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National Breast Cancer Audit
Peer Reviewed Publications
Disparities in access to breast care nurses for breast
surgeons: a National Breast Cancer Audit survey.
Marsh C, Wang J, Kollias J, Boult M, Rice J, Maddern G.
Breast. 2010
Apr;19(2):142-6.
Abstract:
The involvement of a breast care nurse (BCN) in breast cancer treatment
can improve the physical and psychological outcomes and provide the
continuity of care and better information about the disease and
treatment process. This survey examined the current status of BCNs
access to determine the extent and how BCNs were accessed by breast
surgeons across Australia and New
Zealand in different geographical
settings or health service sectors. The survey was disseminated in
December 2006. Response rate was 91%. The results show that the majority
of Australian and New
Zealand breast surgeons either work
with a BCN in their practice or can access a BCN outside their practice.
Patients are more likely to have access to a BCN immediately after
diagnosis while around a third of practices have access to a BCN more
than once, usually "after diagnosis" and "after surgery". More public
practices have direct access to a BCN than private practices,
particularly in the metropolitan and regional areas while access to BCN
is poor in rural public and private practices. The difference in overall
access, either in the practice or external access (Yes or No but can
access a BCN), to a BCN between public and private practices is smaller.
Access to a BCN was best in metropolitan public practices and worst in
rural private practices with one quarter rural private practices had no
access to a BCN and no rural patients can access a BCN more than once in
private practice. The results of this survey demonstrated some evidence
of disparity in access to a BCN which needs to be reduced through more
attention and/or extra resources in this area.
PubMed Reference: PMID: 20172728
Patterns of surgical treatment
for women with breast cancer in relation to age.
Wang J, Kollias J, Boult M, Babidge W, Zorbas HN, Roder D, Maddern G.
Breast J. 2010 Jan;16(1):60-5.
Abstract:
Although treatment recommendations have been advocated for all
women with early breast cancer regardless of age, it is generally
accepted that different treatments are preferred based on the age of the
patient. The aim of this study was to assess the pattern of breast
cancer surgery after adjusting for other major prognostic factors in
relation to patient age. Data on cancer characteristics and surgical
procedures in 31,298 patients with early breast cancer reported to the
National Breast Cancer Audit between 1999 and 2006 were used for the
study. There was a close association between age and surgical treatment
pattern after adjusting for other prognostic factors, including tumor
size, histologic grade, number of tumors, lymph node positivity,
lymphovascular invasion (LVI), and extensive intraduct component. Breast
Conserving Surgery (BCS) was highest among women aged <or=40 years
(OR = 1.140; 95% CI: 1.004-1.293) compared to women aged 51-70 years
(reference group). BCS was lowest in women aged >70 years (OR =
0.498, 95% CI: 0.455-0.545). Significantly more women aged <or=50
years underwent more than one operation for breast conservation
(20.4-24.8%) compared with women aged >50 years (11.4-17.0%). Women
aged >70 years were more likely to receive no surgical treatment,
3.5% versus 1.0-1.3% in all other age groups (<or=40, 41-50 51-70
years). There is an association between patient age and the type of
breast cancer surgery for women in Australia and New
Zealand. Women age <or=40 years are
more likely to undergo BCS despite having adverse histologic features
and have more than one procedure to achieve breast conservation. Older
women (>70 years) more commonly undergo mastectomy and are more
likely to receive no surgical treatment.
PubMed Reference: PMID:
19889171
Are males with early breast cancer treated differently from
females with early breast cancer in Australia and New Zealand?
Wang
J, Kollias
J, Marsh
C, Maddern
G.
Breast. 2009
Dec;18(6):378-81.
Abstract:
Breast cancer in males is much rare than in females so in practice, male
breast cancer treatment is likely to follow the guidelines developed for
female breast cancer patients. The objective of this study is to compare
the characteristics and treatment pattern of male breast cancer patients
with comparable subgroups of female breast cancer patients using data
submitted to the National Breast Cancer Audit. This is a retrospective
analysis of 151 male breast cancers diagnosed and treated between 2000
and 2008. Most of the male early breast cancer cases in this group were
symptomatic ones in men aged >50 years with one invasive tumour.
