Previous Breast Audits

Information about other audits that may be of interest to ABS members.

A national audit of provision and outcomes of mastectomy and breast reconstruction surgery for women in England and Wales.

The National Mastectomy and Breast Reconstruction Audit was commissioned and funded by the Healthcare Commission to assess and improve the quality of care provided to women with breast cancer undergoing mastectomy and breast reconstruction surgery. The audit evaluated the care process and measured treatment outcomes for these women.

What were the aims of the audit?

The audit:

  • described provision of and access to breast reconstruction in England and Wales
  • evaluated current clinical practice in mastectomy and breast reconstruction
  • measured outcomes following mastectomy with or without reconstruction
  • assessed the quality of information provided to women undergoing mastectomy and their satisfaction with the reconstructive choices made.

Who carried out the audit?

The audit was conducted by a team of specialist clinicians and auditors from:

  • the Association of Breast Surgery (Lead Breast Surgeon - Jerome Pereira)
  • the British Association of Plastic, Reconstructive and Aesthetic Surgeons (Lead Plastic Surgeon - Chris Caddy)
  • the Royal College of Nursing (Lead Specialist Nurse - Carmel Sheppard)
  • the National Clinical Audit Support Programme (NCASP) of The Information Centre for health and social care
  • the Clinical Effectiveness Unit of The Royal College of Surgeons of England and London School of Hygiene and Tropical Medicine.

Reports

The National Mastectomy and Breast Reconstruction Audit produced 4 Annual Reports which you can view here.

The Breast Cancer Clinical Outcome Measures (BCCOM) Project aimed to audit the clinical management of symptomatic breast cancers in the United Kingdom. The information needed for the audit was obtained from existing sources such as the data currently collected by cancer registries and individual clinicians. The audit was conducted in collaboration with the UK cancer registries and 191 breast surgeons registered with the UK Association of Breast Surgery at BASO (now the Association of Breast Surgery).

Please be aware that:

  • BCCOM only covered the first invasive breast tumour diagnosed in a patient in that year, so not all tumours were potentially audited
  • BCCOM relied upon the goodwill/time of clinicians to complete this in their own time; response rates varied by hospital and over time
  • BCCOM was not a compulsory audit and only cover ~40% of tumours diagnosed in each audited period, so the results may not be representative of the whole patient (or clinical) communities
  • For these reasons alone, the results from BCCOM should not be directly compared to those of a compulsory data-driven audit like NABCOP

Below you can download copies of the All Breast Cancer Report and BCCOM booklets. 

NABCOP

NABCOP was commissioned by the Healthcare Quality Improvement Partnership (HQIP).

The aim of NABCOP is to support NHS providers to improve the quality of hospital care for older patients with breast cancer. They will achieve this by publishing information about the care provided by all NHS hospitals that deliver breast cancer care in England and Wales. They will look at the care received by patients with breast cancer and their outcomes

There are numerous reports of suboptimal care in the UK for older patients with breast cancer.  This is thought to account for a substantial portion of the gap in survival for patients with breast cancer in the UK compared to other developed countries.

NABCOP data suggests that around 90% of patients aged 70+ with ER+ EIBC are likely to be fit enough to undergo initial surgery (approximately 90% of ER-older patients have surgery).  Significant (>2 SD) differences from a 80% use of initial surgery in a Breast Unit in this population of patients aged 70+ with ER+ EIBC would be of concern.

There will be instances when diminished patient cognition, medical fitness or the presence of frailty or limited life expectancy, suggest surgery is not the preferred pathway.  PET may be appropriate in these circumstances in full transparent discussion with the patient and their family and carers. Deferred surgery following a defined period of PET for a specific reason such as tumour downstaging, medical optimisation which is protocol based or involvement in approved clinical trials is reasonable but the use of PET for fit patients or those with relatively minor co-morbidity outside these circumstances is discouraged.

The NABCOP project team has devised a simple, pragmatic single A4 sheet assessment aid for completion at their initial diagnostic clinic visit in all patients over 70 years, which would further inform the patient discussion at the Diagnostic MDT.

The individual component parts of the form are mandatory, returnable data items on every Trust's COSD returns from 1st April 2020.

Download Fitness Assessment Tool