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Organizational challenges in setting up a breast cancer screening program in Valais and controlling for quality performance in specific IgE measurements

Defense Thèse de privat-docent : Univ. Genève, 2013
Abstract Contributing to organizational challenges through breast cancer prevention programs by mammography in Valais and establishing external quality schemes for specific IgE determinations for the Swiss Society of Allergology and Clinical Immunology has given me experience in bringing together health professionals and insurance agencies at times when practical actions could be taken. The two programs were set up by consensus, knowing that they should be affordable, progessively implementable and professionally managed. Future perspectives and options for development can be drawn from these involvements and could help to support upcoming decisions permitting the programs to evolve toward more equity and professional structures. In Switzerland, the perspective of organized national prevention programs could be built up from local cantonal programs, at least for breast cancer screening program with mammography. The Valais program, started in 1999 was organized as a continuously evaluated program, free of charge for women between 50 and 70 years old. Private and institutional radiologists were involved, six of them were accredited as second readers to include all the regions of the Valais. Indeed, we achieved a participation rate of 70 % in five years, we were able to keep the participation free of charge and to have an external evaluation of the program performed every two years. We also participated in building up a national federation and contributed to the implementation of digital mammography, RIS-PACS transmission, multilingual computer programs and quality management in our program. The external quality assessment program for specific IgE in Switzerland has a ten-year history. It shows that a definite scheme set up to ensure minimal requirements for all participants, in order to be reimbursed by insurances, cannot fulfill the needs for quality control of the larger laboratories and the challenge of new technologies, such as microarray. The external quality assessment for specific IgE measurements was set up together with the “Centre Suisse de Contrôle de Qualité”, Geneva from 2003-2006 as an optional trial phase. A selection of three allergens (birch pollen, peanut and cat dander) was proposed at each distribution to be detected by the different methods used for specific IgE measurements. In the compulsory phase we were able to show that most participants succeeded either in a POC setting or in large laboratories. This program fulfilled the requirements established by the Qualab for other laboratory analyses. The practical environement for allergen-specific IgE is rapidly changing to take into account the great increase of knowledge on the different molecular allergens. We have worked recently on the variation of specific IgE to molecular allergens in the course of immunotherapy. So far, we provided preliminary results that need to be validated to overcome many unresolved issues with these technologies, either molecular allergens or microarray in reproductibility. The clinical adequacy for each approach has not yet been settled. Moreover, it is not yet clear how to ensure a proper quality control for these specific technologies. Innovative solutions can be found to adapt to our specific environment. National cancer prevention programs beyond early breast cancer detection by mammography is now becoming possible. In a similar trend, the professional societies of laboratory medicine have done their best to set up external quality assessment programs in Switzerland in order for all practioners to be able to fulfill the same requirements for reimbursement of equivalent medical procedures. The future will show if such efforts can evolve and cope with the challenge of new technologies and divergent needs in the application of medicine.
Keywords Breast cancer screeningMammographyPrevenrion programExternal quality controlIgE specific measurements
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DAYER, Eric Jean François. Organizational challenges in setting up a breast cancer screening program in Valais and controlling for quality performance in specific IgE measurements. Université de Genève. Thèse de privat-docent, 2013. https://archive-ouverte.unige.ch/unige:30370

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Deposited on : 2013-10-14

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