Compliance with clinical guidelines for breast cancer management: A population-based study of quality-of-care indicators in France

Autoři: Anne Cowppli-Bony aff001;  Brigitte Trétarre aff003;  Emilie Marrer aff003;  Gautier Defossez aff003;  Laetitia Daubisse-Marliac aff003;  Gaelle Coureau aff003;  Pamela Minicozzi aff009;  Anne-Sophie Woronoff aff003;  Patricia Delafosse aff003;  Florence Molinié aff001aff003
Působiště autorů: Loire-Atlantique Vendee Cancer Registry, Nantes, France aff001;  SIRIC ILIAD INCa-DGOSInserm_12558, CHU Nantes, Nantes, France aff002;  French Network of Cancer Registries (FRANCIM), Toulouse, France aff003;  Hérault Cancer Registry, Montpellier, France aff004;  Haut-Rhin Cancer Registry, Mulhouse, France aff005;  Poitou-Charentes Cancer Registry, Poitiers, France aff006;  Tarn Cancer Registry, Albi, France aff007;  Gironde Cancer Registry, Bordeaux, France aff008;  Analytical Epidemiology and Health Impact Unit, Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy aff009;  Doubs and Belfort Territory Cancer Registry, Besancon, France aff010;  Isère Cancer Registry, Grenoble, France aff011
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: 10.1371/journal.pone.0224275



The European Society of Breast Cancer Specialists (EUSOMA), which aims to standardize the quality of patient care in Europe, has defined quality indicators (QIs) for breast cancer (BC) care to assess compliance to current care standards. These QIs are a useful tool to evaluate care organizations. Only population-based studies are able to assess health system performance in “real-life” situations. This population-based study aimed to describe compliance with several EUSOMA QIs overall and according to patient and organizational factors in France.


1 560 adult women with primary invasive non-metastatic BC diagnosed in 2012 were randomly selected among all incident BC from 16 French geographical areas covered by cancer registries. Twelve EUSOMA QIs were selected regarding diagnosis, treatment and staging.


The minimum standard as proposed by EUSOMA was met for nine QIs related to pre-operative definitive diagnosis, multidisciplinary discussion and treatment (single surgery, breast conserving surgery (BCS) for small BC (<3cm), radiotherapy after BCS or mastectomy for regional BC (pN≥2a), hormonotherapy, adjuvant chemotherapy and trastuzumab). Low compliance was observed for sentinel lymph node biopsy (SLNB) and staging imaging. Adherence to guidelines was usually lower in older patients and in patients with comorbidities. Multidisciplinary discussion was positively related to adherence to guidelines for diagnosis, staging practices (SNLB, imaging) and systemic treatments. Compliance also varied by area of residence and by place of first treatment.


This study provides the first current, comprehensive overview of BC quality care at a population level in France. The guidelines were correctly applied in percentage satisfying the EUSOMA standards for the diagnosis and treatment of BC, although staging practices (SLNB, imaging) can be improved. These results highlight the need for continuous measurement of adherence to guidelines to improve BC care.

Klíčová slova:

Breast cancer – Cancer detection and diagnosis – Cancer treatment – France – Radiation therapy – Surgical and invasive medical procedures – Surgical oncology – Treatment guidelines


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