Treatment of stage IC-III, ER/PR positive breast cancer with hormonal therapy (Measure 71)

If a female has stage 1c – III breast cancer (ICD-9 diagnosis codes: 174.0, 174.1, 174.2, 174.3, 174.4, 174.5, 174.6, 174.8, 174.9 AND CPT E/M service codes: 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99218, 99219, 99220, 99221, 99222, 99223, 99231, 99232, 99233, 99234, 99235, 99236, 99241, 99242, 99243, 99244, 99245, 99251, 99252, 99253, 99254, 99255) and tumor is positive for estrogen /progesterone receptors, recommend hormonal therapy. Based on results from multiple large randomized trials, adjuvant therapy for women with hormone receptor-positive breast cancer should include hormonal therapy in order to lower the risk of tumor recurrence.

DESCRIPTION: Percentage of Stage IC-III, estrogen receptor (ER) or progesterone receptor (PR) positive, female breast cancer patients aged 18 years and older who are receiving tamoxifen or aromatase inhibitor (AI) at the time of the visit GUIDELINE: If a female has stage 1c – III breast cancer and tumor is positive for estrogen /progesterone receptors (ER/PR), recommend hormonal therapy. Based on results from multiple large randomized trials, adjuvant therapy for women with hormone receptor-positive breast cancer should include hormonal therapy in order to lower the risk of tumor recurrence.

References:

• American Society of Clinical Oncology, Use of Aromatase Inhibitors As Adjuvant Therapy for Postmenopausal Women With Hormone Receptor-Positive Breast Cancer

http://www.asco.org/portal/site/ASCO/menuitem.c543a013502b2a89de912310320041a0/?vgnextoid=e64ef314170d8010VgnVCM100000ed730ad1RCRD&vgnextfmt=default

• National Comprehensive Cancer Network Breast Cancer guideline recommendations for stage ICIII, ER/PR positive cancer: BINV-G, BINV-5, BINV-6, BINV-9.

http://www.nccn.org/professionals/physician_gls/default.asp