Breast cancer quality standard
Introduction and overview
This quality standard covers the management of early (ductal carcinoma in situ and invasive), locally advanced and advanced breast cancer in adults. This includes the management of both screen-detected and symptomatic breast cancers from the point of referral to a specialist team. The scope does not include adults with rare breast tumours, benign breast disease, lobular carcinoma in situ, or the care of women with an increased risk of breast cancer because of family history.
Breast cancer is the most common cancer in women in England and Wales and also affects a very small proportion of men. Some patients are diagnosed in the advanced stages, when the tumour has spread significantly within the breast or to other organs of the body. In addition, a considerable number of people who have been previously treated with curative intent subsequently develop either a local or regional recurrence or metastases. Breast cancer is the second biggest cause of death after lung cancer. In 2008, 39,972 people were diagnosed with breast cancer in England (39,681 women and 291 men). The lifetime prevalence is 1 in 8 women. There is a trend of increasing incidence because of lifestyle factors and improved detection, and decreasing mortality because of earlier detection and improvements in the quality and availability of effective treatments. There are more than 500,000 people in the UK today who have, or have had, a diagnosis of breast cancer. It is estimated that around 40 to 50% of these may develop metastases in the future, and therefore require treatment for advanced breast cancer. Unusually, lifestyle and environmental issues mean that the prevalence of breast cancer is greater in higher socioeconomic groups. However, mortality is higher among lower socioeconomic groups, highlighting issues of later identification because of a lower uptake of screening, barriers to accessing treatment among these groups and the impact of comorbidities.
This quality standard describes markers of high-quality, cost-effective care that, when delivered collectively, should contribute to improving the effectiveness, safety and experience of care for adults with breast cancer in the following ways:
Preventing people from dying prematurely.
Enhancing quality of life for people with long-term conditions.
Helping people to recover from episodes of ill health or following injury.
Ensuring that people have a positive experience of care.
Treating and caring for people in a safe environment and protecting them from avoidable harm.
The quality standard for breast cancer requires that services should be commissioned from and coordinated across all relevant agencies encompassing the whole breast cancer care pathway. An integrated approach to provision of services is fundamental to the delivery of high quality care to people with breast cancer.
NICE quality standards are for use by the NHS in England and do not have formal status in the social care sector. However, the NHS will not be able to provide a comprehensive service for all without working with social care communities. In this quality standard care has been taken to make sure that any quality statements that refer to the social care sector are relevant and evidence based. Social care commissioners and providers may therefore wish to use them, both to improve the quality of their services and support their colleagues in the NHS.
Subject to legislation currently before Parliament, NICE will be given a brief to produce quality standards for social care. These standards will link with corresponding topics published for the NHS. They will be developed in full consultation with the social care sector and will be presented and disseminated in ways that meet the needs of the social care community. As we develop this library of social care standards, we will review and adapt any published NICE quality standards for the NHS that make reference to social care.
It is important that the quality standard is considered by commissioners, healthcare professionals and patients alongside current policy and guidance documents, including Improving outcomes in breast cancer (NICE cancer service guidance, 2002) and the Manual for cancer services: breast measures (National Cancer Peer Review Programme, 2008), listed in the evidence sources section.
 The commonest form of preinvasive breast cancer, which is confined to normal breast structures and has not infiltrated the supporting breast tissue and thus cannot have spread to other sites in the body.