The Sloane Project NHS - Cancer Screening Programmes
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Sloane Report 30/4/05 6:32 pm Page i
NHS
Cancer Screening Programmes
The Sloane Project
UK prospective audit of screen detected non-invasive
carcinomas and atypical hyperplasias of the breast
Annual Report
2003/2004Sloane Report 30/4/05 6:32 pm Page ii
Sloane Report 30/4/05 6:32 pm Page 1
1
Mr Hugh Bishop,
Chair of Sloane Project
Steering Group
THE SLOANE
PROJECT
A UK Prospective Audit of Screen-detected Non-invasive
Carcinomas of the Breast
INTRODUCTION add your own comments on the design of the
It is a pleasure to contribute to the 2003/04 form, or on particular aspects of the patients’ data.
Annual Report on the Sloane Project. The If we do not receive completed forms from you, it
Sloane Project started on 1st April 2003. At that is up to us on the Sloane Project Steering Group
time, we stipulated that patients could only be to find out why and to engineer an improvement.
included if they had been invited for screening So, don’t worry if all your boxes aren’t ticked, just
after the 1st April 2003. I had failed to send us all the details that you can.
appreciate that this meant that the first patients
that could be registered would only start to Trials (e.g. New DCIS Trial, IBIS II, etc)
emerge in July/August of that year. This did little We positively encourage you to participate in
to swell numbers in 2003/04. Since those early all available DCIS trials. The Sloane Project is
days, I am delighted to report that 67 breast an audit; it does not and should not mean that
screening units have agreed to participate and a Sloane Project patient cannot be entered into
that data have been received from nearly 50 an appropriate clinical trial.
units. I am extremely grateful to all who have
participated for their unstinting generosity. The Other Non-invasive Lesions
high standard of data completeness on the (e.g. ADH, LISN etc)
forms that you have returned to date is We encourage you to register these patients
particularly worthy of note. Surgeons are often with difficult lesions within the Sloane Project.
berated for their supposed inability to fill in
forms, so I am particularly pleased to report that Funding
the treatment forms, submitted by surgeons Until now, the Sloane Project has been
(allegedly) are the most complete! I am financed by a grant from the NHS Breast
delighted to report that over one thousand Screening Programme and we remain very
patients have now been registered in the Sloane grateful to Julietta Patnick for all her
Project. encouragement and support. Unfortunately, the
May I draw your attention to the following: budget for the NHS Cancer Screening
Programmes has been cut considerably this
Data Completeness year. This decision has thrown the whole
Please do not fret if you can’t complete every last Sloane Project into jeopardy. I am therefore
box. Just send us what you can. The West very pleased to tell you that we have secured an
Midlands Cancer Intelligence Unit is not quite as unrestricted educational grant from Pfizer
all knowing as the Inland Revenue, but it does Pharmaceuticals for £75,000, over the next
have considerable skills in pursuing data. We three years, to help to cover the running costs of
know that the pathology data form can be the Sloane Project. We are extremely grateful to
challenging and that pathologists are trained to be Pfizer for their generous support.
accurate and meticulous. Nevertheless, we
would particularly ask pathologists to complete as It only remains to say, how pleased I am that the
many of the data fields as they can and not to Sloane Project is making the progress that it is,
ignore the form, simply because they can’t and I continue to be very grateful for all
complete all of the data fields. Please feel free to voluntary contributions to its success.Sloane Report 30/4/05 6:32 pm Page 2
2
Professor John Sloane
Background and S
of t
There has been a marked increase in the Oncology (ABS at BASO). The Sloane Project is
incidence of non-invasive breast cancers since co-ordinated by Karen Clements, the Sloane
the introduction of the NHS Breast Screening Project Officer.
Programme (NHSBSP). Ductal carcinoma in
situ (DCIS) now accounts for over 20% of all As a prospective audit recording particular
breast cancers detected by the NHSBSP. The characteristics in terms of radiological and
reason for the increase is that DCIS is relatively pathological appearance and details of surgical
easy to detect on a mammogram due to the and adjuvant treatment, the Sloane Project will
microcalcification that is frequently present. compile a database of potentially 10,000 DCIS
cases over five years. At the same time the
Currently over 2,500 new non-invasive breast project will also look at the incidence of lobular
cancers are detected by the NHSBSP each year. in situ neoplasia (LISN), atypical ductal
Unfortunately there are still uncertainties about hyperplasia (ADH) and atypical lobular
the natural history, invasive potential and hyperplasia (ALH).
optimal treatment for this condition. One of the
main aims of the Sloane Project, therefore, is to Participation in the Sloane Project is invited
gain more knowledge regarding the diagnosis, from all 98 UK breast screening units and, at
treatment and clinical outcomes of screen present, 67 units have agreed to take part. A
detected in situ carcinoma and atypical lead clinician needs to be identified to lead the
hyperplasia. This will assist in the construction co-ordination of the Sloane Project in each unit
of proposals for the management of these non- and to ensure complete and accurate data
invasive breast diseases. collection. As the Sloane Project is a multi-
disciplinary project involving surgeons,
The Sloane Project is named after the late pathologists, radiologists and oncologists,
Professor John Sloane, a prominent pathologist communication and a team-based approach are
who worked at the Royal Liverpool Infirmary, essential components to the success of the
who had a great interest in the pathology of Sloane Project in each unit.
