1. Specialist Breast Units – Does it improve Breast Cancer care? These Power Point presentations are free to download only for academic purposes, with due acknowledgements to authors and this website.

2. DR. P. RAGHU RAM MS, FRCS (Edin), FRCS (Glasg), FRCS (Irel) Specialist Registrar in Breast Surgery Specialist Breast Unit St James University Hospital, Leeds, UK Local Convenor & Course Tutor Overseas Surgical Postgraduate Course in India Royal College of Surgeons of Edinburgh, UK Member, National Executive Committee & Overseas Coordinator Indian Association of Surgical Oncology Member of National Governing Council British International Doctors Association, UK Editor in Chief British International Doctors Association website, UK Specialist Registrar in Breast Surgery Specialist Breast Unit St James University Hospital, Leeds, UK Local Convenor & Course Tutor Overseas Surgical Postgraduate Course in India Royal College of Surgeons of Edinburgh, UK Member, National Executive Committee & Overseas Coordinator Indian Association of Surgical Oncology Member of National Governing Council British International Doctors Association, UK Editor in Chief British International Doctors Association website, UK

3. NOTTINGHAM BREAST UNIT A world renowned Centre of excellence ‘ ‘

4. Aim Rationale for evolution of Specialist Breast Units Structure & Function of Specialist Breast Units Do Specialist Breast Units improve Breast Cancer care? Rationale for evolution of Specialist Breast Units Structure & Function of Specialist Breast Units Do Specialist Breast Units improve Breast Cancer care?

5. Evolution in Breast Cancer care Developments - revolutionised Breast cancer care -Screening Mammography -Acceptance of Breast conservation as standard of care -Proof that adj. systemic therapy improves survival -Reconstruction offered to women after mastectomy Developments - revolutionised Breast cancer care -Screening Mammography -Acceptance of Breast conservation as standard of care -Proof that adj. systemic therapy improves survival -Reconstruction offered to women after mastectomy

6. Evolution in Breast cancer care Surgeon required assistance of Radiologist to detect small impalpable lesions detected by Mammography Pre invasive cancer detected with increasing frequency Pathologist became important team member of Team Surgeon required assistance of Radiologist to detect small impalpable lesions detected by Mammography Pre invasive cancer detected with increasing frequency Pathologist became important team member of Team

7. Evolution in Breast cancer care Symptomatic patients – triple test (a major advance) Spared women of physical and emotional trauma of a surgical open biopsy Breast Cancer Dx. made under one roof with results being available on the same or subsequent day Public awareness Symptomatic patients – triple test (a major advance) Spared women of physical and emotional trauma of a surgical open biopsy Breast Cancer Dx. made under one roof with results being available on the same or subsequent day Public awareness

8. Specialist Breast Units Emerged as a solution to cater to a large number of women who required high quality breast evaluation As with all new movements, there were counter forces Comprehensive Specialist Breast units – successful concept in the West Emerged as a solution to cater to a large number of women who required high quality breast evaluation As with all new movements, there were counter forces Comprehensive Specialist Breast units – successful concept in the West

9. Reason for Change in provision of Breast Services (U.K) Early 1990 - Screening Pts getting better quality of care Reduction of Breast Cancer - major targets set by Govt Development of network of Cancer centres & Units End to ‘Cancer lottery of care’ CMO, England & Wales. DoH, April 1994 Health of the Nation, DoH, London 1994 Eur J Surgical Oncol 1995; 21(Suppl A):1-13 Early 1990 - Screening Pts getting better quality of care Reduction of Breast Cancer - major targets set by Govt Development of network of Cancer centres & Units End to ‘Cancer lottery of care’ CMO, England & Wales. DoH, April 1994 Health of the Nation, DoH, London 1994 Eur J Surgical Oncol 1995; 21(Suppl A):1-13

10. NHS BSP 1996-2003 1,507987 7911

11. UK SCREENING PROGRAMME PREOPERATIVE DIAGNOSIS 1996-2002

12. Specialist Breast Unit ‘ A system for delivering coordinated, patient focussed care across the continuum of a woman’s Breast health needs’ Three important components 1.Sub specialised, carefully selected physicians committed to high quality 2.Evidence based protocols 3.MDT approach ‘ A system for delivering coordinated, patient focussed care across the continuum of a woman’s Breast health needs’ Three important components 1.Sub specialised, carefully selected physicians committed to high quality 2.Evidence based protocols 3.MDT approach

