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The quality of surgical outcomes for cancer patients is influenced by multiple factors that must be addressed by both a systemic and an individual surgeon approach. In Australia, like many other countries, changes to the health care system via both federal and state government health care quality agencies are likely to positively impact outcomes for surgical patients. Surgical audit is an important component of quality surgical practice and the most successful surgical audit in Australia is the National Breast Cancer Audit, run by the Royal Australasian College of Surgeons. The audit has helped to document the standard of breast cancer surgery in Australia and New Zealand and in the process identified areas for improvement.