Skip to main content

Advertisement

Log in

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

  • Original Paper
  • Published:
Journal of Cancer Research and Clinical Oncology Aims and scope Submit manuscript

Abstract

Introduction

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.

Materials and methods

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.

Conclusion

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  • Albert US (ed) (2008) Stufe-3-Leitlinie Brustkrebs-Früherkennung in Deutschland 1.Aktualisierung 2008, 1st edn. Zuckschwerdt, Muenchen

    Google Scholar 

  • Albert US, Schulz KD, The members of the guideline steering committee and the chair persons of the task force groups (2004) Short version of the guideline: early detection of breast cancer in Germany. J Cancer Res Clin Oncol 130:527–536. doi:10.1007/s00432-004-0558-7

    Article  PubMed  Google Scholar 

  • Albert US, Schulz KD, Alt D, Beck V, Doherty J, Holsteg K et al (2003) Eine Leitlinie für Leitlinien: die methodische Entwicklung und Anwendung der Leitlinie Fraueninformation. Zentralbl Gynakol 125:484–493 (AWMF Reg. Nr.: 077-002; http://www.awmf-leitlinien.de)

  • Albert US, Schulz KD, Kopp I (2007) Leitlinien-Methodenreport: Aktualisierung der Stufe-3-Leitlinie Brustkrebs-Früherkennung in Deutschland 2007, konsultierte Fassung Version 1.1 edn. http://www.awmf-leitlinien.de, Marburg

  • Amendoeira I, Apostolikas N, Bellocq J, Bianchi S, Boecker W, Borisch B, Elston C, Eusebi V, Faverly D, Heikkila P, Holland R, Kerner H, Kulka J, Jacquermier J, Lacerda M, Martinez-Penuela J, De Miquel C, Nordgren H, Peterse JL, Rank F, Regitnig P, Reiner A, Sapino A, Sigal-Zafari B, Tanous A, Thorstenson S, Zozoya E, Wells C (2006a) Quality assurance guidelines for pathology: Cytological and histological non-operative procedures. In: Wells CA (ed) European guidelines for quality assurance in breast cancer screening and diagnosis, 4 edn. Office for Official Publications of the European Communities, Luxembourg, pp 221–256

  • Amendoeira I, Apostolikas N, Bellocq J, Bianchi S, Boecker W, Borisch B et al. 0, Elston C, Eusebi V, Faverly D, Heikkila P, Holland R, Kerner H, Kulka J, Jacquermier J, Lacerda M, Martinez-Penuela J, De Miquel C, Nordgren H, Peterse JL, Rank F, Regitnig P, Reiner A, Sapino A, Sigal-Zafari B, Tanous A, Thorstenson S, Zozoya E, Wells C (2006b) Quality assurance guidelines for pathology: open biopsy and resection specimens. In: Wells CA (ed) European guidelines for quality assurance in breast cancer screening and diagnosis, 4 edn. Office for Official Publications of the European Communities, Luxembourg, pp 257–311

  • American College of Radiology (ACR) (2003) Breast Imaging reporting and data system (BIRADS™), 4th edn. American College of Radiology, Reston, VA

    Google Scholar 

  • Ball C, Sackett D, Philipps B, Haynes B, Straus S, Dawes M (2001) Oxford-Centre for Evidence-based Medicine Levels of Evidence (2001). http://www.cebm.net/level_of_evidence.asp Zugriff: 08042007

  • Brenner H, Stegmaier C, Ziegler H (2005) Verbesserte Langzeitüberlebensraten von Krebspatienten. Die unterschätzten Fortschritte der Onkologie. Dtsch Arztebl 102:2628–2633

    Google Scholar 

  • Brett J, Bankhead C, Henderson B, Watson E, Austoker J (2005) The psychological impact of mammographic screening. A systematic review. Psychooncology 14:917–938. doi:10.1002/pon.904

    Article  PubMed  CAS  Google Scholar 

  • Bundesärztekammer (BÄK) Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF), Kassenärztliche Bundesvereinigung (KBV) (2007) Nationales Programm für VersorgungsLeitlinien. Methoden-Report, 3rd edn. Berlin, http://www.versorgungsleitlinie.de

