Breast cancer : health care needs assessment : the epidemiologically based needs assessment reviews, second series

This volume, focusing on breast cancer, is part of a survey of health care needs for specific conditions, published on behalf of the Department of Health. This study overall considers questions such as the population's needs, the services available or unavailable to them, the effectiveness of these services, and other perspectives in disease and service areas. This is the second series of needs assessment reviews. MuPDF error: syntax error: invalid key in dict MuPDF error: syntax error: invalid key in dict MuPDF error: syntax error: invalid key in dict MuPDF error: syntax error: invalid key in dict MuPDF error: syntax error: invalid key in dict MuPDF error: syntax error: invalid key in dict MuPDF error: syntax error: invalid key in dict MuPDF error: syntax error: invalid key in dict MuPDF error: syntax error: invalid key in dict Cover 1 Title Page 2 Copyright Page 3 Contents 4 Foreword 7 Preface 8 Contributing authors 9 Introduction 10 ALTERNATIVE APPROACHES 11 Social services assessment 11 Individual health care needs assessment 11 Participatory priority setting 12 Primary care approaches 12 Local surveys 12 Specialty-specific documents 13 Clinical effectiveness research 13 TOOLS 15 THE CHANGING BACKGROUND 17 District health authority changes 18 Cost containment 18 General practitioner fundholding and GPs in purchasing 18 Evidence-based health care 19 USE OF THE HEALTH CARE NEEDS ASSESSMENT SERIES 19 REFERENCES 22 Breast Cancer 24 1 SUMMARY 24 2 STATEMENT OF THE PROBLEM 25 Scale of the problem 25 Strategies to reduce breast cancer mortality and morbidity 25 Resource consequences 25 Male breast cancer 25 Classification 26 Summary 26 3 SUB-CATEGORIES 26 Women attending the NHSBSP 26 Family history of breast cancer 26 Women presenting with symptoms of breast cancer 26 Women with breast cancer 27 Ductal carcinoma in situ 27 Early breast cancer 27 Advanced disease 27 4 PREVALENCE AND INCIDENCE 28 Incidence and mortality 28 Temporal trends in incidence and mortality 28 Survival 30 5 SERVICE PROVISION 31 The National Health Service Breast Screening Programme 31 National structure 31 Regional and district structure 31 Setting 32 Utilization 32 Family history of breast cancer 32 Setting 33 Utilization 33 Symptoms of breast cancer 33 Setting 33 Utilization 33 Women with breast cancer 34 Setting 35 Utilization 35 Summary 36 6 EFFECTIVENESS AND COST-EFFECTIVENESS 36 National Health Service Breast Screening Programme 36 Evidence of efficacy 36 Costs 37 Family history of breast cancer 37 Women presenting with symptoms of breast cancer 37 Women with breast cancer 38 Clinical management of DCIS 38 Clinical management of early breast cancer 38 Advanced disease 42 Psychosocial interventions 42 Strength of recommendation 43 7 MODELS OF CARE 44 National Health Service Breast Screening Programme 44 Age 44 Screening interval period 44 Sensitivity of the test 45 Compliance 45 Diagnosis and treatment 45 Variations in quality of care 46 Impact of breast cancer services on outcome 46 A Policy Framework for Commissioning Cancer Services 47 Levels of service provision 48 Resource implications for notional health authority 49 Summary 50 8 OUTCOME MEASURES 50 National Health Service Breast Screening Programme 50 Compliance 50 Cancer detection rate 50 Interval cancers 51 Characteristics of screen-detected cancers 51 Diagnosis and treatment 51 9 TARGETS 52 National Health Service Breast Screening Programme 53 Diagnosis and treatment 53 Summary 53 10 INFORMATION AND RESEARCH 53 Information 53 Cancer registries 53 National Health Service Breast Screening Programme 54 Hospital information systems 54 Research priorities 54 Primary prevention 54 Family history clinics 54 Screening policy 54 Breast imaging 55 Systemic therapy in breast cancer 55 Radiotherapy schedules 55 Breast cancer in the elderly 56 Summary 57 APPENDIX I: Relevant coding classifications 58 APPENDIX II: Staging classifications 60 APPENDIX III: Age-specific incidence rates for breast cancer 61 APPENDIX IV: National Health Service Breast Screening Programme 62 REFERENCES 63 INDEX 72