Discrepancies in breast cancer management

Introduction
Breast cancer is one of the most frequently diagnosed neoplasms among women, and the number of cases is increasing every year. Although the incidence rate places Poland below the European Union average, the mortality rate shows that a problem with the diagnosis and treatment of breast cancer exists. We tried to answer whether the current path of a breast cancer patient in Poland is optimal, whether patients have access to all possible treatment options, and whether the treatment centre has a significant impact on the treatment method.

Material and methods
To achieve the study goals, we obtained data from the National Health Fund on the structure of procedures related to the treatment of breast cancer, and we conducted a survey in hospitals and performed individual in-depth interviews with experts.

Results
Among all hospitals in Poland, only 8% (47 hospitals) implement at least 4 of the basic profiles of breast cancer treatment: oncological surgery, clinical oncology, radiotherapy, and access to tailored therapies. Only 9 centres in Poland were accredited as a Breast Cancer Unit. Most hospitalizations related to the treatment of breast cancer are carried out in oncology hospitals (28.8%) and national hospitals (24.8%). However, nearly 27% of hospitalizations took place in units with no more than the 2nd-level of referentiality. The results of the survey and interviews with experts indicate that treatment of breast cancer patients, performed in centres with low reference levels, does not ensure an adequate level of treatment quality and coordination.

Conclusions
The right treatment path for a patient with breast cancer is a guarantee of long-term survival and high-quality treatment. Unfortunately, fragmentation of the oncological services in Poland means that there is still no oncological care system for patients with breast cancer that provides an equal level of care to patients regardless of the selected centre for treatment.