Breast Cancer In Germany Research Articles

Missing operationalization of patients' quality of life in diagnostics and therapy of breast cancer in Germany

Missing operationalization of patients' quality of life in diagnostics and therapy of breast cancer in Germany

Quality of life of young mothers with breast cancer in Germany.

9574 Background: Aim of the study is to analyze the health-related quality of life (QoL) in young breast cancer patients and to compare it to that of an age-heterogeneous breast cancer cohort and of an age-adjusted general population sample. Further, predictors for a reduced QoL should be identified. Methods: A retrospective study analyzed quality of life of 517 young mothers (at least 1 child <12 years) first diagnosed between 2006 and 2011 with primary breast cancer. The patients participated in a resident mother-child program. The standardized questionnaire focused on medical, clinical and social data and especially on QoL (EORTC QLQ-C30, -BR23). The data were compared with those of an age-heterogeneous cohort with breast cancer and an age-adjusted general population sample from the state of Schleswig-Holstein, Germany. Results: The median age of the young cohort was 39 years. Inability to work, being unemployed and a higher body mass index were predictors for a reduced global QoL /health status. Unanticipated treatment and clinical issues did not affect quality of life. Young breast cancer patients – as compared to the older breast cancer cohort – showed a reduced social, emotional and cognitive functioning. In contrast, physical and sexual functions were significantly higher and stress by hair loss was significant better tolerated by the younger patients. Compared to the general population the patients showed a seriously reduced QoL. Conclusions: Because of their high risk of reduced QoL, young breast cancer patients with children under the age of 12 should be carefully observed with a focus on emotional and social functions and their ability to work. Our results imply the need to develop interventional procedures to enhance QoL in the vulnerable group of young breast cancer patients.

Is primary surgery of breast cancer patients consistent with German guidelines? Twelve-year trend of population-based clinical cancer registry data

This population-based analysis aimed to describe the 12-year trend of primary surgery following the introduction of national guidelines for the management of breast cancer in Germany, thus the implementation of breast-conserving surgery (BCS) for pT1/2-tumours and the implementation of sentinel lymph node biopsy (SLNB). Cancer registry data from 72 742 breast cancer patients diagnosed between 1999 and 2010 in four different regions in Germany were used. Descriptive statistics and multivariate logistic regression analysis were conducted. Between 1999 and 2010, rates of BCS for pT1/2-tumours rose from 60.5% to 79.9%, rates of SLNB increased rapidly from 0.4% to 79.0%. Both surgical therapies were already adherent to the respective guidelines, although some regional differences could be observed: in 1999-2003, the chance of BCS was 2.6-fold higher [odds ratio (OR) 2.6] in the western regions than in the eastern regions, but this difference decreased over time (2004-2007 OR 1.6; 2008-2010 OR 1.2). A similar pattern was observable for SLNB: in 1999-2003, the chance of receiving SLNB was 4.4-fold higher in the western regions, but these rates converged (2004-2007 OR 3.7; 2008-2010 OR 1.5). The further increase of BCS- and SLNB rates after publication of guidelines and the reduction of regional differences may also be attributable to guideline implementation.

Abstract P5-13-10: Quality of care for premenopausal patients with early-onset breast cancer in Germany

