1. EBCN Meeting Budapest, 24 September 2004 Update on individual data monitoring projects QT and SEED Antonio Ponti CPO Piemonte Torino, Italy

2. SEED and QT Audit Systems Their aim is two-fold: 1) to favour the implementation of European Guidelines (with training and certification implications), and

3. SEED and QT Audit Systems 2) to provide a service to screening programmes and Breast Units to meet their management and evaluation needs.

4. Advantages of monitoring Individual vs Aggregate screening data (1) - Use of common definitions and rules in the process of collecting the minimum dataset: an “educational” process

5. Advantages of monitoring Individual vs Aggregate screening data (2) - Standard analysis of common dataset, including standard reports on European outcome measures

6. Advantages of monitoring Individual vs Aggregate screening data (3) - Much more flexible analytical approach

7. Projects and Partners (6 Countries)

9. To access SEED (on line) www.cpo.it/seed demo has about 100,000 screening episodes

13. SEED Results Seven European programmes 1999-2001 % Technical repeat rate 1.8 IM after assessment 1.6 Invasive Ca <= 10 mm 40.5 B / M ratio 0.27 E.G. standard % > 25.0 0.6 0.9 38.1 0.14 E.G. standard < 1.0 > 30.0 % 124,555 FIRST TESTS 159,511 SUBS. TESTS % < 3.0 < 1.0 Further assessment rate 6.0 2.9 < 7.0 < 3.0 < 0.5 < 0.2

15. To download QT www.cpo.it/qt www.eusoma.org

20. Assessment Episodes Operated lesions Total 5,513 1,450 100 196 29 102 130 96 154 109 113 242 No. 179 298 340 0 454 156 312 404 276 381 1664 No. 1228 Valencia Torino Strasbourg Ravenna Marseille Luxembourg London Leuven Firenze Bremen Center Wiesbaden 50-Budapest

21. 67,8 80,3 99,5 52,9 90,3 87,9 89,1 88,3 89,4 77,0 34,2 99,8 99,1 61,3 YESNO Result % QT outcome measures

22. 92,4 80,2 88,4 88,1 46,3 13,3 64,8 62,5 66,0 68,1 51,4 181 77 91 96 31 13 46 15 99 32 92 Positive preoperative cyto/histolog. diagnosis Cancers with post-operative diagnosis YES?NO Results % CENTER

23. 92,4 80,2 88,4 88,1 46,3 13,3 64,8 62,5 66,0 68,1 51,4 181 77 91 96 31 13 46 15 99 32 92 Positive preoperative cyto/histolog. diagnosis Cancers with post-operative diagnosis YESNO Results % CENTER

24. FNA & Core biopsy (operated only) FNA?NoneBothCB CENTER

25. Fine Needle Aspiration Absolute Sensitivity Full Specificity

26. Pre-operative diagnosis Absolute Sensitivity Full Specificity

27. Time btw screening and assessment <= 3 weeks

28. Time btw referral and surgery <= 30 days

29. European Benchmarking Within the project described we have attempted to bridge guidelines with screening and care evaluation, while providing databases useful for daily management of screening programmes and patient care.

30. European Benchmarking This could serve as a model for other health care areas, particularly colon and cervical cancer for which screening programmes are being offered throughout Europe.

31. European Benchmarking Another bridge is being built: with Cancer Registries networks in the framework of population high resolution studies.

32. European Benchmarking The quality cycle entails a continuous updating of the audit tools in the framework of a comprehensive European activity.

33. European Benchmarking In the meanwhile QT is freely available to anyone and SEED could be used by local and regional screening programmes wishing to mutually agree to share it and concur in its development.