DCIS. The project is an NHSBSP audit, which is
being administered through the West Midlands The data for the Sloane Project are being
Cancer Intelligence Unit (WMCIU) in collected by way of specifically designed data
collaboration with the Association of Breast collection forms for each discipline, which will
Surgery at the British Association of Surgical provide full and detailed information about theSloane Report 30/4/05 6:32 pm Page 3
3
Miss Karen Clements,
Sloane Project Officer
d Summary
f the Sloane Project
patient’s journey from diagnosis to treatment. Eligibility Criteria
The cases will be followed up and the
incidence of local recurrence, contralateral Patients are eligible if:
breast cancer, metastases and deaths will be They have ductal carcinoma in situ (DCIS),
determined. The follow up information will be lobular in situ neoplasia (LISN), atypical ductal
collected on a simple spreadsheet with more hyperplasia (ADH), or atypical lobular
detailed recurrence information being collected hyperplasia (ALH) and
on a specially designed follow up form. There is Their disease was screen-detected within the
a specific pathology protocol to ensure the NHS Breast Screening Programme and
gathering of accurate pathology data, as well as Their disease is non-invasive or micro-invasive
radiology guidelines to assist in the completion
of the radiology form. Patients are not eligible if:
They have invasive disease or
Careful prospective collection of these data will Their disease was not screen detected within
enable the correlation of clinical outcomes with the NHSBSP or
treatment received. This information will allow Their disease was symptomatically detected or
the identification of prognostic indicators, the They have recurrent breast cancer or
examination of the role of margins and adjuvant They have had a previous contralateral breast
therapy on outcome, and the calculation of cancer
survival. As a result, the project will be able to
suggest what might be the optimal treatment for Consent and Ethics Committee Approval
DCIS and other non-invasive breast cancers. Ethics committee approval is not needed for the
Sloane Project as it is a prospective audit rather
than a trial and is covered under the NHSBSP’s
application to the Patient Information Advisory
Group (PIAG).
If you require any further information about any
aspect of the Sloane Project, please contact
Miss Karen Clements, Sloane Project Officer, by
e-mail at karen.clements@wmciu.nhs.uk
or on 0121 415 8190Sloane Report 30/4/05 6:32 pm Page 4
4 Dr Sarah Pinder,
Consultant Breast Pathologist
PATHOLOGY
DCIS now comprises a significant portion of the
breast pathology workload; in many centres
more than 20% of screen-detected cancers are
in the form of DCIS. However, the handling of
breast excision specimens for DCIS is fraught
with difficulties, not least because the lesion is
often not visible to the naked eye and the
preparation of samples is thus often time
consuming and complicated. Specific resources
such as the facility for specimen X-ray are
required, as X-ray of both the whole specimen
and (very often) specimen slices is used to
identify the areas of concern in the form of
microcalcification. It is clear that thorough
sampling to exclude the presence of foci of
invasion and to assess completeness of excision
is vital to the management of patients with
DCIS, but no one method of specimen handling
can be used in all cases. There are a variety of
techniques which can be used and local
laboratory idiosyncrasies are frequently found.
The Sloane Project is an audit of the way DCIS
is identified and treated in the UK, with the aim
of collecting better DCIS data. The Sloane
Project pathology protocol is not prescriptive
and describes several possible methods of
specimen dissection, and it should be noted
that other methods can be used to provide the
Sloane Project pathology data, as long as they
are fully documented.
Previous review of the cases entered into the
first UKCCCR DCIS trial showed that central
review of DCIS was almost impossible with
respect to size of disease and distance of
disease to relevant margins, at least in some
cases. There is no agreement as to what
constitutes an adequate margin of excision and
this requires further evaluation in a large well-
characterised series of cases. It is, however,
Prof Ian Ellis, Prof Andrew Hanby,
Dr Jim Macartney, Dr Jeremy Thomas
Sloane Project Steering Group PathologistsSloane Report 30/4/05 6:32 pm Page 5
5
clear from literature review and previous disease, rather the components are itemised
experience that high quality pathology is separately as (a) necrosis - present and (b) the
essential for the evaluation of features of architecture - solid, cribriform, micropapillary
importance in the biology, diagnosis and or papillary etc.
management of patients with DCIS, including
the two features of size and margin distance. The NHSBSP pathology EQA scheme also
Thus, any multicentre large trial, which does shows that there are significant deficiencies in
not include the highest quality pathological the reproducibility of diagnosis of ADH and
input at the time of assessment in the source micro-invasive carcinoma. Yet these, albeit
breast pathology laboratory, is significantly rare, lesions are seen more often in breast
flawed. The Sloane Project pathology data screening practise than in symptomatic work.
analysis will allow examination of features of Recent evidence also suggests variances in the
interest in a large body of cases of DCIS behaviour of LISN, and information on “high
diagnosed through the UK NHSBSP which have risk” lesions will also be collected in order to
undergone high quality pathological add to the body of knowledge of these diseases.
assessment, with collection of a specified, As no single institution will be able to collect
targeted set of parameters which have such data on these infrequent processes, a large
previously been indicated to be of value. national database is required, and the Sloane
Project will fulfil this need.
