5.2.1

The Breast Unit must have an identified Clinical Director of Breast Services.

5.2.2

Breast Surgeons (including Gynaecologists performing breast surgery)
Two or more nominated surgeons specially trained in breast disease, each of whom must personally carry out the primary surgery on at least 50 newly diagnosed cancers per annum and must attend at least one diagnostic clinic per week.
For an average sized unit the surgeons will need at least eight identified ca. 4 hr sessions per week in Breast Disease. These sessions will allow for operating time, participation in diagnostic clinics, a follow-up clinic and, where appropriate, screening assessment clinics. A session must be allowed for attendance at a weekly team case management and audit meeting. A Unit team must provide breast surgical reconstruction when required for those patients not suitable for breast conserving therapy and be able to apply special techniques for patients with extensive local disease. The breast surgeons in the team should be able to undertake basic reconstruction or recontouring and there should be a standard arrangement or joint reconstruction clinic with one or two nominated Plastic Surgeons (non-core team member) who take a special interest in breast reconstructive and recontouring techniques.

5.2.3

Breast Radiologists
There must be at least two nominated radiologists, fully trained and with continuing experience in all aspects of breast disease and associated imaging, tissue sampling and localisation procedures under image control. Ideally any radiologist investigating breast patients should participate in the screening programme in countries in which this is established and must participate in a national or regional QA scheme. They must fulfil the volume requirements as laid down for breast assessment in Chapter 5 of the 4th edition of 'European Guidelines for Quality Assurance in breast cancer screening and diagnosis' and the previously published document 'Quality Assurance in the Diagnosis of Breast Disease' [12], reading a minimum of 1000 mammograms per year (5000 for those participating in a screening programme). They must attend multidisciplinary meetings for case management and audit purposes. They must be present in diagnostic assessment clinics with the surgeon. Each radiologist must attend at least one diagnostic clinic per week for symptomatic patients or screening assessment.

5.2.4

Breast Pathologists
A lead pathologist plus usually not more than one other nominated pathologist, specialising in Breast Disease, will be responsible for all breast pathology and cytology. Pathologists carrying out these roles must have contractual sessions to attend team case management and audit meetings. They must be familiar with national and/or European performance quality standards and guidelines. They must take part in available European, National and Regional quality assurance schemes.

5.2.5

Breast Oncologists
(a) A nominated radiation oncologist must arrange the appropriate delivery of radiotherapy [16] . He/she must hold advanced disease clinics with other members of the breast team, at the Breast Unit and must take part in the case management and audit meetings of the Unit.
(b) In some countries, Clinical Oncologists carry out both radiation therapy and prescribe the chemotherapy. In centres in which a Medical Oncologist gives the chemotherapy he/she should be a member of the core team and take a full part in case management and audit meetings.

5.2.6

Breast Diagnostic Radiographers (Technicians) Radiographers with the necessary expertise and training in mammography are essential members of the team. They must fulfil the training and working practice recommendations They must be responsible for taking the mammograms, which must not be performed by radiographic or non-radiographic personnel without the above training.

5.2.7

Data Managers
There must be a system covering audit. A data manager must enter data on diagnosis, treatment, pathology and clinical outcomes contemporaneously.

5.2.8

Patient Support staff
Regular support (advice, counselling, psychological help) is given by Breast Care Nurses in some countries and psychologically professionally trained persons with expertise in Breast Cancer in others. These persons must be members of the core team. They must be available to counsel and offer practical advice and emotional support to newly diagnosed patients at the time the diagnosis is given, so as to further explain treatment plans. They should also be available on demand from patients in the Primary Breast Cancer Follow up clinic and in the Advanced Breast Clinic. Particularly they must be present to support women when the diagnosis is given that the disease has become advanced. At least two Breast Care Nurses are needed per breast unit.

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