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Collation of Australasian data regarding breast cancer

breast cancer in Victoria, 1988–92: Tumour characteristics and patient management’, is an historical perspective of the management of these pathologies at the beginning of BreastScreen Australia and at the time when many of the major hospitals were establishing specialist units.1 It was also before the 1995 National Health and Medical Research Council (NHMRC), National Breast Cancer Centre, Guidelines for the Management of Early Breast Cancer were published.2 Much has changed in that decade and it is often hard to recall what those changes have been. Somewhat surprisingly Giles et al. found that 46.5% of in situ cancers presented as a mass. Contemporary Royal Australasian College of Surgeons (RACS) Breast Audit data indicate that 72% of in situ breast disease is diagnosed by mammography and only 28% is diagnosed clinically. Similarly the authors report that 68.8% of invasive cancers of < 10 mm in size were found by the patient or by her doctor. The RACS Breast Audit does not specifically address this question but only 18% of cancers of < 10 mm were recorded as being palpable. The latter figure supports the clinical impression that small cancers are rarely palpable and that examination, and in particular breast self-examination (BSE), cannot be relied upon to find lesions of this size. The authors draw our attention to the fact that one-third of patients with ductal carcinoma in situ (DCIS) underwent some type of axillary surgery. At face value this appears to be high but current RACS Breast Audit data reveal that 68% of women with DCIS have no axillary surgery, 14% have a level 1 axillary sampling and 11% have a level 2 or 3 dissection. Only 38% of patients with small invasive breast cancers treated by breast conservation were given radiotherapy but these cases pre-dated the report on the role of breast irradiation.3 Finally, the pathology reporting of invasive cancers at that time revealed inconsistencies. Grade was not reported in 27.6% of cases, and margins of clearance may have been un-reported in 22.8% of cases. There is early evidence from the RACS Breast Audit that The Pathology Reporting of Breast Cancers, a guide for pathologists, surgeons and radiologists, may have improved the quality of pathology reporting for breast cancer because less than 1% of surgeons indicated that their pathology reports were inadequate.4 This paper provides us with an opportunity to look back to a time before, and at the birth of, BreastScreen Australia, before the National Breast Cancer Centre and before publication of the Guidelines for the Management of Early Breast Cancer. The RACS Breast Audit dataset, which is owned by the Section of Breast Surgery, should be able to give us similar raw data to assess contemporary surgical practice.5