Introduction

This quality standard covers the management of early (ductal carcinoma in situ and invasive), locally advanced and advanced breast cancer, recurrent breast cancer and familial breast cancer in adults. This includes breast cancer identified through screening and by assessment of symptoms, and covers care from the point of referral to a specialist team. It does not cover adults with non-cancerous breast tumours. For more information see the breast cancer topic overview.

This quality standard has been updated. It was identified for update after the annual review of quality standards in 2014. The review identified that there had been changes in the areas for improvement for breast cancer. For further information about the update, see update information. Statements from the 2011 quality standard that are no longer national priorities for improvement, but are still underpinned by current accredited guidance, are included after the updated statements in the list of quality statements.

Why this quality standard is needed

Breast cancer is the most common cancer in the UK, with over 50,000 new cases diagnosed and 11,716 deaths recorded in the UK in 2012 (Cancer Research UK). Of the new cases, a small proportion was diagnosed in the advanced stages, when the tumour had spread significantly within the breast or to other organs of the body. In addition to new diagnoses, people who have been previously treated for breast cancer may subsequently develop either a local recurrence or metastases.

The quality standard is expected to contribute to improvements in the following outcomes:

  • mortality

  • 1- and 5-year survival

  • stage at diagnosis

  • quality of life.

How this quality standard supports delivery of outcome frameworks

NICE quality standards are a concise set of prioritised statements designed to drive measurable improvements in the 3 dimensions of quality – safety, experience and effectiveness of care – for a particular area of health or care. They are derived from high-quality guidance, such as that from NICE or other sources accredited by NICE. This quality standard, in conjunction with the guidance on which it is based, should contribute to the improvements outlined in the following 2 outcomes frameworks published by the Department of Health:

Tables 1 and 2 show the outcomes, overarching indicators and improvement areas from the frameworks that the quality standard could contribute to achieving.

Table 1 NHS Outcomes Framework 2015–16

Domain

Overarching indicators and improvement areas

1 Preventing people from dying prematurely

Improvement areas

Reducing premature mortality from the major causes of death

1.4 Under 75 mortality rate from cancer*

i One- and ii Five-year survival from all cancers

iii One- and iv Five-year survival from breast, lung and colorectal cancer

v One- and vi Five-year survival from cancers diagnosed at stage 1 & 2**

Alignment with Public Health Outcomes Framework

* Indicator is shared

** Indicator is complementary

Indicators in italics in development

Table 2 Public Health Outcomes Framework for England, 2013–16

Domain

Objectives and indicators

4 Healthcare public health and preventing premature mortality

Objective

Reduced numbers of people living with preventable ill health and people dying prematurely, whilst reducing the gap between communities

Indicators

4.5 Under 75 mortality rate from cancer*

Alignment with NHS Outcomes Framework

* Indicator is shared

Safety and people's experience of care

Ensuring that care is safe and that people have a positive experience of care is vital in a high-quality service. It is important to consider these factors when planning and delivering services relevant to breast cancer.

NICE has developed guidance and an associated quality standard on patient experience in adult NHS services (see the NICE pathway on patient experience in adult NHS services), which should be considered alongside this quality standard. They specify that people receiving care should be treated with dignity, have opportunities to discuss their preferences, and be supported to understand their options and make fully informed decisions. They also cover the provision of information to patients and people using services. Quality statements on these aspects of patient experience are not usually included in topic-specific quality standards. However, recommendations in the development sources for quality standards that affect patient experience and are specific to the topic are considered during quality statement development.

Coordinated services

The quality standard for breast cancer specifies that services should be commissioned from and coordinated across all relevant agencies encompassing the whole breast cancer care pathway. A person-centred, integrated approach to providing services is fundamental to delivering high-quality care to people with breast cancer.

The Health and Social Care Act 2012 sets out a clear expectation that the care system should consider NICE quality standards in planning and delivering services, as part of a general duty to secure continuous improvement in quality. Commissioners and providers of health and social care should refer to the library of NICE quality standards when designing high-quality services. Other quality standards that should also be considered when choosing, commissioning or providing a high-quality breast cancer service are listed in related quality standards.

Training and competencies

The quality standard should be read in the context of national and local guidelines on training and competencies. All healthcare professionals involved in assessing, caring for and treating people with breast cancer should have sufficient and appropriate training and competencies to deliver the actions and interventions described in the quality standard. Quality statements on staff training and competency are not usually included in quality standards. However, recommendations in the development sources on specific types of training for the topic that exceed standard professional training are considered during quality statement development.

Role of families and carers

Quality standards recognise the important role families and carers have in supporting people with breast cancer. If appropriate, healthcare professionals should ensure that family members and carers are involved in the decision-making process about investigations, treatment and care.