The National Audit of Breast Cancer in Older Patients (NABCOP) is 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. NABCOP is a three year project that started in April 2016.

NABCOP is 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 are 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 NABCOP is managed by a Project Team at the CEU.

About 45,000 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 NABCOP is 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 are newly diagnosed with breast cancer between 1st January 2014 and 31st December 2017, in NHS hospitals within England and Wales, are eligible for inclusion in NABCOP. Such patients are identified for inclusion from the country-specific cancer registries.

Unlike many other national clinical audits, NABCOP will not directly ‘collect’ patient data. Instead, we will use 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 is no need for Trusts to formally register for this audit, or input data on patients through a separate Database portal. Additionally there is no audit specific deadline for trusts to submit data.

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

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

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

The Welsh Cancer Network provides 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).

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

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

There is no need for your trust to formally register for this audit since the NABCOP uses existing sources of patient data collected. All you need to do is ensure your trust regularly uploads the necessary data to Cancer Registry, COSD, SACT and RTDS (Canisc & PEDW for local health boards in Wales).

The NABCOP uses existing sources of patient data routinely collected by national organisations, therefore, there is no audit specific deadline for your trust to submit data. Rather any deadlines for data submission are those specific to the Cancer Registry, COSD, RTDS, SACT, Canisc deadlines; schedules can be found on their individual websites or via contact with the relevant organisation.

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

A key aspect of the audit is to describe patterns of care within different age groups.  The number of women within some of these groups becomes quite small when we analyse a single year.  Therefore, to ensure the figures were accurate, we used 3-years of data.

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 ODRs in England and Wales to the NABCOP project team. This data is then merged and analysed by the NABCOP project team and written up into the annual report.

For all queries related to NABCOP, please contact us.