Breast cancer care

Any kind of healthcare intervention aimed at preventing, diagnosing or treating breast cancer, including the follow-up of any other condition caused by the disease or the treatment itself. It may include primary prevention when the intervention is specifically targeted to breast cancer (e.g. dietary recommendations for high-risk women).




Breast cancer process (of care)

A cancer process is a step in the pathway of cancer care which a patient goes through. In this document, stages of care are referred to as 'processes'. In ECIBC, the pathway of breast cancer care is divided into six processes:

  1. Screening: Checking for cancer (or for conditions that may become cancer) in people who have no symptoms is called (cancer) screening”. Source: NIH
  2. Diagnosis:
    The act or process of identifying or determining the nature and cause of a disease or injury through evaluation of patient history, examination, and review of laboratory data.
  3. Treatment, see WHO
  4. Rehabilitation: Rehabilitation of people with disabilities is a process aimed at enabling them to reach and maintain their optimal physical, sensory, intellectual, psychological and social functional levels. Rehabilitation provides disabled people with the tools they need to attain independence and self-determination. Source: WHO
  5. Follow-up & survivorship care
  6. Palliative care: Palliative care is an approach that improves the quality of life of patients – young and old – and their families who are facing the challenges associated with life-threatening illness. Sources: "NCI Dictionary of Cancer Terms". National Cancer Institute,The National Agenda for Quality Palliative Care: The National Consensus Project and the National Quality Forum, "Get Palliative Care", WHO

Breast cancer services

Comprises all healthcare services covering, in continuum, the full extent of breast cancer management, from screening to follow-up, and in some cases end-of-life care. These services may provide primary care as well as a range of high specialty services including, but not limited to, screening, diagnostic imaging, pathology, surgery, radiation and medical oncology.




Breast centre

Is the place where breast cancer is diagnosed and treated. It has to provide all the services necessary, from genetics and prevention, through the treatment of the primary tumour, to care of advanced disease, palliation and survivorship. The Breast Centre is made up by a cohesive group of dedicated breast cancer specialists working together as a multidisciplinary team with access to all the facilities required to deliver high quality care throughout the breast cancer pathway.

Source: The Requirements of a Specialist Breast Centre: A.R.M. Wilson, L. Marotti, S. Bianchi,  L. Biganzoli,  S. Claassen, T. Decker, A. Frigerio,  A. Goldhirsch,  E.G. Gustafsson, R.E. Mansel,  R. Orecchia,  A. Ponti, P. Poortmans, P. Regitnig,  M. Rosselli Del Turco,  E.J.Th. Rutgers, C. van Asperen,  C.A. Wells,  Y. Wengstrom,  L. Cataliotti. Eur J Cancer 2013, 49: 3579-3587


Care pathway

The health care pathway describes the health care chain and across health care sector interfaces by bundling and visualising the outcomes of the relevant health care processes involved and under considering quality targets. In detail the care pathway aims at:

•    presenting the intervention/processes for which quality should be assured  in a structured way
•    presenting the relevant health care sectors involved,
•    assigning of responsibilities of health care providers to health care processes,
•    identification of starting points for quality assurance,
•    identification of quality potentials within the treatment pathway.

The care pathway visualises the way a patient takes by a flow chart. This flow chart includes specific services, end points, quality targets and quality potentials relevant to the specific subject of the quality assurance scheme and by considering the disease course as well as the various involved services.

Source: AQUA-Institute: Allgemeine Methoden 2015



Centredness (person-centredness or person/citizen responsiveness)

Consideration of individual patients’ and society’s preferences and values.
Source: WHO

Focus on the experience of the patient / client from their perspective, minimising vulnerability and maximising control and respect. Also patient / client focus.
Source: International Society for Quality in Health Care: Glossary of Terms. 2006. [ISQua]


It is the process of provision of a certificate by an independent body that the product, service or system in question meets specific requirements.

Source: Accreditation legal framework

Certification scheme

‘The scheme operated by the certification body for the certification of a company’s welding activities in accordance with EN ISO 3834’.

Source: EA-6/02 M: 2013 - http://www.european-accreditation. org/publication/ea-6-02-m-rev02-june-2013-rev

Certification scheme owner

‘The party responsible for designing, validating and maintaining the certification scheme, its normative documents and its related criteria’.

