A national audit has found that most women with breast cancer who undergo mastectomy or breast reconstruction surgery viewed their care as high quality.

Eighty eight per cent of patients felt that they had always been treated with respect and dignity while in hospital and 90 per cent of women rated the care they received as excellent or very good.

Over 90 per cent of women were very satisfied with the competence of their consultant surgeon, and 85 per cent were very satisfied with the professionalism of the team. These findings are described in the fourth and final report of the National Mastectomy and Breast Reconstruction Audit and are based on responses from 7000 women who had mastectomy and/or breast reconstruction surgery in NHS and independent hospitals and who completed questionnaires 3 months and 18 months after their surgery.

This unique audit – commissioned by the Healthcare Quality Improvement Partnership and published by the NHS Information Centre in collaboration with the Association of Breast Surgery, the British Association of Plastic, Reconstructive and Aesthetic Surgeons, the Royal College of Surgeons of England and the Royal College of Nursing – has produced the first national figures on how patients view the outcome of mastectomy and breast reconstruction surgery.

Most women with breast cancer who chose to have breast reconstruction surgery at the time of their mastectomy are satisfied with the aesthetic outcome of their surgery. Eighteen months after their reconstructive surgery, 85 per cent of women reported feeling confident in a social setting most or all of the time. Women who underwent mastectomy without reconstruction reported less positive results, with 77 per cent feeling confident in a social setting most or all of the time.

Women who chose breast reconstruction at the time of their mastectomy also reported higher levels of emotional and sexual well-being than those who underwent mastectomy alone. In spite of these differences, the proportion of women who rated the overall outcome of their operation as excellent or very good was similarly high in both groups (73 per cent in patients undergoing mastectomy without reconstruction versus 67 per cent in women undergoing mastectomy with immediate reconstruction) indicating that the treatment received by both groups is viewed favourably.

The National Institute of Health and Clinical Excellence (NICE) recommended in 2009 that clinicians discuss immediate breast reconstruction with all patients who are being advised to have a mastectomy and offer it except where other existing conditions or other planned treatments (like radiotherapy) preclude this option.

Jerome Pereira, the audit's lead breast surgeon, said: “This is a landmark national audit that examines quality of life, patient well-being and satisfaction after breast cancer surgery. For the first time we have demonstrated improvement in the quality of life after breast reconstruction following mastectomy. The ensuing data will enable surgeons to offer evidence based recommendations to their patients and help patients to make informed choices. The clinical and patient outcomes data will empower clinicians and cancer networks to improve access and quality of care at national and international levels.”

Chris Caddy, the audit's lead plastic surgeon, said: “This Audit is a world first and sets a standard which allows patients to be better informed about their treatment options. It provides an evidence base for developing our guidelines for the treatment of patients with breast cancer and reinforces the essential role of teamwork in delivering high quality care. For plastic surgery, this audit will allow us to improve patient access to the full spectrum of reconstructive procedures and allow delivery of excellent cancer management, for all.

Carmel Sheppard, the audit's lead breast care nurse, said: "The results of this audit highlight the benefits of breast reconstruction that some women with breast cancer experience following mastectomy. It is essential that clinical teams work together to ensure all women where appropriate are offered access, information and choice regarding surgery. Breast care nurses particularly play an important role in providing support and information to women throughout the breast cancer treatment journey”

The audit report will be made live at www.ic.nhs.uk/mbr from 00.01 on 22 March 2011.

ENDS

Notes to editors

1. The Audit collected data on women treated between 1st January 2008 and 31st March 2009. All 150 English NHS trusts that provide breast cancer surgery submitted clinical data to the audit, along with 106 independent hospitals and six NHS trusts in Scotland and Wales. Data were submitted on 81 per cent of eligible women. In total, 18,216 women had complete information entered about their mastectomy or breast reconstruction surgery. During the Audit period, 16,485 women underwent mastectomy. Of these women, 3,389 (21 per cent) had a concurrent immediate reconstruction. The remaining 1,731 women underwent a primary delayed breast reconstruction.
2. The Healthcare Quality Improvement Partnership (HQIP) is led by a consortium of the Academy of Medical Royal Colleges, the Royal College of Nursing and National Voices. Its aim is to promote quality improvement, and in particular to increase the impact that clinical audit has on healthcare quality in England and Wales. HQIP hosts the contract to manage and develop the National Clinical Audit and Patient Outcomes Programme (NCAPOP). Their purpose is to engage clinicians across England and Wales in systematic evaluation of their clinical practice against standards and to support and encourage improvement in the quality of treatment and care. The programme comprises 30 clinical audits that cover care provided to people with a wide range of medical, surgical and mental health conditions, including diabetes.
3. The NHS Information Centre for health and social care (The NHS IC) is England's authoritative, central, independent source of health and social care information. It works with a wide range of health and social care providers nationwide to provide the facts and figures that help the NHS and social services run effectively. Its role is to collect data, analyse it and convert it into useful information which helps providers improve their services and supports academics, researcher, regulators and policymakers in their work. The NHS IC also produces a wide range of statistical publications each year across a number of areas including: primary care, health and lifestyles, screening, hospital care, population and geography, social care and workforce and pay statistics.
4. The Royal College of Surgeons of England is committed to enabling surgeons to achieve and maintain the highest standards of surgical practice and patient care. Registered charity number: 212808. For more information please visit www.rcseng.ac.uk
5. A mastectomy procedure involves the removal of all breast tissue and is a common treatment for breast cancer. Breast reconstruction surgery involves the surgical recreation of the breast after it has been removed. A breast reconstruction may be performed at the time of the mastectomy (immediate reconstruction) or performed at a later date (delayed reconstruction).
6. For media queries or to request an interview please contact The NHS Information Centre press office on 0845 2576990 or mediaenquiries@ic.nhs.uk