west midlands cancer intelligence unit extending quality assurance to all breast cancers: the bccom...
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West Midlands Cancer Intelligence Unit
Extending Quality Assurance to all Breast Cancers: the BCCOM Project
UKACR Annual Conference
29 September 2004Gill Lawrence1, Catherine Lagord1, Olive Kearins1, Tom Bates2
1West Midlands Cancer Intelligence Unit
2Association of Breast Surgery at BASO
Tel: 0121 415 8129 Fax: 0121 414 7712
e-mail: [email protected]
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 ABS@BASO 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 ABS@BASO 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 ABS@BASO 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1 has withdrawn due to data collection issues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
% cancers registered within period
0
20
40
60
80
100
A1 A2 B1 B2 C1 D1 E1 E2 F1 G1 H1 H2surgeon
%
90.4%
West Midlands Cancer Intelligence Unit
National pilot study results III
% cancers registered with same consultant
0
20
40
60
80
100
A1 A2 B1 B2 C1 D1 E1 E2 F1 G1 H1 H2surgeon
%
78.5%
West Midlands Cancer Intelligence Unit
1 non-Hodgkins lymphoma1 metastasis of fallopian tube13 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
18.6 15.1 60.5 4.7 1.2
51.4 13.5 18.9 16.2 0
ER status 2001
ER status 200264.9
33.7
69.1 20.3 4.1 1.6 4.9
65.9 27.6 3.3 0 3.3
65.0 30.1 1.6 1.6 1.6
28.5 14.6 48.0 8.1 0.8
Size
Nodal status
Grade
ER status
89.4
93.5
95.1
43.1
64.1 10.7 7.8 7.8 9.7
59.2 32.0 3.9 4.9 0
76.7 11.7 1.9 5.8 3.9
15.5 20.4 60.2 3.9 0
74.8
91.2
88.4
35.94.2 22.5 73.2 0 0
40.6 15.6 31.3 12.5 026.7
56.2
Data itemSame on both (%)
Not on either (%)
Only on BS (%)
Only on WMCIU
(%)
Different (%)
100 0 0 0 0
99.2 0 0 0 0.8
Invasive status
Side
Surgeon H1 = 123 cases
100
99.2
Same on both (%)
Not on either (%)
Only on BS (%)
Only on WMCIU
(%)
Different (%)
93.2 0 0 3.9 0
0 0 0 100 093.2
0
Surgeon H2 = 103 cases
West Midlands Cancer Intelligence Unit
Could WMCIU data be used to produce outcome data which clinicians can trust?
3993 cases 2001/02
3783 (95%) unique surgeon
0
10
20
30
40
50
60
%SD %2+ ops %Mx
%
surgeon 1 surgeon 2
surgeon 3 surgeon 4
Cases diagnosed 2000-2002
3248 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
0
20
40
60
80
100
120
140
160
180
200
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47
Screen Detected Symptomatic
median screening caseload 15
median all breast cancer caseload 75
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