Appendix 1 Cancer Diagnosis and Procedure Codes

Appendix 1 – Cancer Diagnosis and Procedure Codes

Type of Malignant Tumor / ICD-9-CM Diagnosis Codes / ICD-9-CM Procedure Codes / CPT-4 Procedure Codes
Bone / 170.0-170.9 / 84.0-84.19 / 23900-23921, 24900-24940, 25900-25931, 26910-26952, 27290, 27295, 27590-27598, 27880-27889, 28800-28825
Brain and Other Central Nervous System / 191.0-192.3 / 01.1-01.59 / 61510, 61516, 61518, 61520, 61521, 61524, 61526, 61530, 61534, 61536, 61544, 61545
Breast / 174.0-175.9 / 84.4-85.48, 85.20-85.23 / 19120, 19125, 19126, 19160, 19162, 19180-19240
Cervix Uteri / 180.0-180.9 / 68.3-68.9 / 57530, 57531, 58150, 58180, 58200, 58210, 58240, 58260, 58262, 58275, 58285, 58940
Colon and Rectum / 153.0-154.8 / 45.71-45.79, 45.8, 48.5, 48.62, 48.63 / 44140, 44141, 44143, 44144, 44145-44147, 44150-44153, 44155, 44156, 44160, 45110-45114, 45116, 45119
Corpus Uteri / 179, 182.0-182.8 / 68.3-68.9 / 58150, 58180, 58200, 58210, 58240, 58260, 58262, 58275, 58285, 58940
Esophagus / 150.0-150.9 / 42.4-42.69 / 43107-43124
Hodgkins Lymphoma / 201.0-201.9 / Chemotherapy and/or radiation therapy * / Chemotherapy and/or radiation therapy *
Non-Hodgkins Lymphoma / 200.0-200.8, 202.0-202.9 / Chemotherapy and/or radiation therapy * / Chemotherapy and/or radiation therapy *
Kaposi Sarcoma / 176.0-176.9 / Chemotherapy and/or radiation therapy * / Chemotherapy and/or radiation therapy *
Kidney and Renal Pelvis / 189.0-189.9 / 55.4-55.54, 56.4-56.51 / 50220-50240, 50650, 50660
Larynx / 161.0-161.9 / 25.2-25.4, 29.33, 30.1-30.4 / 31360-31420, 41120-41155, 42120, 42410-42426
Leukemia / 205.0-208.9 / Chemotherapy and/or radiation therapy * / Chemotherapy and/or radiation therapy *
Liver and Intrahepatic Bile Duct / 155.0-155.2, 156.0-156.9 / 50.22, 50.3, 50.4, 51.36 / 47120-47130, 47711, 47712, 47760, 47765, 47780, 47785, 47800
Lung and Bronchus / 162.0-163.9 / 32.29, 32.3, 32.4, 32.5, 32.6, 32.9 / 47120-47130, 47711, 47712, 47760, 47765, 47780, 47785, 47800
Melanoma / 172.0-172.9 / 86.24, 86.4 / 11600-11646, 17260-17286, 17304-17310
Mesothelioma / 163.0-163.9 / 32.29, 32.3, 32.4, 32.5, 32.6, 32.9 / 32440, 32442, 32445, 32480, 32482, 32484, 32486, 32488, 32500, 32520, 32522, 32525, 32657, 32663
Myeloma / 203.0, 238.6 / Chemotherapy and/or radiation therapy * / Chemotherapy and/or radiation therapy *
Oral Cavity and Pharynx / 140.0-149.9 / 25.2-25.4, 29.33, 30.1-30.4 / 31360-31420, 41120-41155, 42120, 42410-42426
Ovary / 183.0-183.9 / 65.0, 65.4, 65.5, 65.6, 68.3-68.9 / 58150, 58180, 58200, 58210, 58240, 58260, 58262, 58275, 58285, 58940, 58943, 58950-58952, 58960
Pancreas / 157.0-157.3, 157.8, 157.9 / 44.39, 51.36, 51.39, 51.42, 52.50-52.79;6 / 43820, 43825, 47720 - 47790, 48140-48144, 48146, 48147, 48149 - 48155
Prostate / 185 / 60.5, 62.4-62.42 / 54520, 54530, 55810-55815, 55840-55845
Stomach / 151.0-151.9 / 42.5-43.99 / 43620-43634, 43638
Testis / 186.0-186.9 / 62.3, 62.4 / 54520, 54535, 54690
Thyroid / 193 / 06.11-06.12, 06.2-06.52 / 60210-60271
Urinary Bladder / 188.0-188.9 / 57.33, 57.4, 57.49, 57.71, 57.79 / 51570, 51575, 51580-51597, 51720, J8520, J8521

