Specialist Breast Units Does it improve Breast Cancer

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.

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

NOTTINGHAM BREAST UNIT A world renowned Centre of excellence ‘

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

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

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

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

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

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. Do. H, April 1994 Health of the Nation, Do. H, London 1994 Eur J Surgical Oncol 1995; 21(Suppl A): 1 -13

NHS BSP 1996 -2003 7911 1, 507987

UK SCREENING PROGRAMME PREOPERATIVE DIAGNOSIS 1996 -2002

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

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

Multidisciplinary Team Pathologists Radiologists Surgeons

Breast Units • Integrated Breast Service Diagnosis Radiologist Breast Care Surgeon Nurse Pathologist

Breast Units • Integrated Breast Service Primary Surgery Plastic Surgeon Breast Care Surgeon Nurse Radiologist Pathologist Oncologist

Breast Units Adjuvant Therapy Breast Surgeon Breast Care Nurse Pathologist Oncologist

Breast Units Advanced Disease Radiologist Breast Surgeon Breast Care Orthopaedic Ortho Nurse Radiologist Surgeon Oncologist Palliative care Oncologist Specialist

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

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

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

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

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

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