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

Abstract

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.

Axillary Surgery in Breast Cancer Patients Treated with Breast-Conserving Surgery at German Breast Cancer Centers Within the Last 14 Years – Comparison of a University Center and a Community Hospital

“…Use of SNB increased within the first years and then remained stable with rates of more than 80% in both BCC. These findings are in line with previous published data, showing an initial SNB rate increase 19 and continuous high values up and above 90% 20 , 21 . Overall numbers of patients with BCS decreased within the last years in D-BCC ( Table 1 ) but remained at a stable level in U-BCC.…”

Axillary surgery in breast cancer patients treated with breast-conserving surgery at german breast cancer centers within the last 14 years – comparison of a university center and a community hospital

“…rates of more than 80 % in both BCC. These findings are in line with previous published data, showing an initial SNB rate increase [19] and continuous high values up and above 90 % [20,21]. Overall numbers of patients with BCS decreased within the last years in D-BCC (▶ Table 1) but remained at a stable level in U-BCC.…”

Healthcare providers’ adherence to breast cancer guidelines in Europe: a systematic literature review

“…Most of these studies (22/31, 71%) assessed adherence contrasting healthcare providers' indications for breast cancer patients against a selection of CGs recommendations. Six studies (6/31, 19.4%) addressed adherence as a process indicator integrated in the quality assurance programme of their institution [57][58][59][60][61][62]. In three studies (3/31, 9.7%), a "tumour board", or a multidisciplinary team of physicians, was involved in the clinical pathway of treatment decision [29,31,32,63].…”

“…These studies included patients receiving treatment in the period from 1992 to 2008 [20,35,63].The median adherence for surgical procedures was 86.3% (IQR 75.7-89.2%), and ranged from 65 [63] to 92% [35]. Moreover, eleven studies measured adherence for individual surgical procedures which included (1) breast-conserving surgery (BCS) [45,58,[60][61][62], the median adherence was 74% (IQR 75.7-93%), and ranged from 35 [60] to 95% [45]; (2) mastectomy (MA) [25,45,60], the adherence ranged from 54 [60] to 91% [45]; (3) SLNB [58,62,72], from 51 [62] to 76% [72]; (4) ALND [58,59,73], from 68 [58] to 81% [59]; and (5) other indicators included organisational indicators [54] or "breast surgery without needing a second surgery" [57], which reported 17% and 97% of adherent treatment, respectively.…”