West Midlands Cancer Intelligence Unit Extending Quality Assurance to all Breast Cancers: the BCCOM Project UKACR Annual Conference 29 September 2004 Gill

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]


Acknowledgements

Breakthrough Breast Cancer

Association of Breast Surgeons at the British Society of Surgical Oncology

Breast Surgeons

Cancer registries

Mr Ian Monnypenny


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


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


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1 has withdrawn due to data collection issues


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%


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%


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


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


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


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


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


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


Documents

West Midlands Cancer Intelligence Unit Extending Quality Assurance to all Breast Cancers: the BCCOM Project UKACR Annual Conference 29 September 2004 Gill