Beyond mammography screening: quality assurance in breast cancer diagnosis (The QuaMaDi Project).
As many breast cancer cases are detected outside mammographic screening, a multidisciplinary quality management (QuaMaDi) project involving gynaecologists, double reading by radiologists. and centralised assessment, documentation, evaluation and feedback was implemented into routine breast cancer diagnosis in part of Schleswig-Holstein (Germany) with a population of 365,000 women. A cohort of 59,514 patients eligible for diagnostic mammography was examined from May 2001 to December 2005 and quality indicators, breast cancer incidence and tumour stage distribution were analysed. A total of 102,744 diagnostic processes were initiated, for 23.8% of which (24,470) a third expert reading at the reference centre was performed. Further assessment was recommended for 6.3% (6442) of all patients. In total, 1056 breast cancer cases were diagnosed (10.3 per 1000 examinations). Patients of the QuaMaDi project had a higher proportion of 'in situ' and T1 tumours (62.6% vs Schleswig-Holstein: 48.6%), showing that the implementation of high standards in routine diagnostic mammography can improve the quality of breast cancer diagnosis and care.
Katalinic
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Institute for Cancer Epidemiology, University of Luebeck, Beckergrube 43-47, 23552 Lübeck, Germany. alexander.katalinic@cancer-sh.de
Bartel
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Raspe
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Schreer
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D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008327:Mammography / Q000592:standards*; D008403:Mass Screening / Q000592:standards*; D008875:Middle Aged; D009367:Neoplasm Staging; D010865:Pilot Projects; D011237:Predictive Value of Tests; D011785:Quality Assurance, Health Care; D012017:Referral and Consultation; D012042:Registries; D012680:Sensitivity and Specificity