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 | ||