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.