title: Quality assured health care in certified breast centers and improvement of the prognosis of breast cancer patients.
abstract: BACKGROUND
  Increasing effort has been put in the implementation and certification of breast centers in order to establish standardized, quality assured health care for breast cancer patients. The aim of this analysis was to investigate whether patients treated in certified breast centers (CBC) have a favorable prognosis as compared to patients treated outside of certified breast treatment units.
  
  
  METHODS
  The data of 3,940 patients with invasive nonmetastatic breast cancer were analyzed with regard to differences in patient and tumor characteristics and crude overall survival according to diagnosis in or outside CBC in Middle Franconia, Germany. Patient, tumor, and follow-up data were obtained from the clinical cancer registry.
  
  
  RESULTS
  Patients in CBC were younger, and had lower disease stages and lower grading. Independent of the effects of these variables on overall survival, being treated at a CBC added to the prediction of overall survival. Patients treated at a CBC had a hazard ratio of 0.70 (95% confidence interval 0.52-0.93) in the adjusted Cox model.
  
  
  CONCLUSIONS
  Independent from common prognostic factors, diagnosis and treatment of breast cancer at a CBC improves the prognosis of patients. It can be hypothesized that this effect is mediated through quality assured health care provided by the certification process.
authors: University Breast Center Franconia, Department of Gynecology and Obstetrics, University Hospital Erlangen, Universitätsstrasse 21-23, Erlangen-Nuremberg, Germany. fk-direktion@uk-erlangen.de
authors: Matthias W
authors: MW
authors: Beckmann
authors: Cosima
authors: C
authors: Brucker
authors: Volker
authors: V
authors: Hanf
authors: Claudia
authors: C
authors: Rauh
authors: Mayada R
authors: MR
authors: Bani
authors: Stefanie
authors: S
authors: Knob
authors: Sabrina
authors: S
authors: Petsch
authors: Stefan
authors: S
authors: Schick
authors: Peter A
authors: PA
authors: Fasching
authors: Arndt
authors: A
authors: Hartmann
authors: Michael P
authors: MP
authors: Lux
authors: Lothar
authors: L
authors: Häberle
mesh_terms: D001943:Breast Neoplasms / Q000401:mortality* / Q000628:therapy*; D002568:Certification / Q000592:standards / Q000706:statistics & numerical data; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008875:Middle Aged; D016522:Oncology Service, Hospital / Q000592:standards* / Q000706:statistics & numerical data*; D015995:Prevalence; D011379:Prognosis; D011785:Quality Assurance, Health Care / Q000592:standards* / Q000706:statistics & numerical data; D058996:Quality Improvement / Q000706:statistics & numerical data*; D019984:Quality Indicators, Health Care / Q000592:standards* / Q000706:statistics & numerical data; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome