The Swiss Society of Senology (SGS), together with the Swiss Cancer League (KLS), has developed guidelines for the certification of breast centers that are appropriate to local conditions and has certified two initial centers. Gynecologists should be able to offer their patients the best possible care through flexible collaboration with a center and also benefit from measures such as a multidisciplinary tumor board.
Until the 1970s, senological therapy was firmly in the hands of surgeons,” says PD Christoph Rageth, MD, Zurich. “Then the gynecologists took over surgical therapy.” And now one wonders whether breast surgeons will take over in the future. “Because as senology has evolved greatly in recent years, general gynecologists can no longer fulfill the full spectrum of senology themselves,” Dr. Rageth explained. However, in developing Swiss guidelines for the certification of breast centers, the Swiss Society of Senology (SGS), together with the Swiss Cancer League (KLS), paid particular attention to maintaining an important place for gynecologists. At the end of June 2012, Basel and St. Gallen were the first two centers to receive certification.
International specifications adapted
In 2000, the EUSOMA (European Society of Mastology) established criteria for the treatment and care of women with breast cancer. In it, it requires the treatment of at least 150 newly diagnosed breast carcinomas per year for a breast center to be certified. There must be at least two surgeons each performing at least 50 breast cancer surgeries per year and at least two radiologists with ≥5000 mammography assessments per year. “Back in 2005, SGS decided to develop quality criteria based on guidelines from EUSOMA that fit the conditions in Switzerland,” Dr. Rageth said. For example, the required case numbers were not set as high. Accordingly, 125 cases per center and 30 new cases per core team surgeon are required annually for initial certification.
Physician network as an important component
An important component of the label is the cooperation in the physician network. Dr. Rageth explained, “The goal is for gynecologists today – in collaboration with the center – to be able to offer their patients the most optimal care. For example, they can assign patients to a center for certain examinations. Those who do not work at a breast center themselves can also become network partners of a certified breast center. As network partners, gynecologists commit to ensuring that every patient who needs breast surgery is first pre-discussed at a breast center interdisciplinary conference and that a qualified core team surgeon is present for every breast surgery. If malignant disease is present, the case must again be discussed at an interdisciplinary breast center conference after surgery. The data must be registered in the Swiss Breast Center Database, which was established specifically for this purpose. Every breast cancer patient must also be offered the opportunity to talk with the Breast Care Nurse.
Multidisciplinary meetings
Prof. Monica Castiglione-Gertsch, MD, Geneva, addressed why multidisciplinary, pretherapeutic meetings are important. “Optimal management of breast cancer patients today requires the expertise of specialists from a wide range of disciplines,” she explained. A recent European survey found that multidisciplinary tumor boards (MDTs) are now regularly attended by medical oncologists, tumor surgeons, radiation therapists, pathologists, radiologists, and also specialized nurses [1].
Positive for all involved
“Despite the still limited body of evidence, there is growing evidence that MDTs are associated with improved clinical decision-making, improved clinical outcomes, better patient experience, and a better working environment,” the speaker explained. Vinod et al. found that the MDT’s decisions were largely compliant with applicable guidelines [2]. In Sweden, the introduction of MDTs was associated with improved 7-year relative survival in breast cancer patients [3]. A recent study from Scotland involving over 13 000 patients also found improved survival after the introduction of MDTs [4]. In addition, survival differences between different hospitals were reduced. And data from Australia link MDTs to improved patient care through a mutually agreed upon treatment plan, improved patient satisfaction, improved mental status of health care workers, reduced redundancy in services, and improved access to clinical trials and new medications [5].
But what about the cost of such meetings? “For a tumor board meeting in Geneva, I would estimate the direct costs at around 5500 francs. If about ten patients were discussed, the cost would be 550 francs per patient. So MDTs are expensive and also time-consuming, but they meet the needs of patients and healthcare professionals.” For the future, he said, it is important to find out which structures and functions of an MDT have a particular impact on outcomes so that they can be adjusted accordingly and patient care can be further improved.
Source: Annual Congress of the Swiss Society of Gynecology and Obstetrics (SGGG): “Future of Senology and Breast Centers”, June 28, 2012, Interlaken.
Literature:
- Saini KS, et al: Role of the multidisciplinary team in breast cancer management: results from a large international survey involving 39 countries. Ann Oncol 2012; 23: 853-859.
- Vinod SK, et al: Do multidisciplinary meetings follow guideline-based care? J Oncol Pract 2010; 6: 276-281.
- Eaker S, et al: Regional differences in breast cancer survival despite common guidelines. Cancer Epidemiol Biomarkers Prev 2005; 14: 2914-2918.
- Kesson EM, et al: Effects of multidisciplinary team working on breast cancer survival: retrospective, comparative, interventional cohort study of 13 722 women. BMJ 2012; 344: e2718. doi:10.1136/bmj.e2718.
- National Breast Cancer Centre. Multidisciplinary Care in Australia: a National Demonstration Project in Breast Cancer, 2003, Available online at: http://canceraustralia.nbocc.org.au/resources-for-health-professionals/view-category/Page-3