The pathology protocol for the Sloane Project
has been written in order to facilitate A number of regional workshops for specimen
completion of the pathology data form, which handling and DCIS microscopy have been held
has undergone some simplification since its through the NHSBSP regional pathology co-
inception. The pathology protocol outlines not ordinators’ group. Others can be organised if
only methods for handling, but also for desired through the Sloane Project Team at the
reporting of DCIS in the hope of improving West Midlands Cancer Intelligence Unit. In
consistency of pathological assessment. The addition, a CD of DCIS microscopic images has
NHSBSP pathology EQA scheme has been produced and distributed through the
demonstrated that there is sub-optimal NHSBSP National Pathology Update Course
reproducibility in the assessment of grade of (April 2004). It is intended to expand on this
DCIS. This feature has nevertheless been shown aide memoire in the near future and make this
in several series to be of prognostic importance. available through the NHSBSP pathology EQA
Numerous other factors have been suggested to scheme.
be of importance in the prediction of behaviour
of DCIS including the size of the lesion, the Any additional suggestions and feedback
presence or absence of necrosis, and the regarding the histopathology of the Sloane
architecture of the DCIS. The pathology Project are welcome and can be directed
protocol outlines the definitions of these through Karen Clements to the pathologists on
features in order to clarify completion of the the Sloane Project Steering Group.
form; for example, comedo DCIS is not
considered to be an architectural type of theSloane Report 30/4/05 6:32 pm Page 6
Dr Anthony Maxwell,
Consultant Radiologist
RADIOLOGY
Most cancers of the breast exist in situ for at minutes or so to complete it is hoped that the
least part of their natural history, and an submission rate will improve. Efforts are
understanding of the behaviour of DCIS (the continuing to encourage currently non-
commonest non-invasive breast cancer) is participating units to start data collection - an
crucial to our understanding of breast cancer as average sized unit with around 20 eligible cases
a whole. As DCIS is usually clinically occult, annually would only need a couple of hours of
radiology plays an essential role in the radiologist time to complete the forms each
diagnosis, assessment and follow up of the year. Even if pathology and surgery forms are
disease. Treatment of DCIS is still largely not currently being completed, it is still useful
empirical, the surgical procedure being for radiology forms to be submitted. The more
determined mainly by comparison of cases that are entered into the Sloane Project,
mammographic estimates of disease extent and the greater confidence we can have in the
proximity to the nipple with arbitrary standards. results.
The radiology data, which are being collected With the recent changes to the national breast
through the Sloane Project, will allow a number screening computer system, the easiest way to
of aspects of diagnosis and management to be identify the eligible cases is to run a KC62 (this
investigated. These include analysis of the can be done at any time in the screening year)
radiological appearance, distribution and extent and print a list of women in columns 27 & 28 of
of the disease, the size and density of the breast Tables A - F2. Some minor amendments are
and the patients’ age and screening round. being made to the guidance for completion of
These factors can then be correlated with the the radiology forms, and updated versions of
surgical and pathological data, to suggest future the document will be sent to the Sloane Project
improvements in radiological diagnosis and contacts in participating breast screening units.
assessment of the disease. In the longer term,
correlation of preoperative radiology with local Considerable thought has gone into deciding
recurrence rates will be possible. what information needs to be collected for
Sloane Project patients under follow up.
Of the 784 cases from the 2003/04 screening Mindful of the possibility of overburdening
year which have been registered at the time of radiologists, it has been decided that a follow
writing, radiology forms have been received for up form will only need to be filled in where
660 (84.2%). These forms have a good level of there is proven recurrent or new malignancy (in
data completeness. This is an encouraging either breast).
response, and it is anticipated that the
remaining radiology forms for many of these Please keep the forms coming in, and please
women will be received in due course. remember to include any cases of LISN, ADH
However, over 1,000 cases would be expected and ALH (without associated invasive disease).
from the participating breast screening units. It Our knowledge of the natural history of these
is recognised that many units are short of less common conditions is very poor, and each
radiologists, but as each form only takes five case registered makes a valuable contribution.Sloane Report 30/4/05 6:32 pm Page 7
Dr David Dodwell,
Consultant in Clinical Oncology
RADIOTHERAPY
A number of randomised control trials have there is a tendency for surgical treatment for
now provided evidence for the benefits of DCIS to comprise wide local excision rather
radiotherapy in reducing the incidence of breast than mastectomy, the need for radiotherapy will
cancer recurrence of both invasive and in situ increase and so it was felt important to collect
disease type following initial wide local information on current radiotherapy prescribing
excision for DCIS. Despite this evidence, patterns as part of the Sloane Project.
