Interdisciplinary Screening, Diagnosis, Therapy and Follow-up of Breast Cancer. Guideline of the DGGG and the DKG (S3-Level, AWMF Registry Number 032/045OL, December 2017) – Part 2 with Recommendations for the Therapy of Primary, Recurrent and Advanced Breast Cancer

Abstract

Purpose The aim of this official guideline coordinated and published by the German Society for Gynecology and Obstetrics (DGGG) and the German Cancer Society (DKG) was to optimize the screening, diagnosis, therapy and follow-up care of breast cancer. Method The process of updating the S3 guideline published in 2012 was based on the adaptation of identified source guidelines. They were combined with reviews of evidence compiled using PICO (Patients/Interventions/Control/Outcome) questions and with the results of a systematic search of literature databases followed by the selection and evaluation of the identified literature. The interdisciplinary working groups took the identified materials as their starting point and used them to develop suggestions for recommendations and statements, which were then modified and graded in a structured consensus process procedure. Recommendations Part 2 of this short version of the guideline presents recommendations for the therapy of primary, recurrent and metastatic breast cancer. Loco-regional therapies are de-escalated in the current guideline. In addition to reducing the safety margins for surgical procedures, the guideline also recommends reducing the radicality of axillary surgery. The choice and extent of systemic therapy depends on the respective tumor biology. New substances are becoming available, particularly to treat metastatic breast cancer.

Does chemotherapy improve survival in patients with nodal positive luminal A breast cancer? A retrospective Multicenter Study

“…The five subtypes were: Luminal A, luminal B (human epidermal growth factor receptor 2 (HER2) negative), luminal B (HER2 positive), triple negative and HER2-overexpressing. The expert panel as well as the german S3-guideline provided systemic treatment recommendations for the subtypes including endocrine therapy alone for luminal A, endocrine and chemotherapy for luminal B (HER2 negative); chemotherapy and anti-HER2-therapy as well as endocrine therapy for luminal B (HER2 positive); chemotherapy and anti-HER2-therapy for HER2 overexpressing (non luminal); and chemotherapy for triple negative cancers [5,6].…”

Development and proof-of-concept of a multicenter, patient-centered cancer registry for breast cancer patients with metastatic disease—the “Breast cancer care for patients with metastatic disease” (BRE-4-MED) registry

“…The primary aim is to assess prevalence of guidelineadherent therapies operationalizing quality indicators based on therapy recommendations of evidence-and consensusbased National Breast Cancer Guideline [12,13]. Secondary aims are the association of guideline-adherent therapy of MBC patients with overall and progression-free survival as well as PROs like the following: quality of life, physical function, depression, and anxiety.…”

“…The final indicator set was established during a phone conference of the SAB on April 26, 2018. The national evidence-and consensus-based guideline of the German Guideline Program in Oncology "Screening, Diagnosis, Therapy and Follow-up of Breast Cancer" served as standard to define high quality of health care [4,12,13]. From the initial pool of 14 proposed indicators, a final set of 11 indicators were selected by the members of the SAB on criteria regarding relevance of the indicators for health care/the patient and practicability in clinical routine.…”

“…11 Clinic of Gynecology and Obstetrics, Hospital Aschaffenburg-Alzenau, Aschaffenburg, Germany. 12 Clinic for Gynecology and Obstetrics, Hospital Leopoldina Schweinfurt, Schweinfurt, Germany.…”

Dedizierte PET zur Diagnostik von Herdbefunden in der Brust

“…Die Hybrid-Bildgebung mittels 18F-Fluorodesoxyglukose-Positronenemissionstomografie (FDG-PET) mit integrierter Computertomografie (CT) wird häufig für das Therapiemanagement von Patienten mit malignen Erkrankungen eingesetzt. In der aktuellen S3-Leitline zur Diagnostik von Mammakarzinomen mit Verdacht auf eine Metastasierung wird das Ganzkörper-PET/ CT lediglich als additives Verfahren bei diskrepanten Befunden im Rahmen des Stagings mittels CT-Thorax/Abdomen/Becken und Skelettszintigrafie empfohlen[1]. Wissenschaftliche Hintergründe für den eher zurückhaltenden Einsatz dieses Verfahrens ergeben sich im Wesentlichen durch die geringe Spezifität und räumliche Auflösung, insbesondere bei kleinen (cT1-) Tumoren der Brust.Goldstandard in der Früherkennung vonBrustkrebs und Brustkrebsvorstufen im Sinne eines duktalen Carcinoma in situ (DCIS) ist nach wie vor die Mammografie, die durch die Verfahren Sonografie und Mamma-MRT ergänzt wird.Eine wichtige Rolle in der Brustkrebsdiagnostik könnten in Zukunft hochauflösende dedizierte Brust-PET-Geräte (high-resolution dedicated breast PET, dbPET) in Kombination mit einem Ganzkörper-PET/CT spielen, die eine höhere Auflösung aufweisen.…”