Quality Assurance as an Essential Element in the Breast Cancer Care Service - Essay Example

Running head: QUALITY ASSURANCE Quality Assurance is seen as an Essential Element in the Breast Cancer Care Service You're Abstract Quality Assurance is an essential element in the Breast Care programs that exist within the UK and surrounding geographical areas today. Therefore this research focuses on how these programs work and the impact that they have in the diverse communities around the country. The main purpose of this research is to show that while testing for breast cancer is a positive influence in women's lives it can not provide the quality assurance that is needed without appropriate, timely, and accurate follow up treatment, following the quality imaging that could possibly show an abnormality within the breast. Thereby this research will be explaining how fundamental it is to continue improving these various programs for the population of women in the UK and for that matter, all around the world. The conclusion of the research will define that while early detection of any abnormality in the breast is a positive element of technology today, it is more imperative that there exists programs which will guarantee quality and timely care for those with possible breast abnormalities. Quality imaging can of course bring about more positive outcomes for patients, as well as through the medical professionals giving the appropriate and empathetic care to the patients. To validate these points the literature will define that these breast care programmes should be designated to assist women in breast care and proper treatment and influence them in an encouraging way to go and be tested for breast abnormalities. The point is if the programs can not get these women to attend the screenings that are necessary then the main goal of minimizing the risks associated with breast cancer will remain at a minimal level and not achieve their ambition of saving more lives due to diseases of the breast. Quality Assurance is Seen as an Essential Element in the Breast Cancer Care Service Introduction Quality assurance in breast care is an element in medicine that is imperative to have to bring higher quality health to the population of women around the UK. However, before this can be given the various programs designed to get women to participate in breast screening needs to be effective in encouraging women to get breast health assessments in order to lower the morbidity rate among women due to breast cancer and other serious breast diseases (Klabunde et al, 2004). The main goals of the various breast service programmes across the UK are meant to try and promote positive breast health for women. The point of the fact is, is that there is a higher cost associated in attempting to fight a disease such as breast cancer than there is in providing preliminary services before this form of disease has a chance to develop in a woman's breast. Therefore, the obvious and most pertinent obligatory role these programmes have is to promote positive health through a combination of educational materials, interpersonal relationships, and organizational mechanisms. The actions of these programs bring forth a form of quality assurance that substantially conforms to the needs of the community of women which is stronger support in breast health awareness and disease prevention (Gilbert 1997). The National Health Service Breast Screening Programme (NHSBSP) is a primary example of a coordinated effort to provide quality assurance programmes on a national level. Within this framework all professional groups become involved such as surgeons, radiologists and pathologists as well (Sauven et al, 1996-2001). These medical specialists have one main goal and that is to provide quality and reassuring care to those who become involved in any breast screening programme. Programmes and the professionals participating in them also have extremely crucial roles as they have to ensure that the prescreening and the follow-ups do provide reasonable and extensive care for those women that need further treatment. For those that do not require follow up care and show no signs of adversity in breast health, there simply needs to be a strong interpersonal relationship among the professionals and those patients. This is stated because this type of relationship is necessary in order to effectively provide sound health care with clear understanding to the patients concerns and questions in relation to the programme of which they are involved (NHS 2006). The imaging and technique that tests such as mammograms carry out are also another one of the key components in providing evidence to women of how beneficial breast screening and early detection of abnormalities actually can be. In fact, some would say that it is the quality of the imaging and the way in which the professionals care for the patients needs that draws importance to these early breast cancer detection programmes (NHS 2006). The Importance of Breast Health Care Services and Early Detection In years past there have been many controversies over the extent of how useful mammography screening actually is in the reduction of breast cancer morality rates. However, the quality imaging that is available now puts these arguments to rest as many professionals in this field have come to the realization that the quality of the imaging is one of the most essential tools in breast health care for women (Dershaw 2005). For instance, now new knowledge has shown that digital mammography is possibly more pertinent to the quality of breast care programmes than the traditional style of film mammography. This is due to the fact that the imaging is far more concise and clearly shows early abnormalities far more accurately than the traditional mammogram has been