radiotherapy following wide local excision for
DCIS is not established as routine treatment in It is hoped that the Sloane Project will answer a
all countries including the UK. The decision to number of crucial questions, providing an
use radiotherapy may depend on pathological understanding of how patients are selected for
margin status, grade, size of DCIS, presence of radiotherapy, the techniques and fractionation
necrosis and oestrogen receptor status (and regimens employed, the importance of the
therefore possible confounding use of management of screen detected DCIS on the
concurrent endocrine therapy). There may be utilisation of radiotherapy resources and the
concerns regarding the morbidity of importance of radiotherapy in preventing future
radiotherapy. Its availability within an local recurrence. Happily the radiotherapy form
acceptable time frame is also an issue given the within the Sloane Project is simple and
pressure on radiotherapy resources and the although many returns are outstanding,
waiting lists that have become apparent in compliance with completion of this form has
many UK centres recently. Nevertheless, as generally been very good.Sloane Report 30/4/05 6:32 pm Page 8
Dr Caroline Rubin,
8
Director of Breast Screening, Southampton & Salisbury
UNIT PERSPECTIVE FROM
SOUTHAMPTON AND
SALISBURY BREAST SCREENING UNIT
The Southampton and Salisbury Breast documentation and presentation provided to
Screening Unit serves a population of us, and local acceptance was ameliorated
approximately 58,000 women aged 50-64. The because one of our pathologists had trained
Unit is staffed by 4 consultant radiologists under John Sloane.
undertaking 10 funded sessions, 10
radiographers, including 5 advanced The Director of Breast Screening, who also
practitioners, 2 RDAs and 7 A&C staff. The Unit completes the demographic details on the
has access to 4 breast care nurses, 2 consultant surgical and pathology forms and forwards
breast surgeons and an associate specialist in them to the appropriate consultant, completes
Southampton as well as 2 consultant breast all the radiology data forms. The surgical and
surgeons in Salisbury. Breast reconstruction is pathology forms are forwarded directly to the
provided in partnership with the plastic clinician performing the surgery or the
surgeons based in Salisbury. 6 consultant pathologist who reported on the operative
pathologists provide the cytopathology and specimen. To date only one patient has had
histopathology service, two of whom report on radiotherapy and the clinical oncologist
both histopathology and cytopathology responsible for her care completed the form.
specimens. 2 consultant medical oncologists Reminders are sent if the forms are not returned
and 2 consultant clinical oncologists complete in a timely fashion.
the team.
Data Collection
The Unit has always had a high detection rate The data are collected from the breast screening
of in situ disease. In 2003-2004 the rate was 2.3 unit packets, the case notes (surgery) and the
per 1,000 in the age group 50-64 pathology reports/information system. The multi-
approximating to 28% of total cancers detected. disciplinary meeting does not play a significant
role in identifying cases. Primarily these arise
Sloane Project Participation from an internal review of all FNAs, core
We found out about the Sloane Project via biopsies and operative histology undertaken by
national mammography meetings and regional the Director of Breast Screening. Completion of
QA meetings but got involved after a direct the demographic data on all the forms, filling in
approach from the Sloane Project Officer. We the radiology form and managing a manual
decided to participate as we had observed the tracking system takes between 15 and 30
natural progression of the disease in our own minutes per case. We do not keep a local copy
unit, with patients who we thought had been of the data but a paper log is maintained to track
adequately treated for local DCIS re-presenting the paperwork and identify those cases that have
a variable number of years later with further in been completed and forwarded. We are shortly
situ or invasive disease. The Sloane Project is going to reconcile the cases to date with the
likely to provide information to assist clinicians NBSS to identify any additional cases that have
in the management of these unpredictable non- not been captured.
invasive conditions.
I would like to acknowledge all my colleagues
The Director of Breast Screening undertakes the who have kindly filled in the documentation
role of the Sloane Project contact and the co- and who respond cheerfully to my nagging
ordinator for data collection as the local audit despite their onerous clinical and other
department felt they were unable to contribute. commitments and for whom this is yet another
The Sloane Project was introduced utilising the unfunded burden.Sloane Report 30/4/05 6:32 pm Page 9
9
SCREENING OFFICE MANAGEMENT
PERSPECTIVE FROM
WIRRAL BREAST SCREENING SERVICE
Wirral
Breast
Team
My name is Glen Penn and I am the screening columns 27 and 28 and then knew I had them
office manager for the Wirral Breast Screening all! I then pulled all the film packets from file
Service. We have a population of women aged 50- and sent for the hospital case notes, filled out
70 of 43,500 with approximately 15,000 screened all the demographics on the specialist forms
each year. Last year we diagnosed 105 cancers, (usually 3 for each case, 4 in some instances)
with 11 of them having non-invasive disease and and clipped them to the front of the notes.
therefore eligible for the Sloane Project. I first found Then comes the difficult bit, getting the
out about the Sloane Project at the national A&C specialists to fill them in! I found that if I gave
co-ordinators’ group meeting in London, when the each specialist 3 or 4 at a time when they were
Sloane Project Officer gave a presentation. I met up in clinic and complete with the notes then
with the Sloane Project Officer again when she they got into the swing of them. Of course it
came to repeat the presentation to a North West takes a little while as each patient has 3 or 4
QA Team meeting. I then gave the presentation to specialist forms of different permutations and
my own breast team at our monthly audit meeting. so the case notes hung around in my office for
I found the presentation pack provided was a number of weeks but overall it worked very
excellent although by now I think I could repeat it well and I hope to do the same again this year.
in my sleep!
