The biennial Symposium on Primary Breast Cancer in Older Women is taking place on Friday 4th March 2022. It is hosted by the University of Nottingham under the auspices of the International Society of Geriatric Oncology.

Faculty include Professor Kwok-Leung Cheung, Professor of Breast Surgery and Medical Education, and a NABCOP Clinical Steering Group member.

This one day event aims to help delegates develop an understanding around the support and management of older women with breast cancer.

For further information, please visit the event website.

Published November 2021.

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 NABCOP Newsletter Issue 2021 (4) is now available.

The Newsletter has been emailed to all our known contacts at NHS Trusts and Health Boards that provide breast cancer care in England and Wales. If you would like to be added to our eNewsletter mailing list, please contact us.

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 NABCOP Newsletter Issue 2021 (3) is now available.

The Newsletter has been emailed to all our known contacts at NHS Trusts and Health Boards that provide breast cancer care in England and Wales. If you would like to be added to our eNewsletter mailing list, please contact us.

The NABCOP Newsletter Issue 2021 (2) is now available.

The Newsletter has been emailed to all our known contacts at NHS Trusts and Health Boards that provide breast cancer care in England and Wales. If you would like to be added to our eNewsletter mailing list, please contact us.

The NABCOP Newsletter Issue 2021 (1) is now available.

The Newsletter has been emailed to all our known contacts at NHS Trusts and Health Boards that provide breast cancer care in England and Wales. If you would like to be added to our eNewsletter mailing list, please contact us.

The NABCOP Newsletter Issue 2020 (4) is now available.

The Newsletter has been emailed to all our known contacts at NHS Trusts and Health Boards that provide breast cancer care in England and Wales. If you would like to be added to our eNewsletter mailing list, please contact us.

The NABCOP Newsletter Issue 2020 (3) is now available.

The Newsletter has been emailed to all our known contacts at NHS Trusts and Health Boards that provide breast cancer care in England and Wales. If you would like to be added to our eNewsletter mailing list, please contact us.

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.