Abstract Background and objective: The objective of the study is to evaluate how young breast cancer patients between 2002 and 2011 are treated adjuvantly and whether treatment adheres to the guidelines. The distinction between this cohort and a normally distributed cohort was verified. Materials and methods: The study evaluates the data from a total of 2500 patients who were treated adjuvantly in the period from 2002 until 2011 and participated in a resident mother-child program. Until now, the data of 1053 patients have been analyzed. In cohort I (date of diagnose: 2002 - 2006) 535 women were analyzed, in cohort II (date of diagnose: 2010-2011) 518. The data includes TNM-stage, the biology of tumor, therapies and their guideline-adherence. In addition the amount of participation in studies was evaluated. All data were compared to an age-heterogeneous cohort from the state of Schleswig-Holstein and the DMP- report of the state of North Rhine-Westphalia (“older group”). Results: The median age of the cohort I and II was 39 years. The median age of the age-heterogeneous groups was 59 years. 53% were diagnosed with stage pT1, 37% pT2, 7% pT3 or pT4. 49% of the patients in cohort I were pN0 (cohort II 58%), 31% pN1 (cohort II: 28%) and 20% (cohort II: 14%) had a more intense infestation of lymph nodes. The size of the tumors and the involvement of the lymph nodes were significant higher in the younger patients as in the older patients. 44% of the tumors showed G3, 34% were ER negative, 36% PR negative and 76% Her2 negative. 23% of the patients showed a triple negative carcinoma. The tumor biology was also worse in the younger patients than in the age-heterogeneous group. All in all in cohort I 47% of the patients underwent mastectomie (cohort II:37%, older patients: 29%). 59% of the patients in cohort I with stage pT1 underwent breast-conserving surgery (cohort II: 69%, older group: 82%). Overall 15% of the women in cohort I received mastectomy with subsequent reconstruction (cohort II: 17%, older patients: 7%). 25% of the patients in cohort I received sentinel node biopsy only (cohort II 48%), 90% of the young patients received chemotherapy (older patients 59%), overall 21% of them were treated within studies. 51% of the young patients with antiendocrine therapy received GnRH-analoga, in the age of 40 years or younger 41%. The examination with regard to the conformity with guidelines showed a high guideline adherence in the younger group. Conclusion: Young breast cancer patients provide a special challenge for the therapists because their prognosis is often worse because of a larger tumor and more metastatic lymph nodes as well as the worse tumor biology. They get a more aggressive therapy analogue to their worse situation. The therapies have a high guidelines adherence. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P5-13-10.

Identifying lifestyle and genetic risk factors for breast cancer counseling and management

Jenny Chang-Claude speaks to Marco De Ambrogi, Commissioning Editor: Jenny Chang-Claude is Head of the Unit of Genetic Epidemiology in the Division of Cancer Epidemiology and also is the Deputy Head of the Division of Cancer Epidemiology at the German Cancer Research Center (Heidelberg, Germany). Since 2004 she has been Professor in Epidemiology at the University of Heidelberg (Heidelberg, Germany). Chang-Claude has one of the leading research groups in genetic epidemiology of breast cancer in Germany, with collaborations both nationally and internationally. She has conducted multicenter case–control studies and cohort follow-up studies in Germany, with a research focus on the identification of lifestyle and genetic determinants for risk and prognosis of breast and colorectal cancer, and gene–environmental interactions. Additional research includes studies on cancer survivorship and radiosensitivity. She is also actively involved in research activities of international consortia on breast, ovarian and colorectal cancer. Chang-Claude serves on international scientific advisory boards, committees and editorial boards. She is a (co)author of more than 350 scientific papers published in international scientific journals.

Effect of mammography screening on surgical treatment for breast cancer: a nationwide analysis of hospitalization rates in Germany 2005–2009

The aim of this study was to assess the association between the introduction of the nationwide mammography screening program (MSP) and breast cancer surgery rates in Germany 2005-2009. We used nationwide DRG hospitalization files (2005-2009) and analyzed surgery rates for the treatment of invasive and in situ breast cancer in Germany. We used actual numbers of screened women to model the influence of the introduction of the MSP on surgery rates. During 2005 through 2009, the rate of breast-conserving surgery for invasive and in situ breast cancer increased among all age groups. However, rate increases for invasive and in situ breast surgery were largest among women aged 50-69years (invasive: rate difference [per 100,000] 95.1, 95% CI 90.7; 99.5; in situ: rate difference 34.4, 95% CI 32.6; 36.2). Mastectomy rates generally showed little change over time. Conditional on a 70% participation in the MSP, our model predicts that the estimated increase of mastectomy rates for invasive and in situ breast cancer among women aged 50-69years during the introductory phase of the MSP would be 4.2 (95% CI -0.2; 8.6) and 6.1 per 100,000 (95% CI 5.0; 7.1), respectively. The introduction of the nationwide MSP shows markedly rising rates of breast conserving surgery for women aged 50-69years with invasive and in situ breast cancer. This increase is expected as a consequence of the first screening round. The model-based estimate for the increase of mastectomy rates, assuming a 70% MSP participation, is lower than the reported increases observed in MSP in other countries.

Chemotherapy for 70-Year-Old Women with Breast Cancer in Germany: A Survey by the German Breast Group.

