EBCN Meeting Budapest, 24 September 2004 Update on individual data monitoring projects

1. EBCN Meeting Budapest, 24 September 2004 Update on individual data monitoring projects QT and SEED Antonio Ponti CPO Piemonte Torino, Italy

2. SEED and QT Audit Systems Their aim is two-fold:1) to favour the implementation of European Guidelines (with training and certification implications), and

3. SEED and QT Audit Systems 2) to provide a service to screening programmes and Breast Units to meet their management and evaluation needs.

4. Advantages of monitoringIndividual vs Aggregate screening data (1)- Use of common definitions and rules in the process of collecting the minimum dataset: an “educational” process

5. Advantages of monitoringIndividual vs Aggregate screening data (2)- Standard analysis of common dataset, including standard reports on European outcome measures

6. Advantages of monitoringIndividual vs Aggregate screening data (3)- Much more flexible analytical approach

7. Projects and Partners (6 Countries)

9. To access SEED (on line)www.cpo.it/seeddemo has about 100,000 screening episodes

13. SEED ResultsSeven European programmes 1999-2001 159,511 SUBS. TESTS 124,555 FIRST TESTS E.G. standard E.G. standard % % % % < 3.0 1.8 < 1.0 0.6 Technical repeat rate < 1.0 < 1.0 1.6 0.9 IM after assessment 2.9 < 3.0 < 7.0 6.0 Further assessmentrate < 0.5 < 0.2 0.27 0.14 B / M ratio 38.1 > 30.0 40.5 > 25.0 Invasive Ca <= 10 mm

15. To download QTwww.cpo.it/qtwww.eusoma.org

20. Assessment Episodes Operated lesions Center No. No. Bremen 1664 242 Firenze 381 113 Leuven 276 109 London 404 154 Luxembourg 312 96 Marseille 156 130 Ravenna 454 102 Strasbourg 0 29 Torino 340 196 Valencia 298 100 Wiesbaden 1228 179 Total 5,5131,450 Budapest - 50

21. QT outcome measures Result % 67,8 80,3 99,5 52,9 90,3 87,9 89,1 88,3 89,4 77,0 34,2 99,8 99,1 61,3 YES NO

22. Positive preoperative cyto/histolog. diagnosis Cancers with post-operative diagnosis Results % CENTER 92,4 80,2 88,4 88,1 46,3 13,3 64,8 62,5 66,0 68,1 51,4 181 77 91 96 31 13 46 15 99 32 92 YES ? NO

23. Positive preoperative cyto/histolog. diagnosis Cancers with post-operative diagnosis Results % CENTER 92,4 80,2 88,4 88,1 46,3 13,3 64,8 62,5 66,0 68,1 51,4 181 77 91 96 31 13 46 15 99 32 92 YES NO

24. FNA & Core biopsy (operated only) None FNA CB Both ? CENTER

25. Fine Needle Aspiration Absolute Sensitivity Full Specificity

26. Pre-operative diagnosis Absolute Sensitivity Full Specificity

27. Time btw screening and assessment <= 3 weeks

28. Time btw referral and surgery <= 30 days

29. European Benchmarking Within the project described we have attempted to bridge guidelines with screening and care evaluation, while providing databases useful for daily management of screening programmes and patient care.

30. European Benchmarking This could serve as a model for other health care areas, particularly colon and cervical cancer for which screening programmes are being offered throughout Europe.

31. European Benchmarking Another bridge is being built: with Cancer Registries networks in the framework of population high resolution studies.

32. European Benchmarking The quality cycle entails a continuous updating of the audit tools in the framework of a comprehensive European activity.

33. European Benchmarking In the meanwhile QT is freely available to anyone and SEED could be used by local and regional screening programmes wishing to mutually agree to share it and concur in its development.