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

Standard 1.2: Multidisciplinary Breast Care Conference

The Breast Program Leadership Committee (BPLC) establishes, monitors, and evaluates the multidisciplinary breast care conference (MBCC) frequency, Breast Care Team (BCT) attendance, prospective and total annual case presentation, including American Joint Committee on Cancer (AJCC) staging, and discussion of nationally accepted guidelines.

Definition and Requirements

Breast care conferences are integral to improving the care of breast disease patients by contributing to patient management and outcomes while providing education to physicians and other staff in attendance. Input should be encouraged from all BCT members.

The breast center must ensure the multidisciplinary breast care conferences are scheduled to permit attendance on a regular basis. Conferences must include prospective multidisciplinary case evaluation by the BCT.

This comprehensive approach allows the BCT to:

  1. Promote inclusion of a broad range of physician and other specialists to address early diagnosis, quality of life, ethics, or other relevant topics
  2. Improve patient care, promote effective management of resources, and make decisions which reflect the patient's goals for treatment
  3. Discuss treatment options, including investigational therapy, for breast cancer patients to offer a collaborative recommendation

Monitoring of breast cancer conference activity by the BPLC, including multidisciplinary representation and individual attendance, ensures that conferences provide consultative services for patients as well as offer education to physicians and allied health professionals. The confidentiality of all information disclosed at these conferences is to be maintained by all participants.

The BPLC establishes and monitors individual BCT member attendance from surgery, medical oncology, and radiation oncology.  Attendance by those individuals is no less than 50 percent (50%) of MBCCs held each calendar year. The BPLC may set higher rates.

A representative from both Pathology and Radiology must be present at all MBCCs. Individual attendance rates for radiologists and pathologists are set by the BPLC.

BCT Member

Attendance Rate

Surgeon
Medical Oncologist
Radiation Oncologist

Individuals attend no less than 50%* of MBCCs each calendar year (12 months).

*BPLC can set higher rate

Pathologist
Radiologist

Each specialty is represented at all MBCCs.

BPLC sets the individual attendance rate for each calendar year (12 months).

The MBCC is focused on treatment planning for newly diagnosed patients, patients who have treatment decisions to be made, and patients with recurrent breast cancer. Representation from surgery, medical oncology, radiation oncology, pathology, and radiology is required.

The MBCC includes:

  1. A presentation of relevant history and physical elements, including family history
  2. A discussion of stage, risk profile, surgical options/pre-surgical options
  3. Visual display of pathology slides and radiology imaging and a discussion regarding radiology-pathology correlation
  4. Discussion regarding clinical trials, genetics risk, and reconstructive options
  5. Consideration of nationally recognized guidelines at the conference (for example, the National Comprehensive Cancer Network); these guidelines must be available for reference during the conference
  6. An open discussion by all conference participants

Definition of Prospective case review:

  • Newly diagnosed breast cancer and treatment not yet initiated
  • Newly diagnosed breast cancer and treatment initiated, but discussion and additional treatment is needed
  • Previously diagnosed, initial treatment completed, but discussion of adjuvant treatment or treatment recurrence or progression is needed
  • Consideration for clinical trials
  • Previously diagnosed and discussion of supportive or palliative care is needed

Analytic Case Load

Required MBCC Frequency

Case Presentation

100 cases or less

Every two weeks or twice monthly, or more frequently at the discretion of the BPLC.

  • Centers with fewer than 100 analytic breast cancer cases per year have the option of including these cases as part of a general cancer conference.

Eighty-five percent (85%) of cases reviewed must be prospective.

101–250 cases

Every two weeks or twice monthly, or more frequently at the discretion of the BPLC.

Case presentation thresholds are determined by the BPLC.

251 + cases

Weekly

Case presentation thresholds are determined by the BPLC.

Process Requirements

The BPLC establishes and monitors the MBCC frequency.

The BPLC establishes and monitors specialty and individual member attendance requirements for the BCT.

The BPLC establishes and monitors a case presentation threshold for the MBCC.

Documentation

Complete all required standard fields in the Survey Application Record (SAR).

Upload the breast center MBCC policy.

Upload a copy of the MBCC schedule/calendar from the last complete year, prior to the site visit date.

Complete and upload the NAPBC Multidisciplinary Breast Cancer Conference Attendance Tracking form.

Evaluation

The surveyor will attend a breast cancer conference during the site visit, to observe the multidisciplinary involvement in case presentations.

Rating Compliance

Compliance

The BPLC establishes, monitors, and evaluates the MBCC frequency, BCT attendance, prospective and total annual case presentation, including AJCC staging, and discussion of nationally accepted guidelines.

Noncompliance

The center does not fulfill one or more of the compliance criteria.