Breast cancer is the most diagnosed cancer in woman globally, and its incidence is increasing at a rapid pace—by 2050, cases are projected to increase by 38%, while deaths may increase even more sharply.
In the backdrop of this alarming trend is knowledge that there are wide disparities and differences in breast cancer care throughout the world—and improving the standard of care is a global quality imperative.
In today’s Distinguished Lecture of the International Society of Surgery, 8:00–9:00 am in Room W-178, Kerstin Sandelin, MD, PhD, FACS(Hon), FRCS, will deliver a talk that focuses on “Global Quality Improvements for Breast Cancer Patients.”
As a senior consultant in breast surgery at Karolinska University Hospital in Stockholm, Sweden, a past president of Breast Surgery International, and a leader in cancer registry implementation, Dr. Sandelin’s work spans across borders and offers unique insights into breast cancer quality around the globe.
“Because of my association with these breast cancer groups and treatment centers, I've been fortunate enough to travel to different continents to see breast cancer care and management from very different perspectives,” Dr. Sandelin said.
The lecture will cover four main points, starting with looking at the “global panorama” view of the current state of breast cancer care, particularly the divide between low- and middle-income countries (LMICs) and high-income countries.
“Even though the goals of care are the same around the world, there is significant difference in quality among countries in these economic categories,” she said, adding that she would share information on how LMICs are poised to benefit from global standardization projects like the World Health Organization’s Global Breast Cancer Initiative.
She also will look at how historical figures have had a profound impact on quality improvement.
Notable individuals include William Halsted, MD, a progenitor of modern surgery principles and one of the first to achieve successful oncologic results through radical mastectomy; and Ernest Codman, MD, FACS, an important early figure within the ACS who is known for his advocacy of the “End Result Idea,” which continues to influence the College’s quality improvement principles to this day with its focus on determining the effective of a treatment.
In addition to discussing how clinical practice guidelines have been developed, Dr. Sandelin will focus on the successes and challenges of maintaining a rigorous breast cancer registry in Sweden.
“The Swedish National Register for Breast Cancer is one of the few comprehensive national registries. It covers a patient’s diagnosis, surgical and oncologic treatment, and follow-up care, and as of a few years ago, patient-reported outcomes,” Dr. Sandelin said.
It is an effective registry, but “nothing is perfect because it is very resource demanding,” which may limit its effectiveness in a LMIC, for example.
As the ACS has proven with its Quality Programs, institutions use clinical data to increase their quality of care, which can be enhanced even further by becoming certified with their regional accreditation organizations as centers of excellence.
To that end, Dr. Sandelin will discuss her role as an auditor for the European Society of Breast Cancer Specialists, which has its own quality indicators necessary to achieve certification—and different centers meet the requirements in different ways.
“As I travel around Europe and go to different centers for new accreditation visits or renewal accreditation, I am fortunate to see how different hospitals manage to fulfill the requirements for being an accredited breast center,” Dr. Sandelin said, which is a useful reminder that global breast cancer quality improvement can be standardized but also tailored based on their unique circumstances.
