gms | German Medical Science

MAINZ//2011: 56. GMDS-Jahrestagung und 6. DGEpi-Jahrestagung

Deutsche Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie e. V.
Deutsche Gesellschaft für Epidemiologie e. V.

26. - 29.09.2011 in Mainz

German cancer aid’s priority programme “Epidemiological Research on Data from Population-Based Cancer Registries’ Project”: Synchronisation of patients of the quality-assured mamma diagnostics programme QuaMaDi with the cancer registry Schleswig-Holstein

Meeting Abstract

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  • Heiner Fauteck - Institute for Cancer Epidemiology e.V., University of Lübeck, Lübeck
  • Nadia Obi - Institute for Cancer Epidemiology e.V., University of Lübeck, Lübeck

Mainz//2011. 56. Jahrestagung der Deutschen Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie (gmds), 6. Jahrestagung der Deutschen Gesellschaft für Epidemiologie (DGEpi). Mainz, 26.-29.09.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. Doc11gmds609

doi: 10.3205/11gmds609, urn:nbn:de:0183-11gmds6093

Published: September 20, 2011

© 2011 Fauteck et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Background: In Germany’s northernmost federal state Schleswig-Holstein a multidisciplinary programme for a quality-assured breast cancer diagnosis (QuaMaDi) according to national and international guidelines was introduced in 2001. The QuaMaDi process includes independent double-reading of mammograms, additional ultrasound, and if suspicious an expert reading and assessment. Improved process quality due to QuaMaDi has been shown earlier.

Aims and objectives: The project aims to evaluate the result quality of QuaMaDi by synchronizing the QuaMaDi cohort with the cancer registry in order to answer the following main questions: Does QuaMaDi participation improve breast cancer survival and mortality, respectively? What are the diagnostic parameters at different stages of the diagnostic process? Does QuaMaDi comply with actual guidelines?

Methods: The QuaMaDi cohort containing 159,562 women with mammography between May 2001 and September 2008 was linked to the cancer registry. This enabled us to compare breast cancer patients diagnosed within the QuaMaDi programme with non-QuaMaDi cases, e.g. using multivariate Cox proportional hazard models. Taking the cancer registry data as gold standard diagnostic parameters like sensitivity, specificity, and predictive values at the various stages of the QuaMaDi diagnostic process could be estimated. Additional cancer registry data on tumour staging will allow ascertaining S3 and EUREF quality indicators additionally to the indicators already established in routine reporting.

Results: Synchronisation with the cancer registry revealed 8,135 breast cancer cases in the QuaMaDi cohort. When counting BIRADS V findings as a positive QuaMaDi result we found 99.5% agreement (κ 0.948). Crude hazard ratio for overall survival was 0.43 (95%CI 0.35 - 0.52) for breast cancer cases detected inside QuaMaDi versus those diagnosed outside the programme. After stepwise adjustment for age, grading, histology, treatment, and tumour stage, the survival advantage in QuaMaDi diagnosed breast cancer patients was still statistically significant (HR 0.78, 95%CI 0.64 - 0.96). The QuaMaDi process showed a sensitivity of 24.6% and a specificity of 99.8% for clinical diagnoses, 90.0% and 94.7% for mammographic findings, 97.9% and 77.9% for additional expert readings, 98.0% and 95.1% for the final assessment. Calculated quality indicators largely comply with the mentioned guidelines.

Discussion: We could show that the synchronisation of a large cohort with a cancer registry is feasible and leads to valid results. Using the combined data evidence is provided that the QuaMaDi programme has a beneficial impact on survival of breast cancer patients. We conclude that QuaMaDi offers improved diagnostics quality to patients not eligible for mammography screening.