1. WALES BREAST CANCER CLINICAL AUDIT (WBCCA) MDT DATA FOR PATIENTS DIAGNOSED in 2009, 2010 and 2011 YSBYTY MAELOR WREXHAM (BCUHB) MDT

2. Data Completeness 2 WBCCA 2009, 2010 AND 2011 – Ysbyty Maelor Wrexham See accompanying sheet for key and calculations

3. 4 Key Clinical Indicators (KCI) The Cancer National Specialist Advisory Group (NSAG) has established clinical indicators that measure best practice in the management of cancer. These are reviewed annually and those for invasive breast cancer are listed below: KCI1 KCI1Pre-operative diagnosis rate (%) in symptomatic breast cancer cases. (minimum: 90%, target 95%) KCI2 KCI2% histologically node negative patients having 1-7 nodes removed (minimum: 90%, target 95%) KCI3 KCI3% ER positive women who received adjuvant hormonal therapy (minimum: 90%, target 95%) KCI4 KCI4% of node positive women (aged <=60 years) who received adjuvant chemotherapy (minimum: 80%, target 90%) KCI5 KCI5% of patients who had breast conservation surgery for invasive breast cancer having breast radiotherapy. (minimum: 90%, target 100%) WBCCA 2009, 2010 AND 2011 – Ysbyty Maelor Wrexham

4. KCI 1 Proportion of invasive symptomatic cases with a pre-operative diagnosis (2011) 5 minimum target WBCCA 2009, 2010 AND 2011 – Ysbyty Maelor Wrexham

5. Primary treatment for invasive cancers (2011) 6 No. invasive cases Primary surgical treatment Non-surgical treatment Unknown BRONGLAIS GENERAL HOSPITAL 352762 GLAN CLWYD CANCER SERVICES 120105132 LLANDUDNO GENERAL HOSPITAL 269242270 NEATH PORT TALBOT HOSPITAL 157145102 NEVILL HALL HOSPITAL 9777200 PRINCE CHARLES HOSPITAL 5535191 PRINCE PHILIP HOSPITAL 185142367 PRINCESS OF WALES HOSPITAL 257135 ROYAL GLAMORGAN HOSPITAL 215179306 ROYAL GWENT HOSPITAL 211161473 SINGLETON HOSPITAL 240205341 LLANDOUGH HOSPITAL 309264396 WITHYBUSH GENERAL HOSPITAL 9269176 YSBYTY MAELOR WREXHAM 208166384 ALL WALES 2218182434945 WBCCA 2009, 2010 AND 2011 – Ysbyty Maelor Wrexham

6. Variation by hospital in mastectomy rates for all surgically treated invasive breast cancers (2011, all tumour sizes). 7 WBCCA 2009, 2010 AND 2011 – Ysbyty Maelor Wrexham

7. KCI 2: Variation in the number of nodes removed by hospital from women surgically treated for node negative invasive breast cancers (2011) 10 minimum target WBCCA 2009, 2010 AND 2011 – Ysbyty Maelor Wrexham

8. Variation in recording of axillary clearance in surgically treated women with histologically node-negative invasive breast cancer (2011) 11 Axillary clearance %Total BRONGLAIS GENERAL HOSPITAL 15100.0%15 GLAN CLWYD CANCER SERVICES 914.5%62 LLANDUDNO GENERAL HOSPITAL 1711.6%146 NEATH PORT TALBOT HOSPITAL 912.7%71 NEVILL HALL HOSPITAL 612.5%48 PRINCE CHARLES HOSPITAL 422.2%18 PRINCE PHILIP HOSPITAL 1820.7%87 PRINCESS OF WALES HOSPITAL 00.0%1 ROYAL GLAMORGAN HOSPITAL 1310.4%125 ROYAL GWENT HOSPITAL 78.4%83 SINGLETON HOSPITAL 64.3%139 LLANDOUGH HOSPITAL 63.7%161 WITHYBUSH GENERAL HOSPITAL 13.0%33 YSBYTY MAELOR WREXHAM 1110.6%104 ALL WALES 12211.2%1093 WBCCA 2009, 2010 AND 2011 – Ysbyty Maelor Wrexham