Each completed form was photocopied and
Our team consists of 3 surgeons, 3 radiologists, put into the patient’s screening packet for
3 pathologists, 2 oncologists as well as future reference and the front of the packet
specialist nurses, radiographers, theatre and marked to ensure no duplication. I realise that
ward staff and admin and clerical staff, who all if everyone decided to do it this way then the
seemed very enthusiastic and keen to take part. forms would all descend on the Sloane Project
However, in the cold light of day and with all office at similar times with a large void during
the good will in the world, cases were not being most of the year, although KC62’s can be run
identified regularly and enthusiasm waned! I at any time throughout the year. I know
decided that if our unit was going to participate everyone is very busy and although it might
then I would have to co-ordinate it. seem an extra burden on screening office
managers, our expertise and experience with
Although the multi-disciplinary team meeting filling in of forms for the screening programme
seemed a good source of identifying the data, make us ideal candidates to carry this out. It
in reality some cases were picked up but I really did not take a huge amount of time and
wasn’t convinced I had them all. So I ran the it is very rewarding to know we are helping
KC62, printed out women from tables A – F2 with important research.10
Sloane Report
No. of Sloane Project cases entered (2003/2004)
Number of screening units
30/4/05
0
20
40
60
80
100
120
Ea
0
2
4
6
8
10
12
14
st
Chester M
Ea id
st s
South Devon of
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Cambridge ng
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6:32 pm
Barking
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Walsall E, nd
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North Notts or
ks
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Rotherham H
um
Doncaster be
Page 10
r
Shropshire N
W
Liverpool es
t
Northampton N
Ir e
SW Scotland la
nd
Cornwall
Sc
Medway ot
la
So nd
East Berks
Participating and data submitted
ut
h
Isle of Wight Ea
st
Not participating Screening Region
So (E
Milton Keynes ut )
h
Maidstone Ea
RESULTS
st
Interest show n but participation not confirmed
Dudley & Wolves (W
So )
Wirral ut
h
Leicestershire W
es
t
Participating and collecting data but not yet submitted any
South Essex
Peterborough W
al
es
East Sussex W
es
Portsmouth
Breast Screening Unit
tM
id
North Cumbria s
South Staffs
Hereford & Worcs
Wiltshire
Cases entered to date for screening year 2003/2004
North Yorks
SO FAR
Sheffield
West Devon
Figure 2
Figure 1
Avon
Chelmsford
East Devon
screening unit
Leeds
screening region
Nottingham
Bolton
South Derbyshire
Warks, Solihull & Cov
Gloucs
Number of cases entered into
Southampton
the project in 2003/04 by each
West Scotland
Participating units in each breast
JarvisSloane Report 30/4/05 6:32 pm Page 11
11
The majority of the data presented in the results two years, following promotional activities and
section are for those patients who were letters, more units have agreed to take part,
screened between 1st April 2003 and 31st with recruitment to the project ongoing. This
March 2004. However, Figure 1 shows the has meant that some units have only recently
current situation with regard to participation by been recruited into the project and have just
screening region up to and including March started collecting data. Many units did not
2005. As of the beginning of March 2005, 49 of begin collecting data until the end of 2003,
the 98 (50%) UK Breast Screening Units have with some only beginning to collect data for
sent in data. A further 18 units (18%) have the screening year 2004/05. This is because the
confirmed that they are collecting data and Sloane Project is a prospective audit and
have given the reasons for the delay (e.g. they any retrospective data would have to be
have only just begun to collect data or have complete and very accurate, which many units
previously been experiencing difficulties). 13 would find difficult. It is anticipated that a lot
units (13%) have said that they wish to take part more data will be received for the 2004/05
but have not yet confirmed that they are screening year, as more screening units will be
collecting data. 18 units (18%) have either not collecting a “full screening year’s worth” of
replied or have said they do not wish to or are data.
unable to take part in the Sloane Project at this
time. Breast screening units are still being The beginning of the Sloane Project also
recruited into the Sloane Project in an ongoing coincided with the expansion of the NHSBSP,
process, to which would we would encourage placing additional pressure on the screening
any of those units not participating at present to units. Furthermore, changes in the National
submit data in the future. Breast Screening Computer System meant that
lists of non-invasive cases could not be run until
As of 21st March 2005, 784 cases had been a Crystal Report was created. This has now
entered into the Sloane Project for the been completed and issued nationally, which
screening year 2003/04. It was anticipated that should assist units in collecting their full cohort
more cases would be entered for that screening of cases. In addition to this, manpower
year, as 2,870 cases of non-invasive and problems and lack of funding have also been
micro-invasive cancer were detected by the cited as barriers to participation.
NHSBSP in the screening year 2003/04.