Aim: Around half of all women in Germany with breast cancer are older than 65 and approximately one third of them is older than 70 years of age. In theory, the preferred therapeutic management of women with breast cancer aged 65 and above corresponds to that formulated for younger patients and complies with the S3 Guidelines and the therapy recommendations formulated by AGO. To study the current therapies used to treat women with breast cancer aged 70 and above in Germany, a survey of the clinics of the German Breast Group (GBG) was done. Method: An online survey was carried out with requests sent to 599 physicians registered as principal investigators in the database of the GBG. The 12-item questionnaire was used to investigate the systematic therapeutic management of 70-year-old patients in different settings. The indication for chemotherapy was taken as a given. Results: In a neoadjuvant setting, 62 % of physicians opted for anthracycline and taxane-based therapy as did 56.6 % of physicians in an adjuvant setting. One third of physicians preferred a taxane-based therapy with the anti-angiogenesis inhibitor bevacizumab as first-line therapy for primary metastatic cancer and after anthracycline-based therapy. Capecitabine (around 30 %) and navelbine (around 20 %) were proposed as second-line neoadjuvant and adjuvant therapies after prior anthracycline- and taxane-based therapy. Conclusion: The chemotherapy regimen prescribed for women with breast cancer aged 70 and above in Germany appears to be relatively standardised and corresponds to the recommendations given in the S3 Guidelines and by the AGO Breast Committee.

Relevance of Health Economics in the Early Detection of Breast Cancer in Germany - the View of the Professional Association of Practicing Gynecologic Oncologists e.V. (BNGO)

The introduction of the Mammography Screening Program (MSP) in 2005 has changed the early detection of breast cancer in Germany significantly. We analyzed the frequency and ensuing health care costs of mammograms performed for the early detection of breast cancer before and after the introduction of the MSP. Furthermore, we analyzed the influence of the MSP on the demographics of physicians (gynecologists versus radiologists) performing mammograms in Germany. Whereas the number of ‘curative' mammograms has decreased since the introduction of the MSP, 2 million ‘curative' mammograms per year are still being performed in addition to the 4.6 million mammograms performed annually in the MSP at an additional health care cost of approximately €100 million per year. Only 12% of screening and ‘curative' mammograms are being performed and evaluated by gynecologists.

Are there changes in characteristics and therapy of young patients with early-onset breast cancer in Germany over the last decade?

The objective of the study is to investigate recent changes in patient characteristics and treatment procedures of young breast cancer patients over the last 10 years in Germany. The study describes the data of 518 patients who were treated adjuvantly between 2008 and 2011 and participated in a resident mother-child program for rehabilitation (cohort II). The data includes TNM-categories, biology of tumor and therapies. This population is compared to a cohort of 535 patients, who were treated between 2002 and 2006 (cohort I). Characteristics and treatment of cohort II are compared with a normally age distributed cohort. 51.5 % of the patients in cohort II were diagnosed with tumor category pT1, 36.9 % pT2, 4.4 % pT3 and 1.2 % pT4. 3.3 % had merely DCIS. 58.1 % of the patients were pN0, 28.4 % pN1 and 13.5 % had a more intense manifestation of lymph nodes. 45.8 % of the tumors showed a grading classified as G3, 69.3 % were estrogen and progesterone hormone receptor positive and 21.8 % Her2 positive. 24.5 % of the examined patients showed a triple negative carcinoma. 66.2 % of the patients with pT1 or pT2 underwent breast-conserving surgery. Overall 19.2 % of the women received mastectomy only and 17.4 % received mastectomy with subsequent reconstruction. 98.6 % of the patients received axillary surgery, 87.6 % chemotherapy. Overall, 21.0 % of the patients received their chemotherapy in connection with clinical studies. 88.0 % of the patients with hormone receptor positive tumors received endocrine therapy, 25.5 % of them with GnRH-analogs. In comparison with cohort I the tumors in cohort II were detected with a higher proportion of negative lymph nodes (48.8 %/58.1 %, p = 0.008) and G1 grading (4.9/5.6 %, p = 0.001). On the other hand the percentage of triple negative tumors increased from 21.0 % to 24.5 % (p = 0.018). Operative therapy has adjusted to a more moderate way. Breast-conserving therapy with pT1 and pT2 increases from 57.3 % to 66.2 % (p = 0.006), sentinel lymph node biopsy only from 24.5 % to 47.5 % (p[Symbol: see text]0.001) over the years. The percentages of chemotherapy, radiation, endocrine therapy and antibody therapy with positive receptor have stayed stable over the last decade. Comparing cohort II with a normally age distributed group (DMP II 2007-2009) the young patients have still a much lower portion of negative lymph nodes (58.1 %/67.9 %) and positive hormone receptor status (69.3 %/85.1 %). The percentage of a high grading G3 is 45.8 % in cohort II versus 24.7 % in DMP II. The portion of breast-conserving therapy with pT1 is with 68.9 versus 82.2 % still comparatively low. Young patients received more axillary surgery (98.6 %/81.5 %) but less endocrine therapy with hormone receptor positive tumors (93.3 %/94.7 %). Young breast cancer patients in Germany can still be regarded as a special group. Although tumors are now more often detected before reaching the lymph nodes than 10 years ago, an even bigger percentage is triple negative. Operative treatment has improved to a less aggressive way. Still operative and medical treatments have to be chosen after very careful evaluation.

