Breast Cancer Surveillance Consortium (BCSC):

sponsored by the National Cancer Institute

Cancer Screening Surveillance in Clinical Practice

Tracy Onega, PhDDirector, NH Mammography Network, Assistant Professor of Community & Family MedicineDartmouth Medical School & the Norris Cotton Cancer Center

Circa early-mid 1990s………….

No understanding of screening mammography process or quality

MQSA passed to ensure standardized delivery of quality mammography services

NCI responded to legislative mandate by establishing surveillance system to provide reliable and comprehensive performance data

Flashback to pre-BCSC……..

Breast Cancer Screening Process

PROCESS SURVEILLANCE OUTCOME SURVEILLANCE

Patient Factors

Screening Examination

s

Diagnostic

Evaluations

Intermediate Outcome

Long-term Outcome

Treatment

Surveillance Systems for Routine Clinical

Practice

• Integral to clinical care processes

• Population based / part of consortia

• Interdisciplinary

• Longitudinal

• Informing and Improving:

• Patients’ lives

• Provider care

• Evidence-based guidelines

• Tailored screening approaches

• Research

Screening Registries Should Be…..

The Cornerstone:Infrastructure & Common Data Elements

GHRI

SFMR

CMR

NHMN

VBCSS

Map SCC Consolidated

Data

Data Management /Warehouse

Data Analysis

Registry Data Collection MethodsRegistry Data Collection Methods

Women’s Questionnaire(filled out at time

of mammogram)

Radiologist/Rad Tech Form

(filled out at time ofmammogram)

Pathology Reports(abstracted) State

CancerRegistry

Vital Status (DHHS)

Registry DatabaseRegistry Database

Radiologist Info

Facility Info

Cancer Care Continuum & BCSC Resources

Foundation for Infrastructure

Facilities

Women

Providers

Voluntary registries – how to develop & maintain buy-in?

Fostering Participation

Facilities

Clinicians

Patients

MQSA, quality measures,benchmarking

Performance feedbackRelationships

Disseminating findings,Electronic data capture,Rad tech support

Software for clinical data collection

Tablet PCs

Integration with electronic health records

Continuous breast density

Digital image collection

Standardized data elements for new modalities

Built-in reporting

Data Collection Innovations

Built-in Reporting

From: Geller B.

Confidentiality & Legal Infrastructure

• Federal Certificate of Confidentiality• strongest protection• tested in court• protects providers and patients

http://cancercontrol.cancer.gov/acsrb/priorities_figures.html

Screening in Cancer Control

Concept Map Showing Priority and Thematic Areas of Research for the Applied Cancer Screening Research Branch at NCI

Improved Breast Cancer ScreeningPractices

Expanding the Utility of the BCSC

Medicare Claims

Ovarian Cancers

New Technologi

es

Thank You to the

National Cancer

Institute