Aiello Bowles et al. BMC Cancer 2012, 12:136 http://www.biomedcentral.com/1471-2407/12/136 distributions differences by institution. A report was provided back to each site, where abstractors confirmed any inconsistencies and made changes to the BRCASO database if needed. We continued to review frequencies, perform variable cross-checks, and clean data as neces- sary throughout the abstraction period. The database was designed to keep a detailed log of all entries and edits to the data by user ID to maintain data integrity. Results We have complete data on 4524 of 6095 women (74.2%) and their surgeries in the BRCASO database, to date. The mean age was 61 years (range 20-98 years) and 94% of the study population was white. Approximately 40% of the study population were insured by Medicare and 4% by Medicaid. Nearly 70% of women were diagnosed with IDC, 20% with DCIS, and 10% with ILC. By using electronic administrative data, CRN health plans pre-filled 22 of 72 (30%) data fields. The remain- der of the 50 fields required abstraction from the medi- cal record. In addition, several electronic data fields occasionally required editing by the chart abstractor to update and clarify diagnosis and procedure dates, per- forming surgeon, surgical facility, and lymph node pro- cedures. The total time for chart abstraction ranged from 30-90 minutes per chart depending on the number of surgeries per woman, and the availability of pathology and operative reports within the medical record. A list of potential quality measures that will be evaluated using these data for variation across women, surgeons, and facilities are in Table 1. We specifically selected eight measures that we felt would be meaningful to patients and were previously evaluated in the VBCSO database; [4] we included two additional measures (use of needle biopsy for pre-operative diagnosis, and use of neoadjuvant chemotherapy for T2/T3 tumors) that showed broad variation during data collection. In gen- eral, these were regularly recorded and easily found in Page 5 of 7 automated data or medical records, which increases the adaptability of our methods to other institutions. Discussion Developing quality measures for breast cancer surgery is critical given the high frequency of surgical breast pro- cedures and potential variation that exists across facil- ities and surgeons. Wasif et al. comment that quality measures must 1) be acceptable to various stakeholders; 2) include measureable elements; and 3) impact out- comes [2]. While several national and international groups have developed quality cancer care measures, most focus on treatment other than breast surgery and participation in these programs tends to be voluntary. BRCASO aims to develop a more comprehensive, vali- dated set of breast cancer surgical quality measures, and use these data to conduct research on surgical quality variation among a generalizable (i.e. non-voluntary) population. Current quality measurement programs for cancer care delivery, while valuable, are limited in their ability to specifically address surgical quality and provide detailed data for research. Two of these programs, QOPI - ASCO’s Quality Oncology Practice Initiative [6] and the American College of Surgeons’ (ACoS) Com- mission on Cancer (CoC), [7] are primarily geared toward measuring and documenting overall quality of cancer care. Together, the CoC and American Cancer Society developed the National Cancer Data Base, one of the largest national registries of new cancer diag- noses. The data collected for each of these efforts pri- marily relate to documentation and treatment other than surgery. One recent program dedicated primarily to breast care quality improvement is the American Society of Breast Surgeons’ Mastery of Breast Surgery Program, another voluntary initiative that helps surgeons document their clinical performance; early results showed program Table 1 Potential surgical quality measures to be evaluated using BRCASO data PRIMARY TUMOR AXILLARY MANAGEMENT SURGICAL OUTCOME MEASURE Mastectomy rate Positive/close margin rate following initial partial mastectomy Partial mastectomy re-excision rate Use of needle biopsy for pre-operative diagnosis Use of neoadjuvant chemotherapy for T2/T3 tumors Number of sentinel nodes identified Intra-operative lymph node assessment Nodes examined following axillary dissection Completion axillary dissection rate following positive sentinel lymph node HEALTH CARE DELIVERY Initial breast cancer surgery within 30 days