However, there are a number of reasons for this The Sloane Project Steering Group is therefore
relatively low participation rate. One of these is extremely grateful to all those who have
a delay in recruiting breast screening units into submitted data and would encourage
the Sloane Project due to the difficulty in everybody to continue collecting data for this
disseminating the necessary information to worthwhile audit. Finally, we would like to
such a large group of people. There was an encourage any units who have not submitted
initial burst of interest following the launch of data or have not started to participate to begin
the Sloane Project, then gradually over the past collecting data.Sloane Report 30/4/05 6:32 pm Page 12
12
Cases entered into the Sloane Project to date by screening
region (2003/2004)
160
140
Number of screening units
120
100
80
60
40
Figure 3
Number of cases entered into the Sloane 20
Project for each screening region (for 0
screening year 2003/04)
r
nd
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)
s
s
)
es
t
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on
be
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Screening Region
Number of completed forms returned for each discipline
(2003/2004)
660 676 553
Figure 4
100% Number of completed data collection
90% forms returned for each discipline
80%
& completed forms returned
70%
60%
50%
40%
30%
20%
10%
0%
Radiology Treatment Pathology
Sloane Project data collection form
% forms returned % forms not returned
Data Quality and Completeness radiotherapy forms have been completed and
returned.
An idea of data quality and completeness from
a national and regional perspective is provided Some difficulties have been encountered with
in the following summary which is based on the submission of pathology forms. This is
data collected for the screening year 1st April partly due to the fact that the pathology
2003 and 31st March 2004 and entered onto protocol is quite detailed and therefore that
the Sloane Project database up to the middle of some pathologists believe that this would
March 2005. The data are as up-to-date as create a lot of extra work. However, as the cut
possible, but continually changing. Missing up procedures recommended in the Sloane
data will be chased on a six-monthly basis at Project pathology protocol are now part of the
the end of April and the end of October each NHSBSP pathology guidelines and are
year, so data completeness will also improve for therefore a requirement for pathologists
the screening year 2003/04. working in the breast screening programme, it
is hoped that more pathologists will be
Figure 3 shows that the number of cases entered following the protocol in their routine work. It
by region varies widely, with some regions not is also possible that at times the pathologist
submitting any data to the Sloane Project for the may not be notified that the pathology form
screening year 2003/04. Breast screening units needs to be completed. The Sloane Project
from Breast Test Wales have now started Steering Group is trying to assist
submitting data for the screening year 2004/05. pathologists by creating a CD-ROM for
assisting in classifying nuclear grade, as
Figure 4 shows that overall data collection is mentioned earlier. There are also plans to
good and the number of completed forms being incorporate further training on a new CD-
returned for each patient is excellent for ROM, which will include radiological images
radiology and treatment. 168 of 271 (62%) as well.Sloane Report 30/4/05 6:32 pm Page 13
13
Number of surgical procedures carried out
No surgical
Three operations
procedures
2.81%
1.48%
Two operations
26.18%
Figure 5
Number of surgical procedures carried
out on Sloane Project cases
One operation
69.53%
Adjuvant therapy given to Sloane Project patients in screening year
No surgical procedures One operation Two operations Three operations 2003/2004 (n=676)
Adjuvant therapy
unknown
5.62%
Figure 6
Radiotherapy alone
Adjuvant therapy given to 31.07%
Sloane Project patients
No adjuvant therapy
given
44.23%
Radiotherapy and
Hormone Therapy
8.73%
Hormone Therapy
alone
10.36%
Preliminary Data Adjuvant Therapy
Figure 6 shows the proportion of Sloane Project
Surgical Procedures patients receiving adjuvant therapy. 271 of 654
patients (41%) with known adjuvant treatment
Figure 5 shows that the majority of Sloane data were referred for radiotherapy. 383 of 654
Project patients are just undergoing one patients (59%) with known adjuvant treatment
therapeutic operation, with a further 26% data were not referred for radiotherapy. The
having two operations. Just under 3% of remaining radiotherapy data are to be chased to
patients have three operations. 1.48% of get a more complete and accurate picture.
patients had no therapeutic operation. The Approximately 20% of patients were given
reasons for this included the patient having a hormone therapy. Nearly half the patients with
diagnosis of ADH and the patient choosing not known treatment data received no adjuvant
to have any further surgery following the initial therapy.
diagnosis.
75% of final therapeutic operations (498 out of
666 cases with known surgery) were Hormone Therapy and Oestrogen Receptor
conservation surgery. A mastectomy was Status
undertaken as the final therapeutic operation in
168 cases (25%). 29 (5.8%) patients who Of the patients who were given hormone
underwent conservation surgery also had therapy and also had known pathology data,
axillary surgery. 125 (74%) patients who had a 72 (77%) were oestrogen receptor positive, 4
mastectomy also had nodal surgery. Overall, (4.3%) were oestrogen receptor negative and
23% of patients with known surgery had an 18 (19%) had unknown oestrogen receptor
axillary procedure carried out. status.Sloane Report 30/4/05 6:32 pm Page 14
14
SUMMARY FUTURE PLANS
The Sloane Project has almost finished its Future plans include setting up a Sloane Project
second year of data collection. Though it got off website. It is intended that the website will help
to slow start at first, participation by the UK participants with registration and explain the
breast screening units is now good. Some data collection process. The website will also
interesting findings are coming through already. contain general information on matters relating
Just from looking at the data that have been to the Sloane Project and will hopefully be the
submitted to the Sloane Project so far, it is quite first point of call for anybody seeking
clear that practise in the treatment of DCIS still information about non-invasive breast disease,
varies greatly amongst surgeons and across including recent publications, trial results and
hospitals and breast screening units. The Sloane other educational material which could be used
Project has shown that the data that are being as ongoing training. QA reference centres and
collected are going to be extremely useful for breast screening units will be kept informed of
planning how patients diagnosed with screen progress with the website.
