West Midlands Cancer Intelligence Unit Extending Quality Assurance to all Breast Cancers: the BCCOM Project UKACR Annual Conference 29 September 2004 Gill Lawrence 1, Catherine Lagord 1, Olive Kearins 1, Tom Bates 2 1 West Midlands Cancer Intelligence Unit 2 Association of Breast Surgery at BASO Tel: Fax:

West Midlands Cancer Intelligence Unit Acknowledgements Breakthrough Breast Cancer Association of Breast Surgeons at the British Society of Surgical Oncology Breast Surgeons Cancer registries Mr Ian Monnypenny

West Midlands Cancer Intelligence Unit Breast Cancer Complete Outcomes Measures Project Determine whether routine data collected by regional cancer registries can be used as the starting point for the derivation of clinical outcome measures for symptomatic breast cancers equivalent to those derived for screen detected breast cancers in the annual audit Supplement data with additional locally collected treatment data (if necessary) Ensure clinical ownership through ‘sign off’ of the data by treating consultants

West Midlands Cancer Intelligence Unit The BCCOM project 2 surgeons identified in each cancer registry catchment area who submitted good data to 2003 Symptomatic Audit Stage 1 - surgeons send their 2001/02 cases to their regional cancer registry to check case ascertainment Stage 2 - data completeness and accuracy assessed by comparing values recorded for each data item on cancer registry and databases

West Midlands Cancer Intelligence Unit Stage 1 National pilot study results I East Anglian Mersey & Cheshire North Western Northern & Yorkshire South & West Trent Wales West Midlands 19 breast surgeons agreed to participate 10 submitted data within original deadlines and data have been processed by 8 cancer registries 5 have now submitted data and data are being processed by cancer registries 3 have encountered technical difficulties and have not yet sent data to cancer registries 1 has withdrawn due to data collection issues

West Midlands Cancer Intelligence Unit National pilot study results II 90.4%

West Midlands Cancer Intelligence Unit National pilot study results III 78.5%

West Midlands Cancer Intelligence Unit 1 non-Hodgkins lymphoma 1 metastasis of fallopian tube 13 breast cancer recurrences Were all breast cancer cases submitted to the ABS at BASO Symptomatic Audit registered at the WMCIU? 616 non-screen detected new breast tumours (606 patients, 10 multiple primaries) 15 matched to a patient but not a primary breast tumour 7 tumours not registered 594 (96%) matched to a primary breast tumour Case notes requested Stage 1 West Midlands results I

West Midlands Cancer Intelligence Unit 811 cases (20%) in the screening audit Could the WMCIU have improved data completeness in an audit of all breast cancers? 551 cases (14%) in the symptomatic audit 2631 cases (66%) not submitted to either audit 3993 primary breast cancers registered in 2001/02 Stage 1 West Midlands results II

West Midlands Cancer Intelligence Unit Stage 2 West Midlands results

West Midlands Cancer Intelligence Unit Could WMCIU data be used to produce outcome data which clinicians can trust? 3993 cases 2001/ (95%) unique surgeon Cases diagnosed cases surgery 535 cases no surgery 82% had pre-operative diagnosis 49% had a mastectomy

West Midlands Cancer Intelligence Unit Consultant caseload all West Midlands breast cancers 2001/02

West Midlands Cancer Intelligence Unit Issues and queries Male and female cancers? Surgeons with patients registered at more than one cancer registry owing to patient referral patterns Registration under several consultants e.g. one for each treatment episode - which one do you choose? Need more complete definitions for each data item e.g. size - whole or invasive Follow up of missing registrations Resolution of differences between breast unit and cancer registry databases and amendment of incorrect database

West Midlands Cancer Intelligence Unit