1 / 58

NHSBSP Surgical QA Data for the Year of Screening 1 April 2000 to 31 March 2001

NHSBSP Surgical QA Data for the Year of Screening 1 April 2000 to 31 March 2001. Dr Gill Lawrence and Professor David George on behalf of the BASO Breast Group. Acknowledgements. Mr Hugh Bishop Mr James Bristol Ms Olive Kearins Dr Gill Lawrence Mr Fergus Neilson

shawn
Download Presentation

NHSBSP Surgical QA Data for the Year of Screening 1 April 2000 to 31 March 2001

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. NHSBSP Surgical QA Data for the Year of Screening 1 April 2000 to 31 March 2001 Dr Gill Lawrence and Professor David George on behalf of the BASO Breast Group

  2. Acknowledgements • Mr Hugh Bishop • Mr James Bristol • Ms Olive Kearins • Dr Gill Lawrence • Mr Fergus Neilson • Mrs Julietta Patnick • Mr Paul Sauvern • Dr Matthew Wallis • Dr Jackie Walton • Mrs Margot Wheaton • Miss Emma Wheeler • The BASO Breast Audit Group would like to extend their thanks to the following individuals and groups for their contributions to the 2000/01 BASO Breast Audit

  3. Acknowledgements • Surgical QA Co-ordinators • Breast Screening QA Co-ordinators • Regional QA Directors • BASO • Mrs Veronica Hall • Newcastle QA Reference Centre • West Midlands Cancer Intelligence Unit • Mrs Diane Edwards • Dr Cheryl Livings • Government Actuary Department • Mr Graham Lamberti

  4. Details of the regions and countries in the UK that submitted data to the 2000/01 BASO breast audit

  5. Women included in the BASO audit • In 2000/2001 • 79% invasive • 1% micro-invasive • 19% non-invasive • 54 cancers (1%) had unknown status * data from Scotland not available

  6. Pre-operative diagnosis X

  7. Pre-operative diagnosis rates Minimum Standard > 70% Target > 90% * data from Scotland not available

  8. Pre-operative diagnosis rates for invasive and non-invasive cancers For invasive cancers 10/13 regions meet the 90% target

  9. Pre-operative diagnosis rates for individual screening units Only 2 units fail to meet the minimum standard

  10. What would happen if all the C4/B4 diagnoses were C5/B5?

  11. Pre-operative diagnosis technique 52% MOB C4/B4 16% MOB no pre-operative procedure

  12. Invasive status at pre-operative core biopsy Selective use of core biopsy with micro-calcification?

  13. Open biopsies

  14. Benign and malignant open biopsy rates * data from Scotland not available

  15. Highest pre-operative result for malignant open biopsies High C4/B4 High C1/B1

  16. Lymph nodes

  17. Lymph node status Nodal status should be obtained for all invasive cancers It is desirable to examine a minimum of 4 lymph nodes * data from Scotland and N Ireland not available

  18. Nodal status unknown for invasive cancers in individual screening units 26 -180 invasive cancers

  19. 11-17% nodal status unknown Regional variation in nodal status determination in 2000/01 8.4% with <4 nodes examined

  20. Nodal status of invasive cancers diagnosed on the basis of <4 nodes Up to 7.5% of cancers may have had inadequate nodal assessment

  21. Nodal status where <4 nodes examined for individual units 22 - 87 invasive cancers

  22. Surgical caseload Women should be treated by a specialist breast surgeon

  23. 9 low caseload surgeons 6 low caseload surgeons Number of surgeons treating less than 10 screening cases a year

  24. Type of surgical treatment provided to non-invasive and invasive breast cancers

  25. highest % conservation surgery Treatment for non-invasive and micro-invasive cancers

  26. Non-invasive cancer nuclear grade unknown for individual units 13 and 22 cancers 12 cancers

  27. Non-invasive cancer size unknown for individual units 19 cancers 12 cancers

  28. Non-invasive cancers treated with conservation surgery

  29. high % mastectomy for small tumours high % mastectomy for small tumours Variation in mastectomy rates with invasive tumour size low % mastectomy for larger tumours

  30. 19 16 10 21 1 1 Treatment of small cancers with invasive diameter <15mm

  31. low mastectomy rate for invasive tumours Final treatment for cancers with 2 or more operations low mastectomy rate for non-invasive tumours

  32. Which journeys were undertaken? How long did it take to get there? The patient journey ? What combinations of treatments were given?

  33. Cases included in the analysis highest proportion of cases included Coding error correct value 93% - Wales excluded from analyses

  34. Cancers included in patient journey analysis 3147 Surgery Surgery Surgery Surgery Surgery Other 1033 (33%) RT CT RT CT 61 (2%) 77 (2%) 1521 (49%) RT CT* 382 (12%) 35 (1%) * includes CT and RT started on same day The most common patient journeys Total cancers detected between 1st April and 30th September 2000 5011 Journeys exclude variations in hormone therapy

  35. Regional variations in the patient journey High surgery only, low CT High CT

  36. Non-invasive cases Invasive cases Treatment patterns for non-invasive and invasive cases Higher proportion of invasive tumours receive HT

  37. Times to first treatment and from first treatment to adjuvant therapy

  38. N Ireland 95% S East E 39% Time to first surgery 4941 cases

  39. Wales and Trent 85% Yorkshire 44% Time from surgery to radiotherapy Cases with no S or CT before RT excluded 1931 cases

  40. London 52% South West 4% London, S East E >10% started CT on same day as or before surgery Time from surgery to chemotherapy Cases with no S or RT before CT excluded 603 cases

  41. ? Does ER status influence the use of hormone treatment? ? Does nodal status influence the use of adjuvant radiotherapy in women having conservative surgery? ? Does nodal status influence the use of adjuvant radiotherapy in women having mastectomy? ? Does nodal status influence the use of adjuvant chemotherapy? ? Do women with node negative, ER negative tumours receive adjuvant chemotherapy? Questions about treatment

  42. 45% unknown Only 11% unknown Proportion of cases with unknown ER status

  43. Non-invasive 60% Invasive 12% Invasive and non-invasive cases with unknown ER status 39% invasive cases ER status unknown

  44. ER+ve 92% 12% or more not given HT ER-ve 31% 45% unknown ER status Hormone therapy - invasive tumours 63% ER-ve given HT

  45. Conservatively treated invasive cancers with +ve nodes receiving RT 58% all cancers treated with surgery alone

  46. node +ve 93% node -ve 85% Effect of nodal status on conservatively treated invasive cancers receiving RT Nodal status has little influence on treatment choice

  47. Cancers with +ve nodes treated with mastectomy and radiotherapy 100% given RT Only 50% given RT

  48. node +ve 68% node -ve 16% Effect of nodal status on invasive cancers treated with mastectomy receiving RT 45% given RT Nodal status does influence treatment choice 0

  49. less than 50% given CT node +ve 61% node -ve 9% Effect of nodal status on treatment with chemotherapy 32% all cancers treated with chemotherapy

  50. ER -ve, node -ve tumours treated with chemotherapy In 1992-96 15% tumours were grade III 75% given CT 17% given CT

More Related