detected non-invasive breast carcinomas and
atypical hyperplasias should be treated in the Promotional work for the Sloane Project is
future. ongoing. The Sloane Project Steering Group is
still trying to recruit as many breast screening
The Sloane Project Steering Group is grateful to units as possible and will continue to promote
all who have assisted us in the Sloane Project so the project and provide updates at regional,
far and would like to encourage everyone to national and international meetings and
continue their hard work. conferences. There will be a Sloane Project
promotional stand at the ABS at BASO meeting
on 11th May 2005. There will also be a Sloane
Project and DCIS workshop at the Nottingham
International Breast Cancer Conference on 15th
September 2005.
The Sloane Project Steering Group is conscious
that efforts need to be concentrated on ensuring
that those units who are submitting data already
continue to do so. This will be done by
providing feedback through presentations and
reports such as this. A Sloane Project meeting
will also be held in 2006 for all Sloane Project
contacts who have assisted in co-ordinating the
audit in their breast screening unit.Sloane Report 30/4/05 6:32 pm Page 15
15
Breast Screening Units
Submitting Data
Thank you to all staff who work in and with the following breast screening units
Avon Breast Screening Service Nottingham Breast Screening Service
Barking, Havering and Brentwood Breast Peterborough Breast Screening Service
Screening Service Portsmouth Breast Screening Service
Bedfordshire and Hertfordshire Breast Rotherham Breast Screening Service
Screening Service Sheffield Breast Screening Service
Bolton, Bury and Rochdale Breast Screening Shropshire Breast Screening Service
Service South Derbyshire Breast Screening Service
Cambridge and Huntingdon Breast Screening South Devon Breast Screening Service
Service South Essex Breast Screening Service
Chelmsford and Colchester Breast Screening South Staffordshire Breast Screening Service
Service South West Scotland Breast Screening Service
Chester Breast Screening Service Southampton and Salisbury Breast Screening
Cornwall Breast Screening Service Service
Doncaster Breast Screening Service Surrey (Jarvis) Breast Screening Service
Dudley and Wolverhampton Breast Screening Walsall and Sandwell Breast Screening Service
Service Warwickshire, Solihull and Coventry Breast
East Berkshire Breast Screening Service Screening Service
East Devon Breast Screening Service West Berkshire Breast Screening Service
East Sussex Breast Screening Service West Devon Breast Screening Service
Gloucestershire Breast Screening Service West of Scotland Breast Screening Service
Great Yarmouth Breast Screening Service Wiltshire Breast Screening Service
Hereford and Worcester Breast Screening Wirral Breast Screening Service
Service Wycombe Breast Screening Service
Isle of Wight Breast Screening Service
Leeds and Wakefield Breast Screening Service
Leicestershire Breast Screening Service
Liverpool Breast Screening Service
Maidstone Breast Screening Service
Medway Maritime Breast Screening Service
Milton Keynes Breast Screening Service
North Cumbria Breast Screening Service
North Nottingham Breast Screening Service
North Wales Breast Screening Service
North Yorkshire Breast Screening Service
Northampton Breast Screening ServiceSloane Report 30/4/05 6:32 pm Page 16
Publications and Presentations
(April 2003 to March 2004)
2003
April Promotional Stand at ABS at BASO Study Day, Solihull
Presentation at North West QA Team meeting, Warrington
May Presentation at London Regional Breast Screening Study Day, London
Presentation at South West QA Study Day
Presentations by group members at West Midlands DCIS Study Day, Birmingham
Presentation at QA Co-ordinators meeting, Sheffield
July Presentation at Brighton Breast Cancer Day, Brighton
Promotional Leaflets given out at Cambridge Breast Cancer Conference
Presentation at South West Screening Office Managers’ meeting, Bristol
Presentation at MDT meeting, Royal Hallamshire Hospital, Sheffield
Sept Poster at Nottingham International Breast Cancer Conference, Nottingham
Oct Presentation at Consultant Meeting, Norwich
Poster at UK Association of Cancer Registries conference, Cardiff
Presentation at North Trent Breast Education Meeting, Sheffield University
