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The One Stop Clinic for Breast Health

RSNA_Image aérienne service_04Suzette Delaloge, MD MSc, is Associate Professor of Medical Oncology and Head of Breast Cancer Department at Gustave Roussy Institute, Paris, France and chair of the French National Breast Cancer InterGroup-Unicancer.

Dr Delaloge became head of Breast Cancer Department in 2004: since then, she leads a multidisciplinary team of seventy doctors, care givers and researchers, coordinates and manages all clinical and clinical research activities of the team.

Her major areas of expertise and development, in addition to the breast diagnostic clinic, are the management of individuals at high risk of breast cancer, therapeutic development guided by prognostic and predictive biology, and the organization of care in breast oncology.


How did the “One Stop Clinic” come about?  In 2004, France launched a national screening program, though with no clearly organized post-screening model.  At that time, nationwide, post-screening diagnostic time intervals were high, even at our institution.  With that in mind, coupled with in France alone, each year, 49,000 new breast cancer cases being diagnosed, we took a close look at how we could develop a program that would deliver on the unmet need for faster diagnosis and treatment planning.  Our goal was to create an environment for patients where they would experience shorter time intervals between “positive” screening and diagnosis, coupled with accuracy and high quality care every step of the way. We did our research to determine if a solution like this already existed, it did not, or at least not on a scale as large as we were planning.  From there, we developed a model for the “One Stop Clinic”, which at that time was revolutionary.

Dr. Suzette Delaloge, M.D.

Dr. Suzette Delaloge, M.D.

What type of patients does the “One Stop Clinic” serve?   We are not a screening facility. The women who come to us have already had an abnormal mammography or suspect breast lesion(s) diagnosed elsewhere. Breast cancer does not discriminate, nor do we. Any woman, no matter her social or ethnic background, can get breast cancer; it’s our mission to serve all populations of women with suspicious screenings faster and with more accuracy.

How is the “One Stop Clinic” different than other breast clinics worldwide? Many providers have adopted programs with the intent of faster diagnosis and treatment planning for patients, but Gustave Roussy Cancer Campus is unique in that we provide same-day results and treatment plans for the majority of patients with suspicious findings. The root of what differentiates us is our clinical and economic outcomes as indicated in a recent independent evaluation.  We are able to accomplish these results because of our consolidated group of multi-disciplinary experts who have access to advanced imaging multimodality technology.  With the clinical expertise and advanced technology in one place, it’s essentially a one stop shop.

What does this mean for patients?  It means patients won’t have to wait weeks to get yet another follow-up appointment to see a specialist, or travel elsewhere to get the test they need. In one place, our multi-disciplinary team has access to high- precision technologies that include mammography, ultrasound, contrast-enhanced spectral mammography, image-guided fine needle aspiration, any type image-guided biopsies and magnetic resonance from which the team can share, review, and collectively discuss images to make immediate decisions with the patient who is always at the center of the discussion. We are not aware of any other facility that, to this extent and in one location, has the depth and breadth of expertise in tandem with advanced diagnostic imaging and expert pathologists, workflow and triage structure.

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What type of results can patients expect? The results are remarkable and truly unlike anything we’ve seen happening anywhere else in the world. In fact, a recent independent study confirms 75-percent of approximately 11-thousand patients who visited our facility over the course of eight-and-a-half years received a diagnosis on the same day they arrived to the clinic*. Beyond proving that our approach is faster, they also validated these patients received highly accurate diagnoses – 97% sensitivity and 99.7% specificity.  In particular, this data point is worth noting as key to our success because it means the majority of patients who come to our facility don’t have to worry about false-positives or call-backs which, as you know, are an issue in breast cancer diagnostics.

The clinical outcomes don’t stop here.  Useless biopsies and surgeries were avoided in 10-percent of patients who underwent contrast-enhanced spectral mammography**, a diagnostic tool that has recently proven to be of great additional value to our same-day results One Stop Clinic.  Additional operational and economic benefits to both our institution and the patient include triage efficiency, reduced wait times, lower cost of care and improved patients’ satisfaction.

Why is your collaboration with GE Healthcare critical to the success of the “One Stop Clinic”?  The combination of GE Healthcare’s long-standing imaging expertise with our clinical knowledge of breast cancer makes for a powerful and successful collaboration.  The comprehensive suite of technologies they can provide us clearly meet the physicians’ demands to provide fast and accurate breast cancer diagnoses.

Can other hospitals duplicate this model? Yes of course, some already have in a more limited size or a longer time frame than what we’re seeing with our same day results.   Our model has proven that when you combine the right people, process and technology, you can deliver excellent clinical, operational and financial outcomes with increased value.

What’s next for the future of the “One Stop Clinic”? Gustave Roussy is constantly evolving its “One Stop Clinic” model to include the most advanced diagnostic tools to continue taking patient outcomes to the next level. Since the independent evaluation, we added GEHC’s SenoClaire, digital breast tomosynthesis (DBT) to our fleet of diagnostic technologies, and we’re exploring the addition of molecular diagnostic technology to our repertoire.  We expect the depth and efficacy of the “One Stop Clinic” model to continue to grow beyond what has been evaluated thus far, especially with the new offering of DBT and CESM.   Our goal is to be seen as pioneers in today’s world of breast cancer diagnostics. We believe the “One Stop Clinic” will distinguish Gustave Roussy and GEHC now and in the future.

 

*Long-term multimodal assessment of One Stop Breast Unit. Gustave Roussy, Collection and analysis of data June, 2013.
** Added value of Contrast Enhanced Spectral Mammography as a routine complementary tool in a breast cancer unit.  The Breast Journal. July 2015.

More Information

The Pulse @ ECR 2016