Open Access Research article

Many quality measurements, but few quality measures assessing the quality of breast cancer care in women: A systematic review

Howard M Schachter1*, Vasil Mamaladze1, Gabriela Lewin1, Ian D Graham2, Melissa Brouwers3, Margaret Sampson1, Andra Morrison4, Li Zhang5, Peter O'Blenis6 and Chantelle Garritty1

Author Affiliations

1 Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, ON K1H 8L1, USA

2 Ottawa Health Research Institute, 1053 Carling Ave, ASB Room 2-008, Ottawa, ON K1Y 4E9, USA

3 McMaster University, 1280 Main St West, Rm 314, Hamilton, ON L8S 4L8, USA

4 Canadian Coordinating Office for Health Technology Assessment, 600-865 Carling Ave, Ottawa, ON K1S 5S8, USA

5 Health Sciences Library, Rm B205, University of Saskatchewan, 107 Wiggins Rd, Saskatoon, SK S7N 5E5, USA

6 TrialStat Corporation, 44 ByWard Market Square, Suite 270, Ottawa, ON K1N 7A2, USA

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BMC Cancer 2006, 6:291  doi:10.1186/1471-2407-6-291

Published: 18 December 2006



Breast cancer in women is increasingly frequent, and care is complex, onerous and expensive, all of which lend urgency to improvements in care. Quality measurement is essential to monitor effectiveness and to guide improvements in healthcare.


Ten databases, including Medline, were searched electronically to identify measures assessing the quality of breast cancer care in women (diagnosis, treatment, followup, documentation of care). Eligible studies measured adherence to standards of breast cancer care in women diagnosed with, or in treatment for, any histological type of adenocarcinoma of the breast. Reference lists of studies, review articles, web sites, and files of experts were searched manually. Evidence appraisal entailed dual independent assessments of data (e.g., indicators used in quality measurement). The extent of each quality indicator's scientific validation as a measure was assessed. The American Society of Clinical Oncology (ASCO) was asked to contribute quality measures under development.


Sixty relevant reports identified 58 studies with 143 indicators assessing adherence to quality breast cancer care. A paucity of validated indicators (n = 12), most of which assessed quality of life, only permitted a qualitative data synthesis. Most quality indicators evaluated processes of care.


While some studies revealed patterns of under-use of care, all adherence data require confirmation using validated quality measures. ASCO's current development of a set of quality measures relating to breast cancer care may hold the key to conducting definitive studies.