title: Breast cancer outcomes following a national initiative in Ireland to restructure delivery of services for symptomatic disease.
abstract: BACKGROUND
  A national initiative in Ireland in 2000 defined 13 designated Units to provide care for symptomatic breast cancer, and resources, including an ability to develop audit programmes, were provided. In the absence of a national audit of breast cancer outcomes, the aim of this study is to provide a detailed report of one Unit's subsequent experience, in particular comparing process and outcome data with international norms and benchmarks, and to infer on the likely impact of the national initiative.
  
  
  METHODS
  A 5-year prospective audit of patients presenting to the Symptomatic Breast Clinic from 2001 to 2005 was conducted. All cancer diagnoses were discussed at the Breast Multidisciplinary Conference, and all clinicopathological treatment details and follow-up information were entered by a full-time data manager. Overall survival was calculated using the Kaplan-Meier method.
  
  
  RESULTS
  Eight hundred and thirty-nine patients were diagnosed through the clinic, 18 (2%) Stage 0, 169 (20%) Stage I, 380 (45%) Stage II, 142 (17%) Stage III, and 123 (15%) Stage IV. At a median follow-up of 35 months the overall 5-year survival was 71%, with 100%, 91%, 83%, 72%, and 11% survival for Stages 0-IV, respectively, and disease-specific survival of 82%.
  
  
  CONCLUSIONS
  The process and outcome data are consistent with international benchmarks. These data from one designated centre support the national initiatives in Ireland to restructure breast services.
authors.affiliation: Breast Unit, St. James's Hospital and Trinity College Dublin, Dublin, Ireland.
authors.forename: Catherine
authors.initials: C
authors.lastname: de Blacam
authors.forename: Jennifer
authors.initials: J
authors.lastname: Gray
authors.forename: Terence
authors.initials: T
authors.lastname: Boyle
authors.forename: M John
authors.initials: MJ
authors.lastname: Kennedy
authors.forename: Donal
authors.initials: D
authors.lastname: Hollywood
authors.forename: Javaid
authors.initials: J
authors.lastname: Butt
authors.forename: Mairead
authors.initials: M
authors.lastname: Griffin
authors.forename: Siobhan
authors.initials: S
authors.lastname: Nicholson
authors.forename: Barbara
authors.initials: B
authors.lastname: Dunne
authors.forename: Graham
authors.initials: G
authors.lastname: Wilson
authors.forename: Ronan
authors.initials: R
authors.lastname: McDermott
authors.forename: Pauline
authors.initials: P
authors.lastname: Murphy
authors.forename: Ireneus
authors.initials: I
authors.lastname: Short
authors.forename: Suzanne
authors.initials: S
authors.lastname: Rowley
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Connolly
authors.forename: John V
authors.initials: JV
authors.lastname: Reynolds
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019985:Benchmarking; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D015331:Cohort Studies; D005260:Female; D018166:Health Care Reform; D006801:Humans; D007494:Ireland; D008485:Medical Audit; D008875:Middle Aged; D009313:National Health Programs / Q000458:organization & administration*; D009367:Neoplasm Staging; D010043:Outcome and Process Assessment, Health Care; D015996:Survival Rate