiomyosarcoma (8890/3) and myosarcoma (8895/3) are the same histology because the first three digits of the histology codes are identical, so the code that most accurately describes the tumor is selected.

Q. What histology code should be assigned when pathology report reads: Right ovary papillary cystadenocarcinoma. Left ovary: Metastatic papillary adenocarcinoma, predominantly mucinous?

A. Histology should be coded papillary mucinous cystadenocarcinoma (8471/3). "If the histologies of multiple lesions can be represented by a combination code, use that code."

Q. What histology code should be assigned when the pathology reads "Moderately differentiated adenocarcinoma with squamous differentiation, endometrial currettings?"

A. Code to adenocarcioma with squamous metaplasia (8570/32). "If a more specific histologic type (higher numeric code) is found in the microscopic description, code to the more specific histology."

Q. What histology code should be used for "Papillary adenocarcinoma with a follicular growth pattern?" Is the term "pattern of" used in coding?

A. The term " pattern of" is coded. The correct code would be papillary and follicular carcinoma (8340/3).

Q. What histology should be coded for "Adenocarcinoma of the endometrium, predominantly secretory carcinoma variant, with papillary and endometroid areas?" The ICD-O-2 lists secretory carcinoma as specific to the breast.

A. Code secretory carcinoma (8502/3). The ICD-O-2 says, when appropriate, ignore the topography code and use the appropriate topography as indicated in the diagnosis. The phrase "papillary and endometroid areas" does not describe the majority of tumor.

Q. What histology should be coded when the pathology from a shave biopsy, skin of left arm, reads "porocarcinoma?" The pathology department coded the site as skin and the morphology as endocrine carcinoma.

A. The ICD-O-2 has a classification for endocrine, adenoma but not for porocarcinoma of endocrine carcinoma of the skin. Ask the pathologist for clarification. In the absence of more specific information, code to carcinoma, NOS (8010/3).

Q. What is meant by "cancerization of lobules?" The pathology reads "Ductal carcinoma in-situ, comedo and cribiform types, multifocal with cancerization of lobules. "What histology code should be assigned?

A. "Cancerization of lobules" refers to extension into the lobules and should be ignored when coding. The term "type" indicates majority of tumor. No combination code exists for comedo and cribiform. Code ductal CA in situ, comedo carcinoma, cribiform (8501/2) higher code.

Q. What histology code for: excisional breast BX "Invasive ductal CA, extensive in-situ carcinoma, comedo type. Mastectomy "Residual ductal CA in-situ. Nipple: Paget's Disease

A. Histologies are infiltrating ductal (8500/3), intraductal (8500/2), and Paget's Disease (8540/3). Always code to the invasive disease. Code the infiltrating ductal and Paget's Disease using the combination code (8541/3).

University of Southern California Cancer Surveillance Program-Cosponsored by: Southern California Cancer Registrars Association.The objective of the USC Cancer Registrar Training Program, established in 1976, is to prepare individuals to be employed as cancer registrars with the basic skills necessary to initiate and operate a cancer registry as part of a hospital cancer program. The 24-day program is presented each Spring, with classes held two days per week for 12 consecutive weeks. The subject matter is presented in six modules: Introduction to Cancer, Abstracting, Biostatistics & Epidemiology, Follow-Up, Computerization, and Cancer Program Management.Contact:Donna Morrell, CTR, Director. Phone: (323) 442-2334

E-mail: dmorrell@hsc.usc.edu

July 26-30 & December 6-10, 1999 The SEER Program of the National Cancer Institute Principles of Oncology for Cancer Registry Professionals Presented by Bolger Center for Leadership Development Potomac, Maryland Registration fee: $575.00*Principles of Oncology is a five-day training program in cancer registry operations and procedures emphasizing accurate data collection. The training program includes extensive site-specific, hands-on case abstracting and coding sessions using both full medical records and abstracts that demonstrate the many situations that registrars may face. Faculty includes April Fritz, BA, ART, CTR, Manager of Data Quality at the National Cancer Institute's SEER Program, april.fritz@nih.gov- For more information, contact the National Cancer Institute at (301)496-8510.