able to do in the past. Also, there are a minute few of false positives that digital mammography presents compared to film mammography which is why the technology in the UK is adapting and making explicable progress in implementing this new type of technology into the breast care programmes which are currently in effect. The utilization of digital mammography is of course not for all women but for those who have been found to have denser breasts and for those who are pre- and peri-menopausal; the benefits are more applicable in providing quality assurance in their breast health care regimen. This is due to the fact that the digital imaging technology can gain a better image on a woman with denser breasts than the older traditional model of mammography has the capabilities of doing (Dershaw 2005). For instance with women who have very dense breasts, digital technology has the capability of pulling away the excess tissue in the image to allow for viewing of the actual muscular components of the breast. This is extremely beneficial in the early detection technique as it allows for radiologists to have a wide and totally clear image of the whole breast whereas before hand not all of the muscle of the breast could be totally seen due to the excessive tissue. In this regard this type of technological improvement into the programmes for breast health care is very influential because it provides the quality control tools necessary to greatly enhance the imaging capabilities of mammography (Dershaw 2005). Another remarkable addition to the technology in these programs which offers women early detection of abnormalities within their breast is the utilization of the technology of MRI scanning and imaging (Kriege et al, 2004). Genetics, although not as yet fully proven, has been being questioned as to what part it actually has in the development of breast cancer among women. Due to the questions and due to the need to provide women with quality assurance over their breast health care some facilities in the UK are offering MRI imaging in order to ease many women's worries that have a history of breast cancer in the family. Many medical professionals claim that the utilization of MRI imaging provides far more clarity in pinpointing early abnormalities than any other form of quality imaging that is currently available in the UK and else where in the world as well (Rijnsburger et al, 2004). Furthermore, this imaging has the ability to be able to show the direct blood flow throughout the breast which is beneficial in mammographic imaging because often times many tumors are hypervascular. Therefore blood flow patterns that define irregularities can alert medical professionals to the possibility of what would otherwise have been an undetectable tumor if utilizing techniques such as basic mammography (Dershaw 2005). This is a technique known as a contrast-enhanced image and forms the basis for the utilization of MRI imagery of the breast. Researchers have made the point that if general mammography can somehow be designed to include intravenous methods which could offer similar contrasts of image blood flow in the breast then the more expensive testing such as MRI's would not be needed because the same capability could be made available in a more wide context. However, currently the traditional form of imaging has not had an inclusion of such an option so this is the underlying reason why these breast health care programmes encourage the implementation of these other imaging techniques to more efficiently care for the patient and identify breast cancer at the earliest stages possible (Rijnsburger et al, 2004). Quality Control and Quality Assurance in Breast Imaging Anytime breast imaging is carried out there is always a level of control over the amount of the radiation dosage that is utilized. Without this form of quality control there could not exist quality assurance in these breast health care programmes because this area is just as imperative to the women's long-term well being as gaining an excellent image of the breast is. Quality control in radiographic imaging is possibly the most crucial area that has to be correctly facilitated because radiation dosage and other intricate details in breast screening have to be followed according to very strict guidelines passed down through the NHS (Stromberg & Bailey 1998). The reasoning in-behind this is not only to make sure that there exists quality assurance in the facilitated care of people attending breast screenings and cancer treatments but also to reduce any possibility of malpractice by those performing the tests as well. This might be one of the most pertinent reasons why guidelines were established in breast screening programmes so that patients can be assured the levels of radiation they are being exposed to are not excessive and will not complicate their health in any adverse way, further than what they might already be dealing with. Medical professionals in this area have designed a basic approach to ensure that quality control is kept in any form of prescreening and treatment for breast care health programmes as the following bulleted outline specifies the reasons and practicability more clearly of having this type of implementation in breast care facilities. Quality control produces high quality images while regulating the radiation dosage in the most practical way possible Quality control safeguards women from having to face repeated exposure due to faulty or inaccurate films Quality control ensures that regular medical servicing of the equipment will provide an effective service for women Correct procedures for reporting of faulty equipment to the RQAR and the NCCPM are guaranteed Quality control guarantees staff will be appropriately trained, provide quality assurance to patients and will