Breast Center Definition

The treatment of breast diseases including the screening, diagnosis, and treatment of breast cancer require the interaction of multiple specialists in multiple departments.  These include, but are not limited to, surgery, medical oncology, radiation oncology, radiology, pathology, plastic surgery, physical therapy, behavioral medicine and nursing.

While many or most of these services exist in most health systems, the idea of a breast center is to organize these services into a coordinated, integrated, multidisciplinary approach for the patient.  The direct interaction of these services is synergistic, providing much higher quality care to the patient than she would receive from the same specialists working in isolation. 

Breast centers may provide a full complement of services to encompass all needs of the breast patient or may focus on specific portions of care such as imaging or surgical care.  Breast centers may have all their services available under one roof, or may be a “center without walls,” organizing their services located at different locations under unified leadership. 

For services to be considered as “provided” services by the breast center, the center must maintain “quality control” of that service.  Other services available without “quality control” are considered “referred” services.  (See footnote below). 

Breast Center Types

Breast Centers vary in many ways.  We classify breast centers using two main variables:

1) breast center profile characteristics and
2) “provided” components of services. 

After these two variables have been clearly defined, centers can be separated into five types:

a) Screening Breast Center
b) Diagnostic Breast Center
c) Clinical Breast Center
d) Breast Cancer Treatment Center
e) Comprehensive Breast Cancer Treatment Center  

1)  Breast Center Profile Characteristics:  These would include the size of their breast cancer treatment facility/hospital, size of the community they serve, volume of breast cancer patients seen, number of mammograms performed annually, patient characteristics, regional location and provider compensation structure.  These characteristics will aid centers to compare themselves with similarly structured centers.

2) Components of Service: Depending on the type of breast center, breast centers offer varied services.  We distinguish the types of breast centers by the components of service “provided” by that center (with quality control) not by the components of service available.  In order for a center to be considered “providing” a component of service, they must have “quality control” of that component of service.  Quality control of a service occurs 1) if there is data to review of that service AND 2) if the center can impact the type of care provided.  (See definitions below)

Definitions

“Quality Control” means 1) there is quantitative data of that component of service available to the center AND 2) the breast center has the direct ability to modify that component of service (procedural influence not complete control).  This allows the center to have quality monitoring and influence on the services they provide.

“Provided” components of service are those for which the breast center has “quality control.”  The location of those components of service does not impact the definition of “provided” services as long as quality control exists. Services may occur “on-site” or locally “off-site.”   

“Referred” components of service are performed without “quality control” by the center.  This  means the center does not have BOTH quantitative data AND direct ability to modify that component of service. Services are “referred” to outside vendors who may not readily share quality information or allow influence on their services. 

Footnote:  The NCBC now offers breast centers the opportunity to evaluate themselves through the quality of the components of service they “provide.”  We are not asking for personal information such as financial data or specific numbers of patients seen by each clinician.  We are asking for a snapshot of the characteristics of care being provided.  For an off-site surgeon who is not a direct employee of the breast center, the data question might be, “What is your surgical re-excision rate (%) for the last 30 breast cancer patients?” or an oncologist might be asked, “What percent (%) of breast cancer patients seen with stage 2 breast cancer under the age of 70 have been offered chemotherapy in the last three months?”  This type of data should be shared with the breast center in order for the center to claim they “provide” surgery and oncology components of service.  The center must also have “quality control” of that service.  That means if the answers to these sample questions suggest a modification of the provided service is needed, the center has influence on changing the service.  This doesn’t mean complete control of that component of service but the ability to modify it.  In this example, the surgeon or oncologist would consider the breast center’s input when evaluating the answers to these sample questions. That means the center has both quantitative data AND direct ability to modify the quality of that component of service.  Using this the type of breast care data and feedback creates an environment of quality improvement.  This promotes our idea of interdisciplinary care.

Breast Center Types Table

The types of breast centers are identified by the components that the center “provides” with “quality control.”   Below:
An “X” means this type of center must provide this component. 
An “M” means this type of center “may” provide this component but is optional for that type of breast center. 
An “O” means this type of center would not be expected to provide this component. 

All service categories not “provided” may be “referred” service components at that center (center does not have “quality control” of that service).   However, having “referred” service components does not impact the designation of type of breast center.  Only “provided” services count towards defining breast center type.