Byline: Jothi. Murugesan, David. Valerio, Sheena. Bradley
This review presents current concepts with regard to fast access breast clinic (FABC). Some of the issues addressed include the working pattern of FABC, use of referral guidelines, advantages and problems commonly encountered with diagnosing breast cancer early. A comparison of the health system in India and the UK has been made and possible implementation of the clinic discussed.
Fast access breast clinic (FABC) was popularized in the United Kingdom (UK), in the 1990s. The diagnosis of a breast lesion is based on three complementary aspects namely clinical examination, imaging and cytology or core biopsy, known as triple assessment. The basic aim of this one stop clinic is diagnosing breast cancer rapidly and avoiding unnecessary delay and excluding serious breast pathology at the first visit. It also aims at reducing variation in care, efficient administration and reassuring patients, improving public confidence, earlier referral and lowering the threshold for referral. Everyone in the UK is registered with a general practitioner (GP) within the national health service (NHS). The GP's examine patients initially and refer them to the hospitals should the need arise. There is therefore a waiting time before the patients attend the hospital.
Working pattern of fast access breast clinic
The clinic environment
Adequate consulting and examination rooms should be available to allow patient privacy, allow efficient working practice and enable discussion with breast care nurses. A hospital should seek to function as a cancer unit only if the volume of work related to each cancer site is sufficient to maintain such expertise.
Core team members The core team members include a surgeon with an interest in breast disease, a radiologist, a radiographer, a pathologist, laboratory support staff, a breast care nurse, clinic staff and administrative staff.
Surgeon In general, surgeons who specialize in a particular anatomical area should carry out the surgical management of that cancer. Retrospective data from the UK suggest that a minimum caseload of at least 30 newly diagnosed breast cancer cases per consultant per year is required to optimize patient outcomes. Excessive surgical caseload is also likely to be detrimental. Initial investigations are usually requested by the surgeons.
Radiologist The radiologist should decide on the most appropriate imaging investigations, report significant abnormalities with a characterization of the level of suspicion for cancer of these abnormalities and should also include recommendations for further imaging or guided biopsy.
Pathologist The pathologist should have special expertise in breast pathology and cytology, with designated time for breast work. Cytology and core biopsy standards should be strictly adhered to and a formal report for diagnostic pathology should be available within five working days.
Breast care nurse
A Breast care nurse should provide care in keeping with the set national breast screening standards and keep up to date, the knowledge of breast disease. There must be an agreed programme of continuing education and they should be involved in the education of other nursing staff on breast disease, both in the hospital setting and...
This is a preview. Get the full text through your school or public library.