National Breast Cancer Audit - Frequently asked questions

Getting started

How can I get a new account?
Do I need to set up a new account?
Can I change my login details?
How do I add a Hospital to My Hospitals List?
How do I start entering data online?
What if I come across a computer problem in the middle of data entry?
Is there an alternative method of data entry?

Data entry

What if the value of my data exceeds the permitted range allowed in a data field?
What if the type of breast cancer is both an invasive breast cancer and DCIS?
If I use the Minimum Dataset option, what if I want to include a field outside of this dataset?
Do I need to enter data for patients who received no surgical treatment?
Do I need to enter data for advanced or metastatic cases?
Do I enter data for lobular carcinoma in situ (LCIS) or Paget's disease of the breast?
What do I enter if the receptor status of the larger tumour is negative but the receptor status of a smaller secondary tumour is positive?
Do I need to record two episodes for bilateral cases?
Do I need to record two episodes for multifocal/multicentric cases?
What do I do if the pathology report does not specify tumour size?
What do I do if the pathology report does not specify margin size?
How do I record margin size for a case with a re-excision?
How do I record a case where axillary surgery was performed but no lymph nodes were identified?
A case is marked as incomplete with a red cross. How can I complete it?
How do I record a recurrence?
How do I record data on the follow-up appointment?
How do I record a patient who has had neoadjuvant treatment?
How do I record a case with an unknown primary?
How do I record microinvasion?
How do I enter details for a patient who has yet to decide on adjuvant therapy?

Data access and reporting

How do I get a summary of my data?
Can I have a brief summary of all my procedures?
What if I want to access the group data from my hospital or a group of surgeons?
Who else can access the data I entered?

Support

How do I get the definition or specification of each data field?
Where can I get more help for data entry?
What do I do if I forget my log-in details?
How can I contact NBCA staff?

Getting started

How can I get a new account?

Contact the NBCA Help Desk on +61 8 8219 0918 or breast.audit@surgeons.org.

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Do I need to set up a new account?

Only one account per surgeon is necessary. If you are considering setting up a new account because you have moved to a new hospital or you want to distinguish between your private and public patients, it is not necessary to have a separate account as you can select hospital and patient type during data entry.

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Can I change my login details?

You cannot change your user ID but you can change your password. You can do this by selecting My User Details from the menu on the left side of the screen. The following page will allow you to re-enter a new password and confirm it in the next box.

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How do I add a hospital to My Hospitals List

You can do this by selecting My Hospitals from the menu on the left side of the screen. On this page you can add hospitals to your personalised list. If necessary, you can click on the help button on this page for further details or consult the NBCA Online Data Entry Manual (PDF 776 KB).

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How do I start entering data online?

After you have logged into the system the first page you will see is the summary page. Select My Breast Audit Patients to display a list of all your patients entered on the database. From this page you can add a new patient or episode and/or edit existing patients and/or episodes.

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What if I come across a computer problem in the middle of data entry?

To minimise data loss in the event of computer-related problems, save your data promptly after entering it by clicking the save button on the bottom of each data entry screen. If your data entry is interrupted by a computer problem, restart the data entry program and return to the last patient or episode you had entered; then you can check or re-enter data if necessary.

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Is there an alternative method of data entry?

If you have a small number of patients and/or have difficulty entering data online, you can send us your data on a paper form. This form can be downloaded from the main NBCA webpage. Please make sure you use the most current paper data entry form. The form can then be posted or faxed to the NBCA office.

Institutions with a compatible in-house database already recording this information and a large number of eligible cases may be suitable for our institutional uploads program. Please enquire through our helpdesk at breast.audit@surgeons.org.

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Data entry

What if the value of my data exceeds the permitted range allowed in a data field?

The data field ranges in the online system have been designed to cover most situations and to improve the integrity of the data collection. If you have data which exceeds a permitted range, please check the original data to make sure that there has not been a transcription error. If your data does exceed the permitted range and you consider it should be allowed, please contact us as soon as possible so we can determine whether changes need to be made with the online data entry system.

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What if the type of breast cancer is both an invasive breast cancer and DCIS?

If the patient has both invasive and insitu components, mark it as invasive and complete the appropriate pathology items, including "total extent of lesion". The exception to this rule is if the case involves microinvasion only. If an in situ case involves microinvasion, mark the case as in situ and record the microinvasion in the comments section of the full dataset.

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If I use the Minimum Dataset option, what if I want to include a field outside of this dataset?

The Minimum Dataset option includes only those items necessary for a case to be considered complete. If you have entered all MDS questions and would like to include further information, scroll down to the bottom of the screen and click the button labelled "Full Dataset". This will take you to the Full Dataset view and allow you to answer further questions for record keeping or later data analysis.

If you switch to the Full Dataset view, you do not have to answer every question for the case to be considered complete. Cases necessary for completeness are marked with an asterisk. The system will also alert you on closing a case if you have missed any mandatory completeness fields.

If the information you want to record is not specifically included in the Full Dataset, you can add a note in the comments section. Co-morbidities, for example, can be recorded here.

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Do I need to enter data for patients who received no surgical treatment?

