For breast cancer screening to meet its goal of reducing breast cancer mortality, the screening process must include timely and appropriate surgical intervention.

The role of the surgeon commences during the assessment phase and continues through treatment and follow-up¹.

BreastScreen Aotearoa surgeons must be trained and skilled in the management of breast diseases. In addition to clinical skills they must be able to communicate effectively with women in the Programme and be able to work as part of a Multidisciplinary Team.

It is expected that surgeons in the Programme will be closely involved with assessment and surgical aspects of the diagnosis and therapy of cancers detected. In addition, the surgeon will contribute to setting Standards, audit and administrative aspects of the Programme as required.

General expectations

Surgeons involved within BreastScreen Aotearoa should:

• contribute to setting standards that a woman in the screening programme may reasonably expect including rapid assessment and surgical opinion, access to timely and appropriate therapy for cancer
• set quality standards suitable for use in clinical audit including the number of impalpable lesions correctly identified and surgically removed at the first localisation biopsy.

Professional Standards

Qualifications

• Registration to practise in New Zealand with a current Annual Practising Certificate (APC).
• Hold a qualification in General Surgery and be Vocationally Registered in General Surgery with the Medical Council of New Zealand.
• Participate in a re-certification programme in general surgery by their own college.

Competency

A surgeon in the Programme, in addition to training and experience in general surgery, should have specialist surgical expertise and a major interest in breast cancer management.

Accreditation process

• All surgeons working in the BreastScreen Aotearoa Programme require accreditation to do so.
• Each surgeon will be assessed on their qualifications, training, etc, and a decision will be made by the Accreditation Committee based on information submitted in the Accreditation Template.
• BreastScreen Aotearoa, regarding their ability to work in the Programme, will make a recommendation. The outcome will be communicated to their Lead Provider Manager, Clinical Director and the surgeon.

Indicators

BreastScreen Aotearoa surgeons should be:

• vocationally registered in General Surgery
• credentialled to an accredited hospital.

Criteria

The surgeon should meet these criteria:

• Re-certification requirements:
• participation in audit
• credentialled by an accredited hospital
• meets CPD requirements.
• Meets criteria for full membership of Section of Breast Surgery of RACS:
• enters all cases of breast cancer into RACS Breast Section Audit
• meets CPD requirements for breast disease (this includes attendance at national and international meetings on breast disease).

Continuing professional development and re-certification requirements

BreastScreen Aotearoa surgeons should maintain an ongoing level of specialist expertise in diagnosis and management of screen-detected breast lesions.

Criteria

All surgeons (FRACS and non FRACS) must meet the RACS Breast Section requirements which are:

• full participation in the Breast Section Audit with information on entered cases assessed against the RACS average for a number of clinical indicators. The clinical indicators will be determined and reviewed by the Executive of the Section after consideration by an accreditation sub-committee.
• meeting audit and CPD criteria as for full membership of the Breast Section of the College. The CPD requirements include:
• an ongoing commitment to CPD activities in breast disease. Each year Breast Screen surgeons will be asked to complete three questions which specifically relate to breast disease. These questions will be included in the annual RACS CPD form distributed by the College. This form is to be made available to surgeons who are not Fellows of the RACS for a fee.
  The questions will be:
• attendance at significant breast-related CPD meetings including, for example, RACS ASC Breast Section lectures, ANZ Breast Cancer Trials Group Meetings, Leura, Overseas breast meetings, etc
• attendance at specific breast related clinico-pathology and clinico-radiology meetings (including hospital meetings, BreastScreen Aotearoa and private breast clinics)
• reading of journal articles related to breast disease or computer-based and/or distance learning
• attendance at the greater of 60% or 15 of the unit's clinical multidisciplinary meetings per annum.

¹ NHSBSP QA Guidelines for Surgeons [NZSBSP 1996]. UK.