There was a similar proportion of lymph node positive cancer among males
and females, although male breast cancer was more likely to be unifocal
(P=0.007) and oestrogen receptor positive (P=0.001). Male breast cancer
patients almost always underwent mastectomy and a significant proportion
of them (11%) received no surgical treatment. There were no differences
in axillary surgery although males were more likely to undergo a level 2
axillary surgery and less likely to have sentinel node biopsy. Male
patients were significantly less likely to undergo radiotherapy,
chemotherapy or hormonal therapy for oestrogen receptor positive
tumours. Conclusion: While the female oriented treatment guidelines are
available, male patients with early breast cancer received different
surgical and adjuvant treatment from comparable females.
PubMed Reference: PMID:
19850477
Trends in surgical treatment of younger patients with breast
cancer in Australia and New Zealand.
Wang
J, Boult
M, Tyson
S, Babidge
W, Zorbas
H, Kollias
J, Roder
D, Maddern
G.
ANZ J
Surg. 2008 Aug;78(8):665-9.
Abstract:
BACKGROUND: The optimal surgical treatment of early breast cancer in
young women is not fully determined, while past reports indicate a trend
to the increased use of breast-conserving surgery (BCS). This study aims
to assess the trend in Australia and New Zealand of BCS use between 1999
and 2006 and to determine pathological factors associated with it.
METHODS: Data on cancer characteristics and surgical procedures in
younger patients with early breast cancer reported to the National
Breast Cancer Audit have been analysed. RESULTS: There was little change
in the rate of BCS over the last 7 years with an overall rate of 53%.
The main factors associated with the use of BCS are low histological
grade, absence of extensive intraductal carcinoma (EIC), negative lymph
node involvement, unifocal tumour and small tumour size. CONCLUSION:
Between 1999 and 2006, the use of BCS for early breast cancer treatment
in younger women was stable. These results show that surgeons
contributing data to the National Breast Cancer Audit appear to use
pathological factors that are known to increase the risk of local
recurrence after BCS, in selecting mastectomy for younger women.
PubMed Reference: PMID:
18796024
Commentary: how surgical audits can be used to promote the
update of surgical evidence.
Wang
J, Boult
M, Roder
D, Babidge
W, Kollias
J, Maddern
G.
ANZ J
Surg. 2008 Jun; 78(6):437-8.
Abstract:
Evidence-based medicine (EBM) is an important advance in health care.
The Australian Safety and Efficacy Register of New Interventional
Procedures - Surgical (ASERNIP-S), the Royal Australasian College of
Surgeons, has been at the forefront of promoting EBM in surgery by
developing systematic reviews and managing surgical audits. In EBM,
uptake of evidence is just as important as establishing the evidence.
The prospective, long-term data collection of surgical audits on
treatment processes and outcomes often have a high patient and surgeon
coverage and make them extremely valuable as a tool for assessing the
uptake of evidence. Surgical audits can be used: (i) to assess practice
trends and the impact of systematic reviews or clinical guidelines on
treatment practice, (ii) to identify the disparities in the uptake of
evidence, and (iii) to promote further research on how to bridge
evidence-practice gaps and to overcoming possible barriers for the
evidence uptake. The information gathered through the audit data
assessment on evidence-uptake can be used to improve evidence
dissemination and identify possible barriers to the uptake of
evidence.
PubMed Reference: PMID:
18522561
National Breast Cancer Audit: the use of multidisciplinary
care teams by breast surgeons in Australia and New Zealand.
Marsh
CJ, Boult
M, Wang
JX, Maddern
GJ, Roder
DM, Kollias
J.
Med J
Aust. 2008 Apr 7;188(7):385-8. Comment in:Med
J Aust. 2008 Apr 7;188(7):380-1.
Abstract:
Objective: To explore the involvement of members of the
Royal Australasian College of Surgeons (RACS) Section of Breast Surgery
in Australia and New Zealand in multidisciplinary care (MDC) teams.
