October 2015 | No. 177
  NCBCinc.org     NQMBC.org     BPNC.org
Editors' Corner

October marks the beginning of a new season and welcomes cooler weather along with the start of family and holiday traditions.  October is also synonymous with Breast Cancer Awareness Month, an annual international breast cancer campaign organized by major breast cancer organizations to increase awareness and to raise money for breast cancer research.  It was started in 1985 to promote mammography as the most effective weapon for detecting breast cancer.  That said, it seems like the perfect time to review the mission statement and vision of the National Consortium of Breast Centers.  
Mission Statement

NCBC is the premier interdisciplinary organization committed to the development, maintenance, advancement and improvement of the highest quality patient focused Breast Centers by supporting education, certification and interdisciplinary communication among those we serve. Our vision is to positively impact quality breast care and improve the experience, satisfaction and outcomes of the breast care patient as well as the care providers while being recognized as the premier organization supporting interdisciplinary Breast Centers in the world. NCBC is committed to continued loyalty to our mission and vision statement and is enhanced annually by the ever increasing membership, professional staff, authors and articles.  Our efforts to continue our exemplary service is dependent upon renewed memberships and new members who bring new ideas and information. 
Feature Article

Automating Quality Assurance Metrics to Assess Adequate Breast Positioning in Mammography

Gerald R. Kolb, JD, The Breast Group, Sunriver, OR; Kaier Wang, PhD, VolparaSolutions, Wellington, NZ; Ariane Chan, PhD, VolparaSolutions, Wellington, NZ; and Ralph Highnam, PhD, VolparaSolutions, Wellington, NZ

The October Newsletter includes a feature article by Gerald R. Kolb, JD et al on "Automating Quality Assurance Metrics to Assess Adequate Breast Positioning in Mammography."...  Digital data continues to open new doors in the quest for quality across the breast continuum.  This month's newsletter contains an expansion of an abstract that was presented in poster form at the 2014 NCBC annual meeting, describing early work in analyzing positioning quality from the digital image.  While this work is still preliminary, it is promising and could eventually provide real time quality assessment, reducing repeat rates and improving images for interpretation.

Editorial: Avoiding Over Treatment

In the October Issue of the NCBC Newsletter, an important on-line September publication by Sparano JA et al, (New England Journal of Medicine, 2015) is reviewed by Don Steven Dizon, MD, FACP, Co-Director of Gynecologic Oncology at Massachusetts General Hospital. The article is the first prospective trial confirming the results of the Oncotype DX 21 Gene Assay.
Since Dr. Bonadonna's landmark research in the 1970s proved that adjuvant chemotherapy improved survival in early stage breast cancer, chemotherapy has been used in millions of women with the disease. However, it has been known that not all women derived a survival benefit. Until the advent of the Oncotype DX 21 Gene Assay, there was no accurate way to identify women who could be spared the potential toxicity of chemotherapy. The significance of the many studies cited in the Editorial and as well as others in the literature is that many women can be spared the toxicity of Chemotherapy. At ASCO 2014, it was reported that ~ 20% of women receiving chemotherapy for breast cancer are admitted to the hospital for chemotherapy-related complications. Mortality, however, has been reported in ~ 2%. Medicare approved coverage of the assay in 2006, and it was shortly thereafter incorporated into National Comprehensive Cancer Network (NCCN) Guidelines [Stage I/II, lymph node negative, ER+ tumors]. The American Society of Clinical Oncology (ASCO) also recommends use of the assay.
Despite this overwhelming clinical evidence, NCCN guideline pathway, and ASCO endorsement, the clinical use of the assay has not been widely utilized. Dinan M et al, reviewed 70,802 women in the SEER data base who met the Oncotype DX Test criterion between 2005 and 2009 (JAMA Oncol, 2015; 1[2] : 158). The authors reported that use of the assay increased from 1.1% in 2005 to only 10.1% in 2009. Medicare and CMS are currently evaluating using NCCN Guideline compliance for payment authorization. Hopefully, the recent publication by Sparano et al, will further improve application of Oncotype DX for women with a RS<11 as well as the previously documented studies of little benefit from scores of a RS<18 . We can aid in this effort by informing our clinical care team colleagues and patients. In so doing, chemotherapy can be tailored to women who are more likely to gain a survival benefit, while sparing others the toxicity, and reducing costs to our healthcare system. Breast Centers should document in their breast conference notes the rationale for not following the many guidelines and endorsements and now supported by the Sparano et al study. Read the Editorial included in this issue of The Bulletin which describes this important trial. Read More...

For additional references, see below.
  • New England Journal of Medicine, 2015
  • New England Journal of Medicine, 2004 ; 351 : 2817
  • Lancet Oncology, 2010 ; 11:55
  • JAMA Oncol, 2015 ; 1[2] : 158
Fund Raising

As part of Breast Cancer Awareness month, Brighton Collectibles has chosen to support the NCBC along with other worthwhile organizations around the country with the 'Power of Pink' promotion. Ten Dollars [$10] of every sale of the 2015 Breast Cancer featured bracelet will go toward the NCBC Navigation program. Please see the insert and photo on how you can order the bracelet and donate to a worthy cause as well!  