Yes, data from patients who received no surgical treatment for any reason should be entered. If a patient does not have surgery, please enter the case as a "no surgery" patient. This means ticking the box labelled "no surgery" in the surgery section.

If no surgery was performed, mark all adjuvant treatment questions as "no". Any therapy received must be recorded as Neoadjuvant using the tick box under the relevant therapy.

If any question in the pathology section of the MDS is left blank, the case will be labelled "incomplete" and will have a red cross in the My Patients list. This is unavoidable for "no surgery" cases and the red cross will need to be ignored for these patients.

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Do I need to enter data for advanced or metastatic cases?

No. The NBCA is an audit of early and locally advanced breast cancer. Advanced or metastatic cases are not recorded.

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Do I enter data for lobular carcinoma in situ (LCIS) or Paget's disease of the breast?

If the patient presented with only LCIS or Paget's disease, do not enter data into the audit. The NBCA does not collect information on these conditions. If there was also an invasive or ductal carcinoma in situ component, the patient can be entered.

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What do I enter if the receptor status of the larger tumour is negative but the receptor status of a smaller secondary tumour is positive?

Receptor status questions should be answered in reference to the overall status of the patient so if the principal tumour in the breast is negative but a second tumour is positive please record a positive receptor status.

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Do I need to record two episodes for bilateral cases?

Bilateral synchronous cases need to be recorded as two episodes. Enter all Minimum Dataset (MDS) items for the first breast and save and close the record. Then search for the patient and click "add an episode". You will then need to enter the information for the other breast.

If you are entering data in the MDS view, you will notice that there is not an option to record laterality. You can still record laterality by switching to "full dataset" view using the button at the bottom of the screen. Laterality is recorded in the diagnosis section.

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Do I need to record two episodes for multifocal/multicentric cases?

Multifocal/multicentric cases are recorded as one episode.To fill out the pathology section for a case with multiple tumours in the same breast, record the most prognostically significant information. For example, record the tumour size of the principal tumour, record the distance to margin from the tumour which had the closest margin, and record the receptor status as positive if any of the tumours were positive.

The Full Dataset view includes a question which asks how many invasive tumours in the breast (to switch from Minimum Dataset view use the button at the bottom of the screen). Multifocal cases can be categorised as multicentric for audit purposes. There is currently no equivalent question for in situ cases. If you want to record the number of in situ tumours, please use the comments field located in the Full Dataset view.

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What do I do if the pathology report does not specify tumour size?

If the pathology report does not specify tumour size, please speak directly to the pathologist as this information is mandatory for complete records.

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What do I do if the pathology report does not specify margin size?

When entering your final assessment of relevant margins please note that cases which do not record a precise figure for margin (e.g. that record margin as "more than 10mm" or "clear") are not considered as real integers and cannot be entered. We recommend you request that your pathologist record precise margins if at all possible.

If this is not possible, please record "10" for reports which state "more than 10mm" and the code "99" for cases where the pathologist has recorded "clear" which tells those analysing the data that the margins were "clear" but a precise margin is unknown.

Please note that only one margin size needs to be entered for the case to be considered complete. If, for example, you have only the vertical margin, enter that and leave the circumferential margin questions blank.

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How do I record margin size for a case with a re-excision?

If there is a re-excision, the width should be added to margin clearance. In other words, if the original margin was clear (i.e. more than 0) then you would need to add the distance to margin measurements together.

The margins questions are seeking the distance from the invasive (or DCIS) component to the closest margin, after completion of all surgical procedures. For example, if the margin was clear after the first excision (distance from tumour to margin was 1 mm) and a re-excision was performed (a further 2mm shaved) then the distance from the invasive tumour to the final margin would be the excision margin plus the re-excision distance (3mm). The same is true if a mastectomy was performed after an excision with clear margins.

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How do I record a case where axillary surgery was performed but no lymph nodes were identified?

If there is a case where axillary surgery is performed but no lymph nodes are identified, enter zero nodes examined and zero nodes positive with a note in the comments that no lymph nodes were identified. This will allow for the completeness of the case.

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A case is marked as incomplete with a red cross. How can I complete it?

The 'incomplete' crosses that appear on the patient list for each surgeon act purely as a reminder to go back and add extra information so that the entire Minimum Dataset is filled in. The reason for labelling incomplete cases is so that all cases are as complete as possible to ensure performance assessments are accurate and data is complete enough for analysis.

To determine what is missing from an "incomplete" case, we recommend opening the case in Minimum Dataset view. All fields in this view should be answered. Alternatively, in Full Dataset view, the fields marked with a blue asterisk are required for completeness. When closing a case in either Full or Minimum view, the system will alert users if the case remains incomplete and provide a list of fields yet to be completed.

If a patient has surgery for the primary breast cancer, but no axillary surgery, the case can be completed by inputting zero for both nodes examined and nodes positive in the pathology section of the dataset. This should also be done for cases where an axillary dissection was performed but no lymph nodes were identified.

