Background: The National Cancer Strategy 2007 pointed to fragmented care and unexplained regional differences in Sweden. Breast cancer, one of the three major cancers has the most developed care process. Until 2008 regional reporting on selected clinical and outcome data prevailed. Since 2008 a national quality breast cancer register replaced regional reporting and encompasses the compulsory cancer registration. Since primary breast cancer treatment goes beyond a year in some cases when all adjuvant modalities are used, the annual reports lag. We report data from 2012.
Aim: 1. to report on target levels according to national and international guidelines. 2. to identify regional differences and thereby suggest improvements for health care providers. 3. to make the report comprehensive to consumers and non professional stake holders.
Methods: Reporting of all primary breast cancers is done by electronic transmission, linked to the population register. Data are presented on hospital, regional and county level and compared to national mean levels. Target levels are set according to Swedish national and European guidelines.
Results: The completion rate was 98%. 92% had a confirmed diagnosis preoperatively. Fifty hospitals in Sweden perform breast cancer surgery, 80 % perform >150 cases per annum. Waiting times <3 weeks between treatment plan and surgery were only met in 50%. Breast conserving treatment varied between 60-90 % for small and medium size tumors. Breast reconstruction was nationally preformed in <10 % and in one county in 21%. Locoregional radiotherapy and adjuvant chemotherapy was unevenly distributed.
Conclusions: The report identifies strenghts and weaknesses in Swedish breast cancer care. A strong professional commitment with consumer representative adds to transparency and helps improving the breast cancer process.