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  • Measure Summary
  • NQMC:011215
  • Jul 2016

Breast cancer: proportion of surgically treated patients with breast cancer less than 20 mm whole tumour size on histology (invasive plus in-situ disease) treated by breast conservation surgery.

NHS Scotland, Scottish Cancer Taskforce, National Cancer Quality Steering Group. Breast cancer clinical quality performance indicators. Edinburgh (Scotland): Healthcare Improvement Scotland; 2016 Jul. 37 p. [21 references]

View the original measure documentation External Web Site Policy

This is the current release of the measure.

Primary Measure Domain

Clinical Quality Measures: Process

Secondary Measure Domain

Does not apply to this measure

Description

This measure is used to assess the proportion of surgically treated patients with breast cancer less than 20 mm whole tumour size on histology (invasive plus in-situ disease) treated by breast conservation surgery.

Note from the National Quality Measures Clearinghouse: This measure is part of the Cancer Quality Performance Indicators (QPIs) collection. For more information, including a complete list of QPI measure sets, please visit the Healthcare Improvement Scotland Web site External Web Site Policy.

Rationale

Breast conservation is appropriate for small breast cancers. Randomised trials have shown no difference in survival for tumours treated by conservation surgery followed by radiotherapy to mastectomy (Scottish Intercollegiate Guidelines Network [SIGN], 2005).

Breast conservation may not be appropriate for all patients for a variety of reasons including patient choice, genetic risk and small breast size (NHS Cancer Screening Programmes, 2009).

Evidence for Rationale

NHS Cancer Screening Programmes. Quality assurance guidelines for surgeons in breast cancer screening. Sheffield (UK): NHS Cancer Screening Programmes; 2009 Mar. 36 p.  (NHSBSP publication; no. 20). [17 references]

NHS Scotland, Scottish Cancer Taskforce, National Cancer Quality Steering Group. Breast cancer clinical quality performance indicators. Edinburgh (Scotland): Healthcare Improvement Scotland; 2016 Jul. 37 p. [21 references]

Scottish Intercollegiate Guidelines Network (SIGN). Management of breast cancer in women. A national clinical guideline. Edinburgh (Scotland): Scottish Intercollegiate Guidelines Network (SIGN); 2005 Dec. 50 p. (SIGN publication; no. 84).  [214 references]

Primary Health Components

Breast cancer; tumour size; histology (invasive plus in-situ disease); breast conservation surgery

Denominator Description

All surgically treated patients with breast cancer less than 20 mm whole tumour size on histology (invasive plus in-situ disease) (see the related "Denominator Inclusions/Exclusions" field)

Numerator Description

Number of surgically treated patients with breast cancer less than 20 mm whole tumour size on histology (invasive plus in-situ disease) treated by breast conservation surgery (see the related "Numerator Inclusions/Exclusions" field)

Type of Evidence Supporting the Criterion of Quality for the Measure

  • A clinical practice guideline or other peer-reviewed synthesis of the clinical research evidence
  • A formal consensus procedure, involving experts in relevant clinical, methodological, public health and organizational sciences

Additional Information Supporting Need for the Measure

Unspecified

Extent of Measure Testing

The collection of data is piloted on a small number of patient records using a paper data collection form produced by Information Services Division (ISD). The aim is to identify any anomalies or difficulties with data collection prior to full implementation. At least one NHS board in each Regional Cancer Network participates in the pilot.

Evidence for Extent of Measure Testing

NHS Scotland. National cancer quality performance indicators: overview of development process. Edinburgh (Scotland): NHS Scotland; 2012 Dec. 7 p.

State of Use

Current routine use

Current Use

Internal quality improvement

National reporting

Public reporting

National Quality Strategy Aim

Better Care

National Quality Strategy Priority

Prevention and Treatment of Leading Causes of Mortality

IOM Care Need

Getting Better

Living with Illness

IOM Domain

Effectiveness

Case Finding Period

Unspecified

Denominator Sampling Frame

Patients associated with provider

Denominator (Index) Event or Characteristic

Clinical Condition

Diagnostic Evaluation

Therapeutic Intervention

Denominator Time Window

Does not apply to this measure

Denominator Inclusions/Exclusions

Inclusions
All surgically treated patients with breast cancer less than 20 mm whole tumour size on histology (invasive plus in-situ disease)

Exclusions

  • Patients with multifocal breast cancer
  • Patients with breast cancer who have received neo-adjuvant systemic therapy for greater than or equal to 6 weeks (hormonal therapy or chemotherapy)
  • Patients with high risk*
  • Patients who have had previous radiotherapy
  • Male patients

*High Risk: Patients who have tested positive for BRCA1 or BRCA2 genes, or as agreed by the multidisciplinary team (MDT).

