title: Quality assurance in follow-up and initial treatment for screening mammography programs in 22 countries.
abstract: OBJECTIVE
  To describe the quality assurance activities related to follow-up evaluation of abnormal screening mammograms and subsequent initial treatment of women determined to have breast cancer for the screening programs represented in the International Breast Cancer Screening Network (IBSN).
  
  
  METHODS
  Analysis of data from a survey that included questions about screening program policies, standards, and procedures for follow-up of women with abnormal mammograms, as well as the data and measures that programs use to assess the adequacy of follow-up and initial treatment.
  
  
  METHODS
  IBSN representatives in 23 countries completed a comprehensive questionnaire between May and December 1998.
  
  
  RESULTS
  Two-thirds of IBSN countries reported that they have a written policy or guidelines for follow-up of an abnormal mammogram; 64% require accreditation of the cytology or pathology laboratories that analyze breast specimens, or subject pathology laboratories to external audits. Of the 22 activities and measures related to quality of follow-up and initial treatment that we examined, all countries had in place at least half of them, although countries were more likely to have implemented activities and measures related to data collection and evaluation than to processes of care.
  
  
  CONCLUSIONS
  Population-based screening mammography programs cannot achieve the goal of reducing breast cancer mortality if women with abnormal mammograms do not receive appropriate, timely follow-up and initial treatment. This study shows that IBSN countries vary in their implementation of procedures and measures to assure the quality of follow-up and initial treatment for women with abnormal screening mammograms. There is more emphasis on collecting and evaluating data than establishing mechanisms to ensure that the processes of care for follow-up and initial treatment are of high quality.
authors.affiliation: National Cancer Institute, Health Services and Economics Branch, Bethesda, MD 20892-7344, USA. ck97b@nih.gov
authors.forename: Carrie N
authors.initials: CN
authors.lastname: Klabunde
authors.forename: Hélène
authors.initials: H
authors.lastname: Sancho-Garnier
authors.forename: Stephen
authors.initials: S
authors.lastname: Taplin
authors.forename: Steinar
authors.initials: S
authors.lastname: Thoresen
authors.forename: Noriaki
authors.initials: N
authors.lastname: Ohuchi
authors.forename: Rachel
authors.initials: R
authors.lastname: Ballard-Barbash
mesh_terms: D001943:Breast Neoplasms / Q000517:prevention & control*; D002170:Canada; D005060:Europe; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016247:Information Storage and Retrieval / Q000592:standards; D007557:Israel; D007564:Japan; D008327:Mammography / Q000592:standards*; D008403:Mass Screening / Q000379:methods / Q000592:standards*; D010043:Outcome and Process Assessment, Health Care; D015397:Program Evaluation / Q000592:standards*; D011785:Quality Assurance, Health Care / Q000379:methods / Q000706:statistics & numerical data*; D014481:United States; D014583:Uruguay