FCDS and FTRA will be conducting their respective Annual Conferences in conjunction with one another on the following dates:

August 9-10, 1999 - FCDS will be holding its Annual Conference at the Adam’s Mark Hotel, in Clearwater Beach FL, 430 South Gulfview Blvd., 813-443-5714. Conference registration fee is the same as last year - $25.00. Registration forms will be mailed in July. If you have any questions regarding the annual meeting, please contact Betty Fernandez or Bleu Herard at (305)243-4600 or 1-800-906-3034.

August 11-13, 1999 - FTRA will host its Annual Conference at the Adam’s Mark Hotel, in Clearwater Beach FL, 430 South Gulfview Blvd., (813)443-5714. The cost of the conference is $175. Please, contact Linda Eastridge, ART, CTR at (727)588-5520 for more information.

August 16-20, 1999 , November 8-12, 1999, December 6-10, 1999, Emory University, Atlanta, Georgia – "Principles /Practice of Cancer Registration, Surveillance, and Control". For more information email Steven Roffers, PA, CTR at sroffer@sph.emory.eduor visit the WebSite:http://www.sph.emory.edu/GCCS/training

September 15-17, 1999, Miami, FL - FCDS Incidence Abstracting Workshop. The cost is $100. Please contact Betty Fernandez or Mayra Alvarez at (305)243-4600 for information and registration.

September 16, 1999 - The AJCC will present a two-hour, tumor board interactive videoconference at 1:00 p.m. EDT. The ACoS will provide two CME credits. There is a $25 registration fee for the videoconference. A video conference brochure with registration form will be mailed to Commission on Cancer liaison physicians, cancer committee chairs, and cancer registrars in the area of the participating sites. The following are participating sites in FL; Lee Memorial Health System, Fort Myers, Oak Hill Hospital, Brooksville, Sarasota Memorial Hospital, Sarasota, University of Florida, Gainesville. To participate at a site near you, contact the education department at the hospital, or call the AJCC office at (312)202-5279.

September 18, 1999 will be the next CTR exam. To obtain an application and handbook for the CTR exam, contact the National Board for Certification of Registrars (NBCR) Testing Office, Professional Testing Corporation, 1350 Broadway, 17^th Floor, New York, NY 10018. Phone (212) 356-0660. Visit the website: http://www.nbcr.org Cost of the exam is $175 for NCRA members and $250.00 for all other candidates. If you have any further questions, please contact the FCRA Education Chairman, Steve Peace, CTR, at (305)243-4602.

November 5-6, 1999.the Commission on Cancer will host the 4th Annual Conference. On November 4, from 1:00 - 5:00 p.m., a special presentation, "Survey Savvy," will be given. Place: Wyndham Chicago, 633 N St Clair, Chicago 800/WYNDHAM.or contact CoC at (312)202-5085 http://www.facs.org/about_college/acsdept/cancer_dept/sepregwkshp.html

May 9-12, 2000 will be the NCRA- 26^TH ANNUAL EDUCATIONAL CONFERENCE, in Albuquerque, New Mexico. For more information contact NCRA (913) 438-6272 or email NCRA at : ncra-info@applmeapro.com

The 2001 NCRA Annual Conference will be held at the Hilton in the Walt Disney World Village, Orlando, Florida. Carol Johnson, president-elect is now looking for Florida Registrars and Central Registry volunteers to help staff the hospitality & registration booths as well as the cocktail reception. Any suggestions for local speakers, meeting or volunteers is welcomed. Contact Steve Peace at 305-243-4602 or contact Carol Johnson, 301-402-6226, carol.jonson@NIH.gov or contact Edie Kutlus (302) 798-3978, Ekutlus@cppsinc.com, NCRA (913) 438-6272 or email NCRA at :ncra-info@applmeapro.com

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