1. Breast Cancer Surveillance Consortium (BCSC): sponsored by the National Cancer Institute Cancer Screening Surveillance in Clinical Practice Tracy Onega, PhD Director, NH Mammography Network, Assistant Professor of Community & Family Medicine Dartmouth Medical School & the Norris Cotton Cancer Center

2. Circa early-mid 1990s…………. No understanding of screening mammography process or quality  MQSA passed to ensure standardized delivery of quality mammography services NCI responded to legislative mandate by establishing surveillance system to provide reliable and comprehensive performance data Flashback to pre-BCSC……..

3. Breast Cancer Screening Process PROCESS SURVEILLANCEOUTCOME SURVEILLANCE Patient Factors Screening Examinations Diagnostic Evaluations Intermediate Outcome Long-term Outcome Treatment Surveillance Systems for Routine Clinical Practice

4. Integral to clinical care processes Population based / part of consortia Interdisciplinary Longitudinal Informing and Improving: Patients’ lives Provider care Evidence-based guidelines Tailored screening approaches Research Screening Registries Should Be…..

5. The Cornerstone: Infrastructure & Common Data Elements GHRI SFMR CMR NHMN VBCSS Map SCC Consolidated Data Data Management / Warehouse Data Analysis Reporting

6. Registry Data Collection Methods Women’s Questionnaire (filled out at time of mammogram) Radiologist/ Rad Tech Form (filled out at time of mammogram) Pathology Reports (abstracted) State Cancer Registry Vital Status (DHHS) Registry Database Radiologist Info Facility Info

7. Cancer Care Continuum & BCSC Resources

8. Foundation for Infrastructure Facilities Women Providers

9. Voluntary registries – how to develop & maintain buy-in? Fostering Participation Facilities Clinicians Patients MQSA, quality measures, benchmarking Performance feedback Relationships Disseminating findings, Electronic data capture, Rad tech support

10.  Software for clinical data collection  Tablet PCs  Integration with electronic health records  Continuous breast density  Digital image collection  Standardized data elements for new modalities  Built-in reporting Data Collection Innovations

11. Built-in Reporting From: Geller B.

12. Confidentiality & Legal Infrastructure Federal Certificate of Confidentiality strongest protection tested in court protects providers and patients

13. http://cancercontrol.cancer.gov/acsrb/priorities_figures.html Screening in Cancer Control Concept Map Showing Priority and Thematic Areas of Research for the Applied Cancer Screening Research Branch at NCI Improved Breast Cancer Screening Practices

14. Expanding the Utility of the BCSC Medicare Claims Ovarian Cancers New Technologies

15. Thank You to the National Cancer Institute