Facility Membership

NCBC facility membership offers more value than ever before! You are able to access a one-of-a-kind resource allowing you to log into the members-only area of the breastcare.org website where you  post your breast center specific questions and receive replies from other members who provide expert information from around the world.  Membership also offers a discount off registration to the NCBC annual conference, Breast Center of Excellence certification opportunity via NQMBC, staff level certifications for navigators, CBE, and BSE Trainer, job opening listings, annual conference information and much more. 
Read on for attached application forms and a complete listing of all membership benefits. To log in, visit www.Breastcare.org and go to MEMBER AREA. Click on NCBC Members Logon. Use the email you have on file with NCBC as your username and your five digit zip code as your password. If you have forgotten your already-changed password, please use "forgot password" link. Please check spam or junk email if you have not received a response within 30 minutes.

Post Conference Options
Best Practices in Breast Centers: Quality from NAPBC and NQMBC
Breast Centers all over the country are struggling with how to implement quality metrics, patient navigation, genetic services and survivorship programs. These are all key components for both NAPBC and COC accreditation and are being incorporated into NQMBC certification.  This one-day post session will address Best Practices related to these components that select Breast Centers have developed and demonstrated success.
Practical Applications of Cancer Risk Assessment, Management and Genetics for the Busy Clinician
The past year has witnessed rapid advances in genetic testing for hereditary breast cancer which has directly affected patient care and the genetic testing process.  This course will lead attendees through a comprehensive review of the process of hereditary breast cancer risk assessment, genetic testing and the translation of this information into personalized cancer surveillance and risk reduction.  Focus will be placed on incorporating the latest data and testing options that you may introduce into your high-risk clinic. This will include the implication of breast tumor genomic testing on inherited risk assessment and the controversy surrounding next-generation sequencing as it applies to cancer risk and management.  
The Evolution of Hope for Breast Cancer Survivors 
Survivorship, as both a distinct phase-of-life and stage-of-cancer care, has been recognized- beginning with The Institute of Medicine's 2005 monograph titled "From Cancer Patient to Cancer Survivor: Lost in Transition." Much research has followed on the myriad of issues that may surface and that must be addressed as a person moves from active cancer treatment to survivorship. The potential issues that can surface fall into many domains (e.g. the physical, psychological, sexual, etc.) It is incumbent on all providers (both cancer care and general care) to be cognizant of the issues that survivors may face as well as the interventions that can offer breast cancer survivors the very best quality-of-life. This post conference follows up on previous NCBC presentations offered in the past several years. It takes the exploration and education on these matters to the next level, adding how the dimensions of hope are intertwined in the survivorship experience.

Save the Date
Need CEUs??? Hear from over 70 world renowned speakers, view cutting edge technology, network with over 700 breast care professionals from around the world and so much more!  Register NOW for the NCoBC 2016 26th Annual Interdisciplinary Breast Center Conference, April 9 through 13, 2016, hosted at Paris in Las Vegas. For a complete list of topics and registration information, please see attached. Submit your time off request NOW and register to attend. It is an amazing conference with many opportunities to network and see what is happening all over the world in breast care.  Oh and did I mention Paris?  See you in the spring!  
Cruise the Caribbean:  Primary Care Providers

There is still time to sign up for the Breast Cancer, Breast Care, and Common Breast Issues for the Primary Care Provider: 2015 Update. November 29 through December 6, 2015, NCBC is co-sponsoring a special conference while combining it with a Caribbean cruise. This all inclusive, seven day cruise departs Fort Lauderdale, FL and includes ports-of-call in Haiti, Jamaica and Cozumel. The three days of lecture offer 14 hours of AMA, CMA Category I credits. Topics include everything from screening to surgery, radiation therapy and chemotherapy. All breast care professionals are encouraged to attend this very informative lecture series and have FUN while doing it!  Imagine classes at sea - what better way to learn? Read More...
NCBC Education: Save These Dates

Navigator Certification Exams

November 3, 2015  ~  New York, NY

November 13-14, 2015  ~  Albuquerque, NM

April 12 or 13, 2016  ~ Las Vegas, NV 

Clinical Breast Examiner (CBE)

April 12- 13, 2016  ~  Las Vegas, NV

26th Annual Interdisciplinary Breast Center Conference

April 9-13, 2016  ~  Las Vegas, NV

For more Information please call (574) 267-8058
or Visit  bpnc.org/certificationschedule for details & registration

In closing this October newsletter, we hope you find it informative and helpful. But most of all because October is Breast Cancer month, we here at NCBC would like to dedicate this October issue to all our survivors, those who are currently in treatment, family members and treatment providers - and to those who have fought so very bravely, but lost their battle to breast cancer.  We continue to welcome your support, encourage new members to join and welcome suggested topics of interest and potential authors.


NCBC President
Jennifer Gass, MD, FACS
Breast Fellowship Director
Co-Director, Breast Health Center
Chief of Surgery
Women & Infants Hospital, 
Associate Professor of Surgery, and of Gynecology and Obstetrics
Warren Alpert Medical School, Brown University Providence, RI

Rufus Mark, MD
Radiation Oncology of Central Arizona
Banner University Medical Center
Phoenix, AZ

Susan Casella, RN, OCN
Northside Hospital Cancer Institute Atlanta, GA

Editor Emeritus
Claudia Z. Lee, MBA

NCBC  |  (574) 267-8058  |  [email protected]  |  http://www.breastcare.org

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