These are the guidelines issued by the British Association of Surgical Oncologists for providers of Breast Care in this country and are considered the ideal standards. We meet or exceed nearly all of them.
Breast Care Team * Communication * Referral * DiagnosisSurgery * Radiology * Radiotherapy * Patient Follow-Up
The Unit should be seeing at least 50 new breast cancer cases per year.
A formal multi-disciplinary meeting attended by members of the breast care team involved in primary treatments should be held weekly.
All patients diagnosed with breast cancer should have access to a breast care nurse preferably pre-operatively.
Women should be referred to a trained surgeon who works within a multi-disciplinary breast clinic.
80% of urgent referrals (as deemed by the surgeon) are to be seen within 5 working days of receipt of the referral.
70% of all other new referrals to be seen within 15 working days.
(This has been superceded by the government 2 week waiting time for all 100% of all patients suspected of having cancer)
Over 90% of Fine Needle Aspirates from lesions which subsequently prove to be a cancer should be adequate as deemed by the breast pathologist.
90% of palpable breast cancers should be diagnosed pre-operatively. Less than 10% of primary operable breast cancers should receive a frozen section.
Over 90% of patients proving to have breast cancer or an abnormality requiring an operation should be told within 5 working days of the date of the investigation.
Diagnosis should be based on triple assessment (Examination, Ultrasound / Mammography and cytology.
90% of patients should be admitted for an operation within 10 working days of the surgical decision to operate for diagnostic purposes. 90% of patients for therapeutic operations for cancer should be admitted within 15 working days of informing the patient of the need for surgical treatment.
This should be carried out by trained breast surgeons, trainees with sufficient training in breast disease or trainees under direct supervision at operation.
Units should provide data on the number of patients treated and by what methods.
Histological node status should be obtained on all invasive tumours either by sampling or clearance. It is recommended that "a sample" should contain at least 4 lymph nodes.
The Benign:Malignant operation ratio should be no more than 1:1 ( This is for diagnostic operations only, excluding women who wish the lump to be removed even though it is benign and operations for nipple discharge and abscess.)
Less than 10% of patients undergoing treatment for primary operable breast cancer should develop local recurrence at 5 and 10 years.
Reports of imaging examination should include details of site, size (in mm) and nature of any abnormality with an opinion as to the most likely diagnosis and make appropriate recommendations for further intervention where appropriate.
Mammographic localisation biopsy specimens must be x-rayed to ensure removal of the abnormality.
Adjuvant radiotherapy should start within 4 weeks of surgery.
G.P. should receive communication giving diagnosis, care plan, and toxicity profile of any proposed systemic treatment from the first post-operative review and at the change of any treatment. BASO suggest annual mammography of the treated breast.
Survival and loco-regional recurrences at 5 and 10 years should be monitored.
Centres offering breast cancer treatment should ensure that there are adequate terminal care facilities to support the primary care team.