Non-surgical management of early breast cancer in the United Kingdom: work-load, referral patterns and staging. Clinical Audit Sub-committee of the Faculty of Clinical Oncology, Royal College of Radiologists, and the Joint Council for Clinical Oncology

Variations in treatment and survival in breast cancer

To achieve optimum quality of care for women with breast cancer in the UK, uniformity of care in accordance with consensus guidelines is needed. This review highlights variations in provision of care for women with breast cancer, with particular emphasis on care received in the UK, examines differences in survival, and discusses the factors that may underlie these differences. Strong variation in treatment was identified, which appeared to affect survival significantly. These findings reinforce the need for women with breast cancer to be treated by dedicated specialists working within a multidisciplinary team to provide a high standard of care.

Breast cancer in Scotland: changes in treatment and work-load. Scottish Breast Cancer Focus Group and the Scottish Cancer Therapy Network

Throughout Scotland, the patterns of care of patients with breast cancer were examined for the years 1987 and 1993. Substantial changes in oncological work-load were shown in the intervening period. The number of patients referred to an oncologist (clinical or medical) increased by 52% (from 1076 to 1634), the number of patients receiving postoperative radiotherapy to the breast or chest wall increased by 72% (from 724 to 1248) and the number of patients receiving adjuvant chemotherapy increased by 215% (from 123 to 388). The number of consultant oncologists increased by only 16% (from 32 to 37). If patients are to be treated to the standards expected, then increases in work-load must be matched by appropriate increases in staff.

Variation in postoperative radiotherapy delivery for patients with screen-detected breast cancer in the south Thames (east) Region

This paper stems from a region-wide audit of postoperative radiotherapy treatment for patients with screen-detected breast cancer, commencing from the start of the South Thames (East) screening programme in June 1988 and ending in March 1992. It reports on the variation in treatment practices amongst clinical oncologists in the region. There was diversity in treatment schedules, dose specification points, and the use of lymph node radiotherapy, breast boost and interstitial implants. While local protocols vary by centre and individual oncologist, many treatment decisions appear to have been dictated by the availability of machines and other resources. However, further analysis suggests that the variation is within the same range as that described in the nationwide survey of breast radiotherapy by the Audit Office of the Royal College of Radiologists in 1995 [1-3].

Benefits from specialised cancer care

The Expert Advisory Group's recommendations to establish cancer centres, cancer units, and a network involving primary care for the treatment of cancer patients in the UK is based on the view that specialisation in cancer care will improve outcomes. Evidence to support the various aspects of specialisation (eg, training, caseload, and the formation of multidisciplinary teams) is strongest for breast cancer, ovarian cancer, and some haematological malignant diseases. There is evidence to support the view that some specialised care can be successfully delivered by a network of district hospitals and main general or teaching hospitals and does not always require referral to cancer centres.

Non-surgical management of early breast cancer in the United Kingdom: ductal carcinoma in situ. Clinical Audit Sub-committee of the Faculty of Clinical Oncology, Royal College of Radiologists, and the Joint Council for Clinical Oncology

This paper describes the results of a national survey on the non-surgical treatment of early breast cancer in the UK relating to the management of ductal carcinoma in-situ (DCIS), and the rationale for the current status of the UK DCIS trial. The survey shows that there is considerable clinical uncertainty, which can only be resolved by the trial.