Data entry

Each 'episode' entered into the audit relates to a new episode of cancer care. If a patient has cancer in both breasts simultaneously, enter each breast as a separate episode. If the original surgery on the patient resulted in clear margins and there was a recurrence or a new primary three or more months later, enter as a new episode. These are the only valid reasons for creating a subsequent episode of cancer care for a patient.

The data field ranges in the online system have been designed to cover most situations and to improve the integrity of the data collection. If you have data which exceeds a permitted range, please check the original data to make sure that there has not been a transcription error. If your data does exceed the permitted range and you consider it should be allowed, follow the advice below.

For 'nodes examined' and 'nodes positive' fields: if the number of nodes exceeds 40, enter 40 and make a note in the comments field (full dataset view). An entry of '40' in this field will be interpreted as '40 or more' when the data is analysed.

For all other fields: please contact the help desk as soon as possible so we can determine whether changes need to be made with the online data entry system.

If the patient has both invasive and in situ components, mark it as invasive and complete the appropriate pathology items, including 'total extent of lesion'. The exception to this rule is if the case involves micro-invasion only. If an in situ case involves micro-invasion, mark the case as in situ and record the micro-invasion in the comments section.

Yes, data from patients who received no surgical treatment for any reason should be entered. If a patient does not have surgery, please enter the case as a 'no surgery' patient. This means ticking the box labelled 'no surgery' in the surgery section.

If no surgery was performed, mark all adjuvant treatment questions as 'no'. Any therapy received must be recorded as neoadjuvant using the tick box under the relevant therapy.

No. The BQA is an audit of early and locally advanced breast cancer. Advanced or metastatic cases are not recorded.

Receptor status questions should be answered in reference to the overall status of the patient so if the principal tumour in the breast is negative, but a second tumour is positive, please record a positive receptor status.

Bilateral synchronous cases need to be recorded as two episodes. Enter all items for the first breast and save and close the record. Then search for the patient and click 'add an episode'. You will then need to enter the information for the other breast.

Multi-focal/multi-centric cases are recorded as one episode. To fill out the pathology section for a case with multiple tumours in the same breast, record the most prognostically significant information. For example, record the tumour size of the principal tumour, record the distance to margin from the tumour which had the closest margin, and record the receptor status as positive if any of the tumours were positive.

If the pathology report does not specify tumour size, please speak directly to the pathologist as this information is mandatory for complete records.

If there is a re-excision, the width should be added to margin clearance. In other words, if the original margin was clear (i.e. more than 0) then you would need to add the distance to margin measurements together.

The margins questions are seeking the distance from the invasive (or DCIS) component to the closest margin, after completion of all surgical procedures. For example, if the margin was clear after the first excision (distance from tumour to margin was 1mm) and a re-excision was performed (a further 2mm shaved) then the distance from the invasive tumour to the final margin would be the excision margin plus the re-excision distance (3mm). The same is true if a mastectomy was performed after an excision with clear margins.

Multiple re-excisions can be assigned to a case. Click add surgical procedure to open the surgery options. Choose re-excision under the surgery options a second time to add a second re-excision and add the date to each procedure. Then click add to add your procedures to the case.

Additional surgeries can also be added when editing a case. Click add surgical procedure to open the surgery options again.

ITC should be recorded as node negative. Micro metastases should be recorded as node positive.

If there is a case where axillary surgery is performed but no lymph nodes are identified, enter zero nodes examined and zero nodes positive with a note in the comments that no lymph nodes were identified. This will allow for the completeness of the case.

If the recurrence occurs three months after an operation with clear margins, this would be recorded as a new episode. Search for the patient in your 'my patients' list and click 'add an episode'. If the recurrence occurs prior to three months, treatment would be recorded on the original episode. Either way, the recurrence can be recorded in the follow-up section under the original episode for the patient.

To enter a follow-up: Search for the patient using the 'search' box located above the My Patients table. Click on view/edit episode and select 'Edit Episode' for the original case record for the patient. Click on the Followups tab at the top of the screen. Click on ' Add Followup' and then enter details.

Enter tumour size as zero.

If an in situ case involves micro-invasion, mark the case as in situ and record the micro-invasion in the comments section.

The audit encourages users to enter data after all information related to a case is known; however, there is the facility to enter what information is known and come back and finish the case at a later date.

A case can be saved in the online system as long as all mandatory information is entered. The mandatory fields are indicated by an asterisk on the interface.

If a case is saved without adjuvant therapy information, the case will be labelled as 'incomplete' and a red cross will appear next to it in the patient list. This acts as a reminder that you need to go back in and add some important information on this case.

The 'incomplete' crosses that appear on the patient list for each surgeon act purely as a reminder to go back and add extra information. The reason for labelling incomplete cases is so that all cases are as complete as possible to ensure performance assessments are accurate and data is complete enough for analysis. 

If a patient has surgery for the primary breast cancer, but no axillary surgery, the case can be completed by inputting zero for both nodes examined and nodes positive in the pathology section of the dataset. This should also be done for cases where an axillary dissection was performed but no lymph nodes were identified.

Only one margin size needs to be entered for the case to be considered complete. That is, you do not need to enter both circumferential and vertical margins, one of these will do. 

If more than one surgeon is involved in a case, the patient should be recorded under the account of the surgeon responsible for that case. For example, if a registrar or Trainee performed the surgery, it would be entered under the account of their supervisor. If another surgeon assisted or performed a second operation, it would be entered under the account of the surgeon who is responsible for making the final treatment decisions with the patient.

If a patient's initial surgery (e.g. CLE) was at one hospital and subsequent surgeries (e.g. re-excision, mastectomy, reconstruction) were at a different hospital, all surgeries should be recorded under the one episode. Record against the hospital where the most definitive surgery took place (e.g. if margins were not clear on excision and mastectomy was performed, record all surgeries against the hospital where the mastectomy was performed). The fact that the first surgery occurred elsewhere can be recorded in the comments field.

The exception to this is if the subsequent surgeries occurred more than three months after the initial surgery, where the initial surgery resulted in clear margins. This would be considered a second episode of breast cancer.

If a patient was entered under one surname but at follow-up or subsequent cancer treatment the surname of the patient has changed (due to marriage or divorce for example), for the purposes of maintaining the integrity of the database, it is important that you not duplicate the patient with a new record.

If the name change is discovered at follow-up, search for the patient's old name code (first three letters of surname) and click 'edit episode'. Once the episode is open, change the name code to the first three letters of the new surname, then navigate to the follow-up section to add the follow-up information.

If the name change is discovered during treatment for a subsequent cancer episode, search for the patient's old name code (first three letters of surname) and click 'add episode'. This will create a new episode for that patient, linked to the old episode. Once the new episode is open, you can alter the name code with the first three letters of the new surname. Continue to enter the treatment details as usual.

You may also wish to make a note of the previous name code in the comments section.

Please note that when you alter the name code of a patient, this change affects all episodes of cancer treatment recorded for that patient. You do not have to edit every episode manually. Altering the record in this way allows for accurate data linkage with the National Death Index at a later date.

For both Full and Associate members, episodes should be entered by the surgeon responsible for determining the patient's care pathway (the 'Responsible Surgeon').  Whilst the procedure/s may be performed by someone else (the 'Primary Surgeon' in the theatre at the time), because the audit assesses performance against KPIs related to the care pathway, the patient episode should be recorded by the surgeon who made the treatment decisions/recommendations in consultation with the patient and the care team (the 'Responsible Surgeon').