Exclusions/Exceptions

Medical factors addressed

Numerator Inclusions/Exclusions

Inclusions
Number of surgically treated patients with breast cancer less than 20 mm whole tumour size on histology (invasive plus in-situ disease) treated by breast conservation surgery

Exclusions

  • Patients with multifocal breast cancer
  • Patients with breast cancer who have received neo-adjuvant systemic therapy for greater than or equal to 6 weeks (hormonal therapy or chemotherapy)
  • Patients with high risk*
  • Patients who have had previous radiotherapy
  • Male patients

*High Risk: Patients who have tested positive for BRCA1 or BRCA2 genes, or as agreed by the multidisciplinary team (MDT).

Numerator Search Strategy

Fixed time period or point in time

Data Source

Electronic health/medical record

Paper medical record

Type of Health State

Does not apply to this measure

Instruments Used and/or Associated with the Measure

Unspecified

Measure Specifies Disaggregation

Does not apply to this measure

Scoring

Rate/Proportion

Interpretation of Score

Desired value is a higher score

Allowance for Patient or Population Factors

Unspecified

Standard of Comparison

External comparison at a point in, or interval of, time

External comparison of time trends

Internal time comparison

Prescriptive standard

Prescriptive Standard

Target: 90%

The tolerance within this target accounts for the fact that breast conservation may not always be an appropriate treatment option for a variety of reasons, primarily patient choice.

Evidence for Prescriptive Standard

NHS Scotland, Scottish Cancer Taskforce, National Cancer Quality Steering Group. Breast cancer clinical quality performance indicators. Edinburgh (Scotland): Healthcare Improvement Scotland; 2016 Jul. 37 p. [21 references]

Original Title

QPI 4 – conservation rate.

Measure Collection Name

Cancer Quality Performance Indicators (QPIs)

Measure Set Name

Breast Cancer

Submitter

NHS Scotland - National Government Agency [Non-U.S.]

Scottish Cancer Taskforce - National Government Agency [Non-U.S.]

Developer

NHS Scotland - National Government Agency [Non-U.S.]

Scottish Cancer Taskforce - National Government Agency [Non-U.S.]

Funding Source(s)

Scottish Government

Composition of the Group that Developed the Measure

Breast Cancer QPI Development Group

Financial Disclosures/Other Potential Conflicts of Interest

Unspecified

Adaptation

This measure was not adapted from another source.

Date of Most Current Version in NQMC

2016 Jul

Measure Maintenance

The Cancer Quality Performance Indicators (QPIs) will be kept under regular review and be responsive to changes in clinical practice and emerging evidence.

Date of Next Anticipated Revision

Unspecified

Measure Status

This is the current release of the measure.

Source(s)

NHS Scotland, Scottish Cancer Taskforce, National Cancer Quality Steering Group. Breast cancer clinical quality performance indicators. Edinburgh (Scotland): Healthcare Improvement Scotland; 2016 Jul. 37 p. [21 references]

Measure Availability

Source document available from the Healthcare Improvement Scotland Web site External Web Site Policy.

For more information, contact the Healthcare Improvement Scotland at Gyle Square, 1 South Gyle Crescent, Edinburgh, Scotland EH12 9EB; Phone: 0131 623 4300; E-mail: comments.his@nhs.net; Web site: www.healthcareimprovementscotland.org/ External Web Site Policy.

Companion Documents

The following is available:

  • NHS Scotland. National cancer quality performance indicators: overview of development process. Edinburgh (Scotland): NHS Scotland; 2012 Dec. 7 p. This document is available from the Healthcare Improvement Scotland Web site External Web Site Policy.

NQMC Status

This NQMC summary was completed by ECRI Institute on June 7, 2017.

Copyright Statement

No copyright restrictions apply.

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