Publication:

Evaluation of triple assessment performance against NICE breast cancer standards: a prospective breast clinic audit assessing guideline compliance and diagnostic outcomes in a rural hospital in Bangladesh

Background Breast cancer is a leading cause of mortality worldwide, and early detection is crucial for improving survival. The National Institute for Health and Care Excellence (NICE) breast cancer diagnostic standards provide a structured pathway, but their implementation in resource-constrained, rural settings remains challenging. This study aims to evaluate compliance with NICE diagnostic standards and assess the outcomes of the triple assessment pathway (clinical examination, imaging, and histology) in a rural breast clinic in Bangladesh.

Methods A prospective audit was conducted on 150 patients attending the breast clinic at Bangladesh Korea Friendship Hospital from February to July 2025. Demographic data, compliance rates with triple assessment, diagnostic outcomes, and delays were recorded. The association of resource constraints with compliance and outcomes was evaluated using appropriate statistical tests.

Results Compliance with NICE standards for clinical examination, imaging, and histology was 87%, 76%, and 58%, respectively, with an overall pathway compliance of 73%. Diagnostic outcomes revealed malignancy in 39.5% of patients and benign conditions in 48.6%. The mean time from referral to final diagnosis was 24 days. Inadequate diagnostic tools (p=0.032) and medical facilities (p=0.045) were significantly associated with lower compliance and poorer diagnostic performance.

Conclusions The triple assessment pathway can be implemented in a rural setting, but significant compliance gaps exist due to resource and staffing limitations. Addressing these barriers is essential to improve diagnostic accuracy and ensure timely breast cancer diagnosis in similar contexts.