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According to a recent paper in this journal by Mathers et al,1 the use of a standard proforma for breast cancer resulted in 74% completeness of reporting. However, there is no mention in that paper, or in other reports of audits of compliance with standard data sets,2–5 of clinicians requesting missing data, or of the issue of supplementary reports.
At the Royal London Hospital, we recently audited colorectal cancer resection histopathology reports for compliance with the Royal College of Pathologists' Minimum Data set (MDS). At the ensuing audit meeting, various reasons for non-compliance with the MDS were discussed. It was obvious that not all data items in the MDS were appropriate for every case and that it might be unrealistic to strive for full compliance with the MDS. Indeed, clinicians may have ignored omissions not relevant to patient management. Relevant missing data may have been provided verbally at multidisciplinary team meetings, but few written supplementary reports were issued.
If an MDS truly is minimum, then published reports of audits and our audit have shown that large proportions of patients have their management planned without essential pathological data. Full compliance can probably only be achieved by rigid adherence to the MDS, and by issuing supplementary reports if data items are missing. Unfortunately, full compliance is probably necessary, even when data items are of no clinical relevance, so that accusations of failure to comply with a “minimum” standard are avoided.
To cover every angle, perhaps histopathology cancer audits should record not only compliance with the MDS, but also whether the report was optimal for planning patient management, whether the multidisciplinary team meeting requested further information, and whether supplementary reports were issued.