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

Albert, Ute‐Susann; Altland, H.; Duda, Volker; Engel, Jutta; Geraedts, Max; Heywang-Köbrunner, Syvia; Hölzel, Dieter; Kalbheim, E.; Koller, Michael; König, Klaus; Kreienberg, R.; Kühn, Thorsten; Lebeau, Annette; Naß-Griegoleit, I.; Schlake, W.; Schmutzler, Rita K.; Schreer, Ingrid; Schulte, Hilde; Schulz‐Wendtland, Rüdiger; Wagner, Uwe; Kopp, I.

doi:10.1007/s00432-008-0450-y

Cited by 46 publications

(27 citation statements)

References 20 publications

(17 reference statements)

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“…Although it is known that all available risk calculation models show considerable weaknesses (Antoniou and Easton 2006;Amir et al 2010), Cyrillic 2.1 is a helpful tool and allows uniform decision-making across Germany. Thresholds of a risk of heterozygosity of ≥20% or a residual lifetime risk for breast cancer of ≥30% qualify a woman for management in the high risk group (Albert et al , 2009). These thresholds were set, since the lifetime risk for breast cancer decreases with age, while the risk of carrying a mutation stays the same.…”

Section: Germanymentioning

confidence: 98%

Genetic testing for familial/hereditary breast cancer—comparison of guidelines and recommendations from the UK, France, the Netherlands and Germany

et al. 2011

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In this review, the national guidelines and recommendations for genetic testing for familial/hereditary breast cancer from the UK, France, the Netherlands and Germany were evaluated as to the inclusion criteria for genetic testing. In all four countries, access to genetic testing relies basically on the family history of breast and ovarian cancer. Similarities are obvious for most selection criteria. All four guidelines recommend embedding genetic testing within a framework of genetic counselling, and all agree to perform genetic testing first in an affected person. However, there are differences regarding the thresholds based on certain familial constellations, detailed description of selection criteria, the degree of relatedness between affected individuals and the counsellee, the age of diagnosis, the individual history of early onset breast cancer, bilateral breast cancer, the tumour morphology or the access to intensified surveillance. These differences and open questions not covered by the guidelines, e.g. on how to deal with phenocopies, unclassified variants, genetic variants in newly identified breast cancer susceptibility genes or with family constellations not fitting the criteria, are discussed. New evidence is usually slowly integrated into the guidelines. An exchange process towards the harmonization of the guidelines will ensure high quality health care across Europe.

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Section: Germanymentioning

confidence: 98%

Genetic testing for familial/hereditary breast cancer—comparison of guidelines and recommendations from the UK, France, the Netherlands and Germany

et al. 2011

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“…It is most commonly used to characterize lesions initially detected through mammographic screening or to evaluate patients who present with clinical findings, such a palpable mass [5]. Routine screening with breast ultrasonography is not currently recommended [5][6][7]. Breast magnetic resonance imaging (MRI) has become a commonly used imaging modality and, in skilled hands, MRI is often helpful in patients with a newly diagnosed mass of the breast.…”

Section: MXmentioning

confidence: 99%

“…Currently, most of the guidelines on screening and diagnostic imaging of breast cancer do not recommend 99m Tc-sestamibi scintimammography as part of routine diagnostic cascade [6,7,21,22]. However, in a 2009 consensus conference on image-detected breast cancer, the use of molecular breast imaging, including 99m Tc-sestamibi and 18 F-FDG PET, was recommended as an adjunctive tool after standard imaging and as an alternative to breast MRI when MRI is not available or contraindicated [5] (Fig.6.1).…”

Section: Clinical Indicationsmentioning

confidence: 99%

99mTc-Sestamibi Scintimammography

Bucerius

2011

99mTc-Sestamibi

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From an anatomical point of view, the mammary gland is part of the female secondary sexual characteristics. The primary biological function of the mammary glands is the feeding of infants with breast milk. The mammary glands belong to the major glands of the cutis (glandulae cutis) and develop from epithelial cones, which grow in the surrounding connective tissue. Initially, the mammary glands are established in the same way in both genders.The female mammary glands are located on the major and minor pectoral muscles (M. pectoralis major, M. pectoralis minor) between the third and the seventh rib and between the sternal-and axillary line. The arterial blood supply of the mammary glands is provided by vascular branches (R. mammarii mediales and laterales) of the internal and lateral thoracic arteries (A. thoracica interna, A. thoracica lateralis) as well as by branches (R. preforantes and R. mammarii laterales) of the anterior and posterior intercostal arteries (Aa. intercostales anterior and posterior). The venous drain follows from superficial veins into the lateral and internal thoracic veins (Vv. thoracica lateralis and interna). The mammary glands are characterized by numerous lymphatic vessels, which build a superficial and deep lymphatic mesh with several directions of lymphatic drainage. From a clinical point of view, the main and most important lymphatic drainage reaches the axillary lymph nodes. Additional lymphatic drains flow off to the cervical lymph nodes superior to the clavicles and via the interpectoral lymphatic nodes (N. lymphatici interpectorales) between the pectoral muscles to the axillary lymph nodes, via the parasternal lymph nodes (N. lymphatici parasternales) along the internal thorac vein, and via the

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“…The incidence of breast cancer peaks in patients aged 50-69 years. This age class is the target group for mammography screening in Germany [14]. Following the implementation of screening mammography in Germany, the proportion of patients presenting with non-invasive versus invasive carcinoma has risen [15].…”

Section: Discussionmentioning

confidence: 99%

Adopting Guidelines into Clinical Practice: Implementation of Trastuzumab in the Adjuvant Treatment of Breast Cancer in Lower Saxony, Germany, in 2007

et al. 2011

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Background: Few studies have assessed the quality of medical care in breast cancer patients outside clinical studies and certified centres in German-speaking countries. We used ONkeyLINE, a voluntary tumour registry, to evaluate the rate of adoption into clinical practice of guidelines on the adjuvant use of trastuzumab and to estimate the reliability of ONkeyLINE in assessing quality of care. Material and Methods: Data from ONkeyLINE were analysed to answer questions on the quality of breast cancer care in daily practice in 2007. The influence of age and area (rural/urban) on treatment patterns was also evaluated. Results: Data from approximately 85% of patients diagnosed with breast cancer in Lower Saxony in 2007 were documented in ONkeyLINE. Within 1 year, more than 77% of patients received adjuvant trastuzumab according to the updated guidelines. Variations in chemotherapy and trastuzumab according to age were evident, in part but not fully attributable to comorbidities in the elderly. Access to trastuzumab therapy in rural areas was as high as in urban areas. Conclusions: Adoption of national guidelines into clinical practice was observed at a reasonable but still unsatisfactory rate in Lower Saxony. Although voluntary, ONkeyLINE covered most breast cancer cases and proved to be a reliable tool for assessing quality of care.

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

Abstract: 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.

Cited by 46 publications

References 20 publications

Genetic testing for familial/hereditary breast cancer—comparison of guidelines and recommendations from the UK, France, the Netherlands and Germany

Genetic testing for familial/hereditary breast cancer—comparison of guidelines and recommendations from the UK, France, the Netherlands and Germany

99mTc-Sestamibi Scintimammography

Adopting Guidelines into Clinical Practice: Implementation of Trastuzumab in the Adjuvant Treatment of Breast Cancer in Lower Saxony, Germany, in 2007

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