National Health Service Breast Research Articles

Optimisation of the ActWELL lifestyle intervention programme for women attending routine NHS breast screening clinics

BackgroundAround 30% of post-menopausal breast cancer is related to excess body fat, alcohol intake and low levels of physical activity. Current estimates suggest that there is a 12% increased risk in post-menopausal breast cancer for every 5 kg/m2 increase in body mass index (BMI). Despite this evidence there are few lifestyle programmes directed towards breast cancer risk reduction. This paper describes the process of optimising of the ActWELL programme which aims to support weight management in women invited to attend routine National Health Service (NHS) breast screening clinics.MethodsA feasibility study of a prototype programme aiming to change lifestyle behaviours was successfully undertaken. The programme used educational approaches and behaviour change techniques delivered by lifestyle coaches using individual face to face meetings and telephone sessions. To optimise the intervention for a definitive randomised controlled trial of weight management, data from the feasibility trial, focus group discussions conducted with the target population, feedback from the trial public advisory group and comments from peer reviewers were obtained. Concepts from implementation research provided further guidance to assist in the refinement of the intervention, which was then discussed and agreed by all investigators and the Trial Steering Group.ResultsThe results from the feasibility trial were considered appropriate for moving on to a full trial with 70% of participants finding the programme acceptable. The primary outcomes (weight loss and physical activity) provided an important focus for design input from the target group. The contributions highlighted the need to review programme duration, coach contact time, content and use of behaviour change techniques and communications generally (e.g. science and evidence, non-judgemental approaches and avoiding guilt). In addition, the need for emphasis on support rather than education became apparent. The recommendations from peer reviewers focussed on the magnitude of effort required to achieve the intended weight loss and weight loss maintenance. Implementation science supported the use of the capability/opportunity/motivation (COM-B)model in overall design.ConclusionsThe optimisation process has facilitated the development and evaluation of a programme that enables the delivery of a promising intervention to achieve weight management in post-menopausal women.Trial registrationISRCTN: ISRCTN11057518. Registered on 21 July 2017. Retrospectively registered.

Improving public understanding of ‘overdiagnosis’ in England: a population survey assessing familiarity with possible terms for labelling the concept and perceptions of appropriate terminology

ObjectivesCommunicating the concept of ‘overdiagnosis’ to lay individuals is challenging, partly because the term itself is confusing. This study tested whether alternative descriptive labels may be more appropriate.DesignQuestionnaire preceded by...

Going “paperless” in an English National Health Service (NHS) breast cancer screening service: The intriduction of fully digital mammography

Objective: To test the feasibility of a fully paperless system, termed “paperlite” in a UK breast screening service. To demonstrate in NHS practice, how workload and workflow could be improved by moving to a paperless system and discovering what impact this has upon the complexity within the service. Setting: Warwickshire, Solihull and Coventry Breast Screening Service in the West Midlands of England. Methods: Quality improvement methodologies were employed, including value stream mapping, task analysis and a time-and-motion study. Results: The screening centred screened approximately 50,000 women per year. If they were to implement a paperless system, the administrative workload would decrease. The time saving per batch of screens, which could be achieved by moving to the paperless system ranged from 19 to 56 minutes (mean = 36 minutes). When calculated by batch the mean time saving per woman screened by moving to the paperless system was 42 seconds. This equates to 583 hours of administrative work per year in a centre screening 50,000 women. Conclusions: The paperless system has many benefits compared to the original system in terms of reductions in waste, time and cost. The simplification and standardisation of the process resulted in fewer tasks and interfaces where errors could occur, hence inadvertently improving patient safety. The limitation of the work is the heavy reliance on technology, live interfacing with computer databases and software stability is necessary for a paperless system to be used in NHS practice.

A clinical "near miss" highlights risk management issues surrounding ultrasound-guided and wire-localised breast resections

BackgroundThe introduction of the National Health Service (NHS) Breast Screening Programme has led to a considerable increase in the detection of impalpable breast cancer. Patients with impalpable breast cancer typically undergo oncological resection facilitated either by the insertion of guide wires placed stereo-tactically or through ultra-sound guided skin markings to delineate the extent of a lesion. The need for radiological interventions on the day of surgery adds complexity and introduces the risk that a patient may accidentally transferred to the operating room directly without the image guidance procedure.Case reportA case is described of a patient who required a pre-operative ultrasound scan in order to localise an impalpable breast cancer but who was accidentally taken directly to the operating theatre (OR) and anaesthetised without pre-operative intervention. The radiologist was called to the OR and an on-table ultrasound was performed without further consequence.ConclusionIt is evident that breast cancer patients undergoing image-guided resection are exposed to an additional layer of clinical risks. These risks are not offset by the World Health Organisation surgical safety checklist in its present guise. Here, we review a number of simple and inexpensive changes to the system that may improve the safety of the breast cancer patient undergoing surgery.

Commentary on: Breast screening policy: Are we heading in the right direction?

0009-9260/$ e see front matter 2011 The Royal Co doi:10.1016/j.crad.2011.06.006 Evans and Whelehan1 tackle a difficult issue in breast cancer screening, that of the age range over which screening should be conducted and the screening interval that should be used. The original UK National Health Service (NHS) Breast Screening Programme age range was 50e64 years, which was later extended to 50e70 and more recently 47e73 by including an extra screen at ages 47e49 and an extra screen at ages 71e73 (providing nine screens in total). The extra screening invitation at age 71e73 guarantees women an invitation to screening over the age of 70 and some women will have their last invitation close to their 74th birthday and some women will have their last screen the year they turn 71. There is, however, no arguing that these screens are outside the age range 50e69 recommended by International Agency for Research on Cancer (IARC)2 as the range where there is sufficient evidence and that screening women from age 47 is more than just making sure they get their first screen by age 50. Is the age extension, therefore, justified or does it represent age-range “creep”? If the upper limit was once 64 and then 70 and now 73, what is the chance that it will continue to move upward to say 76 and then 79? The central argument of the paper by Evans and

The relevance of clinical audit results to commissioning services

The Association of Breast Surgery at the British Association of Surgical Oncology audit of screen-detected breast cancers is a clinical audit that monitors diagnosis and treatment outcome data for screen-detected breast cancer against National Health Service (NHS) Breast Screening Programme standards. The audit is used to identify achievement of and failure to meet the standards by screening services and to direct appropriate recommendations and actions. This valuable data resource is unfamiliar to many NHS organisations responsible for commissioning breast cancer services such as Primary Care Trusts, Strategic Health Authorities and Cancer Networks. To make the audit more accessible to these organisations a Key Outcomes booklet was produced for each West Midlands screening service, which aimed to present the findings that are most relevant to commissioners. Results were related to relevant government targets in the NHS Cancer Plan (2000) and the National Institute for Clinical Excellence publication Improving Outcomes in Breast Cancer (2002). Production of the Key Outcomes booklet enabled the Association of Breast Surgery at the British Association of Surgical Oncology audit results to reach a wider, more generalised audience, while the focus on individual screening services allowed a more in-depth analysis of the audit results tailored to areas of particular interest.