  • Calman K, Hine D, Peto R, Boreham J, Clarke M, Purushotham A, Pain S, Miles D (2002) NICE: Improving outcomes in breast cancer. NICE, London

    Google Scholar 

  • Carlson R, Anderson B, Burstein H (2005) NCCN Breast Cancer Clinical practice guidelines in Oncology. National Comprehensivie Cancer Network (http://www.nccn.org), USA

  • Crystal P, Koretz M, Shcharynsky S, Makarov V, Strano S (2004) Accuracy of sonographically guided 14-gauge core-needle biopsy: result of 715 consecutive breast biopsies with at least two-year follow-up of benign lesions. J Clin Ultrasound 33:47–51. doi:10.1002/jcu.20089

    Article  Google Scholar 

  • Elston CW, Ellis IO (1991) Pathological prognostic factors in breast cancer. 1. The value of histological grade in breast cancer: experience from a large study with long-term follow-up. Histopathology 19:403–410. doi:10.1111/j.1365-2559.1991.tb00229.x

    Article  PubMed  CAS  Google Scholar 

  • Encke A, Kopp I, Selbmann H, Hoppe J, Köhler A, Ollenschläger G (2006) Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF), Ärztliches Zentrum für Qualität in der Medizin (ÄZQ), (Hrsg) (2006) Deutsches Instrument zur methodischen Bewertung von Leitlinien: DELBI. Dt Ärztebl 102:A1912–A1913

  • Ferlay J, Autier P, Boniol M, Heanue M, Colombet M, Boyle P (2006) Estimates of the cancer incidence and mortality in Europe in 2006. Ann Oncol 18(3):581–592. doi:10.1.093/annonc/imd498

    Article  Google Scholar 

  • Fishman J, Milikowski C, Ramsinghani R, Velasquez M, Aviram G (2003) US-guided core-needle biopsy of the breast: how many specimens are necessary? Radiology 226:779–782

    Article  PubMed  Google Scholar 

  • Gesellschaft der epidemiologischen Krebsregister in Deutschland e.V.und das Robert Koch Institut (2006) Krebs in Deutschland - Häufigkeiten und Trends, 5. überarbeitete, aktualisierte Auflage edn. RoBo Print, Riegelsberg, Saarbrücken

  • Gotzsche PC, Nielsen M (2006) Screening for breast cancer with mammography. Cochrane Database Syst Rev 18(4):CD001877. doi:10.1002/14651858.CD001877.pub2

    Google Scholar 

  • Harvey JM, Clark GM, Osborne CK, Allred DC (1999) Estrogen receptor status by immunohistochemistry is superior to the ligand-binding assay for predicting response to adjuvant endocrine therapy in breast cancer. J Clin Oncol 17:1474–1481

    PubMed  CAS  Google Scholar 

  • Hoffmann W, Latza U, Terschüren C, Berger K, Bergmann M, Dahl A et al. (2004) Leitlinien und Empfehlungen zur Sicherung von Guter Epidemiologischer Praxis (GEP) - Langversion, 2.mit Änderungen nach Evaluation edn. Arbeitsgruppe Epidemiologischer Methoden der Deutschen Arbeitsgemeinschaft für Epidemiologie (DAE); Deutsche Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie (GMDS); Deutsche Gesellschaft für Sozialmedizin und Prävention (DGSMP); Deutsche Regionen der Internationalen Biometrischen Gesellschaft (DR-IBS); 1.ed: Kurth BM; Hense HW; Hoffmann W; AhrensW; Babitsch B; Becher H; Blettner M; Brasche S; Brenner H; Enderlein G; Greiser KH; Jahn I; Jöckel KH; Kirschner W; Kohlmann T; Liese A; Möhner M; Mueller U; Reintjes R; Stang A; Wyst M: http://www.medweb.uni-muenster.de/institute/epi/dae/vorstand.html, Münster

  • ICSI (2005) Diagnosis of breast disease—guideline ICSI, update 2005. ICSI, (http://www.icsi.org)

  • Katalinic A, Bartel C, Raspe H, Schreer I (2007) Beyond mammography screening: quality assurance in breast cancer diagnosis. Br J Cancer 96:157–161

