Authors (including presenting author) :
Choy WY(1), Chan STF(2), So WSV(3), Chan KM(4), Sheung LM(5) Kwok SM(6), Ng PS(7)
Affiliation :
(1-7)Surgery (Breast Care), Princess Margaret Hospital
Introduction :
The most frequent cancer diagnosed in Hong Kong in 2020, breast cancer is placed the third among the five leading cancer (14.6%). All the top ten cancers showed a drop, but breast cancer is one of the two exemption and with a rising rate of 4.1%. Female breast cancer cases diagnosed in Hong Kong have tripled from 1,152 in 1993 to 4,761 in 2019. On average, about 13 women are diagnosed with breast cancer every day.
According to the international guideline, surveillance mammogram for breast cancer survivors should be performed yearly in the first five year. In Kowloon West Cluster (KWC), the use of mammography for routine surveillance is for patients who have undergone definitive operation till patient completes routine follow up for breast cancer in HA SOPC. There are about 400 newly diagnosed breast cancer recruited in KWC and thus with the snowball effect, the patient required surveillance mammogram will increase rapidly.
Due to the high impact (increasing the number of breast survivors due to improving survival and mortality rate) and high volume, the waiting duration for mammogram appointment (post-treatment imaging surveillance for breast cancer survivors) in our clusters could only offer every 2-3 years for most survivors in the first 5 years. The most updated queue is year of 2025. In order to meet the international guideline (annual surveillence mammography), patients are required to self-pay the cost of interval mammography over two thousand dollars, that may become a financial burden to patient.
In Hong Kong, there are some community resources to provide subsidy for eligible breast cancer survivors to have free mammogram yearly. The aim is to share the long waiting duration for MMG appointment at public setting and assist those breast cancer survivors. For the eligibility criteria, women 40 years old or above; at high risk or with early symptoms of breast cancer; satisfy the below tabulated income limits can be referred. The imaging result will be transferred via eHRSS by the imaging centre. All abnormal reports that require immediate medical attention would be stamped “urgent” and upload to HA electronically
The role of a Breast Care Nurse (BCN) is the liaison with the community resources. BCN acts as resources person to give information for breast cancer survivors on the free surveillance program to patient. In addition, BCN is an advocator and educator to patients on the awareness of breast health after operation. More important, BCN acts as a gatekeeper to minimize patient to delay or miss the appointment
Objectives :
Enhance surveillance mammogram for post operative breast cancer patients
Methodology :
In Princess Margaret Hospital Breast Clinic, the breast surgeon will refer eligible breast cancer survivors to BCN during the follow up appointment, BCN will introduce different free imaging program with pamphlets and referral to patients. After two weeks of referral date, BCN will phone contact patients whether the institution accept them or not. By using nurse clinic record system, BCN collects relevant information including their appointment date, the breast clinic follow up date to review the report and the reason of case rejected, etc.
Result & Outcome :
From August 2022 to December 2022, total 27 patients were referred to community resources for free surveillance mammogram. Two cases have free surveillance imaging. One case was rejected because patient has mammogram appointment within one year. One patient with mammogram paid by self. The rest 23 patients will have appointment before the next follow up appointment.
By phone survey conducted with the patients, most patients expressed gratitude to the free surveillance imaging referral. They also showed appreciation on the follow up action by Breast Care Nurse after referral. Some of them telling that they forgot to book the appointment, while satisfied with BCN to remind them the booking, and also the follow up action made.
