Achieving the gold standard in breast cancer care is possible

Mar 23 2006

A study in the Netherlands has proved that achieving the gold standard in breast cancer care is possible. Teams across the Netherlands set up and met targets for faster diagnosis of breast cancer and a reduction in waiting time for operations.

The 5th European Breast Cancer Conference (EBCC-5) heard how all countries should be striving to hit similar targets.

The project set up in the Netherlands has delivered exactly what it promised, namely measurably improved outcomes for breast cancer patients. Many countries have National Cancer Plans, few of which have delivered their full potential. The Netherlands was one of the first to set up cancer networks in 1980, backed by legislation that ensured cancer patients the right to a specialist oncologist's opinion. Many European countries still do not offer such a right.

Now the Netherlands leads oncology treatment once more. Dr Emil Rutgers, from the Netherlands Cancer Institute (which first showed the potential of gene signatures in prognosticating in breast cancer), described a very low-tech approach to accelerated management of patients suspected of having breast cancer. They set up and achieved targets for faster diagnosis (2 weeks), reduced time to operation (3 weeks), and reduction of unnecessary operations (10- 35%).

All patients visiting a breast cancer clinic were evaluated pre-op by a multidisciplinary team, and yields of cells obtained from the breast lump were improved by only allowing trained professionals to do the breast punctures and by increasing the use of image guided biopsies. 22 teams around Holland took part, and 19 achieved a waiting time of one week. Many others achieved 2 to 3 weeks in other countries, but few got the subsequent time to diagnosis down to one week (18 hospital breakthrough teams did it in this study). And magnificently, all 22 teams had their patients in the operating room for surgical treatment within 3 weeks, 10 teams doing this within 2 weeks.

Surely if the Netherlands can do this, every other European country must strive harder to reproduce this exemplary performance. Ingrid Kvssler, President of Europa Donna comments, "One of the worst experiences a woman can suffer is the delay and uncertainty which follows suspicion of a cancer in the breast. In some countries the time from the family doctor or patient herself finding a lump to first surgical treatment can be two months. Surely this is unnecessary. We congratulate the Dutch breakthrough teams and urge healthcare professionals and politicians to take note of what is possible and we advise breast cancer patients not to accept lower standards of care."