National Audit of Primary Breast Cancer
Find out more about the audit of Primary Breast Cancer
More than 55,000 people are diagnosed with a new primary breast cancer every year in the UK. Enormous amounts of data on these patient are generated but these data are often collected in different silos.
What the national audit will do is to take advantage of these valuable data resources and bring the information all together for the first time, for a comprehensive analysis of all aspects of breast cancer care in England and Wales, whilst protecting patient anonymity.
That will allow us to analyse what is being done well, where it’s being done well, and what needs to be done much better.
Kieran Horgan, clinical co-lead for NAoPri, says the primary audit is a very exciting initiative and will work closely with the audit on metastatic (or secondary) breast cancer. It will build on the previous work done by the national audit of breast cancer in older patients (NABCOP).
Kieran Horgan, Clinical Lead (Surgery), National Audit of Primary Breast Cancer
Since the 1st October 2022, NAoPri have been working on setting up the governance and infrastructure, and have established the project team and Audit Advisory Committee. A scoping exercise has been carried out to inform priorities for the audit and the returns are being analysed.
Similar to the NABCOP breast cancer audit, the NAoPri will wish to limit any additional demands on Trusts and there will be no audit-specific datasets. Instead the audit will use existing sources of patient data routinely collected by national organisations in England and Wales. A minimum dataset will be published in 2023, which hospitals can check are being completed and submitted.
The audit will examine the generality of breast cancer care and also focus on a number of important challenges. These include the care of younger patients, the diagnosis and treatment of patients with more aggressive triple negative cancers, and the needs of smaller groups of patients, including men.
The clinical leads for NAoPri are:
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.
- Email: breastcanceraudits@rcseng.ac.uk
- Twitter: @NAoPri_news
- Visit the NAoPri Website
