Extending Quality Assurance to all Breast Cancers: the BCCOM Project

1. Extending Quality Assurance to all Breast Cancers: the BCCOM Project UKACR Annual Conference 29 September 2004 Gill Lawrence1, Catherine Lagord1, Olive Kearins1, Tom Bates2 1West Midlands Cancer Intelligence Unit 2Association of Breast Surgery at BASO Tel: 0121 415 8129 Fax: 0121 414 7712 e-mail: gill.lawrence@wmciu.nhs.uk

2. Acknowledgements • Breakthrough Breast Cancer • Association of Breast Surgeons at the British Society of Surgical Oncology • Breast Surgeons • Cancer registries • Mr Ian Monnypenny

3. Breast Cancer Complete Outcomes Measures Project • Determine whether routine data collected by regional cancer registries can be used as the starting point for the derivation of clinical outcome measures for symptomatic breast cancers equivalent to those derived for screen detected breast cancers in the annual ABS@BASO audit • Supplement data with additional locally collected treatment data (if necessary) • Ensure clinical ownership through ‘sign off’ of the data by treating consultants

4. The BCCOM project • 2 surgeons identified in each cancer registry catchment area who submitted good data to 2003 ABS@BASO Symptomatic Audit • Stage 1 - surgeons send their 2001/02 cases to their regional cancer registry to check case ascertainment • Stage 2 - data completeness and accuracy assessed by comparing values recorded for each data item on cancer registry and ABS@BASO databases

5. East Anglian Mersey & Cheshire North Western Northern & Yorkshire South & West Trent Wales West Midlands Stage 1 National pilot study results I • 19 breast surgeons agreed to participate • 10 submitted data within original deadlines and data have been processed by 8 cancer registries • 5 have now submitted data and data are being processed by cancer registries • 3 have encountered technical difficulties and have not yet sent data to cancer registries • 1 has withdrawn due to data collection issues

6. National pilot study results II 90.4%

7. National pilot study results III 78.5%

8. 616 non-screen detected new breast tumours (606 patients, 10 multiple primaries) 594 (96%) matched to a primary breast tumour 15 matched to a patient but not a primary breast tumour 7 tumours not registered Case notes requested Stage 1 West Midlands results I Were all breast cancer cases submitted to the ABS at BASO Symptomatic Audit registered at the WMCIU? 1 non-Hodgkins lymphoma 1 metastasis of fallopian tube 13 breast cancer recurrences

9. 811 cases (20%) in the screening audit 551 cases (14%) in the symptomatic audit Stage 1 West Midlands results II Could the WMCIU have improved data completeness in an audit of all breast cancers? 3993 primary breast cancers registered in 2001/02 2631 cases (66%) not submitted to either audit

10. Stage 2 West Midlands results

11. 3783 (95%) unique surgeon 3248 cases surgery 535 cases no surgery 82% had pre-operative diagnosis 49% had a mastectomy Cases diagnosed 2000-2002 Could WMCIU data be used to produce outcome data which clinicians can trust? 3993 cases 2001/02

12. Consultant caseload all West Midlands breast cancers 2001/02

13. Issues and queries • Male and female cancers? • Surgeons with patients registered at more than one cancer registry owing to patient referral patterns • Registration under several consultants e.g. one for each treatment episode - which one do you choose? • Need more complete definitions for each data item e.g. size - whole or invasive • Follow up of missing registrations • Resolution of differences between breast unit and cancer registry databases and amendment of incorrect database

14. Thank you