DESIGN AND SETTING: Questionnaire sent to all full members of the RACS
Section of Breast Surgery in December 2006. PARTICIPANTS: 239 of 262
active full members of the RACS Section of Breast Surgery (response
rate, 91.2%). MAIN OUTCOME MEASURES: Surgeons' use of, and the
composition and functioning of, MDC teams in public and private
practice, and in metropolitan, regional and rural settings. RESULTS: 85%
of responding surgeons reported participating in at least one fully
established MDC team. Public-sector teams were operationally more
consistent and functional than private teams, and rural teams were less
well developed than those in metropolitan and regional centres. The six
core disciplines recommended by the National Breast Cancer Centre appear
to be well represented in most teams. Patients and their general
practitioners were not considered to be part of the treatment team by
surgeons. CONCLUSIONS: MDC is supported by most breast surgeons, but
there are deficits in rural areas, and in the private sector relative to
the public sector.
PubMed Reference:PMID:
18393739
Clinical audits: why and for whom.
Boult
M, Maddern
GJ.
ANZ J
Surg. 2007 Jul;77(7):572-8.
Abstract:
Every surgical activity poses some element of risk to the public and
should include a quality control initiative. Surgical audit is one
strategy used to maintain and/or improve standards in surgical care. The
Royal Australasian College of Surgeons is committed to ensuring best
practice in surgical care and strongly endorses the use of audits to
achieve this. This review provides an overview of clinical audit and its
role in surgical practice.
PubMed Reference: PMID:
17610696
National Breast Cancer Audit: ductal carcinoma in situ
management in Australia and New Zealand.
Cuncins-Hearn
A, Boult
M, Babidge
W, Zorbas
H, Villanueva
E, Evans
A, Oliver
D, Kollias
J, Reeve
T, Maddern
G.
ANZ J
Surg. 2007 Jan-Feb;77(1-2):64-8.
Abstract:
BACKGROUND: Ductal carcinoma in situ (DCIS) is a significant issue in
Australia and New Zealand with rising incidence because of the
implementation of mammographic screening. Current information on its
natural history is unable to accurately predict progression to invasive
cancer. In 2003, the National Breast Cancer Centre in Australia
published recommendations for DCIS. In Australia and New Zealand, the
National Breast Cancer Audit collects information on DCIS cases. This
article will examine these recommendations and provide information from
the audit on current DCIS management. METHODS: Three thousand six
hundred and twenty-nine cases of DCIS were entered by 274 breast
surgeons between January 1998 and December 2004. Data items in the
National Breast Cancer Audit database that were covered in the National
Breast Cancer Centre recommendations were reviewed. Information was
available on the following: diagnostic biopsy rates for all cases and
mammographically positive cases and rates of breast conserving surgery
(BCS), clear margins following BCS, postoperative radiotherapy following
BCS for groups at high risk of recurrence as well as axillary procedures
and tamoxifen prescription. RESULTS: Close adherence was found in
diagnostic biopsy, BCS and clear margin rates. Some high-risk groups
received radiotherapy, although women with 'close' margins did not in
33% of cases. Axillary procedures were conducted in 23% of cases and
most (81%) patients were not prescribed tamoxifen. CONCLUSION: There was
predominantly close adherence to recommendations with three possible
areas of improvement: fewer axillary procedures, an appraisal of
radiotherapy practice following BCS and more investigation into
tamoxifen prescription practices for DCIS.
PubMed Reference: PMID:
17295824
National breast cancer audit: overview of invasive breast
cancer management.
Cuncins-Hearn
AV, Boult
M, Babidge
W, Zorbas
H, Villanueva
E, Evans
A, Oliver
D, Kollias
J, Reeve
T, Maddern
G.
ANZ J
Surg. 2006 Aug;76(8):745-50.
Abstract:
BACKGROUND: The National Breast Cancer Audit is an initiative of the
Breast Section of the Royal Australasian College of Surgeons collecting
surgical information in early breast cancer. It is managed in
conjunction with the Australian Safety and Efficacy Register of New
Interventional Procedures - Surgical. An overview of results for
invasive breast cancer from January 1999 until December 2004 is
presented to provide preliminary data for participating surgeons.