* Chemotherapy was defined by ICD-9-CM codes 99.25, V58.1, V66.2, or V67.2, CPT-4 codes 96400-96549, J9000-J9999, and Q0083-Q0085 and revenue center codes of 0331, 0332, and 0335. Radiation therapy was defined by ICD-9-CM diagnosis codes V58.0, V 66.1 and V 67.1, ICD-9-CM procedure codes 92.2-92.39, CPT-4 codes of 77261-77431, 77499, 77750-77799 and revenue center codes of 0330 and 0333.

Appendix 2 – Results of Analyses Using Definition of Two or More Diagnosis Codes for Incident Cancer

BMP Treatment / p value
Full Cohort / NO / YES
n / % / n / % / n / %
Gender
MALE / 49003 / 33.5 / 41840 / 33.7 / 7163 / 32.5 / 0.0006
FEMALE / 97275 / 66.5 / 82398 / 66.3 / 14877 / 67.5
Age at procedure
67-69 / 28187 / 19.3 / 23604 / 19.0 / 4583 / 20.8 / <.0001
70-74 / 52274 / 35.7 / 44219 / 35.6 / 8055 / 36.6
75-79 / 40335 / 27.6 / 34497 / 27.8 / 5838 / 26.5
80+ / 25482 / 17.4 / 21918 / 17.6 / 3564 / 16.2
Race
White / 137023 / 93.7 / 116275 / 93.6 / 20748 / 94.1 / 0.0001
Black / 5733 / 3.9 / 4884 / 3.9 / 849 / 3.9
Other / 3522 / 2.4 / 3079 / 2.5 / 443 / 2.0
Charlson Comorbidity Index
0 / 59213 / 40.5 / 51063 / 41.1 / 8150 / 37.0 / <.0001
1 / 79182 / 54.1 / 66595 / 53.6 / 12587 / 57.1
2+ / 7883 / 5.4 / 6580 / 5.3 / 1303 / 5.9
Year of Surgery
2003 / 1898 / 1.3 / 1740 / 1.4 / 158 / 0.7
2004 / 29202 / 20.0 / 26628 / 21.4 / 2574 / 11.7
2005 / 29308 / 20.0 / 25263 / 20.3 / 4045 / 18.4
2006 / 29067 / 19.9 / 24022 / 19.3 / 5045 / 22.9
2007 / 28350 / 19.4 / 23023 / 18.5 / 5327 / 24.2
2008 / 28453 / 19.5 / 23562 / 19.0 / 4891 / 22.2
Diagnosis in Follow Up
Any Cancer / 18942 / 13.0 / 16309 / 13.1 / 2633 / 12.0
Bone / 331 / 0.2 / 296 / 0.2 / 35 / 0.2
Brain / 485 / 0.3 / 426 / 0.3 / 59 / 0.3
Breast / 2896 / 3.0 / 2475 / 3.0 / 421 / 2.8
Cervix Uteri / 121 / 0.1 / 104 / 0.1 / 17 / 0.1
Colon and Rectum / 1790 / 1.2 / 1535 / 1.2 / 255 / 1.2
Corpus Uteri / 339 / 0.3 / 299 / 0.4 / 40 / 0.3
Esophagus / 220 / 0.2 / 186 / 0.2 / 34 / 0.2
Hodgkins Lymphoma / 108 / 0.1 / 93 / 0.1 / 15 / 0.1
Non Hodgkins Lymphoma / 1274 / 0.9 / 1078 / 0.9 / 196 / 0.9
Kaposi Sarcoma / 22 / 0.0 / * / * / * / *
Kidney and Renal Pelvis / 840 / 0.6 / 731 / 0.6 / 109 / 0.5
Larynx / 149 / 0.1 / 130 / 0.1 / 19 / 0.1
Leukemia / 571 / 0.4 / 487 / 0.4 / 84 / 0.4
Liver and Intrahepatic Bile Ducts / 512 / 0.4 / 435 / 0.4 / 77 / 0.4
Lung and Bronchus / 2679 / 1.8 / 2314 / 1.9 / 365 / 1.7
Melanoma / 1566 / 1.1 / 1337 / 1.1 / 229 / 1.0
Mesothelioma / 96 / 0.1 / 83 / 0.1 / 13 / 0.1
Myeloma / 773 / 0.5 / 676 / 0.5 / 97 / 0.4
Oral Cavity and Pharynx / 79 / 0.1 / 68 / 0.1 / 11 / 0.1
Ovary / 440 / 0.5 / 373 / 0.5 / 67 / 0.5
Pancreas / 634 / 0.4 / 537 / 0.4 / 97 / 0.4
Prostate / 3180 / 6.5 / 2770 / 6.6 / 410 / 5.7
Stomach / 287 / 0.2 / 244 / 0.2 / 43 / 0.2
Testis / 31 / 0.1 / * / * / * / *
Thyroid / 264 / 0.2 / 225 / 0.2 / 39 / 0.2
Urinary Bladder / 1205 / 0.8 / 1043 / 0.8 / 162 / 0.7
* Frequency suppressed because of sample size < 11

