The National Audit of Breast Cancer in Older Patients (NABCOP) was a clinical audit to evaluate the quality of care provided to women aged 70 years and older by breast cancer services in England and Wales. The NABCOP started in April 2016 and ended in September 2022. Two new breast cancer audits commenced in 2022 and will be informed by the learning from the NABCOP.

The decision to decommission the NABCOP was taken as part of the decision to launch a new National Cancer Audit Collaborating Centre, which will be hosted by the Clinical Effectiveness Unit (CEU) at the Royal College of Surgeons of England, who also ran the NABCOP. As part of the new Centre, breast cancer audit will be expanded into two new audits looking at breast cancer in mean and women of all ages. The work of the NABCOP and lessons learned will all feed into the new audits. Find out more about the new audits.

The NABCOP was a national clinical audit run by the Association of Breast Surgery (ABS) and the Clinical Effectiveness Unit (CEU) of the Royal College of Surgeons of England (RCS). We were commissioned by the Healthcare Quality Improvement Partnership (HQIP) as part of the National Clinical Audit and Patient Outcomes Programme (NCAPOP).

Day to day running of the NABCOP was managed by a Project Team at the CEU.

Over 50,000 new cases of breast cancer are diagnosed each year in England and Wales. National clinical guidelines provide health services with evidence about the best care for breast cancer, and these emphasise that treatment should be based on clinical need and fitness for treatment rather than chronological age.

There is however, evidence of variation in patterns of care among younger and older patients with breast cancer. This variation may be due to factors such as:

(i) Differences in the nature and extent of disease;
(ii) The presence of other conditions that make surgery, chemotherapy or radiotherapy unsuitable for older patients; or
(iii) Patient preferences and cultural values.

The aim of the NABCOP was to understand why differences arise and to identify examples of good and poor practice to inform breast cancer services about how they can improve.

All women aged 50 years or older who were newly diagnosed with breast cancer from 1st January 2014 onwards, in NHS hospitals within England and Wales, were eligible for inclusion in the NABCOP. Such patients were identified for inclusion from the country-specific cancer registries.

Unlike many other national clinical audits, the NABCOP did not directly ‘collect’ patient data. Instead, we used existing sources of patient data collected by national organisations. These include the National Cancer Registration and Analysis Service (NCRAS) in England and the Cancer Network Information System Cymru (Canisc) in Wales.

Therefore, there was no need for NHS organisations to formally register for this audit, or input data on patients through a separate database portal. Additionally there was no audit specific deadline for trusts to submit data.

This model of data access was previously successfully applied by the Clinical Effectiveness Unit (CEU) of the Royal College of Surgeons of England in the National Prostate Cancer Audit.

The national data opt-out service allows patients to opt-out of their confidential patient information being used for purposes other than their immediate clinical care. All NHS organisations are required to be compliant with the national data opt-out policy.

Guidance on the deadline for compliance and how to comply is provided on the NHS website: https://digital.nhs.uk/services/national-data-opt-out/operational-policy-guidance-document/compliance-with-the-national-data-opt-out

For national clinical audits such as the NABCOP, using existing sources of patient data collected by the National Cancer Registration and Analysis Service (NCRAS) in England, individuals’ opt-out preferences were applied by NCRAS prior to the NABCOP receiving the datasets.

The National Cancer Registration and Analysis Service (NCRAS) provided data for women diagnosed and treated in England from the following main data sources:

• Cancer Registry
• Cancer Outcomes and Services Dataset (COSD);
• Hospital Episodes Statistics (HES);
• National Radiotherapy Dataset (RTDS);
• Systemic Anti-Cancer Therapy (SACT);
• Office for National Statistics (ONS).

The Wales Cancer Network provided data for women diagnosed and treated in Wales from the following main data sources:

• Cancer Network Information System Cymru (Canisc);
• Patient Episode Database for Wales (PEDW);
• Office for National Statistics (ONS).

For more detail about the specific data items used for this audit, please see the NABCOP Combined Data Specification

For information about improving the quality of data submissions for future breast cancer audits, the Data Liaison team within the NCRAS have a wealth of knowledge on cancer pathways and processes within NHS Trusts in England and can help with this.

Yes, all NHS healthcare providers are expected to participate in HQIP-funded projects within the National Clinical Audit and Patient Outcomes Programme. The NABCOP was one of these projects.

Further information about national clinical audits is available on the HQIP website.

Unlike many other national clinical audits, the NABCOP did not directly ‘collect’ patient data and so there was no submission of cases to us as such. Instead, we used existing sources of patient data collected by national organisations, including the National Cancer Registration and Analysis Service (NCRAS) in England and the Wales Cancer Network.

We therefore don’t have the information to tell you how many cases were submitted for your trust.

Following guidance from members of the Clinical Steering Group (CSG) of the NABCOP, if an NHS organisation diagnoses fewer than 30 breast cancer patients a year, or diagnosed fewer than 30 breast cancer patients in the most recent year of cancer registry data the report looks at, this NHS organisation would not be included in the annual report tables and figures. The threshold for inclusion in an annual report was agreed at the October 2017 CSG meeting, and re-confirmed at the November 2018 CSG meeting.

In addition, NHS organisations that mainly provide oncological treatment for breast cancer patients as tertiary centres were not included as a named organisation within the NABCOP report. Any patients allocated to this type of NHS organisation in England, within the data provided by NCRAS, would be reallocated to the NHS organisation where the patient was diagnosed, as determined by the location of the Multi Disciplinary Team meeting or surgery.

If you have any further queries about this, please contact us.

The audit used data provided by the English and Welsh cancer registration process. These datasets become available by calendar year rather than financial year and so we followed this format when analysing the data.

A key aspect of the audit was to describe patterns of care within different age groups.  The number of women within some of these groups became quite small when we analysed a single year. Therefore, to ensure the figures were accurate, we generally used all data available from 1 January 2014. The specific years used within an individual section of the annual report are clearly shown at the beginning of each section.

The process involved with registration of a new diagnosis of breast cancer, data querying and validation takes around 11 months, by which point the data is ready to be released by the Offices of Data Release (ODRs) in England and Wales to the NABCOP project team. This data was then merged and analysed by the NABCOP project team and written up into the annual report.

A graphic representation of the NABCOP Analysis Timeline, based on receiving the English dataset from NCRAS, is available to download via our Resources page.

For all queries related to the NABCOP, please contact us.