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15 June 2016

Updated NICE quality standard identifies areas for breast cancer improvement

NICE’s latest quality standard published today says people who have been diagnosed with a type of early breast cancer and who are at risk of the cancer spreading should be offered a test called Oncotype DX.

The test provides information about the genetic makeup of the tumour to help predict how it might develop. This information can be used to help make more personalised treatment decisions by identifying which patients would be most likely to benefit from treatment with chemotherapy after surgery and those who won’t need it, thereby avoiding unnecessary side effects.

The test is one of 3 new key areas for improvement highlighted in the updated quality standard.

It says people with suspected breast cancer who have been referred to a specialist should be offered a full assessment at a single visit to the hospital or specialist unit. This involves an examination, breast imaging and, if needed, a biopsy. Having all 3 in a single visit will help ensure people get a faster diagnosis and be a more efficient use of resources.

The updated standard also recognises that for people who have invasive breast cancer confirmed by a biopsy, or for people who have a type of breast cancer called ductal carcinoma in situ, an MRI scan is not usually needed before surgery. Carrying out an unnecessary scan may cause additional stress without any benefit and waste healthcare resources.

Professor Gillian Leng, deputy chief executive and director of health and social care at NICE said: “Breast cancer is the most common form of cancer in women in England, and around 1 in 8 women will develop breast cancer at some point in their lives. That’s why it’s important that we have clear standards in place to reflect national priorities for improvement, promote best practice and help all those involved in delivering services to provide the very highest levels of care.”

Breast cancer is the most common cancer in the UK, with over 50,000 new cases diagnosed and nearly 12,000 deaths recorded in the UK in 2013 (Cancer Research UK). Of these new cases, a small proportion are diagnosed in the advanced stages, when the tumour has spread significantly within the breast or to other parts of the body. People who have been previously treated for breast cancer may subsequently develop either a local recurrence or metastases.

The NICE quality standard on breast cancer has been updated because there have been changes in the national priorities for improvement for breast cancer since the original standard was published in 2011. The updated quality standard consists of 6 statements setting out what high-quality care for people with breast cancer in the NHS in England should look like.

Ends

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About the breast cancer quality standard

  1. The NICE breast cancer quality standard is available from the NICE website
  2. The NICE breast cancer quality standard consists of the following 6 statements:
  • Statement 1 People with suspected breast cancer referred to specialist services are offered the triple diagnostic assessment in a single hospital visit. [new 2016]
  • Statement 2 People with biopsy-proven invasive breast cancer or ductal carcinoma in situ (DCIS) are not offered a preoperative MRI scan unless there are specific clinical indications for its use. [new 2016]
  • Statement 3 People with oestrogen receptor-positive (ER-positive), human epidermal growth factor receptor 2-negative (HER2-negative) and lymph node-negative early breast cancer who are at intermediate risk of distant recurrence are offered gene expression profiling with Oncotype DX. [new 2016]
  • Statement 4 People with newly diagnosed invasive breast cancer and those with recurrent breast cancer (if clinically appropriate) have the oestrogen receptor (ER) and human epidermal growth factor receptor 2 (HER2) status of the tumour assessed. [2011, updated 2016]
  • Statement 5 People with breast cancer who develop metastatic disease have their treatment and care managed by a multidisciplinary team. [2011, updated 2016]
  • Statement 6 People with locally advanced, metastatic or distant recurrent breast cancer are assigned a key worker. [2011, updated 2016]

About NICE quality standards

NICE quality standards aim to help commissioners, health care professionals, social care and public health practitioners and service providers improve the quality of care that they deliver.

NICE quality standards are prioritised statements designed to drive measurable quality improvements within a particular area of health or care. There is an average of 6-8 statements in each quality standard.

Quality standards are derived from high quality evidence-based guidance, such as NICE guidance or guidance from NICE accredited sources, and are produced collaboratively with health care professionals, social care and public health practitioners, along with their partner organisations, patients, carers and service users.

NICE quality standards are not mandatory but they can be used for a wide range of purposes both locally and nationally. For example, patients and service users can use quality standards to help understand what high-quality care should include. Health care professionals and social care and public health practitioners can use quality standards to help deliver high quality care and treatment.

NICE quality standards are not requirements or targets, but the health and social care system is obliged to have regard to them in planning and delivering services, as part of a general duty to secure continuous improvement in quality.

Quality standard topics are formally referred to NICE by NHS England for health-related areas, and by the Department of Health and Department for Education for areas such as social care and public health.

About NICE

The National Institute for Health and Care Excellence (NICE) is the independent body responsible for driving improvement and excellence in the health and social care system. We develop guidance, standards and information on high-quality health and social care. We also advise on ways to promote healthy living and prevent ill health.

Our aim is to help practitioners deliver the best possible care and give people the most effective treatments, which are based on the most up-to-date evidence and provide value for money, in order to reduce inequalities and variation.

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