This survey is open to healthcare professionals who provide Breast Cancer services in NHS hospitals in England and Wales. We are particularly interested in the views of oncologists and surgeons working in this area.

The purpose of the Scoping Survey is to seek your view, as a stakeholder, on the current priorities for the audit of Primary Breast Cancer and Metastatic Breast Cancer, specifically (1) where care could be improved to provide most benefit and (2) which subgroups of patients could benefit from care being improved.

The findings from the survey will inform initial discussions around areas for Quality Improvement, and related indicators for each of the audits.

Your time helping with this is much appreciated.

1. Deadline for responses: 28 April 2023.
2. Link to Scoping Survey: https://www.surveymonkey.co.uk/r/BCa-Scoping-survey-V2

Note: If you leave the survey and return to it later, you must use the same browser and computer on which the form was started, otherwise answers to the completed questions will be lost.

If you have any problems with the survey or have questions, please contact us at breastcanceraudits@rcseng.ac.uk.

We look forward to receiving your feedback.

The Breast Cancer Audits team

The National Audit of Breast Cancer in Older Patients (NABCOP) has been highly commended by the Richard Driscoll Memorial Award 2022, for an excellent patient involvement programme and co-produced resources.

The Richard Driscoll Memorial Award celebrates great public and patient involvement in the national clinical audit and patient outcomes programme (NCAPOP), and is presented to the HQIP commissioned programme that has been judged to have best demonstrated that they have meaningful engagement with patients, carers and families embedded in their work.

Feedback from the judging panel included:

• The NABCOP is very patient-focused, with a well defined approach to patient engagement and involvement that has clearly thought about how to support a niche group of patients.
• The co-produced clinic guide was specifically mentioned as a positive, as was the fact that live surveys were used to gather feedback on the impact and value of the resources.
• The annual report, with a separate explainer report for patients and the public, is good.
• Charities as well as individual patients have been engaged and involved.

The NABCOP’s submission to the award is available on the HQIP website, or by clicking the image below.

You can also find out about this year’s winner on the HQIP website.

Preparations are under way to commence two new national breast cancer audits, as the work of the National Audit of Breast Cancer in Older Patients (NABCOP) draws to a close.

As announced earlier this year, on 1 October 2022, the new National Cancer Audit Collaborating Centre (NATCAN) will be launched and is designed to strengthen NHS cancer services by looking at treatments and patient outcomes across England and Wales. The NATCAN will be run by the Clinical Effectiveness Unit (CEU) at the Royal College of Surgeons of England.

The NATCAN’s programme of work includes two new breast cancer audits. The first audit will look at primary breast cancer, while the second will focus on secondary (metastatic) breast cancer, for women and men of all ages.

The CEU has been managing the NABCOP since April 2016, and the work of the NABCOP and lessons learned will be used to inform the planning and delivery of the two new audits.  Resources from the NABCOP such as the guide to the breast cancer pathway for older women, and the fitness assessment for older patients in the breast clinic, continue to be made available.

The Clinical Leads and CEU staff who have worked for the NABCOP will also continue to be involved in the two new audits, helping to ensure a smooth transition and continuity of expertise in breast cancer audit. The new audits will also use the same data sources, principally the cancer registration datasets.  Improving data completeness among key data items will continue to be imperative for accurate reporting. Breast cancer units should continue their cancer registration data returns and implement NABCOP recommendations while the new audits are established.

The NABCOP website will remain available and the NABCOP Twitter account (@NABCOP_news) and newsletters will provide updates about the new audits as more information becomes available.

More information about the NATCAN is available on the HQIP and Royal College of Surgeons of England websites.

For any queries relating to either of the two new breast cancer audits (including any questions not answered by the information above), or if additional colleagues at your services should be added to our distribution lists for the new audits please email the audit team at breastcanceraudits@rcseng.ac.uk.

Any queries relating to the NABCOP can be addressed to the NABCOP team via the website contact form or at nabcop@rcseng.ac.uk.

The National Audit of Breast Cancer in Older Patients (NABCOP) has published its 2022 Annual Report on May 12th 2022.

