Purpose The Breast Quality Audit (BQA) is a bi-national initiative capturing 80% of all breast cancers treated in Australia and New Zealand. Established in 1998, its purpose is to centralise surgical data, track trends, develop key performance indicators (KPIs), and ensure the quality of breast cancer care through evidence-based practice and benchmarking across both countries. Methodology The BQA collects anonymised data from over 350 surgeons and 263 hospitals, recording over 30,203 episodes in 2020-2021. Data includes patient demographics, tumour pathology, and surgical outcomes. Surgeons can compare their performance against 13 KPIs, which cover key aspects of breast cancer management. The BQA interfaces with multiple national organisations and provides a platform for surgeons to self-assess clinical performance. Results The updated BQA system launched in 2023, allowing participants to track their performance and compare outcomes across multiple metrics. Membership criteria currently require the management of at least 10 breast cancer cases per annum, which is under review for future increases. The audit has led to significant collaborations and publications that assess trends in breast cancer management. Conclusion The BQA plays a critical role in improving breast cancer outcomes through standardised data collection and monitoring. Future developments include integrating patient-reported outcomes and expanding coverage to enhance surgical quality and patient care across both nations.