Risk of Cancer Associated with BMP Administration in Unadjusted and Adjusted Models Using Definition of Two or More Diagnosis Codes for Incident Cancer

Crude Hazard Ratio / Adjusted Hazard Ratio
HR / 95%CI / HR / 95%CI
Diagnosis in Follow Up
Any Cancer / 0.97 / 0.93 / 1.01 / 0.98 / 0.94 / 1.02
Bone / 0.70 / 0.50 / 1.00 / 0.71 / 0.50 / 1.01
Brain / 0.84 / 0.64 / 1.10 / 0.83 / 0.63 / 1.09
Breast / 1.02 / 0.92 / 1.13 / 1.02 / 0.91 / 1.13
Cervix Uteri / 0.94 / 0.55 / 1.59 / 0.94 / 0.56 / 1.60
Colon and Rectum / 1.01 / 0.89 / 1.15 / 1.02 / 0.90 / 1.17
Corpus Uteri / 0.77 / 0.55 / 1.08 / 0.78 / 0.56 / 1.08
Esophagus / 1.11 / 0.77 / 1.60 / 1.13 / 0.79 / 1.63
Hodgkins Lymphoma / 0.99 / 0.57 / 1.70 / 1.00 / 0.58 / 1.73
Non Hodgkins Lymphoma / 1.10 / 0.95 / 1.29 / 1.12 / 0.96 / 1.30
Kaposi Sarcoma / 0.58 / 0.14 / 2.49 / 0.59 / 0.14 / 2.52
Kidney and Renal Pelvis / 0.91 / 0.74 / 1.11 / 0.92 / 0.75 / 1.12
Larynx / 0.89 / 0.55 / 1.44 / 0.91 / 0.56 / 1.47
Leukemia / 1.05 / 0.84 / 1.33 / 1.08 / 0.85 / 1.36
Liver and Intrahepatic Bile Ducts / 1.11 / 0.87 / 1.41 / 1.12 / 0.88 / 1.43
Lung and Bronchus / 0.97 / 0.86 / 1.08 / 0.97 / 0.87 / 1.08
Melanoma / 1.04 / 0.91 / 1.20 / 1.06 / 0.93 / 1.22
Mesothelioma / 0.97 / 0.54 / 1.75 / 0.99 / 0.55 / 1.77
Myeloma / 0.86 / 0.69 / 1.06 / 0.87 / 0.70 / 1.07
Oral Cavity and Pharynx / 0.99 / 0.52 / 1.88 / 1.02 / 0.54 / 1.93
Ovary / 1.08 / 0.83 / 1.40 / 1.08 / 0.83 / 1.40
Pancreas / 1.13 / 0.91 / 1.40 / 1.14 / 0.92 / 1.42
Prostate / 0.92 / 0.83 / 1.02 / 0.92 / 0.83 / 1.02
Stomach / 1.08 / 0.78 / 1.50 / 1.10 / 0.79 / 1.52
Testis / 0.75 / 0.23 / 2.47 / 0.73 / 0.22 / 2.42
Thyroid / 1.05 / 0.75 / 1.47 / 1.02 / 0.73 / 1.44
Urinary Bladder / 0.95 / 0.81 / 1.12 / 0.98 / 0.83 / 1.16

