Triple assessment breast clinics: The value of clinical core biopsies.

BACKGROUND: Triple Assessment Breast Clinics are designed for rapid diagnosis of symptomatic patients. When there is no concordance between clinical and radiological assessment, clinicians perform clinical core biopsies. In patients with a clinically suspicious examination (S4, S5) and normal imaging, clinically guided core biopsy should be performed as per NCCP guidelines. However, substantial research does not exist on the diagnostic value or use of clinical core biopsies in non-suspicious palpable (S3) lesions and practices differ in each health system. AIMS: The aim of this research was to assess the diagnostic value of clinical core biopsies in nonsuspicious, probably benign palpable breast lesions (S3) where image guided cores were not indicated (R1/R2). METHODS: The cohort consisted of patients undergoing clinical core biopsies at a Symptomatic Breast Unit from January 2014 to 2019. Data regarding patient demographics, outcome of triple-assessment and incidence of malignancy were obtained from a prospectively maintained database and results were analysed using Minitab 2018. RESULTS: Three hundred and sixty patients had a clinical core biopsy performed in this period. Clinical examination scores for these patients were S1/S2 (66), S3 (277), S4 (15), and S5 (2). Radiology Scores were R1/R2 (355) and R3(5). Two patients with clinical score S3 (0.6%) were diagnosed with breast cancer due to their clinical cores. Both patients had normal mass imaging. There was no association between uncertain palpable breast lesions (S3), and atypia or malignancy on biopsy results when breast imaging was normal (P = 0.43, χ2 test). CONCLUSION: Despite clinical core biopsies being used in triple assessment, there is no certainty in their value except that there is high clinical suspicion. Imaging modalities are constantly improving and are already well established. When the patient is assigned a clinical score of S3 and has normal radiology, a clinical core biopsy is not required in most cases.

Requerimientos del esquema de control de calidad europeo para el tratamiento de las pacientes con cáncer en las unidades de mama. Iniciativa de la Comisión Europea para el Cáncer de Mama (ECIBC) / Requirements of the European quality assurance scheme for the treatment of cancer patients in breast units. European Commission Initiative on Breast Cancer (ECIBC)

Consciente del problema que supone el cáncer de mama, tanto a nivel de incidencia como de mortalidad, la Dirección General para la Salud y la Seguridad Alimenticia de la Comisión Europea ha creado el programa de la Iniciativa para el Cáncer de Mama de la Comisión Europea (ECIBC) para establecer una igualdad en la oportunidad del manejo del cáncer de mama en todas las pacientes de la Unión con independencia del país en el que se traten. En este proyecto se han redactado 86 requerimientos que engloban aspectos generales de cribado, de diagnóstico, de tratamiento, de rehabilitación, de seguimiento y de cuidados paliativos del cáncer de mama, que han de cumplir aquellas Unidades de Mama (UM) que quieran obtener esta certificación. De momento se ha lanzado un programa piloto para las UM voluntarias con la finalidad de evaluar la viabilidad de la aplicación de estos requerimientos y obtener un feedback por parte de las mismas para el redactado final de estos. En esta contribución se exponen los requerimientos que integran el proyecto. (AU)

Aware of the problem of breast cancer in terms of both incidence and mortality, the European Commission's Directorate General for Health and Food Safety has created the European Commission Initiative on Breast Cancer (ECIBC) program to establish equal opportunity in the management of breast cancer in all patients in the Union, regardless of the country in which they are treated. In this project, 86 requirements have been designed, covering general aspects of: screening, diagnosis, treatment, rehabilitation, follow-up and palliative care of breast cancer, which must be met by those Breast Cancer Services (BCS) that wish to obtain this certification. A pilot program has been launched for voluntary BCS in order to evaluate the feasibility of applying these requirements and to obtain feedback from them for the final drafting of these requirements. This contribution sets out the requirements. (AU)

Aesthetic results following breast cancer surgery: A prospective study on 6515 cases from ten Italian Senonetwork breast centers.

Breast cancer treatment has deeply changed in the last decades, since clinical and oncological cure cannot be achieved without patient's satisfaction in term of aesthetic outcomes. Several methods have been proposed to objectively assess these results. However, Italian breast centers have not yet agreed on measurable, reproducible and validated aesthetic outcome indicators to monitor their performance. METHODS: The study was designed and conducted by Senonetwork, a not-for-profit association of Italian breast centers. Ten breast centers were selected based on specific eligibility criteria. This multicentre observational prospective study recruited 6515 patients with diagnosis of in situ or invasive breast cancer who underwent breast surgery in the years 2013-2016. Thirteen indicators of aesthetic results and of related quality of care were analyzed. Data collection and analysis were conducted using a common study database. RESULTS: On average, seven out of ten centers were able to collect data on the proposed indicators with a proportion of missing values < 25%. By expert consensus based on study results, some seven indicators have been defined as "mandatory" while the remaining six have been defined as "recommended" because they require further refinement before they can be proposed for monitoring aesthetic outcomes or because there are doubts on the feasibility of data collection. The minimum standard is reached for 5 of 13 indicators. This finding and the wide range between centers reveal that there is ample room for improvement. CONCLUSIONS: From the present study useful measurable aesthetic parameters have emerged, leading to the definition of target objectives that breast centers can use for benchmarking and improvement of quality of care.

European Breast Cancer Conference manifesto on breast centres/units.

MANIFESTO-CALL TO ACTION.

The European patient advocacy perspective on specialist breast units and accreditation.

Europa Donna--The European Breast Cancer Coalition has been advocating for all women to have access to care in specialist breast units since 2003. Two European Parliament Resolutions, (2003 and 2006) as well as the Written Declaration against breast cancer in the EU of 2010 called on member states to ensure that all women in the European Union have access to treatment in such units set up in accordance with the "European Guidelines for quality assurance in breast cancer screening and diagnosis," by 2016. Once mammography screening implementation according to EU Guidelines commenced, it became evident that it would be essential to have high-quality units where women would receive specialised treatment upon diagnosis. Europa Donna was a member of the revision committee for Chapter 9 of the 4th edition of these Guidelines (2006) which provided a detailed description of these services as previously defined by EUSOMA. Moreover, the 2010 Written Declaration on the fight against breast cancer in the EU called on the Commission "to develop a certification protocol for specialist breast units in accordance with EU Guidelines by 2011". The most important thing for a woman diagnosed with breast cancer to know is where to go to get the best treatment, i.e. she needs to know that the clinic or unit is accredited as having implemented appropriate quality standards that meet EU Guidelines thus ensuring provision of high level breast services, and that her national health system will pay for it. Progress on accomplishing this has not moved quickly, nor has it been accepted by all stakeholders involved.

Standards in breast surgery - Breast Units - future and necessity.

Breast cancer is the most common type of malignant neoplasm affecting women. In Poland there are nearly 15 500 new cases of the disease and over 5200 deaths due to it observed annually. As it was necessary to provide those suffering from breast cancer with combined highly specialist treatment, it was required that separate units specialising in breast surgery be established. In Europe they are referred to as Breast Units. The idea of forming such separate and fully profiled centres specialising in breast diseases, which was developed in 1998 by EORTC, EUSOMA as well as Europa Donna, gave foundations for the organisation of such centres. The situation of Breast Units in other European countries is different. Poland has failed so far to organise an effective system of Breast Units. Leading Polish authorities underline that formation of multi-disciplinary Breast Units is the organisational priority for the year 2013.