Table 1

Characteristics of included studies

First author, year of publicationPeriod of data collectionCountryRecords evaluated (N)Source populationType of administrative dataDiagnostic codesAlgorithmReference standard
Fisher  et al 41 19921984–1985USA33 cases (any position); 24 cases (first position) from each 239 hospitalsAll National Medical beneficiaries,Medicare claim database: inpatient hospital discharge.174–174.9(a) Diagnosis in any position.
(b) Diagnosis in primary position.
Medical records review
McBean et al 55 19941986–1987USA5744 casesPersons 65 years of age and older living in the five states participating in the SEER Program.Medicare claim database: inpatient hospital data.174–174.9New cases of breast cancer with diagnostic codes in any position.Cancer Registry (SEER)
Solin et al 50 19941988–1989USA469 casesWomen aged ≥21 years enrolled in the USA. Healthcare in the southeastern Pennsylvania region.Claims database included inpatient hospital stays, short procedure unit stays and professional services. Each claim included the USA (comprised ICD-9 code and CPT-4).174–174.9; 233.0(A) Initial algorithm based on new case of breast carcinoma+one or more of the following: (1) mastectomy, (2) partial mastectomy with lymphadenectomy, (3) excision, breast biopsy or partial mastectomy+lymphadenectomy, (4) excision, breast biopsy or partial mastectomy+the diagnosis of carcinoma of the breast, (5) excision, breast biopsy or partial mastectomy followed by radiation therapy treatment or (6) excision, breast biopsy or partial mastectomy followed by chemotherapy treatment.
(B) Best algorithm with multiple modifications of the initial algorithm.
Medical records review
Warren et al 53 19961989USA3454 casesAll women aged 65+ years with one or more hospitalisations with a diagnosis of breast cancer in Medicare.Medicare Hospital Inpatient (ICD-9-CM).174–174.9; 233.0(i) Any hospitalisation breast cancer (ICD-9-CM 174–174.9 and 233.0) as principal diagnosis.
(ii) Incident cases of breast cancer (no prior hospitalisation with breast cancer in any of the 5 positions from 1984 to 1988 or history of breast cancer (ICD-9-CM V.10.3) appearing as any of the five positions from 1984 to 1989).
(iii) Analysis limited to women who were residents in one of the five SEER states.
Cancer Registry (SEER)
Solin et al 51 19971993–1994USA177 casesAll women aged ≥65 years enrolled in the US Healthcare (Pennsylvania and New Jersey).Claims database included hospital inpatient, short procedure unit stays and professional services (ICD-9 diagnosis code, and the CPT-4 procedure code).174–174.9; 233.0This study was performed to evaluate prospectively a previously published algorithm50 used to identify women with the new diagnosis of carcinoma of the breast.Medical records review
McClish et al 46 19971986–1989USA3690 casesAll residents aged 65+ years diagnosed with breast cancer (Virginia).MEDPAR (Medicare) inpatient hospital claim database (ICD- 9 CM).174–174.9; 233.0Incident cases of breast cancer ICD-9-CM 174; V174.9; 233 and 233.0.Cancer Registry
Cooper et al 61 19991984–1993USA71 862 casesAll women aged 64+ years with breast cancer (Atlanta, Detroit, Seattle-Puget Sound, San Francisco Oakland, Connecticut, Hawaii, Iowa, New Mexico and Utah).(1) MEDPAR (Medicare: inpatient hospital claim database (ICD-9 CM and specific procedural codes ICD-9-CM and HCPCS/CPT-4.
(2) Part B: physician and outpatient claim data.
174–174.9 Basic: incidence breast cancer (174.0–174.9); (i) all other inpatient diagnostic codes; inpatient cancer-specific surgical code (local excision/lumpectomy: 85.20, 85.21, 85.22);
Part B: first position diagnosis code; any other part B diagnosis codes and part B cancer-specific surgical code; (ii) first position diagnostic coding+the inclusion of the following: all other part B diagnosis codes; part B cancer-specific procedural code; inpatient first position diagnosis; all other inpatient diagnoses and inpatient cancer-specific surgery.
Cancer Registry (SEER)
Warren et al 52 19991992USAWomen residing in the SEER states n=6 59 260; cases=6784.All Medicare eligible women residing in one of five SEER states who were age 65 years and older as of 1 January 1992.Medicare inpatient and physician claim database (ICD-9).174–174.9; 233.0 Model 1: inpatient primary diagnosis (174–174.9, 233.0), excluding prevalent cases), inpatient-secondary diagnosis, and physician bills—reference group).
Model 2: inpatient-secondary diagnosis and cases identified from the physician data, breast cancer-related procedures.