Presentation at MDT Co-ordinator’s Study Day, Birmingham Women’s Hospital
Article in NHSBSP Network magazine
Nov Presentation at Royal College of Radiologists Breast Group Annual Scientific meeting,
Cardiff
DCIS and Sloane Project pathology workshop, cut up demonstration and presentations,
Liverpool
Presentation at MDT Meeting, Rotherham
Article in ABS at BASO Newsletter
2004
Jan Presentation at Breast Test Wales Annual Conference, Cardiff
Feb Presentations and Pathology Cut-up demonstration at East of England DCIS & Sloane
Project
pathology meeting, Cambridge
March Poster at 4th European Breast Cancer Conference, HamburgSloane Report 30/4/05 6:32 pm Page 17
Acknowledgements
Sloane Project Steering Group
Radiologists
Dr Hilary Dobson Consultant Radiologist, The West of Scotland Breast Screening
Programme, Glasgow
Dr Andy Evans Consultant Radiologist, Nottingham Breast Institute, Nottingham
Dr Anthony Maxwell Consultant Radiologist, Royal Bolton Hospital, Bolton
Dr Matthew Wallis Consultant Radiologist, Coventry & Warwickshire Teaching Hospitals
NHS Trust, Coventry
Pathologists
Professor Ian Ellis Reader in Histopathology, Nottingham City Hospital, Nottingham
Professor Andrew Hanby Professor of Breast Pathology, St James’ University Hospital, Leeds
Dr James Macartney Consultant Pathologist, Walsgrave Hospital NHS Trust, Coventry
Dr Sarah Pinder Consultant Breast Pathologist, Addenbrooke’s Hospital, Cambridge
Dr Jeremy Thomas Consultant Pathologist, Western General Hospital, Edinburgh
Professor Sunil Lakhani Professor of Breast Cancer Pathology, The Breakthrough Tony Robins
Breast Cancer Research Centre, London
Surgeons
Mr Hugh Bishop Consultant Surgeon and Chair of Sloane Project Steering Group, Royal
Bolton Hospital, Bolton
Professor W D George Regius Professor of Surgery, Western General Infirmary, Glasgow
Mr Martin Lee Consultant Surgeon, Coventry & Warwickshire Teaching Hospitals NHS
Trust, Coventry
Oncologists
Dr John A Dewar Consultant Radiotherapist & Oncologist, Nine Wells Hospital, Dundee
Dr David Dodwell Consultant in Clinical Oncology, Cookridge Hospital, Leeds
Dr Gillian Ross Honorary Consultant in Clinical Oncology, Royal Marsden Hospital,
London
Management
Miss Karen Clements Sloane Project Officer, West Midlands Cancer Intelligence Unit
Dr Gill Lawrence Regional Director of Breast Screening Quality Assurance,
West Midlands Cancer Intelligence Unit, Birmingham
Miss Olive Kearins Deputy Director of Breast Screening Quality Assurance,
West Midlands Cancer Intelligence Unit
Mrs Margot Wheaton Programme Manager
Warwickshire, Solihull and Coventry Breast Screening ServiceSloane Report 30/4/05 6:32 pm Page 18
18
Special thanks to the following
Sloane Project contacts
Ms Claire Alexander Mrs Annette Mainon
Dr Pam Alleyne Ms Karen Makinson
Ms Jenny Andrews Ms Joanne Mann
Dr Holly Archer Ms Nina Margetts
Dr Geoff Athey Mr Jamal Maroof
Dr Rob Bailey Mrs Patricia McCubbin
Dr Joanna Basten Dr Sarah Moorhouse
Ms Sharon Bayles Ms Debbie Nicholson
Dr Linda Bobrow Dr Anna Parker
Dr Peter Britton Dr Margaret Payne
Mrs Helen Brown Ms Sophia Peart
Ms Adrienne Catcheside Mrs Glen Penn
Mr Sankaran Chandrasekharan Ms Christine Phillips
Ms Alison Chatten Ms Marilyn Phillips
Miss Jane Clarke Mr Joe Psaila
Ms Joanne Cooper Dr Hugh Renny
Dr Eleanor Cornford Ms Bethan Richardson
Mrs Ruth Croft Mrs Sheila Roath
Ms Maggie Cutler Mr Neil Rothnie
Dr Cathy Dale Dr Caroline Rubin
Dr Hilary Daintith Dr Gary Rubin
Ms Anne-Marie Dare Ms Vicky Sands
Ms Diane Davis Dr Ali Sever
Mr Peter Donnelly Mr Mark Sibbering
Mrs Christine Duff Dr S Sivathasan
Miss Julie Dunn Mrs Jean Smith
Mr Karl Fortes Mayer Ms Karen Smith
Dr Roderick Grant Ms Eleanor Spalding
Ms Jennifer Greatbatch Ms Helen Stansby
Dr Marcia Hall Dr Kerstin Stepp
Ms Freda Hammerton Mr Guy Stevens
Mrs Claudia Harding-Mackean Mrs Anne Stotter
Ms Julia Hayes Dr Richard Suarez
Mrs Judith Hearne Dr Caroline Taylor
Mrs Linda Heppenstall Mrs Lynn Todd
Dr Luci Hobson Ms Ruth Thorpe
Mr Chris Holcombe Mr Tamoor Usman
Dr Sue Hotston Dr Susan Varkey
Ms Sandra Hullock Ms Lynda Wagstaff
Dr Christine Ingram Dr Matthew Wallis
Dr Samar Jader Mr Roger Watkins
Mrs Sharon Kirkham Ms Maureen Wells
Dr Monica Lamont Dr Jenny Wise
Dr Elsbeth Lindsay Dr Suzanne Wright
Mrs Sarah MacdonaldSloane Report 30/4/05 6:32 pm Page iii
Sloane Report 30/4/05 6:32 pm Page iv
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