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Triple assessment guideline for secondary care 2006 version

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Description: Triple assessment guideline for secondary care for the initial assessment of women with suspected breast cancer

Publet Introduction:

Computerised decision support for the initial assessment of women
referred to specialist breast units (original version, Patkar et al, British Journal of Cancer 2006).

Triple assessment is a common procedure in the UK National Health Service to determine whether or not a patient with suspected breast cancer does or does not have malignant or benign breast disease. The process involves taking a comprehensive clinical history followed by decisions about imaging (typically mammography and ultrasound);
biopsy (needle sampling) and the management of confirmed cancer.
Genetic risk assessment is also included in this
application.

 Information
Guideline Objectives

The application includes decision support for four areas crucial to the evaluation of a patient attending a triple assessment clinic (updated from the original workflow).

  • Genetic risk assessment.
    The application helps assess familial and genetic risk of breast cancer. The RAGs applet is used here to construct a pedigree and calculate genetic risk for the individual patient, expressed as high, medium or low. Support for this task is based on NHS NICE Familial Breast Cancer guidelines.
  • Selection of correct mode of imaging (mammography, ultrasound or neither). The medical knowledge for this task is derived mainly from ACR guidelines.
  • Selection of the right mode of biopsy (if any). The knowledge for this task is derived from NHSBSP guidelines.
  • Selection of the optimum way to manage the patient based on examination, imaging and cytology results (it is assumed that core biopsy results if any would not be available on same day). The knowledge for this task is derived mainly from BASO guidelines.

 

Target SettingSecondary care
Target Users
  • Author
  • Release Date
Overview
Provenance7.No provenance has been assigned (default value)
Management

The application includes decision support for four areas crucial to the evaluation of a patient attending a triple assessment clinic (updated from the original workflow).

  • Genetic risk assessment.
    The application helps assess familial and genetic risk of breast cancer. The RAGs applet is used here to construct a pedigree and calculate genetic risk for the individual patient, expressed as high, medium or low. Support for this task is based on NHS NICE Familial Breast Cancer guidelines.
  • Selection of correct mode of imaging (mammography, ultrasound or neither). The medical knowledge for this task is derived mainly from ACR guidelines.
  • Selection of the right mode of biopsy (if any). The knowledge for this task is derived from NHSBSP guidelines.
  • Selection of the optimum way to manage the patient based on examination, imaging and cytology results (it is assumed that core biopsy results if any would not be available on same day). The knowledge for this task is derived mainly from BASO guidelines.

 

Safety Case
Sources
References
  • NICE (Familial Breast Cancer guidelines);
  • BASO (Management of symptomatic breast disease in the UK, 1998);
  • NCCN (Breast Cancer Screening and Diagnosis);
  • SIGN (Breast Cancer in Women);
  • ACR (Appropriate imaging work-up of palpable breast masses; Appropriate imaging work-up of breast microcalcifications; Performance of diagnostic mammography; Performance of a breast ultrasound examination);
  • ASCO (Breast cancer surveillance, 1998);
  • NHSBSP (Breast cancer screening assessment;
  • Non-operative diagnostic procedures and reporting in breast cancer screeni