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The adherence to recognized guidelines and the constant monitoring of performance throughout quality indicators (QIs) are strategic tools to improve the quality of care. The study is aimed to assess the effect of the EUSOMA (European Society of Breast Cancer Specialists) certification process on the quality of breast cancer care of an EUSOMA certified Breast Unit (BU) of Northern Italy.Seventeen mandatory and recommended EUSOMA QIs, based on 594, were analysed for the years 2015-2018. Univariate logistic regression models were performed to compare QIs performance in the years before and after obtaining the EUSOMA certification (2015-6 vs. 2017-8).Compared to the years 2015-6, the second period of BU activity showed a higher number of QIs achieving both the minimum standard (15 vs. 11) and the 100% of completeness (6 vs. 1). There was a significant improvement of the two QIs evaluating the proportion of Ductal Carcinoma in situ receiving just an operation (from 76% to 95.2%; p=0.033) and the completeness of the prognostic characterisation of invasive cancers (from 94.6% to 99.5%; p=0.022). Conversely, the QI related to the endocrine-sensitive invasive carcinoma receiving adjuvant hormonal therapy dropped from 92.1% to 85.9% (p=0.042) and was significantly lower for patients over 74 compared to those aged ≤54 (73.8% vs. 94.7%; p0.0001 Fisher's exact test).The EUSOMA certification process enhanced the clinical practice, promoting a tailored-patient primary systemic or adjuvant therapy and avoiding unnecessary invasive surgical and local-regional treatments.