333P - Cost Effectiveness of Adjuvant Cyclophosphamide Containing Regimes to at in the Treatment of Breast Cancer in Germany

ABSTRACT Objectives 58,000 women in Germany are diagnosed with breast cancer each year. Anthracycline-containing regimes - in addition to other treatment options - have been standard adjuvant breast cancer regimens. The purpose of this analysis was to estimate the cost-effectiveness of AT (doxorubicin, docetaxel) compared with AC (doxorubicin, cyclophosphamide), CMF (cyclophosphamide, methotrexat, 5-fluoruracil) and FEC (5-fluoruracil, epirubicin, cyclophosphamide) administered as adjuvant therapy to women with node-positive breast cancer in Germany. Methods We developed a multi-country Cost-Utility-Model to simulate the long-term consequences from initiation of adjuvant chemotherapy over 10 years. Markov modelling techniques were used to estimate incidence of complications during chemotherapy (febrile neutropenia, chemotherapy induced nausea/vomiting, dose-reduction, dose-delay, other grade 3/4 adverse events) and long-term consequences like local or distant relapse, secondary acute myelogenous leukemia, chronic heart failure and death. Monte-Carlo-simulation accounted for uncertainty. Probabilities were derived from clinical and epidemiological studies; direct costs from published sources from the payer's perspective. QALYs, life years and costs were discounted at 3% p.a. Results Over a 10-year timeframe, costs and outcomes associated with AT amounts to 21,055.91 € and 6.3 QALYs (7 LYs). Costs associated with AC are 17,018.04 €, while outcomes are comparable to AT. The cost saving potential associated to AC vs. AT amounts to 4,037.87 € per patient. Costs and outcomes associated with CMF are 17,790.42 € and 6.3 QALYs (6.94 LYs), leading to a cost saving potential of € 3,265.49 with CMF vs AT. FEC associated total costs are 18,471.84 €. Quality-adjusted life expectancy increases to 6.5 years, which represents a QALY gain of 0.2 QALYs over 10 years vs. AT. The increase in life expectancy without quality adjustment amounts to 7.4 years and leads to 0.4 LYs gained with FEC versus AT. Accordingly, FEC dominates AT. Conclusion Cyclophosphamide-based regimens (FEC, AC and CMF) demonstrate a better performance from cost-effectiveness perspective vs. AT (doxorubicin, docetaxel). Disclosure All authors have declared no conflicts of interest.

Population-based hormone receptor-specific incidence trends of breast cancer in Germany

ObjectivesSeveral countries reported a drop in prescription of hormone replacement therapy (HRT) in the 2000s, followed by decreases in breast cancer incidence among postmenopausal women aged 50–69 years. The aim of this study was to provide hormone receptor specific incidence rates of breast cancer in Germany. MethodsBreast cancer data were extracted from the cancer registries of the Federal States of Brandenburg and Saarland and the area of Munich for the period from 1998 to 2007. We obtained nationwide data on HRT prescription in 1998–2007 from health insurances. Multiple imputation was used on missing values for the receptor status. Age-standardized (European standard population) and age-specific rates were calculated. ResultsThe age-standardized incidence rates in breast cancer were virtually constant over the entire period in all regions. In particular, no substantial changes over time occurred within the age- and receptor-specific analyses. In the same period we observed a drop in HRT use, starting in 1999 and leveling off in 2004. The incidence trends of carcinoma in situ of the female breast increased during the study period. ConclusionsIn our data, we did not observe an association between the decline in HRT prescription and breast cancer incidence among women aged from 50 to 69 years. The lack of temporal changes in breast cancer incidence may be explained by introduction of opportunistic and organized mammography screening and low absolute levels of HRT prescription in Germany.

