Beyond mammography screening: quality assurance in breast cancer diagnosis (The QuaMaDi Project)

Br J Cancer. 2007 Jan 15;96(1):157-61. doi: 10.1038/sj.bjc.6603506. Epub 2006 Dec 19.


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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Breast Neoplasms / diagnosis*
  • Breast Neoplasms / epidemiology
  • Cohort Studies
  • Female
  • Germany / epidemiology
  • Humans
  • Incidence
  • Mammography / standards*
  • Mass Screening / standards*
  • Middle Aged
  • Neoplasm Staging
  • Pilot Projects
  • Predictive Value of Tests
  • Quality Assurance, Health Care*
  • Referral and Consultation
  • Registries*
  • Sensitivity and Specificity