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. The NABCOP is a five year project that started in April 2016.

The 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 the 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 the 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 the NABCOP. Such patients are identified for inclusion from the country-specific cancer registries.

Unlike many other national clinical audits, the 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 NHS organisations 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 data opt-out allows patients to opt-out of their information being used for purposes other than their immediate clinical care (such as for audit and research purposes). All NHS organisations are required to be compliant with the national data opt-out policy by 30th September 2020; guidance on this is provided on the NHS website: https://digital.nhs.uk/services/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, individual’s opt-out preferences are applied by NCRAS prior to the NABCOP receiving the datasets. We will be publishing further information on how NHS organisations can ensure they are compliant with the national data opt-out, specifically with regard to the NABCOP, in advance of the 30 September 2020 deadline.

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

The Wales 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. The NABCOP is one of these projects.

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

There is no need for your NHS organisation 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 NHS organisation 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.

Unlike many other national clinical audits, the NABCOP does not directly ‘collect’ patient data and so there is no submission of cases to us as such. Instead, we use 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 have been 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 diagnoses fewer than 30 breast cancer patients in the most recent year of data the report looks at, this NHS Organisation will not be included in the Annual Report tables and figures. The threshold for inclusion in the Annual Report was agreed at the October 2017 CSG meeting, and re-confirmed at the November 2018 CSG meeting.

For the NABCOP 2019 Annual Report, this applies to those NHS Organisations with fewer than 120 patients diagnosed over the 4 year period of 2014–17 or fewer than 30 patients diagnosed at their NHS Organisation in 2017 (as per the registration dataset provided by NCRAS in England and Canisc in Wales in December 2018).

In addition, NHS Organisations that mainly provide oncological treatment for breast cancer patients as tertiary centres, are not included as a named trust within the NABCOP report. Any patients allocated to this type of NHS Organisation in England, within the data provided by NCRAS, will 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 queries about how your data is submitted to NCRAS, please contact the Data Improvement Lead within your area who will be able to help:

Note: Details are correct as of May 2019.
If you have queries about how your data is submitted to Canisc, please contact the CaNISC training and support team who will be able to help.

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

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 4-years of data in the NABCOP 2019 Annual Report.

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 is 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.