Abstract
The Commission for Health Improvement report into the West of London Breast Screening Service recommended that a formal structure for the follow up of recommendations made at quality assurance (QA) visits should be implemented. In the West Midlands, breast screening services are visited every 3 years as part of a rolling programme. Ad hoc visits can occur during this period to a service or one or more disciplines if there are issues or concerns with a particular aspect of a service. Following a QA Team visit, a breast screening service can expect 3-month and longer term recommendations, and occasionally immediate recommendations, which highlight areas that require action to improve service delivery. In order to allow structured follow-up, recommendations are classified into the following disciplines; administration and clerical, radiography, radiology, medical physics/user QA, pathology, surgery, nursing and management. A detailed process has been put into place that tracks the receipt of recommendation responses from the service, which allows completed recommendations to be analysed by discipline, type and time to completion. This detailed analysis can be used to identify which recommendations are completed effectively and within the set timescale, to identify which types of recommendations take longer to complete than anticipated, and to identify ways in which the arrangement and/or wording of recommendations can be improved in order to ensure that recommendations are achieved.
Highlights
Axillary lymph node dissection has been standard practice for staging invasive breast cancer
Best estimates for where to credit this dramatic drop in death rate place approximately 50% of the credit with improved adjuvant chemotherapy and 50% with mammography
Full field digital mammography (FFDM) had a higher detection rate for ductal carcinoma in situ (DCIS) but no difference was observed for invasive tumours
Summary
Axillary lymph node dissection has been standard practice for staging invasive breast cancer. Aim To assess the feasibility of surgeons performing breast US in symptomatic breast clinics either as an adjunct to triple assessment or on their own for diagnostic and therapeutic purposes. The performance of individual units is monitored to ensure all women have access to an excellent service Aim This project aims to demonstrate how the Liverpool Breast Unit addressed failure to meet the national quality standard for the benign. Method A retrospective review of the records of patients who had undergone benign biopsy (2001–2002) was conducted to establish reasons for surgical referral and suggest corrective measures to enable the unit to meet the standard in the future. Columnar cell change (CCC) is diagnosed on core biopsies performed for indeterminate microcalcification. Method Mammograms of 33 cases with established CCC on core biopsy were reviewed and the radiological features, follow-up imaging and surgical excision histology (if performed) were collated. The results were completed when all units were undergoing assimilation onto the new banding procedures
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