Benchmarks of quality breast care over 10 years.

272 Background: In 2005, the National Quality Measures for Breast Centers (NQMBC) was initiated as a web-based program to capture breast center performance using process of care measurements. The program participant enters data verified by the breast center director or administrator which was randomly audited. As a center submits data, their results are immediately compared with other similar centers as well as with all submitting centers.

METHODS: Of the 31 measures, we focus on six pertinent measures of quality breast care; time from diagnostic mammogram to needle biopsy, time from needle biopsy to initial breast cancer surgery, breast conservation rate, use of radiation therapy for breast conserving patients, use of endocrine therapy, and use of chemotherapy. Data was submitted in aggregate form, with each center submitting their average performance for any measure every 6-12 months from 2005 to 2014. Each submission included the number of patients used to calculate their submission. For this report, we have defined the "benchmark" as the average performance of all centers submitting data for a particular time period.

RESULTS: At the end of 10 years, the time from diagnostic mammogram to needle biopsy decreased by 2 days (207,425 patients reviewed), while the time from needle biopsy to initial cancer surgery increased by 5 days (86,084 patients). Breast conserving surgery markedly decreased 2.4% per year from 2005 to 2010, yet increased 2% per year from 2010 to 2014 (29,455 patients). For use of adjuvant therapies, we saw gradual increase in use. At 10 years, use of radiation therapy was at 92.5%, had increased at 0.7% per year, 6.5% overall increase (13,202 patients); use of endocrine therapy was 89%, had increased at 1.2% per year, 12% overall increase (12,684 patients); and use of chemotherapy was 97%, had increased at 0.5% per year, 10% overall increase (2,467 patients).

CONCLUSIONS: Benchmarks of quality breast care are necessary as guideposts for providers. While the use of adjuvant therapies have increased over 10 years as expected, the fluctuations of use of breast conserving surgery as well as changes in time spent prior to surgery were unexpected. Benchmarks may change over time in unpredictable ways which supports ongoing monitoring the level of breast quality care.