Nine out of ten women with breast cancer who undergo mastectomy or breast reconstruction surgery say that their care was of a high quality, according to the third annual report of the National Mastectomy and Breast Reconstruction Audit.

A survey of nearly 7,000 women in England, conducted as part of the audit, found that 88 per cent of women 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.

Overall, nine out of ten women also felt that they had received the right amount of information about the surgical procedure they underwent. However, only two thirds of patients who had a mastectomy without reconstruction felt that they had received the right amount of information about breast reconstruction surgery. Some women said that this lack of information contributed to them choosing not to have an immediate reconstruction.

The audit, commissioned by the Healthcare Quality Improvement Partnership and published today by the NHS Information Centre and the Royal College of Surgeons of England in collaboration with the Association of Breast Surgery, the British Association of Plastic, Reconstructive and Aesthetic Surgeons and the Royal College of Nursing, makes a number of key recommendations aimed at improving breast cancer services in England. One recommendation is that the option of breast reconstruction is discussed with all patients undergoing mastectomy, as recommended by NICE in 2009.

The audit also found that women undergoing different types of procedure seemed equally satisfied that the staff treating them had done everything they could to control their pain. Six per cent of women who had mastectomy reported severe pain in the first 24 hours following surgery, which compares well to 11 per cent for other types of major surgery.

However, the proportion was higher among women who had immediate and delayed reconstruction, with around 18 per cent reporting severe pain in the first 24 hours following surgery. The audit recommends that hospitals investigate ways in which this proportion could be reduced.

All 150 English NHS trusts that provide breast cancer surgery participated in the Audit, along with 106 independent hospitals and six NHS trusts in Scotland and Wales. Between April 2008 and July 2009, the audit sent 8,159 women a questionnaire about their experience of breast cancer treatment three months after their surgery. Of these women, 6,963 (85 per cent) responded.

Carmel Sheppard, the audit's lead breast care nurse, said: “Breast care nurses play pivotal roles within the breast team providing patient information and supporting women make decisions about the care. With these Audit findings, we are now able to better inform women regarding the options available to them and to help address their on-going supportive needs. This will ultimately enhance the care they receive and lead to a speedier recovery.”

Jerome Pereira, the audit's lead breast surgeon, said: "This is the first comprehensive audit of patient-reported outcomes following breast cancer surgery and our patients should feel greatly reassured that this clinician-led study has demonstrated excellent standards of care at a national level. The results will support us in continuing to provide this standard of care, while also helping us to improve specific areas, like postoperative pain control."

Chris Caddy, the audit's lead plastic surgeon, said: “Care for women with breast cancer is improving year on year in the UK, but there is still more to be done to ensure that women receive the highest quality care. Not all women are getting access to information on breast reconstruction, which suggests plastic surgeons should be involved in the treatment of more women with breast cancer. It is only through collaborative working among surgeons and nurses that we can ensure the best possible care.”

Emma Pennery, Clinical Director at Breast Cancer Care, said: “By questioning women directly, this Audit provides a valuable insight into the experiences of women having a mastectomy and/or breast reconstruction following a diagnosis of breast cancer. While it is reassuring that the vast majority received high levels of care and support, the report highlights the need for better pain management and for more information to be provided, particularly prior to breast reconstruction. It is vital that all patients are given clear details on the options open to them, whether they are available locally or not. We look forward to seeing improvements over the coming year.”

The Audit report can be accessed at www.ic.nhs.uk/mbr

ENDS

Notes to editors

1. The Audit collected data on women treated between 1st January 2008 and 31st March 2009. 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%) 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