Review and analysis of external quality assessment of breast cancer services in Europe : supporting information for the development of a European quality assurance scheme for breast cancer services

Background. The Joint Research Centre, the European Commission's in-house science service, was assigned with the task of developing a voluntary European Quality Assurance scheme for breast cancer services (the European QA scheme) based on the European legal framework on accreditation. This task, among others, are part of the European Commission Initiative on Breast Cancer (ECIBC). Methods. A search of external quality assessment schemes for breast cancer care already in place in Europe was carried out using different strategies in: MEDLINE, website of relevant scientific societies, and EC Reports. Only schemes fully implemented, with evidence of current activity, with at least one centre in Europe currently holding the certificate awarded by that organisation and foreseeing a third-party audit / on-site survey were considered. Results. Seventeen schemes specifically addressing breast cancer were identified in Europe and thirteen countries have at least one scheme in place. For eight schemes the requirements and procedures were available in a language known to the JRC Healthcare Quality Team and were thus included in this research. The number of breast cancer services implementing such schemes goes from three to 277 with a median of 23. In some countries, more than one scheme is present, with a maximum of 4 schemes present in one country. Six schemes are managed by private entities and two by public organisations. All the schemes covered more than one stage of breast cancer care, with requirements for diagnosis included in all the schemes. Requirements are highly variable, as in the format, wording and organisation of these. However, they always included requirements related to the clinical management of breast cancer (or breast cancer diagnosis), as well as a list of organisational requirements and quality indicators. For all the schemes the awarding process includes a preparation phase, a site visit and a follow-up. The duration of the award is usually 3 or 5 years. Conclusion. This research provides a collection of relevant features for the definition of the European QA scheme, both from a requirement definition point of view as well as for the organisation of the on-site visit and its follow-up. A European-wide scheme could help harmonise the situation in Europe and ensure that European citizens receive the same quality of care, at least for the essential aspects, regardless of where they live.