EBCN Meeting Budapest, 24 September 2004 Update on individual data monitoring projects

EBCN MeetingBudapest, 24 September 2004

Update on individual data monitoring

projects

QT and SEEDAntonio Ponti

CPO PiemonteTorino, Italy

SEED and QT Audit Systems

Their aim is two-fold:

1) to favour the implementation of European Guidelines (with

training and certification implications), and

SEED and QT Audit Systems

2) to provide a service to screening programmes and Breast Units to meet their management

and evaluation needs.

Advantages of monitoringIndividual vs Aggregate

screening data (1)

- Use of common definitions and rules in the process of collecting

the minimum dataset: an “educational” process

Advantages of monitoringIndividual vs Aggregate

screening data (2)

- Standard analysis of common dataset, including standard reports on European outcome measures

Advantages of monitoringIndividual vs Aggregate

screening data (3)

- Much more flexible analytical approach

Projects and Partners (6 Countries)

Center SEED3.8

QT1.1

Bremen Firenze Leuven London Luxembourg Marseille Ravenna Strasbourg Torino Valencia Wiesbaden

To access SEED (on line)

www.cpo.it/seed

demo has about 100,000 screening episodes

SEED ResultsSeven European programmes 1999-2001

%

Technical repeat rate 1.8

IM after assessment 1.6

Invasive Ca <= 10 mm 40.5

B / M ratio 0.27

E.G. standard

%

> 25.0

0.6

0.9

38.10.14

E.G. standard

< 1.0

> 30.0

%

124,555 FIRST TESTS 159,511 SUBS. TESTS

%

< 3.0

< 1.0< 1.0

Further assessment rate 6.0 2.9< 7.0 < 3.0

< 0.5 < 0.2

To download QT

www.cpo.it/qt

www.eusoma.org

Assessment Episodes Operated lesions

Total 5,513 1,450

10019629

10213096

154109113242No.

1792983400

4541563124042763811664No.

1228ValenciaTorinoStrasbourgRavennaMarseilleLuxembourgLondonLeuvenFirenzeBremenCenter

Wiesbaden

50-Budapest

0% 20% 40% 60% 80% 100%

Operation within 30 dd.Hormonal rec. available

Grading availableImmediate reconstruction

No axillary diss. in DCISMore than 9 lymph nodes

Clear margins 1 mm.Single operation

Cons. int. in DCIS <21mm.Cons. int. in pT1

No frozen section in Ca <11mmNo failed biopsy

Triple assessmentPreop. diagnosis 67,8

80,399,552,990,387,989,188,389,477,034,299,899,161,3

YES NO

Result %QT outcome measures

0% 20% 40% 60% 80% 100%

MLIHGFEDCBA 92,4

80,2

88,4

88,1

46,3

13,3

64,8

62,5

66,0

68,1

51,4

181

77

91

96

31

13

46

15

99

32

92

Positive preoperative cyto/histolog. diagnosis

Cancers with post-operative diagnosis

YES ? NO

Results %CENTERCENTER

0% 20% 40% 60% 80% 100%

MLIHGFEDCBA 92,4

80,2

88,4

88,1

46,3

13,3

64,8

62,5

66,0

68,1

51,4

181

77

91

96

31

13

46

15

99

32

92

Positive preoperative cyto/histolog. diagnosis

Cancers with post-operative diagnosis

YES NO

Results %CENTERCENTER

0% 25% 50% 75% 100%

A

B

C

D

E

F

G

H

I

L

M

FNA & Core biopsy (operated only)

FNA

?None

BothCBCE

NTE

RCE

NTE

R

0

20

40

60

80

100

0 20 40 60 80 100 120

B

C

D

F

G

I

L

All

Fine Needle AspirationAb

solu

teSe

nsiti

vity

Full Specificity

0

20

40

60

80

100

0 20 40 60 80 100

ABCDEFGILMAll

Pre-operative diagnosisAb

solu

teSe

nsiti

vity

Full Specificity

0 20 40 60 80 100

A

B

C

D

E

F

G

I

L

M

Time btw screening and assessment <= 3 weeks

0 20 40 60 80 100

A

B

C

D

E

F

G

H

I

L

M

Time btw referral and surgery <= 30 days

European Benchmarking

Within the project described we have attempted to bridge guidelines with screening and care evaluation, while providing databases useful for daily

management of screening programmes and patient care.

European Benchmarking

This could serve as a model for other health care areas, particularly colon

and cervical cancer for which screening programmes are being

offered throughout Europe.

European Benchmarking

Another bridge is being built: with Cancer Registries networks in the framework of population high

resolution studies.

European Benchmarking

The quality cycle entails a continuous updating of the audit

tools in the framework of a comprehensive European activity.

European Benchmarking

In the meanwhile QT is freely available to anyone and SEED could

be used by local and regional screening programmes wishing to

mutually agree to share it and concur in its development.