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Breast Unit Guidelines

The requirements of a specialist breast unit

4. General recommendations

Definitions

Unit: Essentially a group of specialists in breast cancer and need not necessarily be a geographically single entity, although the separate buildings must be within reasonable proximity, sufficient to allow multidisciplinary working.

Clinic: used to mean a session, usually around 3 hours at which a number of patients are seen for clinical examination and investigations.

Specialists: completed training and certified in own discipline (e.g.) Surgery, Radiology etc and for Core Team members, spending half their working time (clinics, operating, pathology or imaging reading, multidisciplinary meetings, inpatient care etc.) in breast cancer.

Radiologist: a specialist in imaging for diagnosis.

Radiographer: a technician, taking the mammograms and responsible for mammographic quality.

Radiation Oncologist: specialist in radiotherapy only.

Medical Oncologist: specialist in medical oncology.

Breast Care Nurse: qualified nurse, trained to give psychological support to breast cancer patients (especially at the time diagnosis is given) and to act in follow up as link between patient and breast Team.

Psychiatrist: medically qualified specialist in pharmacological treatment of patients with psychiatric and psychological problems.

Psychologist: not usually medically qualified and therefore unable to prescribe pharmacological therapies.

Surgeon: gynaecological surgeons specialising in breast cancer are included in this term

4.1

Recognition of a Breast Unit must be based on mandatory requirements.

4.2

A European process of voluntary accreditation of Breast Units, based on the fulfilment of mandatory requirements should be established. To give uniformity a standard database should be made available.

4.3

Units must record the basic data on diagnosis, pathology, primary treatment and clinical outcomes. The data must be available for audit and the Unit team should hold regular audit meetings inspecting separate topics and designing and amending protocols and QA systems. These meetings must be minuted. Performance and audit figures must be produced yearly and set alongside defined quality objectives and outcome measures, such as those laid down in the EUSOMA Guidelines on the various aspects of care [12] [13] [14] [15] [16] or in other suitable guidelines.

4.4

The Unit must have written protocols for diagnosis and for the management of cancer at all stages (primary and advanced cancer). All protocols must be agreed upon by the core team members. New protocols and protocol amendments should be discussed by the core team at the audit meetings (see 4.3).

4.5

Breast Units will most often be established in large or medium sized hospitals; they should generally cover one-quarter to one-third of a million total population. Some highly specialised units will be larger.

4.6

Population Breast Screening programmes should be based within or be closely associated with a recognised Breast Unit and not work as a separate service. The radiologists, surgeons and pathologists working in the screening programme must be core members of the associated Breast Unit.

4.7

There has to be a minimum size for a Breast Unit from the point of view of numbers of specialist staff required, arrangement of frequent clinics, provision of equipment and cost-effectiveness. If two hospitals are close together it is more practical for only one of them to establish a functional breast unit serving both hospitals, i.e., the breast team works at both centres.

4.8

A Breast Unit should hold outreach clinics for symptomatic referred women, screening assessment and follow-up, in the smaller hospitals in the neighbourhood if these are at a distance from the Breast Unit. In areas with low population density, out-reach arrangements are preferable to the establishment of small Breast Units without the clinical volume to allow expertise. In that circumstance outreach clinics may be only held as infrequently as once per month; such scheduling may prolong waiting times for appointments but clinical evaluation by an expert team is considered preferable to maintaining short waiting times.

4.9

Breast Units must provide care of breast disease at all its stages - from screening through to the care of advanced disease. Occasionally the patient may need to be sent to an associated large oncology centre for radiotherapy but the patient must essentially be managed and followed-up at her Breast Unit.

4.10

Breast Units should manage their own budget, covering all the work of the unit.


Please use this address to send us any comments you want to make on the guidelines - we welcome your feedback: information@eusoma.org

 



San Antonio Breast Cancer Symposium. 5th-9th December 2017 , San Antonio,Texas,USA

San Antonio
Breast Cancer Symposium
5th-9th December 2017
San Antonio,Texas,USA


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