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 October 2022 and will be informed by the learning from the NABCOP.

Clinical audit is a tool used by health care professionals to monitor and improve patient care by comparing how patients are treated and their outcomes against explicit standards or guidelines.

In a clinical audit, information on the care received by patients is collected and analysed to see if individual clinicians and hospitals are following national clinical standards, such as those published by the National Institute for Health and Care Excellence (NICE). These audits usually also produce information for hospitals to compare their outcomes of care with other hospitals.

This national clinical audit was 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 funded by the Healthcare Quality Improvement Partnership (HQIP).

Day to day running of the NABCOP was managed by a project team at the CEU.

We wanted to support the improvement of hospital care for older patients with breast cancer. Research shows that there are differences in the care given to younger and older patients with breast cancer. The NABCOP aimed to find out what these differences were and to understand why these differences were happening.

We shared our findings with hospitals in England and Wales. In particular, we told hospitals about the areas of breast cancer care that they were doing well in and where they could improve.

All NHS hospitals in England and Wales that provide breast cancer care participated in the NABCOP.

The NABCOP did not ‘collect’ patient data directly. Instead, we used information about patients that had already been collected by national organisations in England and Wales. These include the National Cancer Registration and Analysis Service (NCRAS) in England and the Cancer Network Information System Cymru (CANISC) in Wales. To find out more about information collected by cancer registration services, please visit the NCRAS website.

Findings from the NABCOP are published on this website.

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 were required to be compliant with the national data opt-out policy by 31st March 2022.

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 were applied by NCRAS prior to the NABCOP receiving the datasets.

For more information on the national data opt-out, please visit the NHS website: https://www.nhs.uk/your-nhs-data-matters/

We used data collected on patients who were diagnosed with breast cancer from 1st January 2014 onwards and received care in NHS hospitals in England and Wales.

The aim of the audit was to improve the care received by patients with breast cancer, by making recommendations to breast cancer services based on our findings. For example, the NABCOP made recommendations on:

• How women were diagnosed and their fitness was assessed
• The type of surgery that older women have for breast cancer
• The use of radiotherapy after surgery
• The use of chemotherapy

We worked closely with patient representatives and patient charities on many aspects throughout the project, from deciding what information to collect to how the results were reported.

The following websites provide general breast cancer information and support:

• Cancer Research UK: https://www.cancerresearchuk.org/about-cancer/breast-cancer
• Breast Cancer Now: https://breastcancernow.org/
• Macmillan Cancer Support: https://www.macmillan.org.uk/cancer-information-and-support/breast-cancer
• NHS information on breast cancer: https://www.nhs.uk/conditions/breast-cancer/
• The Breast Cancer Haven: https://www.breastcancerhaven.org.uk/
• Flat Friends: https://www.flatfriends.org.uk/

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.

For patient information about the NABCOP, please read our patient information leaflet.
For all queries related to the NABCOP, please contact us.