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

Standard 2.3: Breast Conservation

Breast-conserving surgery is offered to appropriate patients with breast cancer. A target rate of at least 50 percent of all eligible patients diagnosed with early-stage breast cancer (Stage 0, I, II) is treated with breast conserving surgery.

Definition and Requirements

Breast-conserving surgery for patients with early-stage breast cancer is a nationally accepted standard of care in appropriately selected patients.

Patients are generally considered eligible for breast-conserving surgery if the tumor is localized and can be completely removed with negative margins, leaving a cosmetic result that is acceptable to the patient, and if they are candidates for radiation treatment.

Performance Measure

The NAPBC requires the Breast Program Leadership Committee (BPLC) to review the quality of patient care using the NAPBC-identified performance measures appropriate to the patients who are treated by the center each year.

Performance Measure

Breast-conservation surgery rate for women with American Joint Committee on Cancer (AJCC) Stage 0, I, or II breast cancer.

Process Requirements

Accession List and Data Review Requirements for the Site Visit

The center is required to provide a de-identified accession (case) list of breast cancer cases diagnosed and/or treated at the center (class of case 10–22) prior to the site visit date. Class of case is defined in the Facility Oncology Registry Data Standards (FORDS) manual.

Despite strong evidence supporting the safety of breast-conserving surgery for the treatment of early-stage breast cancer, an increasing number of women are opting for mastectomy. There appear to be regional differences in the patient’s preference of operation, making a target rate for breast-conserving surgery difficult to apply across the country.

The BPLC evaluates the breast-conservation surgery rate for women with AJCC Stage 0, I, or II breast cancer, treated at the breast center, annually, and comments on whether the rate is appropriate and expected in their community. The BPLC should consider the influences that are driving the decision making and discuss approaches to understanding the driving forces.

Evidence of this monitoring activity will be documented in the BPLC meeting minutes, including action(s) taken to correct any identifiable performance issues.

Compliance is reviewed annually by the BPLC.

Documentation

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

Document the annual audit by the BPLC in the meeting minutes. Include the calculation and discussion of the breast-conservation surgery rate for women with AJCC Stage 0, I, or II breast cancer.

Evaluation

The surveyor will review patient medical records during the medical records review portion of the site visit to evaluate compliance with performance measure(s) and the use of breast-conserving surgery. If the breast-conserving surgery rate is below fifty percent (50%), the surveyor will review and determine if it is justified.

Rating Compliance

Compliance

  1. Breast-conserving surgery is offered to appropriate patients with breast cancer as evidenced by the medical records review.
  2. A target rate of at least 50 percent of all eligible patients diagnosed with early-stage breast cancer (Stage 0, I, II) is treated with breast-conserving surgery.
  3. The breast-conserving surgery rate is evaluated during the annual audit by the BPLC and documented in the meeting minutes.
  4. Annual performance rates are reported for the breast-conservation surgery rate for women with AJCC Stage 0, I, or II breast cancer, and performance rates and action(s) taken to correct any identifiable performance issues are documented in the BPLC meeting minutes.

Noncompliance

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

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