Table 1.
Criteria for stratification of healthcare facilities
| Health Facility Stratification | ||
|---|---|---|
| LEVEL 1 (NCCN Enhanced) | LEVEL 2 (NCCN Core) | LEVEL 4 |
| Screening and clinical diagnosis | Screening and clinical diagnosis | Screening and clinical diagnosis |
|
-Clinical breast examination -Mammography |
-Clinical breast examination | -Clinical breast examination |
| Pathologic confirmation & Imaging | Pathologic confirmation & Imaging | Pathologic confirmation & Imaging |
|
-Core needle biopsy -Skin punch biopsy -Pathological review (in house or external) -ER/PR status testing (in house or external) -HER2/neu status testing (in house or external) -Ultrasound -X Ray -Mammography -CT scan -Bone scan -Breast MRI -Genetic counseling and genetic testing |
-Core needle biopsy -Pathological review (in house or external) -ER/PR status testing (in house or external) -Ultrasound -X Ray -Mammography |
-Excisional biopsy, incisional biopsy, core needle biopsy, or fine needle aspiration cytology -Pathological review (in house or external) -Ultrasound -X Ray |
| Surgical treatment | Surgical treatment | Surgical treatment |
|
-Lumpectomy -Mastectomy -Axillary dissection -Sentinel lymph node biopsy -Breast reconstruction -Oophorectomy (or medical ovarian suppression) |
-Lumpectomy -Mastectomy -Axillary dissection -Sentinel lymph node biopsy -Oophorectomy (or medical ovarian suppression) |
-Mastectomy (always or sometimes available)a -Axillary dissection (always or sometimes available)a |
| Non-surgical treatment | Non-surgical treatment | |
|
-Chemotherapy -Radiotherapy -Endocrine therapy -Trastuzumab -Long term surveillance/follow up -Supportive/palliative care |
-Chemotherapy -Radiotherapy -Endocrine therapy -Long term surveillance/follow up -Supportive/palliative care |
|
| LEVEL 3 (NCCN Basic) | LEVEL 5 | |
| Screening and clinical diagnosis | Screening and clinical diagnosis | |
| -Clinical breast examination | -Clinical breast examination | |
| Pathologic confirmation & Imaging | Pathologic confirmation & Imaging | |
|
-Excisional biopsy or incisional biopsy -Pathological review (in house or external) -ER/PR status testing (in house or external) -Ultrasound -X Ray -Mammography |
-Excisional biopsy, incisional biopsy, core needle biopsy, or fine needle aspiration cytology -Pathological review (in house or external) -Ultrasound |
|
| Surgical treatment | LEVEL 6 | |
|
-Mastectomy -Axillary dissection -Oophorectomy (or medical ovarian suppression) |
Screening and clinical diagnosis | |
| -Clinical breast examination | ||
| Non-surgical treatment | ||
|
-Endocrine therapy -Long term surveillance/follow up -Supportive/palliative care | ||
Table 1 Detailed list of services required to be categorized under each health facility level. A health facility must have ALL listed services to be categorized under a specific level. These services must be available > 80% of the time throughout the year unless otherwise specified. Level 6 represents a hospital with the fewest breast cancer services
a“Sometimes available” includes hospitals that reported offering a service, but it is only available < 80% of the time throughout the year