Open Access Research article

Certification of breast centres in Germany: proof of concept for a prototypical example of quality assurance in multidisciplinary cancer care

Sara Y Brucker1, Michael Bamberg2, Walter Jonat3, Matthias W Beckmann45, Andreas Kämmerle6, Rolf Kreienberg78 and Diethelm Wallwiener1*

Author Affiliations

1 German Society of Senology, and Department of Obstetrics and Gynaecology, University of Tübingen, Tübingen, Germany

2 German Cancer Society and Department of Radiooncology, University of Tübingen, Tübingen, Germany

3 German Society for Gynaecology and Obstetrics and Department of Obstetrics and Gynaecology, Christian-Albrechts-Universität, Kiel, Germany

4 Working Group on Gynaecological Oncology of the German Society for Gynaecology and Obstetrics, Munich, Germany

5 Department of Obstetrics and Gynaecology, University of Erlangen, Erlangen, Germany

6 OnkoZert GmbH, Ulm, Germany

7 Certification Committee of the German Cancer Society and German Society of Senology, Berlin, Germany

8 Department of Obstetrics and Gynaecology of the University of Ulm, Ulm, Germany

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BMC Cancer 2009, 9:228  doi:10.1186/1471-2407-9-228

Published: 14 July 2009



The main study objectives were: to develop a set of requirements of comprehensive breast centres; to establish a nationwide voluntary certification programme for breast centres based on such requirements, a certified quality management system (QMS), and scheduled independent, external audits and periodic recertification; and to demonstrate the general acceptance of such a certification programme with a view to introducing similar certification programmes for other major cancers.


Breast centres introduced a QMS and voluntarily participated in an external certification procedure based on guideline-derived Requirements of Breast Centres specifically developed for the application procedure, all subsequent audits and recertification. All data (numbers of pending and successful applications, sites/centre, etc.) were collected by a newly founded, independent organisation for certification of cancer services delivery. Data analysis was descriptive.


Requirements of Breast Centres were developed by the German Cancer Society (DKG), the German Society of Senology (DGS) and other relevant specialist medical societies in the form of a questionnaire comprising 185 essential items based on evidence-based guidelines and the European Society of Breast Cancer Specialists' (EUSOMA) requirements of specialist breast units. From late 2002 to mid 2008, the number of participating breast centres rose from 1 to 175. As of mid 2008, 77% of an estimated 50,000 new breast cancers in Germany were diagnosed and treated at certified breast centres, 78% of which were single-site centres.


Nationwide voluntary certification of breast centres is feasible and well accepted in Germany. Dual certification of breast centres that involves certification of breast services to guideline-derived requirements in conjunction with independent certification of a mandatory QMS can serve as a model for other multidisciplinary site-specific cancer centres.