What I presented was the European Commission Initiative on Breast Cancer. Basically, this is very innovative in terms that we are outlaying a pathway which will be accredited, that means quality assured, ensuring that for breast cancer patients, women, obviously – mostly women, there are some cases of men – they will be ensured minimum standards to be fulfilled at every stage along the pathway, because even today, unfortunately, the patients are falling between the stools of breast cancer healthcare. The way we do that is we are updating the guidelines.
There are European guidelines for breast cancer screening and diagnosis. Those guidelines are being updated and they will be updated in real time. So as evidence becomes available it will be injected into the guidelines, transformed to indicators, those indicators, quality indicators, will be measured by the European Corporation for Accreditation, a continuous improvement, never out of date. Furthermore, for the other parts of the treatment pathway – that means treatment, post-treatment, palliative care, psychosocial care, pain management, all very important – there we will provide a platform of the best practice guidelines worldwide, with our experts together, and these will also be measured so ensuring that the patient pathway has the highest standards built in from the beginning. It will not be about the name of the institution or a certain professor or whatever it is. It will be basic quality assurance but of a very, very high level, and we’re developing it in such a way that it is a blueprint for other cancer sites – colorectal cervical, etc. – and other disease paradigms. I think that Europe and the world deserves this because it is unacceptable that basic mistakes are still being made, and the key to it all is that the patient will be at the centre. This is a patient-centric approach.
How can you ensure these guidelines will be followed by all countries involved?
In the design of this initiative, and we have 70 experts with us doing this, experts on guidelines, experts on quality assurance, but we did a lot of extensive research first. We did a mapping of all breast cancer services in the European Union, looking at how it’s organised, the levels etc. Indeed, to lay out one protocol that fits all is almost impossible because what you want is a scheme that is not impossible for, let’s say, less advanced countries to jump on board, but also you want a scheme that will not bring down the levels of others. But we’ve cracked that knot, it has been very, very straightforward. Basically, for those member states and clinical settings that are very, very advanced, they should quite easily come on board, ticking the boxes – does the radiologist have sufficient training? Are there double readings in case of doubt? Basic steps like that. For them, it should be a case of yes, yes, yes, or maybe some areas of improvement. Then for the countries that are less advanced they can aspire to doing it, and here we will also through our networking, exchange best practices. There’s not rocket science behind this. Of course, you have the issue of the finances that are available and what not, but all that will be considered. So in 2018 when we do the piloting, we will be going to each country, to the various countries looking at their set up and making sure it is implementable. So it’s a big challenge but it can work. It’s a very good question. The diversity is there but the inequalities are also there and this is one way to address the inequalities.
What will happen if the infrastructure of a country cannot yet meet these guidelines?
If the infrastructure is not then that infrastructure will not be able to come on board. So there you might think oh, that’s again a discrimination, well actually it is not in a way, because the levels that we are setting should be reachable. It will boil down a lot to what’s available there, and basically we don’t want a system also that’s just working well in Western or Northern Europe but not in Eastern or Southern, this would also be wrong. Basically, the bar is set quite low but you would be amazed, you will be so surprised that even at that level a lot of these steps are not being fulfilled. I mean, multidisciplinary meetings – such an obvious one, but does it happen? No, the hospitals are overburdened, the disease paradigm, chronic disease is going through the roof, patients are numbers, they are not people anymore. Do they sit together with the oncologists, the radiologists, the chemotherapists, the breast cancer nurse, to have that rounded discussion? Even today, even in advanced, we know that unfortunately it doesn’t happen. Issues like that need to be improved.
Will these guidelines be updated frequently?
In the past when European guidelines were produced, and they were excellent, there’s no talking about the past and even, like I said in the speech, the Americans look to Europe and they even wanted those guidelines, so they were well accepted. But it’s like anything, we need to measure impact. You can have the best legislation in the world but if you don’t measure its impact, does it work or not? It’s like having held data. You can have the most wonderful data, harmonised, great coverage – if you don’t use it, what good is it? So again in this case here, basically the impact is the most important thing and the implementation of the guidelines will be done in real time. So as evidence becomes available, they will be injected, so they will be on the European Commission Initiative for Breast Cancer Science, our web hub, there you can enter as a patient/citizen, as a politician or as a physician. The pathways of entry are for all three segments. This will help to bridge the gap between science, citizens and policy. This is very important. We need to all work together for this. They will not be collecting dust on the shelf, it’ll be updated real time, and then you have continuous improvement. Everything we produce is open source, is shared, so available to all.
