The last few decades have seen unprecedented advances in the screening, diagnosis, and treatment of patients with breast cancer. This prodigious growth in knowledge and information has necessitated a shift toward increased specialization within each discipline, such that those with a specific interest in breast cancer have been able to focus their efforts toward achieving a high level of expertise in their specialty. Without question, the end result of this specialization has been a greater refinement of cancer care and dramatically improved outcomes for patients with breast cancer; the 5-year survival rate for a woman diagnosed with breast cancer between 1975 and 1979 was 74.9%, compared with 87.7% for a woman diagnosed between 1995 and 2000.1
The growing recognition of the importance of multidisciplinary care has also mandated the creation of health care delivery systems that foster and support collaboration among specialists. The comprehensive breast center has been a model for coordinated multidisciplinary care, and this concept is even more timely now than when the Van Nuys Breast Center opened its doors almost 30 years ago. The goals of a breast center, whether real or virtual, remain excellence in the delivery of breast health care within a multidisciplinary environment, although substantial variations among centers exist around additional goals such as education, outreach, and research. Here, we will discuss the advantages favoring the treatment of breast cancer within such an infrastructure, consider the metrics by which performance and quality can be assessed, and review the individual components vital to ensuring the success of such a center, for both patient outcome and community impact.
The increased number of treatment options coupled with the growing complexity of multidisciplinary cancer care has resulted in a growing awareness of the importance of coordinated cancer care. In addition, concurrent with these changes in medical treatment, enormous changes in the fabric of American society coalesced to create a demand for greater patient involvement in all aspects of health care decision-making and patients were empowered to seek treatment in the most comprehensive care environments. Breast cancer treatment has been at the forefront of this challenge, since the effectiveness of multidisciplinary care for breast cancer had been empirically shown for several decades in randomized clinical trials of radiation therapy for women undergoing lumpectomy as well as for systemic treatment in women with surgically resected locoregional disease. By combining access to screening, diagnosis, and multimodal therapy within one setting, comprehensive breast centers were an attractive model of care, and indeed, the emergence of coordinated breast programs has facilitated the achievement of 2 primary goals: (1) delivery of patient-centered care and (2) delivery of improved quality care for patients with breast disease.
Until the middle of the 20th century, the mainstay of treatment for breast cancer was the radical mastectomy described by Sir William Halsted in the 1890s.2 However, in the 1960s and 1970s, powerful forces of social and political reform ...