Only one margin size needs to be entered for the case to be considered complete. That is, you do not need to enter both Circumferential and Vertical margins, one of these will do. If, for example, you have only the vertical margin, enter that and leave the circumferential margin questions blank. If both margin sizes are unknown please record the code "99" which tells those analysing the data that the margins were "clear" but a precise margin is unknown.

With the current constraints to the system, cases that have no surgery will be marked incomplete. This is an issue with the way "completeness" is calculated. Unfortunately,  these patients will remain marked as "incomplete" until the system is updated.

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How do I record a recurrence?

If the recurrence occurs three months after an operation with clear margins, this would be recorded as a new episode. Search for the patient in your "my patients" list and click "add an episode". If the recurrence occurs prior to three months, treatment would be recorded on the original episode. Either way, the recurrence can be recorded in the follow-up section of the Full Dataset view under theoriginal episode for the patient.

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How do I record data on the follow-up appointment?

To enter a follow-up: Search for the patient using the 'find' boxes at the bottom of the 'my patients' list. Click on view/edit episode. Click on edit this episode. If the case has opened in Minimum Dataset view, scroll to the bottom of the screen and click on the Full Dataset button. Click on the Follow-ups tab at the top of the screen. Click on add. Enter details.

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How do I record a patient who has had neoadjuvant treatment?

If a patient has had neoadjvant treatment, mark the neoadjuvant tick box under the relevant treatment (e.g. chemotherapy, radiotherapy). Please note that you still need to provide details of whether they have had adjuvant treatment. Mark yes/no/referred but not used under the relevant treatment option.

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How do I record a case with an unknown primary?

Enter tumour size as zero.

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How do I record microinvasion?

If an in situ case involves microinvasion, mark the case as in situ and record the microinvasion in the comments section of the full dataset.

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How do I enter details for a patient who has yet to decide on adjuvant therapy?

The NBCA encourages users to enter data after all information is known, however, there is the facility to enter what information is known and come back and finish the case at a later date. A case can be saved in the online system as long as all mandatory information is entered (patient name, DOB, clinic reference, gender, public/private status, postcode, treating hospital, and diagnosis date). If a case is saved without adjuvant therapy information, the case will be labelled as 'incomplete' and a red cross will appear next to it in the patient list. This acts as a reminder that you need to go back in and add some important information on this case.

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Data access and reporting

How do I get a summary of my data?

Selecting My Reports will allow you to get a summary of your  data in Microsoft Excel format. Click on the "Export my data to Excel" button. This will download an Excel worksheet of all episodes entered. If you are having trouble finding the data you are looking for or performing analyses on this data, contact the helpdesk for assistance: breast.audit@surgeons.org.

To get a printable summary of one particular patient record, similar to the minimum dataset paper form, click the "episode summary" button on the display episodes screen. This screen is accessed by clicking view/edit episode(s) next to the patient listed in the My Patients module of the online portal.

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Can I have a brief summary of all my procedures?

Yes, by selecting My Breast Surgery Summary you can see a brief summary of the number of procedures you have carried out on your patients. The quality thresholds for several performance indicators and your practice values are also available on the same webpage for you to compare your personal data with the set level.

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What if I want to access the group data from my hospital or a group of surgeons?

To obtain de-identified data that is not accessible under your account, a formal request should be made using the NBCA Data Request Form (PDF 266 KB). The request will be assessed by the Data Request Subcommittee based on the Data Release Policy (Word 53 KB). If surgeon identification is required, or if the subset is small enough that identification may be possible, written permission is required from each surgeon concerned.

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Who else can access the data I entered?

The data collected from the Audit will only be used for the stated objectives of the NBCA.

In Australia, the audit has been declared under Part 95 of the Health Insurance Act 1973 to be a quality assurance activity. In New Zealand, the audit has been declared a protected quality assurance activity under the Health Practitioner's Competence Assurance Act 2003. For this reason the identifiable individual information obtained through our activity cannot be disclosed to another person, organisation or to a court without your written consent.

For more information on who can request data from the NBCA, see our Data Release Policy (Word 53 KB).

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Support

How do I get the definition or specification of each data field?

All data fields have been defined and specified in the NBCA Data Dictionary (PDF 530 KB) which can be accessed from the main NBCA webpage. Other useful information available on this website includes our regular newsletter, the latest data entry paper form and audit reports.

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Where can I get more help for data entry?

Each data entry field has its own help icon which provides a definition of the field when hovered over with the mouse. The Online Data Entry Manual (PDF 776 KB) and NBCA Data Dictionary (PDF 530 KB) are also available for download. You can also contact the helpdesk and we will be glad to help.

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What do I do if I forget my log-in details?

If you forget your log-in details, you can contact the helpdesk for a reminder, however, these reminders can only be sent to the email address on record for that participant. It is important, therefore, to keep your contact details up to date. If you update your details with the College, this will not be automatically filtered down to the NBCA.

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How can I contact NBCA staff?

National Breast Cancer Audit
Royal Australasian College of Surgeons
199 Ward Street
North Adelaide SA 5006 Australia
Telephone: +61 8 8219 0918
Fax: +61 8 8219 0999
Email: breast.audit@surgeons.org

We welcome your feedback on any aspect of the National Breast Cancer Audit.