Appendix 3 – Results of Analyses Using Definition of Two or More Diagnosis Codes and One or More Treatment Codes for Incident Cancer

Full Cohort / BMP Treatment / p value
NO / YES
n / % / n / % / n / %
Gender
Male / 49003 / 33.5 / 41840 / 33.7 / 7163 / 32.5 / 0.0006
Female / 97275 / 66.5 / 82398 / 66.3 / 14877 / 67.5
Age at procedure
67-69 / 28187 / 19.3 / 23604 / 19.0 / 4583 / 20.8 / <.0001
70-74 / 52274 / 35.7 / 44219 / 35.6 / 8055 / 36.6
75-79 / 40335 / 27.6 / 34497 / 27.8 / 5838 / 26.5
80+ / 25482 / 17.4 / 21918 / 17.6 / 3564 / 16.2
Race
White / 137023 / 93.7 / 116275 / 93.6 / 20748 / 94.1 / 0.0001
Black / 5733 / 3.9 / 4884 / 3.9 / 849 / 3.9
Other / 3522 / 2.4 / 3079 / 2.5 / 443 / 2.0
Charlson Comorbidity Index
0 / 59213 / 40.5 / 51063 / 41.1 / 8150 / 37.0 / <.0001
1 / 79182 / 54.1 / 66595 / 53.6 / 12587 / 57.1
2+ / 7883 / 5.4 / 6580 / 5.3 / 1303 / 5.9
Year of Surgery
2003 / 1898 / 1.3 / 1740 / 1.4 / 158 / 0.7
2004 / 29202 / 20.0 / 26628 / 21.4 / 2574 / 11.7
2005 / 29308 / 20.0 / 25263 / 20.3 / 4045 / 18.4
2006 / 29067 / 19.9 / 24022 / 19.3 / 5045 / 22.9
2007 / 28350 / 19.4 / 23023 / 18.5 / 5327 / 24.2
2008 / 28453 / 19.5 / 23562 / 19.0 / 4891 / 22.2
Diagnosis in Follow Up
Any Cancer / 14362 / 9.8 / 12440 / 10.0 / 1922 / 8.7
Bone / 370 / 0.3 / 322 / 0.3 / 48 / 0.2
Brain / 401 / 0.3 / 363 / 0.3 / 38 / 0.2
Breast / 3166 / 2.2 / 2731 / 2.2 / 435 / 2.0
Cervix Uteri / 122 / 0.1 / 108 / 0.1 / 14 / 0.1
Colon and Rectum / 1385 / 1.0 / 1198 / 1.0 / 187 / 0.9
Corpus Uteri / 311 / 0.2 / 273 / 0.2 / 38 / 0.2
Esophagus / 192 / 0.1 / 166 / 0.1 / 26 / 0.1
Hodgkins Lymphoma / 111 / 0.1 / 93 / 0.1 / 18 / 0.1
Non Hodgkins Lymphoma / 932 / 0.6 / 795 / 0.6 / 137 / 0.6
Kaposi Sarcoma / 17 / 0.0 / * / * / * / *
Kidney and Renal Pelvis / 596 / 0.4 / 526 / 0.4 / 70 / 0.3
Larynx / 130 / 0.1 / 117 / 0.1 / 13 / 0.1
Leukemia / 319 / 0.2 / 281 / 0.2 / 38 / 0.2
Liver and Intrahepatic Bile Ducts / 295 / 0.2 / 245 / 0.2 / 50 / 0.2
Lung and Bronchus / 1962 / 1.3 / 1686 / 1.4 / 276 / 1.3
Melanoma / 1461 / 1.0 / 1260 / 1.0 / 201 / 0.9
Mesothelioma / 58 / 0.0 / * / * / * / *
Myeloma / 487 / 0.3 / 429 / 0.4 / 58 / 0.3
Oral Cavity and Pharynx / 53 / 0.0 / * / * / * / *
Ovary / 356 / 0.2 / 305 / 0.3 / 51 / 0.2
Pancreas / 412 / 0.3 / 344 / 0.3 / 68 / 0.3
Prostate / 2327 / 1.6 / 2024 / 1.6 / 303 / 1.4
Stomach / 290 / 0.2 / 248 / 0.2 / 42 / 0.2
Testis / 30 / 0.0 / * / * / * / *
Thyroid / 177 / 0.1 / 152 / 0.1 / 25 / 0.1
Urinary Bladder / 794 / 0.5 / 692 / 0.6 / 102 / 0.5
*Frequency suppressed because of cell size < 11