Source: EA-6/04 M: 2011 - http://www.european-

The care pathway describes the healthcare chain and interfaces across healthcare sectors by bundling and visualising the outcomes of the relevant healthcare processes involved and considering quality targets. In detail, the care pathway aims at:

  • Presenting  the  intervention/processes  for  which  quality  should  be assured in a structured way;
  • Presenting the relevant healthcare sectors involved;
  • Assigning the responsibilities of healthcare providers to healthcare processes;
  • Identifying starting points for quality assurance;
  • Identifying quality potential within the treatment pathway.

Conditional recommendation

In a conditional recommendation the desirable effects probably outweigh the undesirable effects (conditional recommendation for an intervention) or undesirable effects probably outweigh the desirable effects (conditional recommendation against an intervention) but appreciable uncertainty exists.
A conditional recommendation implies that not all individuals will be best served by the recommended course of action, and that there is a need to consider more carefully than usual the individual patient’s circumstances, preferences, and values. For conditional recommendations healthcare professionals need to allocate more time to a shared decision making, making sure that they clearly and comprehensively explain the potential benefits and harms to the patient. Alternative names for “conditional” recommendations are “weak”, “discretionary”, or “qualified” recommendations.
Source: GRADE Handbook


Fulfilment of a requirement, where nonconformity is non-fulfilment of a requirement.
Source: Quality management systems - Fundamentals and vocabulary (EN ISO 9000:2005)


Conformity Assessment Bodies

A body that performs conformity assessment activities including calibration, testing, certification and inspection" upon accreditation from the NAB.
Source: Accreditation legal framework



Continuity of care

Continuity of care has been defined as ‘the degree to which a series of discrete healthcare events is experienced as coherent and connected and consistent with the patient’s medical needs and personal context’.

Dimensions (of quality in healthcare) – see also Quality

  • Effectiveness: the degree of achieving desirable outcomes, given the correct provision of evidence-based health care services to all who could benefit (but not to those who would not benefit). This may include related dimensions of appropriateness, competence and capability.
  • Safety: the degree to which health care processes avoid, prevent, and ameliorate adverse outcomes or injuries that stem from the processes of health care itself.
  • Responsiveness: how a system treats people to meet their legitimate non-health Expectations. This may include patient-centeredness, acceptability, continuity, timeliness.
  • Accessibility: the ease with which health services are reached. Access can be physical, financial or psychological, and assumes that services are available.
  • Equity:  closely related to access, this is used as a metric to assess health-system financing and outcomes or health status.
  • Efficiency: optimal use of available resources to yield maximum benefits or results.

Source: OECD, Kelley and Hurst


Evidence-based medicine is the integration of best research evidence with clinical expertise and patient values.
Source: Sackett, 1996


Clinical practice guidelines are state­ments that include recommendations intended to optimize patient care that are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options. Rather than dictat­ing a one-size-fits-all approach to patient care, clinical practice guidelines offer an evaluation of the quality of the relevant scientific literature, and an assessment of the likely benefits and harms of a particular treatment. This information enables health care clinicians to select the best care for a unique patient based on his or her preferences.

Source: American Academy of Family Physicians

National Accreditation Bodies (NABs)

"The sole body in a Member State that performs accreditation with authority derived from the State"
It is agreed that each Member state will appoint one National accreditation body (NAB) or address the NAB of another Member State. The NABs operate on a non-profit basis and the Member State is expected to provide the appropriate financial and personnel resources. They are in charge of evaluating, certifying and monitoring assessment bodies and are able to restrict, suspend or withdraw the given accreditation certificates in case of a breach.

Source: Accreditation legal framework

Quality (of health systems – of healthcare)

The level of attainment of health systems’ intrinsic goals for health improvement and responsiveness to legitimate expectations of the population.
Source: WHO, 2000

The degree to which the treatment dispensed increases the patient’s chances of achieving the desired results and diminishes the chances of undesirable results, having regard to the current state of knowledge.
Source: Council of Europe, 1998

Quality assurance

Quality assurance is the part of quality management which is directed at the creation of trust that quality requirements are satisfied.
Source: Quality management systems - Fundamentals and vocabulary (EN ISO 9000:2005)


Quality improvement

Ongoing response to quality assessment data about a service in ways that improve the processes by which services are provided to clients.
Source: International Society for Quality in Health Care: Glossary of Terms. 2006. [ISQua]


Quality potentials

Quality potentials correspond to known or anticipated deficits in the quality of care for a specific disease, indication or intervention. They correspond with processes in the treatment pathway for which under-, over- or inadequate treatment has been reported, respectively treatment is not being provided at the required quality. Quality potentials are thus starting points for measures to improve the quality of care.