9. Variation in clearance of margins by hospital for invasive breast cancers following final surgery by breast conservation (2009- 2011) 12 WBCCA 2009, 2010 AND 2011 – Ysbyty Maelor Wrexham

10. 13 KCI 5: Variation in radiotherapy given after conservative surgery for invasive breast cancers (2009-2011) minimum target WBCCA 2009, 2010 AND 2011 – Ysbyty Maelor Wrexham

11. Variation by hospital in age of invasive breast cancers receiving no radiotherapy after conservative surgery (2009-2011) 11 2009-2011 DATA<65%65+% BRONGLAIS GENERAL HOSPITAL00.0%450.0% GLAN CLWYD CANCER SERVICES1616.7%1113.8% LLANDUDNO GENERAL HOSPITAL3914.5%1810.2% NEATH PORT TALBOT HOSPITAL148.1%77.1% NEVILL HALL HOSPITAL54.5%47.3% PRINCE CHARLES HOSPITAL312.5%00.0% PRINCE PHILIP HOSPITAL1810.7%1010.4% PRINCESS OF WALES HOSPITAL00.0%0 ROYAL GLAMORGAN HOSPITAL165.9%106.5% ROYAL GWENT HOSPITAL178.1%1110.6% SINGLETON HOSPITAL197.2%86.8% LLANDOUGH HOSPITAL124.0%74.8% WITHYBUSH GENERAL HOSPITAL33.6%1219.0% YSBYTY MAELOR WREXHAM2413.8%1919.0% ALL WALES1868.6%1219.9% WBCCA 2009, 2010 AND 2011 – Ysbyty Maelor Wrexham

12. KCI 3: patients with invasive ER positive breast cancer receiving adjuvant hormone therapy (2011) 12 minimum target WBCCA 2009, 2010 AND 2011 – Ysbyty Maelor Wrexham

13. KCI 4: Variation by hospital of node positive invasive cases, under 61 years of age, receiving chemotherapy following surgery (2009-2011) 13 minimum target WBCCA 2009, 2010 AND 2011 – Ysbyty Maelor Wrexham

14. Variation in ER and HER-2 negative breast cancers receiving chemotherapy (2011) 14 WBCCA 2009, 2010 AND 2011 – Ysbyty Maelor Wrexham

15. 14 Further information and feedback Full report on Cancer NSAG website DN: add link For audit queries and feedback contact clinical leads, information leads, analysts or cancer NSAG colorectal group representatives via Louise.Carrington@wales.nhs.uk Louise.Carrington@wales.nhs.uk For Network resources to help improve outcomes contact: SOUTH WALES CANCER NETWORK (SWCN) Hywel.Morgan2@wales.nhs.ukHywel.Morgan2@wales.nhs.uk. Tom.Crosby@Wales.NHS.UK Tom.Crosby@Wales.NHS.UK NORTH WALES CANCER NETWORK (NWCN) Damian.Heron@Wales.NHS.UK Caroline.Williams@Wales.NHS.UK Cancer NSAG Breast group Dr Kate Gower Thomas(Chair) Radiologist Dr Peter Barrett-Lee (Deputy Chair) Clinical Oncologist Prof Robert ManselSurgeon Mr Ian MonypennySurgeon Mr Rhodri WilliamsSurgeon Dr Andy GashRadiologist Dr Nick DallimoreHistopathologist Rosemary FoxDeputy Director of Screening Dr Gianfilippo BertelliMedical Oncologist Sue BradyNurse Mr Walid SamraNWCN Tumour Site Lead Mr Simon HoltSWCN Tumour Site Lead Dr Jacinta AbrahamSWCN Tumour Site Deputy WBCCA 2009, 2010 AND 2011 – Ysbyty Maelor Wrexham