Implementation of the EMBPP

East Midlands Breast Pain Pathway National Audit Report

The National Audit had a specific focus on the health economics of the EMBPP, and provided further evidence of the reproducibility and safety of the pathway. The EMBPP was implemented at community sites and delivered by 17 services from 9 different Cancer Alliances (CA) across England. It included data from initial implementation in the East Midlands CA in June 2021 through to North and Central London CA commencing in May 2024.

14 services were in Cohort A providing the full audit data set including follow up data. The 3 services in Cohort B commenced later in the audit period and provided data on immediate clinic outcomes, but no follow up data. 

Results

7,326 patients were seen at CBPC sites across England. The median patient age was 48 (range 16-92) years. 6439 patients (88%) were discharged from the clinic with breast pain management advice. 887 (12%) patients were referred for further assessment at a 2WW breast diagnostic clinic.

Objective family history risk assessment identified 845 patients (12%) at above population risk of developing breast cancer, who were offered referral to familial cancer services for ongoing management. In addition, 1338 (19%) patients were found to have a breast cancer family history but assessed as at near population risk of breast cancer and reassured.

Patient reported outcomes from anonymised questionnaires showed that satisfaction with the service was high with 99% “extremely likely or likely” to recommend the service to family and friends, among numerous other positive quantitative and qualitative PROMs.

3,819 patients had a full 12-month follow-up period after their CBPC appointment, with 17 cancers diagnosed. 3 of those patients were ineligible for the CBPC due to the specified exclusion criteria. For eligible patients with a full 12-months follow-up, the incidence of breast cancer was 3.7 per 1,000, confirming that the EMBPP identifies and manages a population at low risk of developing breast cancer.

The Cost Benefit Ratio for the CBPCs in Year 1 was 1.26, meaning that for each pound spent, the health system receives £1.26 in benefits. For Year 2 the cost benefit ratio rises to 1.40.

Outcome

• Patients with breast pain only were successfully managed at multiple community sites across 9 Cancer Alliances in England.
• Most patients did not require a breast diagnostic clinic assessment.
• Patients attending the clinic reported high levels of satisfaction with the service.
• Familial breast cancer risk assessment helped identify unmet need in the community.
• Safety data confirms that the pathway identifies and manages a population at low risk of developing breast cancer.
• The EMBPP has cost benefits.

The National Audit period provided additional evidence of the reproducibility, acceptability, safety and cost benefits  of the EMBPP on a larger scale.

BMJ OQ 200825

ABS Presentation 19/05/2025

Implementation of the East Midlands Breast Pain Clinic Model across the East Midlands and nationally has been facilitated through a collaborative agreement between Roche Products Limited and HITS – Health Improvement Transformation Strategies C.I.C.