1. ¹Institute for Cancer Epidemiology, University of Luebeck, Beckergrube 43-47, 23552 Lübeck, Germany
2. ²Institute for Social Medicine, University Medical Centre Schleswig-Holstein, Beckergrube 43-47, 23552 Lübeck, Germany
3. ³Department of Gynaecology and Obstetrics, University Medical Centre Schleswig-Holstein, Michaelisstrae 16, 24105 Kiel, Germany

Correspondence: Dr A Katalinic, E-mail: alexander.katalinic@cancer-sh.de

Received 19 June 2006; Revised 3 November 2006; Accepted 6 November 2006; Published online 19 December 2006.

Abstract

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.