Characteristics and therapy of premenopausal patients with early-onset breast cancer in Germany

The objective of the study is to investigate what kind of tumors young, premenopausal breast cancer patients in Germany show at diagnosis and how they are treated adjuvantly in comparison with a normally distributed cohort. The study describes the data of 535 patients who were treated adjuvantly between 2002 and 2006 and participated in a resident mother-child program for rehabilitation (Groemitz cohort). The data includes TNM categories, biology of tumor and therapies. This population is being compared to an age-heterogeneous cohort from the state of Schleswig-Holstein and the DMP-report of the state of North Rhine-Westphalia. 45.8 % of the patients were diagnosed with tumor category pT1, 37 % pT2, 7.3 % pT3 and 1.9 % pT4. 5 % had merely DCIS. 48.8 % of the patients were pN0, 31.4 % pN1 and 17.4 % had a more intense manifestation of lymph nodes. 43.5 % of the tumors showed a grading classified as G3, 64.3 % were estrogen and progesterone hormone receptor positive and 26.2 % Her2 positive. 21 % of the examined cohort members/patients showed a triple negative carcinoma. 59.1 % of the patients with pT1 underwent breast-conserving surgery, 56.1 % of those with pT2 and 25.6 % of those with pT3. Overall 31.0 % of the women received mastectomy and 14.8 % received mastectomy with subsequent reconstruction. 97.6 % of the patients received axillary surgery, 89.9 % chemotherapy. Overall 23.7 % of the patients received their treatment in connection with clinical studies. 95.3 % of the patients with hormone receptor positive tumor received endocrine therapy, 61.3 % of them with GnRH-analogs. In comparison with the OVIS and DMP cohorts patients of the Groemitz cohort were on average 20 years younger. Their tumors were of bigger size and had more often reached the axillary lymph nodes (pN0 48.8 % Groemitz/62.0 % OVIS/66.7 % DMP). The hormone receptor status was more often negative (35.7/16.6/16.5 %) and tumor grading higher (G3 43.5/29.0/28.5 %). Surgery was more extensive even with small tumors (breast conserving surgery with tumor stage pT1 59.1/81.2/77.6 %) and axillary surgery was performed more often in the young collective (97.6/89.3/62.5 %). More patients of the young collective received chemotherapy (89.9/58.4 %/unknown) and more patients of the young collective with hormone receptor positive tumor received endocrine therapy (95.3/77.4/90.6 %). Our study shows that young breast cancer patients in Germany can be regarded as a special group. At the time of diagnosis the tumor has frequently reached a more advanced stage, and carcinomas are more aggressive. Operative and medical treatment will often be more aggressive.

Ganzkörper-MRT in der präoperativen Diagnostik des Mammakarzinoms – ein Vergleich mit den Stagingmethoden in der S 3-Leitlinie

The German Society of Senology (step-3 guidelines for the early recognition of breast cancer in Germany) recommends whole-body staging including chest X-ray, ultrasound of the liver and bone scintigraphy before systemic therapy in patients with breast cancer. The performance of these three examinations is time-consuming and involves radiation exposure. Whole-body MR imaging (WB-MRI) allows staging in a single examination without radiation exposure. The purpose of this study was to compare the diagnostic accuracy of WB-MRI with staging according to the guidelines. During 04/07 and 06/09, the initial staging in 51 patients (56 ± 12 yrs) with breast cancer (24 patients with lymph node metastases) was performed according to the S 3-guidelines. Additionally, all patients underwent contrast-enhanced WB-MRI (1.5-Tesla-Magnetom Avanto, Siemens, Erlangen). The findings of the different modalities were compared after correlation of the lesions by follow-up. The detection of suspicious findings and the accuracy of prediction of malignancy of the detected lesions were evaluated. Overall, 14 metastases were detected in 4 of 51 patients after completion of the follow-up. By means of WB-MRI, all 14 metastases could be detected, while just 4 of these metastases were identified by the conventional methods. The detection of distant metastases has an important impact on patient management. In this study WB-MRI in breast cancer staging has shown promising results in regard to possible clinical implementation as a matter of routine staging.