follow correct protocols (Kristin & Bogan 2004). These listed steps of course show how very serious the implementation of Quality Control is in breast health care programmes. It takes the competency of the mammographers and other imaging technicians to ensure that all of these protocols are met and the program runs as smoothly as possibly to continue to give quality assurance to patients in regards to the techniques and the validity of the equipment as well. Thereby, mammographers are expected to guarantee that the routine protocols are followed at all times. They should always be involved in what equipment will be chosen to be utilized with specificity of the utilization of the equipment having importance. Common knowledge does indeed clarify that it is the quality of the mammography and the expertise of those performing the tests which dictates what level of quality assurance will develop and how effective quality control will be in the facilitated testing (Rijnsburger et al, 2004). To extend this concept further, in order to guarantee top quality care, the equipment itself has to be functioning correctly and at top condition to provide highly efficient imaging of the breast. It is extremely important that the guidelines concerning the utilization of the equipment are followed appropriately as well for they play one of the most detrimental roles in determining the present of an abnormality or not. Improper usage could result in a false positive or a negative feedback which either way could place a woman's life in danger. The following bulleted points give the reasoning why careful use of the equipment should be followed and managed effectively along with the statements that have been subsequently made (Yaffe et al, 1990). All mammography equipment should be correctly installed All mammography equipment should meet any and all requirements to exceed the level of quality assurance and quality control set up by the NHS Mammography equipment and other technology should meet the safety and health requirements under legislation Of course this type of equipment is meant to be utilized in an appropriate environment In order for the equipment to be effective they have to be implemented and utilized appropriately (Yaffe et al, 1990). The many points that have been made in regards to quality control and quality assurance obviously define the pertinence that all variables have in the proper facilitation of breast health care and the procedures that are to be followed. There is no doubt that these protocols make an extreme difference in providing the appropriate care to those who need breast cancer screening and of who depend upon accurate and reliable testing. The Impact that Quality Control and Quality Assurance has on Image Quality Quality control has an extreme impact on the type of image that will be developed through breast screening equipment. Not only this, but it possibly plays the most imperative role in improving upon the chances of saving someone's life and safeguarding their health as well. Without quality control, equipment used might not be serviced correctly or the technicians own competence might become questioned. These are only some of the areas that would be limited without this formal protocol (Urbain 2005). As was mentioned, the radiologists own competence and capability to be able to logically interpret the images from mammograms and other testing procedures is especially critical in guaranteeing a form of efficacy in the screening of the mammography breast health programs. Over the years this idea has become more and more apparent as the literature has shown false positive or even results coming back showing no growth can impact a female's life in a very adverse way. It is impingements on the normalcy of a woman's life which could be avoided if quality control and quality assurance are indeed being followed. For instance, a woman with breast cancer can have this detected early if the radiologist has a decent competency level, the equipment is running correctly, and the image quality is of the necessary standard to allow for interpretation. If all of these areas are appropriately taken into consideration then women can have a higher probability of medical intervention that could alleviate the problems associated with a tumor or other disease of the breast (Urbain 2005). Many studies that have been carried out in this area have given variant interpretations of how different radiologists interpret the tests. There of course has to be a high level of reading accuracy by these professionals and not only this fact but again, the equipment has to be running in an efficiently operable and standardized manner to bring back the highest feasible results. Again, as has been mentioned repeatedly, the equipment, the technician and the level of interpretation play an astounding role in the accuracy and dependability of the testing which has a huge role in maintaining quality control as well. Review of the Literature Over all it is the sensitivity of the usage of mammography in the detection of the disease of breast cancer that determines a patient's outcome. However the other factors that are important are relative to the patient's age, the possible size and location of a lesion, what the hormone percentage is of a tumor, of course the image quality and then the interpretative skills of the radiologist as well (Urbain 2005). Furthermore, the literature has also emphasized the fact that the density of a woman's breasts plays a role in imaging as well. If the wrong type of test is performed, such as film mammography then the chances of detecting a cancerous lesion in the breast is minimized. MRI imaging has been validated to be the best form of radiology equipment to be used in a case such as this. The criteria for comprehending the need