American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

NAPBC Standards

The NAPBC Standards Manual is available for purchase or download.

Chapter 1 Center Leadership

Purpose: The standard establishes the medical director and/or co-directors, or interdisciplinary steering committee as the Breast Program Leadership (BPL) responsible and accountable for breast center activities.

Standard 1.1 Level of Responsibility and Accountability
The organizational structure of the breast center gives the BPL responsibility and accountability for provided breast center services.

Standard 1.2 Interdisciplinary Breast Cancer Conference
The BPL establishes, monitors, and evaluates the interdisciplinary breast cancer conference frequency, multidisciplinary and individual attendance, prospective case presentation, and total case presentation annually, including AJCC staging and discussion of nationally accepted guidelines.

Standard 1.3 Evaluation and Management Guidelines
The BPL identifies and references evidence-based breast care evaluation and management guidelines.

Chapter 2 Clinical Management

Purpose: The standards identify the scope of clinical services needed to provide quality breast care to patients. The managing physician is essential to coordinating a multidisciplinary team approach to patient care.

Standard 2.1 Interdisciplinary Patient Management
After a diagnosis of breast cancer, the patient management is conducted by an interdisciplinary team.

Standard 2.2 Patient Navigation
A patient navigation process is in place to guide the patient with a breast abnormality through provided or referred services.

Standard 2.3 Breast Conservation
Breast conserving surgery (BCS) is offered to appropriate patients with breast cancer. A target rate of 50 percent of all eligible patients diagnosed with early stage breast cancer (Stage 0, I, II) are treated with BCS, and the BCS rate is evaluated annually by the BPL.

Standard 2.4 Sentinel Node Biopsy
Axillary sentinel lymph node biopsy is considered or performed for patients with early breast cancer (Clinical stage I, II), and compliance is evaluated annually by the BPL.

Standard 2.5 Breast Cancer Surveillance
A plan is in place for assuring follow-up surveillance of breast cancer patients.

Standard 2.6 Breast Cancer Staging
The Breast Program Leadership (BPL) develops a process to monitor physician use of American Joint Committee on Cancer (AJCC) staging in treatment planning for breast cancer patients. The process and results of such monitoring are discussed among the BPL and breast center staff, and the findings are documented annually.

Standard 2.7 Pathology Reports
The CAP Committee guidelines are followed for all breast cancers, including estrogen and progesterone receptors, and Her2 status for all invasive breast cancers. Estrogen receptor status is recommended for DCIS (but not required by CAP). Outside pathology is reviewed.

Standard 2.8 Diagnostic Imaging
Screening mammography and diagnostic mammography are performed at Mammography Quality Standards Act (MQSA)-certified facilities and interpreted by MQSA-certified physicians.

Standard 2.9 Needle Biopsy
Palpation-guided or image-guided needle biopsy is the initial diagnostic approach rather than open biopsy.

Standard 2.10 Ultrasonography
Diagnostic ultrasound and/or ultrasound-guided needle biopsy are performed at an American College of Radiology (ACR) accredited facility or by an American Society of Breast Surgeons (ASBS)-certified surgeon.

Standard 2.11 Stereotactic Core Needle Biopsy
Stereotactic core needle biopsy is performed at an American College of Radiology (ACR) accredited facility, or by surgeons under the standards and requirements developed by the American College of Radiology (ACR) and the American College of Surgeons (ACoS) or by an American Society of Breast Surgeons (ASBS) certified-surgeon.

Standard 2.12 Radiation Oncology
Radiation oncology treatment services are provided by or referred to radiation oncologists that are board certified or in the process of board certification at their initial survey. The center has been accredited either by the American College of Radiology, Radiation Oncology Practice Accreditation (ACR - ROPA), American Society for Radiation Oncology, Accreditation Program for Excellence (ASTRO - APEx) or the American College of Radiation Oncology (ACRO) or has a quality assurance program in place, and the breast cancer quality measure endorsed by the National Quality Forum (NQF) for radiation.

Standard 2.13 Medical Oncology
Medical oncology treatment services are provided by or referred to medical oncologists that are board certified or in the process of board certification, and the breast cancer quality measures endorsed by the National Quality Forum (NQF) for medical oncology are utilized.

Standard 2.14 Nursing
Nursing care is provided by or referred to nurses with specialized knowledge and skills in diseases of the breast. Nursing assessment and interventions are guided by evidence-based standards of practice and symptom management.

Standard 2.15 Support and Rehabilitation
Support and rehabilitation services are provided by or referred to clinicians with specialized knowledge of diseases of the breast.

Standard 2.16 Genetic Evaluation and Management
Genetic risk assessment, genetic counseling, and genetic testing services are provided or referred.

Standard 2.17 Educational Resources
Culturally appropriate educational resources are available for patients along with a process to provide them. The materials provided are reviewed on an annual basis and adjusted for the patient population.

Standard 2.18 Reconstructive Surgery
All appropriate patients undergoing mastectomy are offered a preoperative referral to a reconstructive/plastic surgeon. Reconstructive surgery is provided by or referred to reconstructive/plastic surgeons that are board certified or in the process of board certification. Compliance is evaluated annually by the BPL.

Standard 2.19 Evaluation and Management of Benign Breast Disease
Evaluation and management of benign breast disease follows nationally recognized guidelines.

Standard 2.20 Breast Cancer Survivorship Care
A comprehensive breast cancer survivorship care process, including a survivorship care plan with accompanying treatment summary, is in place within six-months of completing active treatment and no longer than one-year from date of diagnosis. The survivorship care process is evaluated annually by the Breast Program Leader (BPL).

Chapter 3 Research

Purpose: The standards promote advancement in prevention, early diagnosis and treatment through the provision of clinical trial information and patient accrual to breast cancer-related clinical trials and research protocols.

Standard 3.1 Clinical Trial Information
Information about the availability of breast cancer-related clinical trials is provided to patients through a formal mechanism.

Standard 3.2 Clinical Trial Accrual
Two percent or more of all eligible breast cancer patients are accrued to treatment-related breast cancer clinical trials and/or research protocols annually.

Chapter 4 Community Outreach

Purpose: The standards ensure that breast cancer education, prevention, and early detection opportunities are provided to the community, patients, and their families.

Standard 4.1 Education, Prevention and Early Detection Programs
Each year, two or more breast cancer education, prevention, and/or early detection programs are provided on-site or coordinated with other facilities or local agencies targeted to the community and follow-up is provided to patients with positive findings.

Chapter 5 Professional Education

Purpose: The standard promotes increased knowledge of breast center staff through participation in local, regional, or national educational activities.

Standard 5.1 Breast Center Staff Education
Professionally certified/credentialed members of the breast center participate in local (in addition to breast cancer conference attendance), state, regional, or national breast-specific educational programs annually.

Chapter 6 Quality Improvement

Purpose: The standard ensures that breast services, care, and patient outcomes are evaluated and improved continuously.

Standard 6.1 Quality and Outcomes
Each year the breast program leadership conducts or participates in two or more center-specific studies that measure quality and/or outcomes, and one or more of your physician members participate in their specialty-specific quality improvement program. The findings are communicated and discussed with the breast center staff, participants of the interdisciplinary conference, or the cancer committee, where applicable.