A breast cancer care report card. An assessment of performance and a pursuit of value.

The transition to managed care raises concerns about the resulting quality of care. The report card, a publicly released, standardized report on quality, has received widespread acceptance as a method to evaluate physician performance. Current report cards provide insufficient information to allow purchasers of health care to assess accurately the performance of professionals who provide breast care. To overcome these limitations, we propose an expanded report card on breast cancer care. Mammographers and general surgeons would assess an independent series of at least 100 consecutive cases of newly diagnosed breast cancer. Mammographers would determine the percentage of invasive cancers < 15 mm detected on screening mammograms in asymptomatic women aged 50 to 74 years. Surgeons would determine the percentage of combined stages 0 and 1 breast cancers detected and the percentage of patients receiving breast-conserving surgical therapy. Performance targets are set at 60% for invasive cancers < 15 mm detected on screening mammography, 60% for combined stage 0 and 1 breast cancers, and 50% for patients receiving breast-conserving therapy.