of breast health programs have been clearly depicted in this literature. For many women they seek out help because they are suffering with pain which is confusing and creating a severe physical burden in their life. Therefore, when it comes to this point where the functions of life become limited due to an unknown medical problem then effective screening for breast cancer, as well as various holistic interventions become necessary and should be readily available to any woman regardless of their economic situation, demographics, or other personal beliefs and values. There are very few researchers and medical professionals that would offer any form of dispute in regards for the necessity of breast cancer screening in the communities, especially for women aged 50-69 years of age. Also, where history shows that breast screening use to be about what the real need for it was and whether or not there was a serious importance for it, times have shifted and transformed it into an idea that shows people don't question the necessity of it but instead focus on how to get programs for breast screening implemented into society (Urbain 2005). Conclusion of the Literature Women, on an individual basis have a part to play in their breast health which is just as important as any test is. Preventing a form of breast cancer from developing is the main goal of any breast health care programme and it should be the same goal for the individual female regardless of whether she has entered into a programme for breast cancer screening or not. Even though the screening and the treatment that is available is beneficial to a woman's health the fact is, is that cancer is not 100% curable by any means. There are often side affects from the treatments associated with cancer and there are always long term risks involved as well. This is of course one of the main reasons screening for it ahead of time is so important because as has been said preventive care is far less costly than attempting to try and combat the disease of cancer once it has progressed in the body. Not only is there screening that can aid in preventive intervention of breast cancer but there are personal risk factors that can be minimized as well. However there are some, like those with genetic factors that can't always be changed but with screening procedures any sign of cancer has a high possibility of being detected early which will limit the mortality rate among women and possibly save many more lives in the long run. It is imperative to keep in mind that by eating a balanced diet, exercising, managing body weight effectively, limiting alcohol consumption, and keeping smoking to a minimal amount will also provide more positive reinforcements in the prevention of breast cancer. For any female that is concerned with developing breast cancer, they should follow up on the services that are available to protect their own health and safeguard their mental health as well because breast cancer can create many forms of depression which can develop into severely crippling mental instability. So, to reiterate, clinical breast exams should be carried out every three years in the age range of 20-39 and then once reaching the age of 39 it should drop to once every year. Upon turning 40 women should enter into a breast health care programme and have a baseline mammogram performed on a yearly basis to prevent the occurrence of breast cancer. Breast cancer can be cured in the early stages with minimal complications in the long term quality of life. Therefore it is essential that prevention includes avoiding the many risk factors associative with the disease, that medical professionals make sure equipment is constantly updated and running correctly, that radiologists have a high level of competency in reading mammogram films, and that personal breast examination is carried out at least yearly following an accurate reading of a mammogram which shows no signs of breast cancer. These various issues that have been discussed will save many women from having to deal with being told that they have breast cancer and ultimately will save lives. References Dershaw, David. (2005). Cancer Screening-Detection: Future Directions in Imaging. [online] Available from: http://www.touchbriefings.co.uk/pdf/1677/Dershaw.pdf Gilbert, F.J. (1997). Screening for Breast Cancer. Br J Hosp Med, 58, 595-598. Klabunde, C. J., et al (2002). Quality Assurance in Follow Up and Initial Treatment for Screening Mammography Programs in 22 Countries. International Journal for Quality in Healthcare, 15, 449. Kriege, Mieke., et al (2004). Efficacy of MRI and Mammography for Breast-Cancer Screening in Women with Familial or Genetic Predisposition. The New England Journal of Medicine, 351, 427-437. Kristin, M. & Bogan, Terri. (2004). Operating a Comprehensive High-Risk Breast Cancer Management Program in a Community Hospital Setting. AWHONN Lifelines, 8, 434-440. NHS. (2006). Breast Screening Programme: Quality Assurance. [online] Available from: http://www.cancerscreening.nhs.uk/breastscreen/ Rijnsburger, A. J., et al. (2004). Impact of Screening for Breast Cancer in High Risk Women on Health Related Quality of Life. British Journal of Cancer, 91, 69-76. Sauvan, P., et al (1996-2001). The National Health Service Breast Screening Programme and British Association of Surgical Oncology Audit of Quality Assurance in Breast Screening. Wiley Interscience, 90, 82-87. Stromberg, Marilyn & Bailey, Lara. (1998). Cancer Screening and Early Detection Managing Malpractice Risk. Cancer Practice, 6, 206-216. Urbain, Jean-Luc. (2005). Breast Cancer Screening, Diagnostic Accuracy, and Health Care Policies. Canadian Medical Association, 172, 195-199 Yaffe, Marlin., et al. (1990). Equipment Requirements and Quality Control for Mammography. AAPM Report, 29, 1-79. Read More