Date Published: 7 March 2008

Breast cancer services must meet challenge of increased incidence (National mastectomy audit)

Health News from the Royal College of Nursing (RCN).

Only one in ten of women with breast cancer are getting access to reconstruction surgery at the time of their mastectomy, despite recommendations from the National Institute for health and Clinical Excellence (NICE) in 2002 that it should be available to all. These are the early findings of the National Mastectomy and Breast Reconstruction Audit, published today by the Royal College of Surgeons of England and the NHS Information Centre on behalf of the Healthcare Commission.

The number of women diagnosed with breast cancer has risen steadily in recent years. As a result there was a 37% increase in the total number of operations performed for breast cancer in the NHS in England between 1997 (24,684) and 2006 (33,814). While this expansion in capacity shows a remarkable flexibility on the part of the NHS there are a number of problems with breast cancer surgery services that remain to be addressed.

Other findings include:

The number of English NHS Trusts carrying out breast conserving and mastectomy surgery has fallen by 27% since 1997 as a result of the centralisation of services designed to improve the quality of care. This should be regarded as a good thing, particularly for difficult and complex cancer surgery.
A fifth of English NHS Trusts that perform breast cancer surgery do not employ a consultant radiologist, pathologist or oncologist specialising in breast cancer diagnosis or treatment.

John Browne, Senior Lecturer in Health Services Research at the Royal College of Surgeons Clinical Effectiveness Unit said:

This audit of breast cancer surgery shows that a good service is available in England, despite the health services being under pressure. However, over the last ten years we have seen little improvement in access to immediate reconstruction after mastectomy. Current funding arrangements in the NHS, cancer waiting list targets and problems with the information and support provided to patients while making their decision about breast reconstruction may have contributed to this lack of progress.”

Tim Straughan, Chief Executive of the NHS Information Centre said:

" We hope frontline NHS organisations will find the initial results of this audit useful in the planning and delivery of breast reconstruction services and in assessing how well they are implementing NICE guidelines. We would also encourage surgeons and other health professionals working in this area to engage with the audit and submit their data to help improve further the care breast cancer patients receive. "

Jonathan Boyce, Head of Clinical Audits, Healthcare Commission, said:

It is important that women with breast cancer who have a mastectomy are offered the choice of breast reconstruction at the time of their operation. This can help reduce the number of operations needed as well as minimise the psychological impact of a mastectomy. These preliminary results show that not enough women have access to immediate reconstruction, and this needs to be addressed. We also know that not enough trusts have signed up to the next stage of the audit. The audit can help deliver better care for cancer patients and we encourage trusts to take part as a matter of urgency.”

Chris Caddy, consultant plastic surgeon and member of the British Association of Plastic Reconstructive and Aesthetic Surgeons, said:

This audit is the first step in giving us a comprehensive picture of the services available to women who are suffering from breast cancer. For many patients, reconstruction is felt to be the final step in their recovery. Currently, most women have reconstructive surgery some time after their mastectomy. Whilst immediate breast reconstruction has a longer anaesthetic and recovery time, it tends to achieve better cosmetic results, smaller breast scars and only one hospital stay. BAPRAS believes the NHS needs to do more to ensure that women have all the information they need to access immediate reconstruction and understand the benefits it has for their recovery.

Jerome Pereira, consultant breast surgeon and member of the Association of breast surgery, said:

" Whilst it is encouraging that approximately 75% of breast units are providing immediate breast reconstruction and employ teams of specialists for breast cancer care, the lack of national uniformity in patient management remains a serious concern. Aside from resource issues, a shortage of trained oncoplastic breast surgeons and a lack of public awareness about breast reconstruction may also contribute to the low number of operations undertaken nationally.

The ABS continually aims to improve standards in breast surgery through quality audits, and is therefore keen for all NHS and private units to participate in this study, in order to achieve even higher national standards of patient care. "

The National Audit, the first of its kind in the world, describes the initial findings of a four year comprehensive study of mastectomy and breast reconstruction practices and outcomes in England and is due for completion in December in 2010. Future annual reports will gather new data on patient experience and outcome to gain a full picture of how NHS services for breast cancer are working.

The project is funded by the Healthcare Commission and is a collaboration between the Association of Breast Surgeons at the British Association of Surgical Oncology, the British Association of Plastic Reconstructive and Aesthetic Surgeons and the Royal College of Nursing. The audit is managed by the NHS Information Centre, supported by the Clinical Effectiveness Unit at the Royal College of Surgeons of England.

The first annual report and more detail about the audit available at: www.ic.nhs.uk/mbr

 

Source: The Healthcare Commission (England, UK).

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