    Article  PubMed  CAS  Google Scholar 

  • Kopp I, Encke A, Lorenz W (2002) Leitlinien als Instrument der Qualitätssicherung in der Medizin. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 45:223–233. doi:10.1007/s00103-002-0378-3

    Article  Google Scholar 

  • Lorenz W, Ollenschläger G, Geraedts M, Gerlach F, Gangjour A, Helou A et al (2001) Das Leitlinien Manual:Entwicklung und Implementierung von Leitlinien in der Medizin. ZaeFQ 95:1–84

    Google Scholar 

  • Madjar H, Ohlinger R, Mundinger A, Watermann D, Frenz J, Bader W et al (2006) BI-RADS analoge DEGUM Kriterien von Ultraschallbefunden der Brust - Konsensus des Arbeitskreises Mammosonographie der DEGUM. Ultraschall Med 27:374–379. doi:10.1055/s-2006-926943

    Article  PubMed  CAS  Google Scholar 

  • NBCC (2004a) Clinical practice guidelines for the management and support of younger women with breast cancer, 1st edn. National Health and Medical Research Council (NHMRC), (http://www.nbcc.org.au), Camperdown, NSW

  • NBCC (2004b) Position Statement early detection of breast cancer. In: NBCC (ed) National Health and Medical Research Council, (http://www.nbcc.org.au), Canberra

  • NBCC (2006) The investigation of a new breast syptom—a guide for GP. NBCC, http://www.nbcc.org.au, Australia

  • National Breast Cancer Center (NBCC) (2001) Clinical practice guidelines for the management of early breast cancer, i Soruce edn. National Breast Cancer Center (NBCC) (http://www.nbcc.org.au), Australia

  • National Breast Cancer Centre (NBCC) (2006) Evidence relevant to guidelines for the investigation of breast symptoms, 2nd edn. National Breast Cancer Centre, (http://www.nbcc.org.au), Camperdown, Australia

  • National Comprehensive Cancer Network (NCCN) (2006) Breast Cancer. NCCN Clinical Practice Guidelines in Oncology, http://www.nccn.org, USA

  • National Comprehensive Cancer Network (NCCN) (2007a) Breast cancer screening and diagnosis guidelines. NCCN Clinical Practice Guidelines in Oncology, (http://www.nccn.org), USA

  • National Comprehensive Cancer Network (NCCN) (2007b) Clinical Practice Guidelines in Oncology: Genetic/Familial High-Risk Assessment: Breast and Ovarian, Clinical Practice Guidelines in Oncology edn. Clinical Practice Guidelines in Oncology, (http://www.nccn.org), USA

  • National Quality Management Committee of BreastScreen Australia (2004) Breastscreen Australia–National Accrediation Standards. 2004

  • NICE NCCfPC (2006c) Familial breast cancer - The classification and care of women at risk of familial breast cancer in primary, secondary and tertiary care Update July 2006. NICE, http://www.nice.org.uk/CG041, UK

  • NHMRC (1999) Psychosocial clinical practice guideline. NHMRC, (http://www.nhmrc.health.gov.au), Australia

  • NHS Centre for Reviews, Dissemination (2000) Effective health care: Informing, communicating and sharing decision with people who have cancer. Latimer Trend & Company Ltd, Plymouth

    Google Scholar 

  • NHSBSP (2001) Guidelines for non-operative diagnostic procedures and reporting in breast cancer screening (vol NHSBSP Publication No. 50). NHS Cancer Screening Programmes, Sheffield

  • NICE (2005) NICE clinical guideline no 27: referral guidelines for suspected cancer. NICE, http://www.nice.org.uk/CG027, UK

  • NICE (2006a) Breast cancer: diagnosis and treatment. NICE, (http://www.nice.org.uk), UK

  • NICE (2006b) Image-guided vacuum-assisted excision biopsy of benign breast lesions. NICE, http://www.nice.org.uk/IPG156, UK

