A Breast Center review of compliance with National Comprehensive Cancer Network Breast Cancer guidelines

Background National Comprehensive Cancer Network (NCCN) guideline compliance for breast cancer was determined in a breast center. Methods A retrospective study of 200 new breast cancer patients seen in 2004 was performed. Results NCCN guideline compliance rates for preoperative evaluation, breast surgery, lymph node surgery, radiation treatment, and systemic adjuvant therapy were 87%, 97%, 97%, 77%, and 63%, respectively. The most common reasons for noncompliance were partial breast radiation, no radiation, limited life expectancy, and patient choice to defer systemic treatment. Conclusions The investigation of quality of breast cancer care requires measurement of compliance and reasons for noncompliance with established guidelines. A review that focuses only on percentage compliance has the potential to penalize institutions that (1) practice informed consent detailing absolute risks of survival with and without systemic therapy, (2) practice evidence-based medicine before the standardized guideline is changed to reflect it, and (3) serve populations with limited life expectancy.