Therapeutic management of male breast cancer in Germany.

e11036 Background: Male breast cancer (MBC) is a rare disease, representing less than 1% of all breast cancer cases. Due to the rareness of the disease and lack of prospective randomized trials, gu...

Vergleich der Lebensqualität nach konventioneller Axilladissektion gegenüber der Sentinel-Node-Biopsie bei brusterhaltender Therapie des Mammakarzinoms

Almost 57 000 women were diagnosed with breast cancer in Germany in 2004. Breast cancer ist the most common malignant tumor in women. In recent years, there has been a gradual shift based on scientific studies from conventional axillary lymph node dissection to sentinel lymph node biopsy. This gives rise to questions concerning possible improvements in the quality of life of women with breast cancer. OBJECTIVE: The purpose of this study is to compare the quality of life of women with breast cancer after conventional axillary dissection with patients who were treated with sentinel lymph node biopsy. METHODS: 80 women undergoing surgical treatment after a diagnosis of breast cancer between June 2005 and December 2007 in the Alfried Krupp Hospital Essen were analyzed. All women were invited by letter to participate in the interviews which were conducted by telephone. Mean duration of the interviews was 60 minutes. 150 women were invited to take part; 80 of them satisfied the previously defined criteria of the study and agreed to participate, providing written informed consent. 40 women were classified into the axillary lymph node dissection group and 40 women were classified into the sentinel lymph node biopsy group. The interviews were held from July to October 2008. The EORTC QLQ C-30 questionnaire was used as well as the optimized MRP-disease specific questionnaire from 2007 of the German universities Marburg and Regensburg. RESULTS: Average age of the women in the axillary dissection group was 57.55 ± 12 years, significantly lower than the average age in the sentinel lymph node biopsy group. The primary tumor size was comparable in both groups and showed no measurable difference. All women received postoperative radiation therapy. Six patients in the sentinel group received adjuvant chemotherapy. In the axillary lymph node dissection group, four patients received neoadjuvant chemotherapy and 28 women were given adjuvant chemotherapy. This difference was statistically significant. There were no statistically significant differences between groups with regard to postsurgery pain, wound healing disturbance, bodily and psychological recovery, cosmetic results, insomnia, motion-dependent pain, limitation of arm motion, difficulties at home, limitations with regard to hobbies and sports activities, swelling of the arm, hand or breast, sensory disturbance and skin problems of the operated breast, contact to self-help groups, problems with their partner, and sexual activity. Statistically significant differences between the analyzed groups were found with regard to chronic postoperative pain, sensory disturbance and disturbance in the muscular power of the arm and shoulder, number of treatments, pain in the affected breast and individual concerns about their health. CONCLUSION: Six sections of the questionnaire showed a significantly better quality of life for women in the sentinel lymph node biopsy group compared with women in the axillary lymph node dissection group. While some of the sections showed no statistically significant difference, they still demonstrated a trend towards a better quality of life as subjectively experienced by the patients in the sentinel lymph node biopsy group. However, prior to the study, it was thought that the difference in quality of life in the sentinel lymph node group compared with the axillary dissection group would be even higher; that this was not the case may be due to the limited number of analyzed cases and the short time period between surgery and interview. Moreover, although the two groups were highly sensitive and were analyzed on the basis of many different parameters, axillary lymph node dissection is a mature procedure perfected over many years. Axillary lymph node dissection was compared with sentinel lymph node biopsy, a relatively new approach where the learning curve may not yet have peaked. Higher numbers of patients and prospective studies are indicated.

Cost Effectiveness of Exemestane versus Tamoxifen in Post-Menopausal Women with Early Breast Cancer in Germany

Background: Medical studies have shown that switching to exemestane after 2–3 years of adjuvant treatment with tamoxifen is effective when looking at overall survival. No cost effectiveness study of exemestane has been conducted in the German health care context. Patients and Methods: To assess the cost effectiveness of switching to exemestane vs. continued tamoxifen therapy for early-stage breast cancer, a Markov model was developed. The model population was set as postmenopausal women who are in remission from early-stage breast cancer. Upon model entry, either a continuing daily therapy with 20 mg tamoxifen or a switch to 25 mg exemestane for the next 2–3 years takes place. The model takes a German health care perspective. Results: The total incremental costs of exemestane on a lifetime basis are 4,195 Euro, resulting in an incremental cost effectiveness ratio of 17,632 Euro per additional quality-adjusted life year (QALY), or 16,857 Euro per life year gained. Incremental costs per disease-free year of survival are 12,851 Euro. Probabilistic sensitivity analyses proved the robustness of these findings. Conclusion: Compared to extended tamoxifen therapy, switching to exemestane after 2–3 years turned out to be a cost-effective strategy in adju-vant therapy for early-stage breast cancer in postmeno-pausal women within the German health care context.