Aligning quality assurance along quality potentials contributes to its effort benefit balance. The identification of quality potentials is followed by the question of whether it is possible to reliably measure health service performance at these quality potentials in a systematic way that allows for comparing between services. It needs to be acknowledged that not for every identified quality potential quality relevant data can be assessed, be it that the necessary information cannot be retrieved by data or that an adequate data source is not available to the quality assurance scheme. 

Source: AQUA-Institute: Allgemeine Methoden 2015



Quality target

There is a consensus that health care that is of high quality, succeeds in reaching its set targets. These targets relate to health care being effective, safe and patient oriented, as well as that access to adequate care is granted and health care is well coordinated.

Quality targets consider these dimensions, however, define them specific to the diagnosis, indication or intervention that is subject to a quality assurance scheme as well as they define by which parameters good quality displays.

Source: AQUA-Institute: Allgemeine Methoden 2015




A need or expectation that is stated, generally implied or obligatory

Source: Quality management systems - Fundamentals and vocabulary (EN ISO 9000:2005)

A general word used in the ECIBC that encompasses the meaning of given standard in the healthcare field (see STANDARD); it is the level of performance required by a certain quality assessment scheme with respect to a certain aspect meaningful for breast cancer care and diagnosis. In the European QA scheme, a requirement is intended as the whole set of statement, criteria, and reference document attached.




European women's probability of developing breast cancer over a lifetime is approximately 1 in 8*. A woman's individual risk of breast cancer may be higher or lower than this average, depending on a number of factors, including age, family history, reproductive history (such as menstrual and childbearing history), race/ethnicity, and others.

*This estimate is not intended for determining individual risk as it is only a measure of the average lifetime risk of developing breast cancer within the female population within each country (CI5 2014).


Screening is the presumptive identification of unrecognized disease or defects by means of tests, examinations, or other procedures that can be applied rapidly.
Source: WHO

Checking for cancer (or for conditions that may become cancer) in people who have no symptoms is called (cancer) screening. Source: NIH

The the systematic application of a screening test in a presumably asymptomatic population. In cancer screening, it aims to identify individuals with an abnormality suggestive of a specific cancer. These individuals require further investigation.
Source: Cancer control: Early detection. WHO guide for effective programmes. WHO, 2007

Cancer screening programmes can be implemented in the following ways:

  1. Non-programme screening (commonly referred also as opportunistic screening): Examinations for early detection of breast cancer performed in a diagnostic or clinical setting, independent from the public screening policy (if existing)
  2. Programme screening: Examinations financed by public sources performed in the context of a public screening policy documented in a law, or an official regulation, decision, directive or recommendation, and where the policy defines, at minimum: the screening test, the examination intervals, group of persons eligible to be screened.
  3. Organised screening: Programme screening where other procedures (e.g. standard operating procedures) are specified and where a team at national or regional level is responsible for implementing the policy, i.e. for coordinating the delivery of screening services, quality requirements, reporting on performances and results.
  4. Population-based screening: Programme screening where in each round of the screening the persons in the eligible target area served by the programme are individually identified and personally invited

Source: Von Karsa et al, 2008 – adapted by Lerda et al., 2013


In the ISO context, a standard is a document that provides requirements, specifications, guidelines or characteristics that can be used consistently to ensure that materials, products, processes and services are fit for their purpose.

Source: Accreditation legal framework



Strong recommendation

In strong recommendations the guideline panel is confident that the desirable effects of an intervention outweigh its undesirable effects (strong recommendation for an intervention) or that the undesirable effects of an intervention outweigh its desirable effects (strong recommendation against an intervention).
A strong recommendation implies that most or all individuals will be best served by the recommended course of action (GRADE Handbook). Therefore, all healthcare professionals should follow a strong recommendation unless a clear and compelling justification for an alternative approach is extraordinarily present.
Source: GRADE Handbook

Trustworthy guidelines

Trustworthy guidelines should:

  • Be based on a systematic review of the existing evidence;
  • Be developed by a knowledgeable, multidisciplinary panel of experts and representatives from key affected groups;
  • Consider important patient subgroups and patient preferences as appropriate;
  • Be based on an explicit and transparent process that minimises distortions, biases, and conflicts of interest;
  • Be clear in their explanation of the logical relationships between alternative care options and health outcomes;
  • Be rated in terms of both the quality of evidence and the strength of the recommendations;
  • Be reconsidered and revised as appropriate when important new evidence warrants modifications of the recommendations.

Source: IOM (Institute of Medicine). 2011. Clinical Practice Guidelines We Can Trust. Washington, DC: The National Academies Press