Q: Does the multidisciplinary breast cancer conference need to be designated solely for breast cases or can the cases be woven into other existing cancer conferences (i.e. Tumor Boards?)?
A: The intent of Standard 1.2 is to have a dedicated breast cancer conference with specific breast cancer care specialists, and the focus would remain on breast cases and treatment modality. However, the NAPBC realizes that this may not be practical for smaller centers. Therefore, for centers with less than 100 analytic breast cancer cases each year are given the option of either presenting their breast cancer cases at a breast-specific conference every two weeks or twice monthly or may be incorporated their breast cancer cases into their general cancer conference providing that it is held at a designated time and includes appropriate specialists. Centers with less than 100 analytic cases per year are required to present 85% of their cases prospectively each year.
Centers with between 100-250 annual analytic breast cancer cases must host a breast-specific conference every two weeks or twice monthly and the prospective case presentation defined by the Breast Program Leader (BPL). Centers with 250 or more breast cancer cases per year are required to meet weekly and the prospective case presentation defined by the BPL.
Q: Can the Cancer Committee be the organizational structure/BPL of the breast center?
A: It is acceptable for the multidisciplinary breast cancer committee to be a subcommittee of the cancer committee. However, the BPL or breast program leadership team should be identified, and shall have the responsibility and accountability for providing breast center services, as outlined in Standard 1.1 – Level of Responsibility and Accountability.
Q: During the breast conference, is it sufficient to have the pathologist provide available staging information, or should the staging be provided by the managing physician with the known or available information at the time?
A: The pathology certainly adds to the overall staging of the patient, but the managing physician has the responsibility of assigning clinical stage. The Breast Cancer Conference provides an opportunity for all clinicians to actively discuss the clinical or working stage as well as the recommended treatment options for each patient presented.
Q: The NAPBC requires physician certification for the performance of diagnostic ultrasound, ultrasound-guided needle biopsy, and stereotactic core needle biopsy. Define “ACR-qualified” physician. Is this just a way of saying that they have completed the ACR course? Must the physician complete one of the voluntary certification programs for each of these procedures in order to be compliant with these standards?
A: Breast ultrasound and stereotactic core needle biopsy certification refers to surgeons and radiologists that perform these procedures. The American Society of Breast Surgeons (ASBS) offers a voluntary certification program for these procedures for surgeons, and the American College of Radiology (ACR) has these programs in place for radiologists. For radiologists, the ACR defines specific requirements that the physicians within the Department of Radiology must meet and provide documentation at the time of application. These qualifications are outlined in both the Stereotactic Breast Biopsy Accreditation Program Requirement and Breast Ultrasound Accreditation Program Requirement documents available on the ACR website. The difference between the two programs, ASBS and ACR, is that the ASBS certifies individual surgeons as opposed to the ACR that certifies “qualified” radiologists performing these procedures and awards this certification to the department.
Q: Standard 1.2 – Interdisciplinary Breast Cancer Conference recommends multidisciplinary attendance by surgeons, medical and radiation oncologists, radiologists, and pathologists. Do these providers need to be “physically” present? If this is not possible, can they “phone” in on speaker phone or videoconference in from a remote location?
A: The NAPBC strongly recommends that physicians and other providers are physically available to attend the interdisciplinary breast cancer conference. If attendance is not possible, videoconferencing would be acceptable as that would allow them to review materials presented at the conference, including mammography films, breast ultrasound images, and pathology slides.