Risk of Cancer Associated with BMP Administration in Unadjusted and Adjusted Models Using Definition of Two or More Diagnosis Codes and One or More Treatment Codes for Incident Cancer

Diagnosis code + treatment / Diagnosis code + treatment
Crude Hazard Ratio / Adjusted Hazard Ratio
HR / 95%CI / HR / 95%CI
Diagnosis in Follow Up
Any Cancer / 0.94 / 0.89 / 0.98 / 0.95 / 0.90 / 0.99
Bone / 0.93 / 0.68 / 1.26 / 0.94 / 0.69 / 1.27
Brain / 0.65 / 0.46 / 0.90 / 0.64 / 0.46 / 0.90
Breast / 0.98 / 0.88 / 1.08 / 0.97 / 0.88 / 1.08
Cervix Uteri / 0.80 / 0.46 / 1.39 / 0.79 / 0.45 / 1.38
Colon and Rectum / 0.96 / 0.82 / 1.12 / 0.97 / 0.83 / 1.13
Corpus Uteri / 0.83 / 0.59 / 1.16 / 0.83 / 0.59 / 1.17
Esophagus / 0.97 / 0.64 / 1.47 / 0.99 / 0.65 / 1.50
Hodgkins Lymphoma / 1.23 / 0.74 / 2.04 / 1.24 / 0.75 / 2.06
Non Hodgkins Lymphoma / 1.05 / 0.88 / 1.26 / 1.06 / 0.89 / 1.27
Kaposi Sarcoma / 0.38 / 0.05 / 2.88 / 0.38 / 0.05 / 2.84
Kidney and Renal Pelvis / 0.82 / 0.64 / 1.05 / 0.83 / 0.64 / 1.06
Larynx / 0.68 / 0.38 / 1.20 / 0.69 / 0.39 / 1.22
Leukemia / 0.84 / 0.60 / 1.18 / 0.85 / 0.61 / 1.19
Liver and Intrahepatic Bile Ducts / 1.26 / 0.93 / 1.71 / 1.27 / 0.93 / 1.72
Lung and Bronchus / 1.00 / 0.88 / 1.13 / 1.00 / 0.88 / 1.13
Melanoma / 0.98 / 0.85 / 1.14 / 1.01 / 0.87 / 1.17
Mesothelioma / 1.00 / 0.47 / 2.11 / 1.01 / 0.48 / 2.13
Myeloma / 0.82 / 0.62 / 1.08 / 0.83 / 0.63 / 1.09
Oral Cavity and Pharnyx / 0.81 / 0.35 / 1.89 / 0.83 / 0.36 / 1.95
Ovary / 1.03 / 0.76 / 1.38 / 1.02 / 0.76 / 1.38
Pancreas / 1.23 / 0.95 / 1.59 / 1.23 / 0.95 / 1.60
Prostate / 0.94 / 0.83 / 1.06 / 0.94 / 0.83 / 1.06
Stomach / 1.05 / 0.76 / 1.46 / 1.06 / 0.77 / 1.48
Testis / 1.40 / 0.53 / 3.69 / 1.40 / 0.53 / 3.70
Thyroid / 1.01 / 0.66 / 1.54 / 0.99 / 0.65 / 1.52
Urinary Bladder / 0.90 / 0.73 / 1.11 / 0.93 / 0.76 / 1.15