METHODS: Invasive breast cancer cases were retrieved from the National
Breast Cancer Audit database for the 274 participating breast surgeons
in Australia and New Zealand. Data for a variety of clinical parameters
were analysed to provide an overview of the diagnostic, histological,
surgical and adjuvant therapy management issues. RESULTS: There were
25,026 cases of invasive breast cancer. Annual percentages of
mammographically detected cancers from 1999 to 2004 did not differ
significantly. Breast-conserving surgery rates also remained stable at
60%. Margins were involved in 5% of patients; an additional 9% had final
margins of less than 1 mm. Radiotherapy followed breast-conserving
surgery in most cases (86%). Patients undergoing mastectomy with large
tumours (>5 cm) underwent radiotherapy in 71% of cases. When at least
four lymph nodes were positive, radiotherapy followed mastectomy in the
majority (75%) of cases. The most frequently carried out axillary
procedure was a level 2 dissection. Chemotherapy was received by 78% of
oestrogen receptor negative, axillary node positive, postmenopausal
patients. Tamoxifen was used in the majority (83%) of oestrogen receptor
positive cases. CONCLUSION: Surgeons contributing their invasive breast
cancer data show a high quality of treatment. Some further improvement
may be possibly related to excision margins and tamoxifen prescription
for oestrogen receptor negative cancers. Chemotherapy prescription might
also warrant further investigation.
PubMed Reference: PMID:
16916399
National Breast Cancer Audit: establishing a web-based data
system.
Boult
M, Cuncins-Hearn
A, Tyson
S, Kollias
J, Babidge
W, Maddern
G.
ANZ J
Surg. 2005 Oct;75(10):844-7.
Abstract:
BACKGROUND: An audit of surgical treatment of early breast cancer was
introduced nationally in 1999. In August 2002, the Australian Safety and
Efficacy Register of New Interventional Procedures - Surgical, under the
auspices of the Royal Australasian College of Surgeons, assumed
responsibility for managing this audit. This article provides an update
of audit activities, now known formally as the National Breast Cancer
Audit (NBCA), including a description of the new governance structure
and the development of a secure online surgical audit system. METHODS:
Major changes have taken place in the design and governance of the NBCA
during the last two years. Two committees have been established to
oversee the audit. A clinical advisory committee comprises experts from
a number of fields including breast surgery, oncology, government, and
from peak breast cancer and consumer bodies. A technical advisory
committee oversees many of the technical issues that have arisen with
the development of an online data entry system. The online system of
data entry was developed and launched to surgeons in May 2004. RESULTS:
There are now 28,000 cases of primary breast surgery in the audit.
Around 250 surgeons are currently participating, an increase of over 50
surgeons since May 2004. Surgeons can review their data using the online
system and compare their own results by generating reports which graph
their own results against national aggregate data. CONCLUSIONS: There
has been a significant increase in the volume of data received since the
launch of the secure online system. The governing committees are working
towards creating a clinical audit which will provide an improved data
entry system and better reporting for all participating surgeons. The
NBCA can also serve as a template on which to base other surgical
audits.
PubMed Reference: PMID:
16176221
Collation of Australasian data regarding breast
cancer.
Malycha
P.
ANZ J
Surg. 2001 May;71(5):265. Comment on: ANZ
J Surg. 2001 May;71(5):266-70.
PubMed Reference: PMID:
11374472
National breast surgery audit.
Malycha
P, Tyson
S.
Aust
N Z J Surg. 2000 Dec;70(12):834-6.
Abstract:
BACKGROUND: Surgical audit is routinely conducted throughout the
surgical community in order to examine practice in a peer-review
environment. A national audit for breast cancer surgery has been
implemented in Australia and New Zealand. It aims to standardize the way
in which surgical activities are recorded. The present paper describes
the development and implementation of the audit project. METHODS: An
audit kit including instruction manual, data dictionary and choice of
two data collection instruments (paper or database) were distributed
among participants. Surgeons record their patients prospectively, submit
data to central office and provide feedback. RESULTS: Information on
3000 breast cancer patients has been collected within the first 6
months. CONCLUSION: The project has been successfully implemented and is
continuing to develop. Many surgeons have incorporated the patient
record forms in their routine case management activities. Comments and
other submissions have been reviewed and changes incorporated into the
second and subsequent releases of the kit.
PubMed Reference: PMID:
11167568
Last Modified: 1 June 2010
© Royal Australasian College of Surgeons. All rights reserved.
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