Over the next pages we give you detailed information about cancer services throughout the United Kingdom. Cancer services are now organised into cancer networks. These combine screening units, which perform diagnostic tests and attempt to diagnose cancer as early as possible, and 'symptomatic units', based in hospitals, where both diagnosis and treatment take place.
The screening units and hospitals are displayed by network, since as a patient you will be under the care of a network of hospitals which together should provide all the services you need. The networks are organised into 11 regions: North (including Cumbria, Northumbria, Durham and North and West Yorkshire), North West (Lancashire, Merseyside and Cheshire), West Midlands (including Hereford and Worcestershire), East Midlands (from South Yorkshire to Lincolnshire), Eastern (including Cambridgeshire and Bedford), South East (the home counties as far as Hampshire and Northamptonshire), London and South West (from Dorset and Wiltshire to Cornwall), Wales, Scotland and Northern Ireland. The information for England, Scotland, Wales and Northern Ireland is not the same, but below we explain what the various pieces of information mean.
Symptomatic Units
· Triple: We detail whether or not the hospital provides triple assessment (eg mammogram and/or ultrasound, core biopsy/needle aspiration on one day) at first urgent appointment to all patients requiring it. This is more convenient for the patient and is best practice.
· MDT: A 'yes' means that the multi-disciplinary team (eg surgeon with special interest in breast cancer, radiologist, pathologist, breast care specialist oncology nurse, oncologist, palliative care specialist) meets weekly. Ideally, the team should be meeting to discuss patients once a week. In Scotland we simply tell you whether there is a team in place.
· BASO: A 'yes' if all consultants performing breast surgery meet British Association of Surgical Oncologists guidelines on training. This is designed to ensure that all the surgeons performing breast surgery have sufficient experience. If the answer is no, you should check whether the surgeon operating on you meets the guidelines.
· Lymphoedema: This identifies hospitals where all patients with lymphoedema are referred to a specialist clinician (nurse/physiotherapist/other) and are seen by the clinician on-site. Most hospitals can refer patients to a lymphoedema specialist if necessary but they may have to travel to another hospital.
· Nurse: A 'yes' if breast care nurse specialists are available at all assessment clinics. Ideally they will be. In Scotland we tell you simply if you will have access to a breast care nurse.
· Opening times: This tells you if the clinic assesses or treats patients outside normal working hours (9am-5pm, Mon-Fri).
· Complementary therapy: Hospitals are increasingly willing to provide these services. We tell you which hospitals offer acupuncture, aromatherapy, homeopathy, reflexology or other therapies. If the answer is no, you can still arrange such therapies yourself but should talk to your doctor.
· Total number of symptomatically diagnosed patients: This figure provides a picture of the overall workload in the clinic.
· Diagnosis rate: The percentage of patients who are symptomatically diagnosed before any operative procedure is carried out. Ideally, relatively few patients should undergo surgery without a clear diagnosis.
· Waiting time for non-urgent referrals/mammogram: The average waiting time in weeks during the last quarter for non-urgent referrals from GPs. In general waiting times for urgent referrals are now under two weeks. In some hospitals now all referrals are treated as urgent. However in other cases, non-urgent referrals can take several weeks. It is important to try to keep the non-urgent waits low since, in some cases, the patients will be found to have cancer.
· Delay from decision to treat to first radiotherapy: The wait in days between decision and treatment for patients undergoing radiotherapy as a first treatment; 'decision to treat' is usually when the oncologist meets with the patient, recommends radiotherapy and the patient consents, or when the patient is discussed at a multi-disciplinary team meeting and radiotherapy is recommended. Note that this is usually shorter than the waiting time for radiotherapy following surgery.
· Percentage given written information about condition: Ideally, all patients should be given written information about their condition. In Scotland we simply tell you if the hospitals have systems in place to do this.
· Percentage told about support/self-help groups: A common request from patients is that hospitals help them contact support groups. In Scotland we simply tell you whether the hospitals have systems in place to do this.
· Number of specialist consultants performing breast surgery/reconstructive surgery in the unit: The figure relates to the overall number of diagnosed patients.
· List of surgeons: Names of specialists.
Screening units
· Nurse: 'Yes' if breast care nurse specialists are available at assessment clinics. o Dedicated surgeon: 'Yes' if a dedicated breast cancer surgeon is available to patients either in the assessment clinic or within 5 working days.
· Total number of patients screened: This provides a picture of overall workload in the clinic.
· Diagnosis rate: The percentage of patients from the screening unit's catchment area who were diagnosed by screening before any operative procedure was carried out. A lower figure means more cancers are coming to light that were not detected by screening.
· Cancer detection rate: This is the number of small invasive cancers (less than 15mm in size) detected per 1,000 women screened. Detecting smaller cancers means diagnosing cancer earlier which means more effective treatment.
· Standardised detection rate: The number of observed invasive cancers detected divided by the number expected given the age distribution of the population. A score of one is exactly in line with the national average. A lower number means the unit is detecting fewer cancers than would be expected, which may be a concern.
· Current screening interval: Provided in months. Women should be invited for a mammogram every 36 months; the shortage of radiologists means this is not always possible.
· Current interval from screening decision to assessment clinic in working days: The delay between the result of a mammogram leading to referral to an assessment clinic, and the patient's attendance at the clinic.
· Patients per radiographer: Calculated from the total number of patients screened and total whole-time equivalent radiographers.
This guide includes all screening units in England as well as data for the screening service in Northern Ireland. Only the Pennine Breast Screening unit was unable to supply data. The breast screening services in Wales and Scotland are currently unable to supply information. The guide includes listings of almost all major hospitals in England Scotland and Wales. In some cases hospitals have not returned full data. A dash marks the missing information; n/a marks where the information is not applicable.
