BREAST CANCER

What we know
What information do we have about the Eastern Board area?
What is the result of this on our health locally?
Policies
What is happening in the Eastern Board area?

 

Statistics
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Links
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Documents
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What we know

Cancer is a term for a group of diseases in which abnormal cells start to develop in a part of the body e.g. the breast. These abnormal malignant cells continue to grow and then spread (metastasise) through the blood stream and lymphatic system to other parts of the body such as the lymph glands, liver or brain. Cancer of the breast can be detected at an early stage by a mammogram (special X-ray) or by breast self-examination. It is very difficult to distinguish between a cancerous (malignant) lump and a harmless (benign) lump on examination and further tests may be required.

The Northern Ireland Cancer Registry (NICR), based in Queen's University Belfast, collects information about cancer in Northern Ireland from a range of sources to accurately record the number and type of all cases of cancer in Northern Ireland. The NICR then provides information about the number of new cases of cancer each year (incidence) and the number of existing cases of cancer (prevalence) for all the different cancer types. The NICR now has data going back to 1993, which enables us to see the trends in cancer types over time.

Cancer is predominantly a disease of middle age and old age. According to data from the Northern Ireland Cancer Registry, half of all patients are aged 68 or over at the time of diagnosis. Females have a 1-in-8 chance and males a 1-in-6 chance, of dying of cancer by age 74. One in three people will develop some type of cancer during their lifetime, but the news is not all bad. With increasing research and new treatment, many types of cancer can be cured or at least halted for a time.

The Northern Ireland Cancer Registry reports that in 2001, breast cancer accounted for approximately one fifth of all cancers registered in females. Half of the cases were diagnosed in women under 60 years of age. Cancer of the breast was the most common cancer diagnosis and most common cancer death in females in Northern Ireland. Interestingly, the following year it was overtaken by lung cancer as the most common cancer death in women. On a more positive note, 82% of women diagnosed with breast cancer are still alive five years later.

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What information do we have about the Eastern Board area?

In 2005, there were 1591 deaths from all causes in residents of the Eastern Board area: 810 males and 781 females. Of these, 134 women died from breast cancer. When we look back to 1991, the rate of death for breast cancer has been decreasing. The rates fluctuate from year to year, because of the small numbers of deaths, but the trend is downwards. According to the Cancer Registry report, more cases of breast cancer are being diagnosed per year in Northern Ireland, however survival has improved, leading to fewer deaths from breast cancer. The reasons for this are complex, but the increase in incidence coincided with the introduction of mammography screening. This probably allowed more cases to be diagnosed at an earlier stage. Survival in breast cancer, as with most other cancers is better if the condition is diagnosed as early as possible.

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What is the result of this on our health locally?

Reducing risk
Although the number of deaths from breast cancer is relatively small, we aim to decrease the rate still further. Research has identified a number of risk factors. Many of these cannot be changed, such as age or family history. However, there are some modifiable factors. These are listed below:

Not having children, or having a first baby after 30 years of age increases the risk of breast cancer.
Lack of breastfeeding increases risk.
Hormone replacement therapy increases the risk of breast cancer.
Obesity and alcohol consumption contribute to increased risk.
Four to five hours of exercise per week can reduce the risk of breast cancer.

Early detection – screening
The outlook (prognosis) for patients with cancer is better if the cancer is detected as early as possible. In the case of breast cancer women are advised to conduct breast self-examination to detect any change in the breast or any lumps that occur. Many of these are not cancerous, but a check up is advisable. For women in the 50 to 64 age group, the Northern Ireland Screening programme will issue an invitation to attend for a mammogram every three years. A mammogram is a special X-ray of the breast tissue and is able to select those women who require further examination to determine whether they might have cancer. For further details of this process, please see section on breast screening.

 

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Policies

The Report of the Expert Advisory Group on Cancer, "A Policy Framework for Commissioning Cancer Services" (the Calman/Hine Report), 1995, recommended a framework for cancer services in England and Wales.

The Cancer Working Group of the Department of Health and Social Services (N.I.) built upon the Calman/Hine principles and in its 1996 report "Cancer Services: Investing for the Future" (the Campbell Report), described a structure for future cancer services in Northern Ireland.

The Eastern Health and Social Services Board Palliative Care Strategic Action Plan 2002 – 2007 was published in 2002 (Palliative Care Services - The next 5 Years).

