Shifting Breast Cancer Diagnosis to Earlier Stages Through Program Alignment with National Accreditation Program for...

Nationally, approximately 66% of breast cancers are diagnosed at an early stage (0-II). Review of the 2022 analytic breast cancer cases at HCA Florida Ocala Hospital demonstrated an early-stage diagnosis rate of 65%, slightly below the national benchmark. In 2023, breast oncology physician stakeholders aligned the program with National Accreditation Program for Breast Centers (NAPBC) standards, pursuing accreditation in 2024. The objective was to improve breast oncology program quality, shift diagnoses to earlier stages, and enhance patient outcomes.

Three initiatives were implemented to align with NAPBC standards. • A dedicated bi-weekly multidisciplinary breast cancer conference was established for prospective case review, involving radiology, pathology, surgery, medical oncology, radiation oncology, and genetic counseling. Post-operative pathology was also reviewed to confirm adjuvant treatment plans, re-excision needs, and supportive service referrals. • A high-risk women's program (HRWP) launched in June 2023, incorporating cancer risk assessments for mammography patients and offering point-of-care genetic testing for those meeting National Comprehensive Cancer Network criteria. Identifying high-risk patients and coordinating follow-up in clinic enabled personalized screening and surveillance. • Outmigration was addressed as a quality initiative through improved breast imaging access, enhanced nurse navigation, and targeted outreach to referring providers.

Outcomes on the three components above demonstrated: • Breast cancer conference case presentations increased 62% in 2023 compared to prior year, with continued growth of 10% in 2024 and 16% in 2025. • Prospective pathology review of outside biopsies identified four non-concordant cases between 2023-2025, resulting in changes to surgical management. • The HRWP achieved 98% assessment completion rate, identified over 1,000 patients with elevated Tyrer-Cuzick scores, and detected more than 150 pathogenic mutations. Program care coordination enabled cascade family testing, a 69% increase in breast magnetic resonance imaging utilization from 2023-2025, and personalized surveillance plans. • Breast cancer outmigration decreased from 71% in 2024 to 62% in 2025.

Alignment with NAPBC standards resulted in a 9% improvement in early-stage breast cancer diagnosis, increasing from 66% in 2022 to 75% in 2023, and sustaining at 73% in 2024. The HRWP emerged as the program's primary service differentiator and continues to drive early detection and quality outcomes. Completion of 2025 abstraction is anticipated to demonstrate continued improvement.