Distant metastasis detected by routine staging in breast cancer patients participating in the national German screening programme: consequences for clinical practice.

Peter Rusch,Oliver Hoffmann,Anna-L Stickelmann,Stefan Niesert,Andrea Schmidt,Karl G Krüger,Rainer Kimmig,Regine Gätje,Stephan Böhmer

doi:10.1186/s40064-016-2703-6

Abstract

PurposeTo determine frequency of routine radiological staging of breast cancer patients diagnosed in a German Breast Cancer Screening Center from 2007 to 2014, the incidence and consequences of distant metastases detected and the resulting implications for clinical routine.MethodsRecords of 896 patients with primary breast cancer diagnosed in the Screening Centre and treated in five participating hospitals were analyzed retrospectively. Evaluation included frequency and type of staging procedures and results with respect to distant metastasis and their consequences on clinical management.Results894/896 Patients (99.8 %) received staging for distant metastases by bone scintigraphy, chest X-ray and liver sonography and/or CT/MRT diagnostics. Distant metastasis was suggested In 6/894 patients but excluded in 3 by further diagnostics or clinical course. Thus, 3 (0.3 %) were clinically verified to have metastatic disease in bone (n = 2; both pT2) or in bone and lung (n = 1; cT4, cN3).ConclusionDue to the low incidence of verified metastatic disease, the high false positive rate of staging procedures and the unfavorable cost/benefit ratio routine radiological staging should be completely omitted in asymptomatic breast cancer patients diagnosed in a breast cancer screening programme.

Highlights

Breast cancer is the most frequent malignant disease in women in Europe; in Germany the incidence is 70,000 new breast cancer diagnoses annually (Kaatsch et al 2014)
A routine radiological staging for exclusion of distant metastasis in early breast cancer is not recommended by current guidelines (Kreienberg et al 2013; Gradishar et al 2016), it seems still to be performed in the majority of patients (Chand et al 2013; Simos et al 2015)
896 Patients who were diagnosed with primary breast cancer in the German Breast Cancer Screening Center Diavero®/Essen between 2007 and 2014 via the German Mammography-Screening-Programme were included in the study

Summary

Introduction

Breast cancer is the most frequent malignant disease in women in Europe; in Germany the incidence is 70,000 new breast cancer diagnoses annually (Kaatsch et al 2014). Aiming at an improved breast-cancer-therapy several countries introduced screening-programs for early breast cancer detection by mammography (Giordano et al 2012; Shapiro et al 1998). In Germany a suchlike program started in accordance with European guidelines in 2004, since 2009 a region wide maintenance exists in all 16 states, organized in more than 94 so-called. After diagnosis of breast cancer via Screening-Programme further oncological treatment follows national and international guidelines. A routine radiological staging for exclusion of distant metastasis in early breast cancer is not recommended by current guidelines (Kreienberg et al 2013; Gradishar et al 2016), it seems still to be performed in the majority of patients (Chand et al 2013; Simos et al 2015). Modalities focus on organs which would be primarily involved: the skeletal system via whole-body-scintigraphy, the lung via chest-X-ray and the liver via ultrasound and/or CT- or MRI-scan in some

Methods

Results

Conclusion