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Breast Services at L & D. D Ravichandran PhD FRCS Consultant Surgeon. Breast waiting time National Targets. Two week cancer wait. Max 2 weeks to see specialist after urgently referred with suspected cancer by GP . The operational standard 93%.

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breast services at l d

Breast Services at L & D

D Ravichandran PhD FRCS

Consultant Surgeon

two week cancer wait
Two week cancer wait
  • Max 2 weeks to see specialist after urgently referred with suspected cancer by GP.
  • The operational standard 93%.
  • Quarter ending Dec 2011, England: 96.2%
  • Quarter ending June 2012, L & D: 99.1% (224/226). 2 misses were patient choice.
all breast referrals
All Breast Referrals
  • Max 2 weeks when referred urgently with breast symptoms, where cancer was not initially suspected.
  • The operational standard 93%
  • Quarter ending Dec 2011, England – 96.3%
  • Quarter ending June 2012, L & D: 96.8% (299/309). 9 misses were patient choice, 1 pt rescheduled appointments 4 times.
one month 31 day wait
One month (31-day) wait
  • Max wait 31 days between diagnosis and the start of first definitive treatment.
  • Measured from the point at which the patient is informed of a diagnosis of cancer
  • The operational standard 96%.
  • Quarter ending Dec 2011, England:99.2%
  • Quarter ending June 2012, L & D: 98.1% (52/53). 1 miss due to patient having pneumonia just before diagnosis.
two month 62 day wait
Two month (62-day wait)
  • 85% of patients would wait a maximum of 62 days to begin first definitive treatment following urgent referral for suspected cancer from their GP.
  • Quarter ending Dec 2011, England: 98.0% (87% for all cancers)
  • Quarter ending June 2012, L & D: 100%

62 days from referral from NHS Cancer screening Programmes (breast, cervical and bowel) to treatment for cancer

breast screening
Breast Screening
  • Age: 50-70 now being extended to 47-73.
  • 3-yearly mammograms
  • Over the age limit – no automatic invitation but patient can request.
family history
Family History
  • New Family history clinic in L & D
  • Refer patients to this clinic.
  • Risk assessment, referral for genetic counselling & genetic testing
  • Clinical examination and mammogram
symptomatic one stop clinic triple assessment
Symptomatic One-Stop ClinicTriple Assessment
  • Patient fill a questionnaire
  • Clinical examination of Breasts, axilla, SCF / ICF
  • Imaging: Mammogram, US
  • Collection of tissue for pathological analysis: FNA or Core biopsy

Why triple assessment?

imaging
Imaging

US

mammogram

MRI used for certain indications

benign conditions one visit only
Benign Conditions: one visit only
  • Fibroadenoma – discharge
  • Fibroadenosis – discharge
  • Breast pain – reassurance, leaflet, mammogram if over 35, tamoxifen
early or advanced breast cancer
Early or Advanced Breast Cancer
  • Early: confined to breast and axilla
  • Late: gone beyond breast and axilla

Treatment goals are different……..

Screening everybody for metastatic disease is a waste of time and resources

treatment decisions are made by multi disciplinary teams mdt s
Treatment Decisions are made by Multi Disciplinary Teams (MDT’s)
  • Surgeon
  • Oncologist
  • Radiologist
  • Pathologist
  • Breast care nurses
5 modalities to treat breast cancer
5 modalities to treat breast cancer…..
  • Surgery
  • Radiotherapy
  • Chemotherapy
  • Hormonal therapy
  • Immunotherapy: Herceptin

Both in early and advanced

local

systemic