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Breast Audit

Funded by GAIN, this audit looked at breast cancers diagnosed in 2012

The report “Monitoring care for female breast cancer patients in Northern Ireland diagnosed 2012 (with comparisons to 1996, 2001 and 2006)” is a comprehensive audit of breast cancer patients that reports on all aspects of cancer patients’ care pathway including, referral and presentation, investigation, diagnosis, treatment & after-care. The audit is funded by Guidelines and Audit Implementation Network (GAIN). Data on all breast cancers diagnosed in 2012 were available from the NICR database, we sought additional clinical information on patients diagnosed between September to December 2012 (Audit subset (n=411) from the Cancer Patient Pathway System (CaPPS) and the Clinical Oncology Information system (COIS).
The findings showed:

  • The number of women diagnosed with invasive breast cancer in N. Ireland has increased from 849 cases in 1996 to 1287 in 2012, with almost a third referred from the breast screening services in 2012, an increase from previous years reflecting the extension of the screening age limit.
  • One in 5 women had a positive family history of breast cancer in a first degree relative.
  • 52% of women presented with a breast lump.
  • CT scan use increased from 22% in 2006 to 37% in 2012.
  • 70% of women had a sentinel node biopsy (increased from 21% in 2006). As a result axillary node clearance fell from 82% in 1996 to 45% in 2012.
  • 100% of patients were discussed at a MDT.
  • 76% of women were diagnosed at early Stage I or Stage II disease (39% Stage 1, 37% Stage II, 13% Stage III and 5% Stage IV).
  • Use of endocrine treatments increased to 84% in 2012. 90% of women had surgery, 49% of these having mastectomy, 51% breast conserving surgery.
  • 62% screen age women had breast conserving surgery (younger or older women 40% approx).
  • Primary reconstruction following mastectomy was recorded for 14% of women overall, 20% in patients resident in Belfast Trust and South Eastern Trust areas and much lower for those resident in other Trust.
  • In 2012, 95% of patients were diagnosed on day of presentation. 93% had surgery within 62 days, 70% within 31 days and 25% within 14 days.
  • Survival overall for breast cancer has improved significantly since 1996. Specifically compared 1993-97 diagnosed patients with those diagnosed 1998-2002, 10-year survival increased from 66% to 72%.
  • 2-year observed survival increased from 84% to 89% for all breast cancer patients.
  • Survival improvements were most marked for older ladies (65+) and the late Stage IV disease. Some but not all of this improvement is because of general improved health care and survival.
  • Recorded clinical trial enrolment was higher than for previous years at 14%
  • 13% of women were offered a genetic referral.

Recommendations

  • Differences by Trust in breast reconstruction should be investigated.
  • Awareness needs to be raised of the less common symptoms such skin changes as these account for about 10% of presentations. Differences in the assessment of oestrogen and progesterone receptor status by age at diagnosis and age at presentation should be investigated. 
  • The proportions of patients having surgery within 62 days of diagnosis in 2012 audit subset were similar to that observed in previous audit years, however a decrease in proportions of patients receiving surgery within 31 days of diagnosis in 2012. This may be due to treatments or investigations carried out before surgery in 2012 and warrants further investigation. 
  • A review of records to assess the proportion of patients commencing on aromatase inhibitors that received a DEXA scan in line with the NICE Clinical Guideline for breast cancer care (2009), showed that only half of patients starting on Aromatase Inhibitors had a DEXA recorded. This observation may be a true reflection of clinical practice or may be due to availability of this information within the electronic records searched. This should be investigated further

The complete 2012 Breast Audit Report can be downloaded here

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