Cancer Registry (SEER)
Leung et al 45 19991994–1996USA1033 casesAll women aged 21 years or older who were enrolled in Health Net (California).Claims database includes claims received for inpatient hospital stays, short procedure unit stays and professional services (code ICD-9-CM).174–174.9; 233.0Basic breast cancer diagnosis and one of the following: (1) mastectomy; (2) partial mastectomy with lymphadenectomy; (3) excision, breast biopsy or partial mastectomy+lymphadenectomy; (4) excision, breast biopsy or partial mastectomy+diagnosis of carcinoma; (5) excision, breast biopsy or partial mastectomy followed by radiation therapy or (6) excision, breast biopsy or partial mastectomy followed by chemotherapy.Medical chart review
Freeman et al 42 20001990–1992USA7464 cases; 1415 controls:Females aged 65–74 years (in 1992) diagnosed with breast cancer (San Francisco/Oakland, Detroit, Atlanta and Seattle and the states of Connecticut, Iowa, New Mexico, Utah and Hawaii).ICD-9 inpatient record; outpatient record; physician claim (Medicare).174–174.9; 233.0; V103Model 1 (6 predictors): hospital inpatient: breast cancer principal or additional diagnosis) or 1992 hospital.
Model 2: (10 predictors) (model 1 or breast cancer-related procedure (mastectomy, partial mastectomy, excisional biopsy, incisional biopsy).
Model 3 (36 predictors): (hospital inpatient, hospital outpatient, physician claim): model 1 and breast cancer-related procedure (mastectomy biopsy, biopsy, chemotherapy); mammography, breast cancer-related radiology, radiation oncology, laboratory test on a hospital outpatient.
Model 4 (hospital inpatient, hospital outpatient, physician claim): 
model 1 and breast cancer-related procedure (mastectomy biopsy, biopsy, chemotherapy); mammography, breast cancer-related radiology, radiation oncology, laboratory test on a hospital outpatient; biopsy, radiation oncology, laboratory test on a physician claim; mammography, other radiological procedures in 1992 on a hospital outpatient claim.
Cancer Registry (SEER)
Wang et al 57 20011989–1991USA8872 casesAll women aged 20 years and older who were enrolled in either Medicaid or Medicare and PAAD (New Jersey State).Medicaid in patient files.ICD-9 code: not reportedNew cases of breast cancer:
primary algorithm definitions:: surgical claims for (a) a CPT or ICD-9 procedure code for a mastectomy; (b) a CPT or ICD-9 procedure code for an excision of a breast mass+CPT or ICD-9 procedure code for an axillary node biopsy; (c) a DRG hospitalisation code for breast cancer surgical hospitalisation.
Alternative algorithms: combinations of ICD-9 diagnostic codes, DRG hospitalisation codes, and codes for non-surgical treatments.
Cancer registry
Koroukian et al 44 20031997–1998USA2635 incident casesWomen aged 40 years or older (Ohio).Medicaid claims and enrolment files. ICD-9-CM.174–174.9; 233.0Incident of breast cancer (ICD-9 174.0–174.9 233.0) and combinations of diagnosis and procedures codes (chemotherapy or radiation therapy, mastectomy, lumpectomy).Cancer Registry (OCISS)
Ganry et al 54 20031998France198 incident casesAll women aged 15 years or older who were diagnosed or treated (in the Amiens University Hospital and five general hospitals) of the Somme area.French hospital database adapted from the Diagnosis Related Group (DRG).ICD-9 code: not reportedNew case of breast cancer—at least one of the following criteria: (a) breast cancer as primary diagnosis, alone or with (i) mastectomy; (ii) partial mastectomy with lymphadenectomy or (iii) excision, breast biopsy or partial mastectomy for procedures; (b) breast cancer as secondary diagnosis, with (i) chemotherapy as principal diagnosis or (ii) without specific procedures (excluding prevalent cases: women with history of breast cancer between 1991 and 1997).Cancer registry (French Somme Area)
Nattinger et al 47 2004Validation set: 1994; training set: 1995USA7607 cases and 120 317 controlsTraining set: claims from 7700 SEER-Medicare breast cancer subjects (age 65+ years) diagnosed in 1995, and 124 884 controls. Validation set: claims from 7607
SEER-Medicare breast cancer subjects diagnosed in 1994, and 120 317 controls.
Random sample; ICD-9 inpatient record; outpatient record; physician claim (Medicare).174–174.9; 233.0Four-step algorithm:
(1) breast cancer diagnosis+procedure code; (2) both conditions: (a) mastectomy or a lumpectomy or partial mastectomy followed by at least one outpatient or carrier claim for radiotherapy with a breast cancer diagnosis; (b) at least two outpatient or carrier claims on different dates containing breast cancer as the primary diagnosis; (3) this step applies to all potential cases that passed step 1, but were not directly included at step 2; (4) removal of prevalent cases.
