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The Value of "One-Stop" Breast Cancer Clinics Confirmed in the U.K.

Posted Jul 02 2009 6:32pm

Important topics for the future of healthcare will be integrated diagnostics, the merger of pathology and radiology, and integrated diagnostic centers (IDCs). The latter are multidisciplinary, integrated clinics where patients can be referred for rapid and efficient diagnosis. It turns out that IDCs are called "one-stop" breast clinics in the UK and that they have achieved an admirable record of success there (see: Missed cancer diagnoses rare at ‘one-stop’ breast clinics ). Below is an excerpt from an article about these facilities with boldface emphasis mine:

Missed breast cancer diagnoses are very rare among UK women discharged from one-stop symptomatic breast clinics, indicate reassuring findings published in the British Journal of Cancer.Patients with breast concerns may attend clinics with multidisciplinary teams (MDTs) offering “triple assessment” of clinical breast examination, mammography and/or ultrasound imaging, and where necessary, needle biopsy....To determine how often women attending these clinics are later diagnosed with breast cancer, the team reviewed data from 7004 patients who were discharged after initial assessment between 2001 and 2003. Over 36 months of follow-up, 29 patients were subsequently diagnosed with breast cancer, giving a symptomatic interval cancer rate of 0.9, 2.6, and 4.1 cases for the first, second, and third years, respectively. The researchers note that breast cancer diagnoses were most common in women aged 40–49 years who “present the greatest imaging and diagnostic challenge.” Multidisciplinary review indicated that, of the women with a subsequent breast cancer, 10 women experienced no delay in diagnosis, and seven experienced probable delay....This gave triple assessment by a MDT an overall diagnostic accuracy of 99.6% and a missed cancer rate of 1.7 cases per 1000 women discharged.

I enthusiastically support the notion of multidisciplinary diagnostic centers (one-stop breast clinics in the U.K.) staffed by multidisciplinary teams (MDTs). Such an approach seems particularly apt for what is described above as a "triple assessment" of breast masses. In a previous note, I had this to say about MDTs from the perspective of cancer diagnosis ( Bootstrapping the Integration of Pathology and Radiology ):

[T]he most successful current examples of such [integrated diagnostic] "centers" where heterogeneous groups of medical specialists collaborate are cancer hospitals. The unifying factor for such centers is that all of the various physicians working in them can focus on patients with a specific type of disease -- cancer. In a diagnostic center, all of the various specialists will collaborate on a set of processes in the healthcare delivery continuum: the diagnosis of disease, the assessment of disease prognosis based on the diagnosis, and the choice of therapy based on the nature of the diseased tissue or neoplasm.

Of great interest to me that the overall diagnostic accuracy for women aged 40-49 with a breast mass in U.K. one-stop centers was 99.6%. I find this diagnostic accuracy rate quite remarkable. This group of patients is described as "presenting the greatest imaging and diagnostic challenge" for breast cancer, presumably because of the high incidence of concomitant benign breast lesions in them. Such a high accuracy makes sense to me in the setting described using all available diagnostic techniques. All of these factors provide an opportunity for effective team management and seamless hand-offs in a short time span.

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