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Breast Services at L & D

Breast Services at L & D. D Ravichandran PhD FRCS Consultant Surgeon. Breast waiting time National Targets. Two week cancer wait. Max 2 weeks to see specialist after urgently referred with suspected cancer by GP . The operational standard 93%.

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Breast Services at L & D

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  1. Breast Services at L & D D Ravichandran PhD FRCS Consultant Surgeon

  2. Breast waiting time National Targets

  3. Two week cancer wait • Max 2 weeks to see specialist after urgently referred with suspected cancer by GP. • The operational standard 93%. • Quarter ending Dec 2011, England: 96.2% • Quarter ending June 2012, L & D: 99.1% (224/226). 2 misses were patient choice.

  4. All Breast Referrals • Max 2 weeks when referred urgently with breast symptoms, where cancer was not initially suspected. • The operational standard 93% • Quarter ending Dec 2011, England – 96.3% • Quarter ending June 2012, L & D: 96.8% (299/309). 9 misses were patient choice, 1 pt rescheduled appointments 4 times.

  5. One month (31-day) wait • Max wait 31 days between diagnosis and the start of first definitive treatment. • Measured from the point at which the patient is informed of a diagnosis of cancer • The operational standard 96%. • Quarter ending Dec 2011, England:99.2% • Quarter ending June 2012, L & D: 98.1% (52/53). 1 miss due to patient having pneumonia just before diagnosis.

  6. Two month (62-day wait) • 85% of patients would wait a maximum of 62 days to begin first definitive treatment following urgent referral for suspected cancer from their GP. • Quarter ending Dec 2011, England: 98.0% (87% for all cancers) • Quarter ending June 2012, L & D: 100% 62 days from referral from NHS Cancer screening Programmes (breast, cervical and bowel) to treatment for cancer

  7. Breast Screening • Age: 50-70 now being extended to 47-73. • 3-yearly mammograms • Over the age limit – no automatic invitation but patient can request.

  8. Family History • New Family history clinic in L & D • Refer patients to this clinic. • Risk assessment, referral for genetic counselling & genetic testing • Clinical examination and mammogram

  9. Symptomatic One-Stop ClinicTriple Assessment • Patient fill a questionnaire • Clinical examination of Breasts, axilla, SCF / ICF • Imaging: Mammogram, US • Collection of tissue for pathological analysis: FNA or Core biopsy Why triple assessment?

  10. Inspection & Palpation

  11. Imaging US mammogram MRI used for certain indications

  12. Pathological Assessment FNAC Core Biopsy

  13. Benign Conditions: one visit only • Fibroadenoma – discharge • Fibroadenosis – discharge • Breast pain – reassurance, leaflet, mammogram if over 35, tamoxifen

  14. Early or Advanced Breast Cancer • Early: confined to breast and axilla • Late: gone beyond breast and axilla Treatment goals are different…….. Screening everybody for metastatic disease is a waste of time and resources

  15. Treatment Decisions are made by Multi Disciplinary Teams (MDT’s) • Surgeon • Oncologist • Radiologist • Pathologist • Breast care nurses

  16. 5 modalities to treat breast cancer….. • Surgery • Radiotherapy • Chemotherapy • Hormonal therapy • Immunotherapy: Herceptin Both in early and advanced local systemic

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