Cancer Registry (SEER)
Penberthy et al 59 20051995USA249 casesWomen aged 65+ years with breast cancer diagnosis.(a) lnpatient Medicare; (b) inpatient or Part B claims.ICD-9 174Six case definitions: A1) diagnosis first position; A2) inpatient diagnosis in any position; A3) inpatient diagnosis in any position+inpatient surgical procedure; B1) inpatient diagnosis in any position+inpatient surgical procedure; B2) inpatient diagnosis in any position+inpatient surgical procedure OR a diagnostic procedure+diagnosis+a surgery or chemotherapy or radiation therapy procedure in an outpatient or physician office record within 4 months of a diagnostic procedure; B3) inpatient diagnosis in any position OR a diagnosis+a surgery or chemotherapy or radiation therapy procedure in an outpatient or physician office record.Cancer Registry (Virginia State); medical chart review
Setoguchi et al 56 20071997–2000USA2004 casesSubjects aged 65+ years Medicare recipients in Pennsylvania.Medicare inpatient hospital claim and drug benefit programme data.UnclearFour algorithms based on the combination of the following: (a) ICD-9 diagnosis codes (numbers not provided), (b) CPT codes for screening procedures, surgical procedures, radiation therapy, chemotherapy and nuclear medicine procedures and/or (c) National Drug Code prescription codes for medications used for cancer treatment available in Pharmaceutical Assistance Contract for the Elderly.Cancer Registry (Pennsylvania
State)
Baldi et al 38 20082000 training set, 2001 validation setItaly925 casesAll residents in Piedmont region.Regional inpatient administrative database.174–174.9; 233.0Algorithms based on combination between (i) ICD-9-CM diagnosis breast cancer (invasive 174.0–174.9, in situ 233.0); and ICD-9-CM procedures code incisional breast biopsy: 85.12 excision or destruction of breast tissue: 85.20–85.25 subcutaneous mastectomy: 85.33–85.36 mastectomy: 85.41–85.48Cancer Registry (Piedmont Region)
Couris et al 40 20092002France995 casesWomen aged 20 years or older living in one of the nine French districts covered by a cancer registry in 2002.Inpatient hospital administrative data (French National Institute of
Statistics and Economic Studies) based on ICD-10.
C50.0 to C50.9(a) Principal diagnosis for invasive breast cancer—ICD-10 codes C50.0 to C50.9; (b) principal diagnosis+specific surgery procedures.French cancer registries
Yuen et al 10 20112002–2005Italy11 615 casesWomen aged 20 years older with incident breast cancer (Emilia-Romagna region).Regional administrative database (Hospital discharge files).174–174.9; 233.0Women having a diagnosis code for cancer as well as a principal or secondary surgical code for lumpectomy or mastectomy: principal or secondary procedure indicating excision or destruction of breast tissue (ICD-9-CM code 85.20–85.25) or mastectomy (ICD-9-CM code 85.41–85.48); and principal or secondary diagnosis of carcinoma in situ of the breast (ICD-9-CM code 233.0) or malignant neoplasm of the breast (ICD-9-CM code 174.0–174.9).Cancer registry (AIRTUM)
Kemp et al 43 20132004–2008Australia2039 women with invasive breast tumourWomen aged 45+ years who had completed breast cancer-related items in the baseline survey of the 45 and up study (New South Wales).i) Administrative hospital separations records (ICD-10-AM); ii) outpatient medical service claims; iii) prescription medicines claims and iv) the 45 and up study baseline survey.C50.0 to C50.9Principal inpatient diagnosis of invasive breast cancer using ICD-10- AM codes C50.0-C50.9.Cancer Registry
Sato et al 49  20152011Japan50 056 women included in the study cohort (633 with breast cancer)Women with no prior cancer-related history, from the claims data at a single institution between 1 January and 31 December 2011.ICD for oncology, third edition (ICD-O-3): topography code of breast cancer (C500 to C506, C508, C509).C50.0 to C50.914 definitions starting from (1) breast cancer alone and subsequent addition of (2) diagnosis code related to breast cancer (3) diagnostic imaging code (4) biopsy code (5) marker test code (6) surgery code (7) chemotherapy code (8) medication code (9) radiation procedure code (10) the other code related to breast cancer (11) diagnosis code related to breast cancer or marker test code (12) surgery, chemotherapy, medication or radiation procedure code (13) diagnosis code related to the breast cancer, marker test code, surgery, chemotherapy, medication or radiation procedure code (14) ≥3 diagnoses of breast cancer.Cancer Registry
  • AIRTUM, Associazione Italiana dei Registri Tumori; CPT-4: current procedural terminology-4; HCPCS, Healthcare Common Procedure Coding System; ICD, International Classification of Diseases; MEDPAR, Medicare Annual Demographic Files, the Medicare Provider Analysis and Review; OCISS, Ohio Cancer Incidence Surveillance System; SEER, Surveillance, Epidemiology, and End Results Program.