Table 1.

Hospital stratification

Level 1 (NCCN enhanced) screening and clinical diagnosis Clinical breast examination Mammography	Level 2 (NCCN Core) screening and clinical diagnosis Clinical breast examination	Level 4 screening and clinical diagnosis Clinical breast examination
Pathological confirmation and 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 counselling and genetic testing	Pathological confirmation and imaging Core needle biopsy Pathological review (in house or external) ER/PR status testing (in house or external) Ultrasound X-ray Mammography Surgical treatment Lumpectomy Mastectomy Axillary dissection Sentinel lymph node biopsy Oophorectomy (or medical ovarian suppression)	Pathological confirmation and imaging Excisional biopsy, incisional biopsy, core needle biopsy or fine-needle aspiration cytology Pathological review (in house or external) Ultrasound X-ray Surgical treatment Mastectomy (always or sometimes available)* Axillary dissection (always or sometimes available)*
Surgical treatment Lumpectomy Mastectomy Axillary dissection Sentinel lymph node biopsy Breast reconstruction Oophorectomy (or medical ovarian suppression)	Non-surgical treatment Chemotherapy Radiotherapy Endocrine therapy Long-term surveillance/follow-up Supportive/palliative care
	Level 3 (NCCN basic) screening and clinical diagnosis Clinical breast examination	Level 5 Screening and clinical diagnosis Clinical breast examination
Non-surgical treatment Chemotherapy Radiotherapy Endocrine therapy Trastuzumab Long term surveillance/follow-up Supportive/palliative care	Pathological confirmation and imaging Excisional biopsy or incisional biopsy Pathological review (in house or external) ER/PR status testing (in house or external) Ultrasound X-ray Mammography Surgical treatment Mastectomy Axillary dissection Oophorectomy (or medical ovarian suppression)	Pathological confirmation and imaging Excisional biopsy, incisional biopsy, core needle biopsy or fine-needle aspiration cytology Pathological review (in house or external) Ultrasound
		Level 6 screening and clinical diagnosis Clinical breast examination
	Non-surgical treatment Endocrine therapy Long-term surveillance/follow-up Supportive/palliative care

Detailed list of services required to be categorised under each hospital level. A hospital must have all listed services to be categorised 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.

*’Sometimes available’ includes hospitals that reported offering a service, but it is only available <80% of the time throughout the year.

ER, oestrogen receptor; HER2, human epidermal growth factor receptor 2; NCCN, National Comprehensive Cancer Network; PR, progesterone receptor.