Bildgebende Diagnostik des invasiv lobulären Mammakarzinoms

Early diagnosis of invasive lobular breast carcinoma by physical examination and mammography is often difficult. It is thus often diagnosed only at an advanced tumor stage. Sonography of the breast can increase the sensitivity for diagnosis of invasive lobular breast cancer, but this modality has its limitations even when performed by experienced investigators. The combination of mammography and sonography also has limitations, particularly with regard to the staging of the invasive lobular cancer, as tumor dimensions are often underestimated and multifocality or multicentricity often not recognized. At present, MR mammography is the most sensitive modality for the diagnosis and staging of invasive lobular breast cancer. It has therefore been recommended for local staging of invasive lobular carcinoma in the updated stage 3 guidelines for the early detection of breast cancer in Germany 2008.

0153 Routine clinical usage of trastuzumab (Herceptin®) in the adjuvant treatment of breast cancer in Germany - a prospective registry study

0153 Routine clinical usage of trastuzumab (Herceptin®) in the adjuvant treatment of breast cancer in Germany - a prospective registry study

Imaging Studies for the Early Detection of Breast Cancer: Imaging Is Not Sufficient

Recently, quality assured mammography screening has been implemented in Germany, which is based on the guidelines of international experts but has important structural differences. Imaging is not the only factor that contributes to successful early detection of breast cancer. Women’s confidence is undermined by diverging articles in the press, political campaigns, and different methods such as digital mammography, magnetic resonance tomography, or ultrasonography. The result of all this is that participation rates are still low. How might the situation in Germany be improved? Early detection (screening) programs cannot be merely transferred from other countries to Germany. The treatment and often the diagnosis of breast cancer in Germany are in the hands of gynecologists, who are not integrated into mammography screening projects. The gynecologists are not informed about the results of the mammograms which is an unnecessary loss of information and confidence in the system. In Germany, screening units have not been affiliated to certified breast cancer centers in the same way as in other countries. Information programs for women have not been conducted to a sufficient degree. Providing information and by doing so eliminating fears—this is an essential improvement for early detection programs. Known risk groups should be screened differently, not only by means of mammography. The radiation density (>50%) affecting the breast is currently the biggest risk factor. Physical examination by trained personnel is not being undertaken either. How else is it possible that in breast cancer centers, women whose tumors are easily palpable are operated on an almost daily basis? About half of all women (younger than 50 and older than 69) are not included in mammography screening. We are in the position of being able to conduct controlled randomized studies of the validity of breast cancer screening. An initial, promising contribution has been made in Schleswig-Holstein. What has been lacking thus far is only the will to jointly succeed.

2008 update of the guideline: early detection of breast cancer in Germany

The goal of the 2008 updated guideline: early detection of breast cancer in Germany is to support physicians as well as healthy and affected women in the decision-making process involved in the diagnostic chain for the early detection of breast cancer by providing them with evidence- and consensus-based recommendations. The updated guideline replaces the guideline issued in 2003. The guideline forms the basis for developing an effective and efficient national early breast cancer detection program that meets the standards set by the Council of Europe and WHO for cancer control programs. The guideline presents the current, evidence- and consensus-based state of scientific knowledge in a multidisciplinary approach for the entire diagnostic chain, consisting of history taking and risk consultation, information on health behavior, clinical breast examination, diagnostic imaging, image-guided percutaneous tissue-acquisition techniques, open surgical excisional biopsy and pathomorphological tissue evaluation. The guideline recommends a set of quality indicators to assure resource availability, performance quality and outcomes enhancing total quality management for early breast cancer diagnosis. Currently, early detection of breast cancer offers the most promising possibility to optimize the diagnosis and treatment of breast cancer and, as a result, reduce breast cancer mortality and improve health related quality of life in women.