13. MDT care in Breast Cancer MDT – essential component of healthcare MDT - First recognised in Mx. Of Breast Cancer MDT Approach – Diagnostic accuracy Clinical effectiveness Reduces morbidity & mortality Raises standards MDT – essential component of healthcare MDT - First recognised in Mx. Of Breast Cancer MDT Approach – Diagnostic accuracy Clinical effectiveness Reduces morbidity & mortality Raises standards

14. Multidisciplinary Team Radiologists Surgeons Pathologists

15. Breast Units Integrated Breast Service Surgeon Radiologist Pathologist Diagnosis Breast Care Nurse

16. Breast Units Integrated Breast Service Breast Surgeon Surgeon Plastic Plastic Surgeon Surgeon Pathologist Pathologist Primary Surgery Oncologist Radiologist Radiologist BreastSurgeon Pathologist Plastic PlasticSurgeon Breast Care Nurse

17. Breast Units Adjuvant Therapy Breast Surgeon Surgeon Pathologist Pathologist Oncologist BreastSurgeon Oncologist Oncologist Breast Care Nurse

18. Breast Units Advanced Disease Breast Surgeon Surgeon Radiologist Radiologist Oncologist Ortho Surgeon Surgeon BreastSurgeon Radiologist Radiologist Oncologist Oncologist OrthopaedicSurgeon Breast Care Nurse Palliative care Palliative careSpecialist

19. Role of Breast Care Nurse To cure sometimes, to relieve often, to comfort always. Sir James Calnan To cure sometimes, to relieve often, to comfort always. Sir James Calnan Breast Care Nurse

20. Evolution of Guidelines Breast Cancer (U.K) BASO - Quality Assurance Guidelines for Breast Cancer Screening (Revised 1996) NHSBSP No 20 1992 BASO - Guidelines for Mx of Patients with symptomatic breast disease Eur J Surg Oncol 1996, 1998 SIGN - Guidelines for Breast Cancer, 1998 BASO Guidelines for Mx of metastatic Breast Cancer in the UK Eur J Surg Oncol 1999; 25: 3-23 BASO - Quality Assurance Guidelines for Breast Cancer Screening (Revised 1996) NHSBSP No 20 1992 BASO - Guidelines for Mx of Patients with symptomatic breast disease Eur J Surg Oncol 1996, 1998 SIGN - Guidelines for Breast Cancer, 1998 BASO Guidelines for Mx of metastatic Breast Cancer in the UK Eur J Surg Oncol 1999; 25: 3-23

21. Volume of work versus Outcome Min. workload for maintaining high standard of care - at least 50 new cases / year Outcome proportional Volume of breast cancer surgery Calman-Hine Cancer report, 1995 Cancer guidance report on improving the outcomes of breast cancer Department of Health, 1996 SIGN Guidelines, 1998 Eur J Surg Oncol 1996, 1998 Gillis CR et al BMJ 1996; 312: 145-148 Sainsbury et al Lancet 1995; 345: 1265-70 Min. workload for maintaining high standard of care - at least 50 new cases / year Outcome proportional Volume of breast cancer surgery Calman-Hine Cancer report, 1995 Cancer guidance report on improving the outcomes of breast cancer Department of Health, 1996 SIGN Guidelines, 1998 Eur J Surg Oncol 1996, 1998 Gillis CR et al BMJ 1996; 312: 145-148 Sainsbury et al Lancet 1995; 345: 1265-70

22. Breast Units – Advantages Integrated Breast Service (MDT) Reduced referral time between specialists Service delivery better Audit, Research Integrated Breast Service (MDT) Reduced referral time between specialists Service delivery better Audit, Research More patients receive best ‘standard of care’ Less anxiety for patients Early detection, better Qol, Improved survival Improves Breast cancer care

23. Conclusion Organisation & delivery of Breast Service happened not by serendipity, but by diligent planning Specialist Breast units is a new & successful concept in the West Major advance in the Mx of a common, emotionally charged well publicized Cancer Organisation & delivery of Breast Service happened not by serendipity, but by diligent planning Specialist Breast units is a new & successful concept in the West Major advance in the Mx of a common, emotionally charged well publicized Cancer

24. Conclusion Do Specialist breast Units improve Breast Cancer care? YES ‘ TRAVELLER, THERE ARE NO PATHS, PATHS ARE TO BE MADE’ Do Specialist breast Units improve Breast Cancer care? YES ‘ TRAVELLER, THERE ARE NO PATHS, PATHS ARE TO BE MADE’