It presents results from the prospective audit of women aged 50 years and over, diagnosed with breast cancer between 1 January 2014 and 31 December 2020, in England and Wales. Specifically, it looks at the impact of age on patterns of care, treatment received and outcomes.

This is a collaboration between the Association of Breast Surgery (ABS) and the Clinical Effectiveness Unit (CEU) of the Royal College of Surgeons of England (RCS), and was commissioned by the Healthcare Quality Improvement Partnership (HQIP) as part of the National Clinical Audit and Patient Outcomes Programme (NCAPOP).

If you have any queries about the audit, please let us know.

For more information about NABCOP, please visit our FAQs for professionals and the public.

Thank you to the GIRFT team for providing the following comprehensive summary of the breast surgery report:

Measures which will allow clinicians to focus on older patients, who are more likely to have breast cancer, are among the key recommendations in the recently-published GIRFT national report for breast surgery; helping the NHS to restore safe and efficient care post-pandemic.

The GIRFT report – written by Tracey Irvine (consultant oncoplastic breast surgeon at the Royal Surrey County Hospital NHS Foundation Trust) and Fiona MacNeill (consultant breast surgeon at the Royal Marsden NHS Foundation Trust) – is the most complete picture of breast surgery activity there has ever been: the first time data about all breast operations in England has been brought together, whether carried out as plastic surgery, breast surgery, general surgery or another specialty. It focuses on surgery related to breast cancer but also looks at surgery for non-cancer reasons.

It is now available for everyone working in the specialty to download, even if you do not have an NHS email address. Click on the picture of the report to download it (you will need to register for access to this site, but permission is granted quickly).

The report follows meetings with clinicians and managers in 129 breast surgery units.

GIRFT’s deep dive discussions showed that the need to meet the ‘two week wait (2WW)’ access standard is the biggest challenge facing breast surgery teams. There are more than 500,000 new outpatient referrals every year in England and the number is increasing, but cancer detection rates have stayed the same. This is because referrals are rising for younger women, especially those under 40 who are least likely to have cancer, with a smaller increase in referrals among older women, who are more at risk.

One of GIRFT’s core recommendations aims to make referrals more flexible and to standardise assessments, giving patients more control and choice over their tests and treatment while still ensuring services can meet the new 28 Day Faster Diagnosis Standard (FDS).

The ability to manage new referrals is more crucial than ever as services work to maintain the capacity for early diagnosis in a post-COVID system. The pandemic has demonstrated the need for a more nuanced approach which can target those at greater and lesser risk of cancer in different ways and support appropriate breast assessments as efficiently and safely as possible.

Innovations which could help to achieve this include:

• Better breast health awareness information for everyone, especially those with lower risk of cancer, and more targeted breast cancer awareness information for those in higher-risk groups, such as those over 70;
• Piloting new assessment pathways such as ‘straight to mammogram’ for women over 40 who have concerns about breast changes;
• Piloting open access clinics so that patients can choose when to attend.

The report is enriched with patient stories and aligns with the NABCOP principles – at the time of GIRFT’s national review visits only 16% of trusts had a dedicated pathway for the older patient, but this was discussed and explored further at every deep dive meeting.

The authors also address the need to reduce unnecessary visits to hospital, minimise unnecessary interventions and improve data collection to inform future improvements in a post-COVID system.

GIRFT’s data shows around 102,000 breast operations are carried out every year in the NHS in England – 85% performed by breast or general surgeons and 15% by plastic surgeons. More than 60% of admissions are directly related to primary breast cancer treatment.

Recommendations in the report aim to ensure that any woman with breast cancer can make a balanced and informed choice on her treatment, unrestricted by resources. This includes having full access to the latest oncoplastic surgery techniques and neoadjuvant therapies, supporting safe cancer surgery and breast appearance after breast conservation or mastectomy. Careful selection of procedures can help to avoid some mastectomies in all age groups, and help ensure patients do not undergo more surgery than they need, making more effective use of resources for essential care.

