Evaluation of triple assessment performance against NICE breast cancer standards: a prospective breast clinic audit assessing guideline compliance and diagnostic outcomes in a rural hospital in Bangladesh
DOI:
https://doi.org/10.18203/2320-6012.ijrms20260942Keywords:
Breast cancer, NICE standards, Diagnostic compliance, Rural healthcare, Triple assessment, Resource constraints, BangladeshAbstract
Background: Breast cancer is a leading cause of mortality worldwide, and early detection is crucial for improving survival. The National Institute for Health and Care Excellence (NICE) breast cancer diagnostic standards provide a structured pathway, but their implementation in resource-constrained, rural settings remains challenging. This study aims to evaluate compliance with NICE diagnostic standards and assess the outcomes of the triple assessment pathway (clinical examination, imaging, and histology) in a rural breast clinic in Bangladesh.
Methods: A prospective audit was conducted on 150 patients attending the breast clinic at Bangladesh Korea Friendship Hospital from February to July 2025. Demographic data, compliance rates with triple assessment, diagnostic outcomes, and delays were recorded. The association of resource constraints with compliance and outcomes was evaluated using appropriate statistical tests.
Results: Compliance with NICE standards for clinical examination, imaging, and histology was 87%, 76%, and 58%, respectively, with an overall pathway compliance of 73%. Diagnostic outcomes revealed malignancy in 39.5% of patients and benign conditions in 48.6%. The mean time from referral to final diagnosis was 24 days. Inadequate diagnostic tools (p=0.032) and medical facilities (p=0.045) were significantly associated with lower compliance and poorer diagnostic performance.
Conclusions: The triple assessment pathway can be implemented in a rural setting, but significant compliance gaps exist due to resource and staffing limitations. Addressing these barriers is essential to improve diagnostic accuracy and ensure timely breast cancer diagnosis in similar contexts.
Metrics
References
Anderson BO, Yip CH, Smith RA, Shyyan R, Sener SF, Eniu A, et al. Guideline implementation for breast healthcare in low-income countries. Cancer. 2008;113(8):2221-43. DOI: https://doi.org/10.1002/cncr.23844
Sachdeva R, Vora DJ, Umaraniya SV, Doctor S. Diagnostic accuracy of triple assessment in breast cancer: A comprehensive clinical evaluation with statistical analysis. Int J Pharm Res Technol. 2026;16(1):53-66.
Ginsburg O, Bray F, Coleman MP, Vanderpuye V, Eniu A, Kotha SR, et al. The global burden of women’s cancers. Lancet. 2017;389(10071):847-60. DOI: https://doi.org/10.1016/S0140-6736(16)31392-7
Johnston G, Crombie IK, Davies HT, Alder EM, Millard A. Reviewing audit: barriers and facilitating factors for effective clinical audit. Quality Health Care. 2000;9(1):23-36. DOI: https://doi.org/10.1136/qhc.9.1.23
Kaufman Z, Shpitz B, Shapiro M, Rona R, Lew S, Dinbar A. Triple approach in breast cancer diagnosis. Ann Surgical Oncol. 1994;1(6):505-10.
National Institute for Health and Care Excellence Suspected cancer: recognition and referral (NG12). London: NICE. Updated. 2023. Available at: https://www.nice.org.uk/guidance/ng12?utm. Accessed on 17 May 2025.
Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide. Cancer J Clinicians. 2021;71(3):209-49. DOI: https://doi.org/10.3322/caac.21660
Unger-Saldaña K. Challenges to the early diagnosis and treatment of breast cancer in developing countries. World J Clin Oncol. 2014;5(3):465-77.
World Health Organization (2023) Breast cancer fact sheet. Geneva: WHO. Available at: https://www.who.int/news-room/fact-sheets/detail/breast-cancer. Accessed on 17 May 2025.
Yip CH, Smith RA, Anderson BO, Miller AB, Thomas DB, Ang ES, et al. Guideline implementation for breast healthcare in Asia. Cancer. 2008;113(8):2261-71. DOI: https://doi.org/10.1002/cncr.23842
Adesina A, Chumba D, Nelson AM, Orem J, Roberts DJ, Wabinga H, et al. Improvement of pathology in sub-Saharan Africa. The Lancet Oncol. 2013;14(4):e152-7. DOI: https://doi.org/10.1016/S1470-2045(12)70598-3
Akram M, Iqbal M, Daniyal M, Khan AU. Awareness and current knowledge of breast cancer. Biological Res. 2017;50(1):33-41. DOI: https://doi.org/10.1186/s40659-017-0140-9
Unger-Saldaña K. Challenges to the early diagnosis and treatment of breast cancer in developing countries. World J Clin Oncol. 2014;5(3):465-77. DOI: https://doi.org/10.5306/wjco.v5.i3.465
Farmer P, Frenk J, Knaul FM, Shulman LN, Alleyne G, Armstrong L, et al. Expansion of cancer care and control in countries of low and middle income. The Lancet. 2010;376(9747):1186-93. DOI: https://doi.org/10.1016/S0140-6736(10)61152-X
Harford JB. Breast-cancer early detection in low-income and middle-income countries. Lancet Oncol. 2011;12(5):461-7. DOI: https://doi.org/10.1016/S1470-2045(10)70273-4
Knaul FM, Frenk J, Shulman L. Closing the cancer divide: a blueprint to expand access in low and middle income countries. Harvard Global Equity Initiative. 2012;1-112.
Pruitt L, Mumuni T, Raikhel E, Ademola A, Ogundiran T, Adenipekun A, et al. Social barriers to diagnosis and treatment of breast cancer in sub-Saharan Africa. Breast J. 2015;21(5):480-6.
Richards MA, Westcombe AM, Love SB, Littlejohns P, Ramirez AJ. Influence of delay on survival in patients with breast cancer. The Lancet. 1999;353(9159):1119-26. DOI: https://doi.org/10.1016/S0140-6736(99)02143-1
Sankaranarayanan R, Ramadas K, Thara S. Clinical breast examination: preliminary results from a cluster randomized controlled trial in India. J National Cancer Institute. 2010;102(19):1476-87. DOI: https://doi.org/10.1093/jnci/djr304
Vanderpuye V, Grover S, Hammad N, Puri P, Simonds H, Olopade O, et al. An update on the management of breast cancer in Africa. Infect Agents Cancer. 2017;12(1):13-20. DOI: https://doi.org/10.1186/s13027-017-0124-y
Downloads
Published
How to Cite
Issue
Section