It is also important to review and consider recent guidance:

Regional Guidance:

Review of clinical genetic services in Northern Ireland
Gynaecological Cancer Guidelines
Dermatological Cancer Guidelines
Haematological Cancer Guidelines
Endocrine Cancer Guidelines
Lymphoedema Review
Review of Clinical Pathology Laboratory Services

National Institute of Clinical Excellence (NICE) National Collaborating Centre for Cancer Guidance:

Breast Cancer Service Guidance (August 2002)
Urological Cancers Service Guidance (September 2002)
Haemato-oncology cancer service guidance (October 2003)
Supportive and Palliative care (March 2004)
Head and Neck Cancers (Anticipated publication date October 2004)
Lung cancer (Anticipated publication date January 2005)
Colorectal cancer (Anticipated publication date January 2005)
Referral guidelines for suspected cancer (Anticipated publication date March 2005)
Prostate cancer ((Anticipated publication date to be confirmed)

NHS Modernisation Agency Cancer Services Collaborative Service Improvement Guides:

Multidisciplinary Team Resource Guide
Breast Service Improvement Guide
Chemotherapy Service Improvement Guide
Radiotherapy Service Improvement Guide
Upper GI Service Improvement Guide
Urology Service Improvement Guide
Patient and Carer Experience : A Service Improvement Guide

 

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What is happening in the Eastern Board area?
Northern Ireland Cancer Network
The Eastern Board is currently in the process of reviewing current cancer service provision in light of recent regional developments such as the Northern Ireland Cancer Network (NICaN) and the Regional Cancer Services Framework group. This process will also review progress against the EHSSB Cancer Commissioning Group report recommendations.

In 1997 the Eastern Health and Social Services Board (EHSSB) convened a multi-agency Cancer Commissioning Group, with the remit to oversee implementation of policy on the prevention and treatment of cancer for Eastern Board residents. Seven Cancer Commissioning sub-groups were established to inform this process:

breast cancer;
lung cancer;
gastrointestinal cancers, including colorectal;
gynaecological cancers;
urological cancers;
palliative care;
cancer prevention.
In March 1998, the Eastern Board established the EHSSB Cancer Implementation Group which was tasked to take forward the recommendations from the Cancer Commissioning Group report. Site-specific implementation subgroups were (re)convened to take forward this work in phases.
Published in August, the EHSSB Cancer Commissioning Group report described the recommendations for future cancer services for Eastern Board residents. The report covered all aspects of care from prevention through to cure and palliation and outlined the strategic and resource implications of the proposed service models.
Service quality standards, professional standards and care pathways for breast, colorectal, and lung cancer were outlined separately in the report ‘Cancer Services in the Eastern Health and Social Services Board: Quality Standards and Care Pathways’.
The Eastern Board area contains the Cancer Centre and two Cancer Units at the Belfast City Hospital and the Ulster Hospital. However, given the varied initial clinical presentation of malignant disease, general specialties within all acute Eastern Board hospitals continue to have an important role in investigation and diagnosis, local treatment where appropriate, and referral onward as part of multidisciplinary treatment.
Regional Cancer Centre
Construction of the new Regional Cancer Centre building on the Belfast City Hospital site commenced in 2002. The work is progressing well and is on schedule, with the building expected to be opened for clinical service at the start of 2006.
The aim of the breast screening programme is to reduce the mortality in the target age group (50 - 64 years old). Breast screening does not prevent cancer but does identify the cancer at an early stage when treatment can be more effective. The staff in the Screening Centre send out an invitation to all eligible women every three years. All women who are registered with a General Medical Practitioner are included.
As per the Campbell Report recommendation, there are now two breast units within the Eastern Board, one in the Belfast City Hospital and the other in the Ulster Hospital. Both breast units have multi-disciplinary multi-professional breast care teams. Multidisciplinary meetings are held in Belfast City Hospital and the Ulster Hospital to review the treatment plan for breast cancer patients pre- and post-operatively.


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For further information on this topic please contact us at publichealth@ehssb.n-i.nhs.uk

Eastern Health and Social Services Board Champion House, 12-22 Linenhall Street, Belfast BT2 8BS Telephone: (028) 9032 1313 Fax: (028) 9055 3681 Text Phone:(028) 9032 4980 Website: www.ehssb.org E-mail: pr@ehssb.n-i.nhs.uk
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