GIRFT strongly recommends that oncoplastic multidisciplinary teams (MDTs) are established in all units, both to support more oncoplastic conservation and, for women who opt for mastectomy, to provide access to the full range of reconstruction techniques most appropriate for her needs, regardless of age.

New data in the report on immediate reconstruction rates by age group shows that around half of women under 50 have an immediate reconstruction following mastectomy, compared to under 10% of women over 70. There has been a small increase in the proportion of women over 70 who have an immediate reconstruction in recent years – in an ageing population, with a growing proportion of people having different expectations of what ‘old age’ should be like, it is likely that demand will increase further.

The report also strongly recommends that clinical coding and data capture in the specialty must be improved – including the routine collection of patient reported outcome measures (PROMS) – to provide quality evidence to help understand progress, track the impact of COVID-19 and better plan future care.

Published November 2021

The National Audit of Breast Cancer in Older Patients (NABCOP) has published its 2021 Annual Report on August 12th 2021.

It presents results from the prospective audit of women aged 50 years and over, diagnosed with breast cancer between 1 January 2014 and 31 July 2020, in England and Wales. Specifically, it looks at the impact of age on patterns of care, treatment received and outcomes.

This is a collaboration between the Association of Breast Surgery (ABS) and the Clinical Effectiveness Unit (CEU) of the Royal College of Surgeons of England (RCS), and was commissioned by the Healthcare Quality Improvement Partnership (HQIP) as part of the National Clinical Audit and Patient Outcomes Programme (NCAPOP).

If you have any queries about the audit, please let us know.

For more information about NABCOP, please visit our FAQs for professionals and the public.

The National Audit of Breast Cancer in Older Patients (NABCOP) has published its 2020 Annual Report on July 9th 2020.

It presents results from the prospective audit of women aged 50 years and over, diagnosed with breast cancer between 2014 and 2018, in England and Wales. Specifically, it looks at the impact of age on patterns of care, treatment received and outcomes.

This is a collaboration between the Association of Breast Surgery (ABS) and the Clinical Effectiveness Unit (CEU) of the Royal College of Surgeons of England (RCS), and was commissioned by the Healthcare Quality Improvement Partnership (HQIP) as part of the National Clinical Audit and Patient Outcomes Programme (NCAPOP).

If you have any queries about the audit, please let us know.

For more information about NABCOP, please visit our FAQs for professionals and the public.

Understanding the treatment of older women with breast cancer – Survey

NABCOP collaborators, based at the Brighton and Sussex Medical School, are conducting a research study to understand decision making for treatment options of older women with breast cancer.

They are seeking clinicians, with expertise in breast cancer treatment, to answer a survey based on their experience of treatment decision making.

Click the button below to read more about this research study and to take part.

Treatment of Older Women with Breast Cancer Survey

The National Audit of Breast Cancer in Older Patients (NABCOP) has published its 2019 Annual Reports.

The NABCOP 2019 Annual Report describes the findings from its prospective audit. This was a collaboration between the Association of Breast Surgery (ABS) and the Clinical Effectiveness Unit (CEU) of the Royal College of Surgeons of England (RCS), and was commissioned by the Healthcare Quality Improvement Partnership (HQIP) as part of the National Clinical Audit Patient Outcomes Programme (NCAPOP).

The Public and Patient version of this report is also available to download.

If you have any queries about the audit, please let us know.

For more information about NABCOP, please visit our FAQs for professionals and the public.

The National Audit of Breast Cancer in Older Patients (NABCOP) has published its 2018 Annual Report.

The NABCOP 2018 Annual Report describes the findings from its prospective audit. This was a collaboration between the Association of Breast Surgery (ABS) and the Clinical Effectiveness Unit (CEU) of the Royal College of Surgeons of England (RCS), and was commissioned by the Healthcare Quality Improvement Partnership (HQIP) as part of the National Clinical Audit Patient Outcomes Programme (NCAPOP).

If you have any queries about the audit, please let us know.

For more information about NABCOP, please visit our FAQs for professionals and the public.