Breast cancer is the most prevalent malignancy among women in the United States, and it is the major cause of death in women between the ages of 45-60. Because of the magnitude of the impact of this disease, society has mandated an increase in breast cancer research funding, particularly over the past decade. This has resulted in the generation of an immense amount of data, with the goal of this effort being to improve the overall outcome of patients with breast cancer. This explosion in breast cancer research has been paralleled by a trend toward complex multidisciplinary treatment. Current ¿standard of care¿ recommends treatment of breast cancer patients with some standard combination of surgery, radiation, and systemic therapy. These treatment decisions are often made by attempting to extrapolate data from clinical trials to an individual patient who may not fit the strict inclusion criteria of patients enrolled on the trial. This is problematic, as it is the rare patient who exactly matches the inclusion criteria for the trials from which treatment decisions are derived. This problem is compounded by a lack of data at the point of care. Thus, rather than ¿custom-fitting¿ therapy, oncologists must make treatment recommendations based on conventional ¿off the rack¿ protocols, rarely taking into account individualized data. Conventionally, physicians and patients have opted to err on the side of caution. The inadvertent end result is probable over or less than optimal treatment of patients with resultant treatment-related complications, poor resource utilization, and patient dissatisfaction.

Our goal is to improve the quality of breast cancer care by integrating knowledge and tailoring treatment to biology, preference, and performance. We propose to create a Center of Excellence for Customized Breast Cancer Care, the goal of which will be to custom-tailor the best-fitting treatment plan for every patient. The components necessary to realize such a profound shift from the current ¿off the rack¿ approach are (1) to establish a process by which custom tailoring can be performed for each patient; (2) to create the instruments for this process, including risk assessment tools for both the patient and oncologist to make collaborative treatment decisions; and (3) to assess the long-term appropriateness of the fit, from the viewpoint of the patient, oncologist, and society as a whole.

This will require a multidisciplinary team organized around a center of excellence. The bedrock of our proposal is the commitment of providers, scientists, advocates, industry partners, sociologists, decision analysts, management scientists, and epidemiologists, each with a specific strength. Our team has expertise in breast cancer, quality measures, risk assessment, outcomes, management science, public policy, health care delivery, technology, and breast cancer translational science. We intend to create a framework for approaching the problem and a system to support solutions with scalable, open architecture, both of which will serve as a prototype for ongoing regional and national efforts to improve breast cancer outcomes. By combining the power of informatics with our expertise in management science and breast cancer, we will provide a blueprint for quality improvement in service and treatment of patients that can be scaled to other providers and health care delivery areas.