  • Nothacker M, Lelgemann M, Giersiepen K, Weinbrenner S (2007) Evidenzbericht 2007 zur S-3-Leitlinie Brustkrebsfrüherkennung in Deutschland, version 1.00 edn. Ärztliches Zentrum für Qualität in der Medizin (ÄZQ), Band 31 http://www.aezq.de/publikationen0index/schriftenreihe/view, http://www.awmf-leitlinien.de, Berlin

  • O’Higgins N, Linos DA, Blichert-Toft M, Cataliotti L, de Wol C, Rochard F et al (2006) European guidelines for quality assurance in the surgical management of mammographically detected lesions. In: Perry N, Broeders M, de Wolf C, Toernberg S, Holland R, von Karsa L (eds) European guidelines for quality assurance in breast cancer screening and diagnosis, 4th edn. Office for official publication of the European Communities, Luxembourg, pp 315–320

    Google Scholar 

  • Perry N, Broeders M, de Wolf C, Törnberg S, Holland R, von Karsa L (2006) European guidelines for quality assurance in breast cancer screening and diagnosis, 4th edn. European Communities Publication, Luxembourg

    Google Scholar 

  • Raab-Schlesinger A, Eckel R, Engel J, Sauer H, Löhrs U, Molls M et al (2005) Metastasiertes Mammakarzinom: Keine Lebensverlängerung seit 20 Jahren. Aerzteblatt 102:B2280–B2288

    Google Scholar 

  • Remmele W, Stegner HE (1987) Recommendation for uniform definition of an immunoreactive score (IRS) for immunohistochemical estrogen receptor detection (ER-ICA) in breast cancer tissue. Pathologe 8:138–140

    PubMed  CAS  Google Scholar 

  • Robert Koch-Institut (Hrsg) und die Gesellschaft der epidemiologischen Krebsregister in Deutschland e.V. (Hrsg) (2008) Krebs in Deutschland 2003–2004. Häufigkeiten und Trends, 6. überarbeitet Auflage edn. Druckhaus Berlin-Mitte GmbH, Berlin

  • Schreer I, Katalinic A (2007) Is high quality breast imaging and diagnosis possible in a decentralized system? Breast Care 2:20–24. doi:10.1159/000099367

    Article  Google Scholar 

  • Schulz KD, Albert US, und die Mitglieder der Arbeitsgruppe “Konzertierte Aktion: Brustkrebs-Früherkennung in Deutschland (2003) Stufe 3 Leitlinie Brustkrebs-Früherkennung in Deutschland, 1 edn. Zuckschwerdt Verlag, München

  • Schwartz G, Veronesi U, Clough K, Dixon J, Fentima I, Heywang-Köbrunner S et al. (2006) Consensus Conference on Breast Conservation. Milan, Italy, 28 April–1 May 2005. Cancer 107:242–250. doi:10.1002/cncr.21988

    Google Scholar 

  • Scottish Intecollegiate Guideline Network (SIGN) (2005) SIGN Scottish Intecollegiate Guideline Network. Management of breast cancer in women. SIGN, (http://www.sign.ac.uk), Edinburgh

  • Silverstein MJ, Poller DN, Waisman JR, Colburn WJ, Barth A, Gierson ED et al (1995) Prognostic classification of breast ductal carcinoma-in-situ. Lancet 345:1154–1157. doi:10.1016/S0140-6736(95)90982-6

    Article  PubMed  CAS  Google Scholar 

  • Smith R, Saslow D, Sawyer K, Burke W, Costanza M, Evans W et al. Hendrick E, Eyre H, Sener S (2003) American Cancer Society guidelines for breast cancer screening. Update 2003. CA Cancer J Clin 53:141–169 (http://www.caonline.amcancersoc.org/cgi/content/full/53/3/141)

  • Smith R, Caleffi M, Albert US, Chen T, Duffy S, Franceschi D et al (2006) Breast cancer in limited-resource countries: early detection and access to care. Breast J 12:S16–S26. doi:10.1111/j.1075-122X.2006.00200.x

    Article  PubMed  Google Scholar 

  • Sobin L, Wittekind C (2002) UICC. TNM classification of malignant tumours, 6th edn. John Wiley & Sons, Inc. Publication, New York

    Google Scholar 

  • The Association of Breast Surgery at BASO, RCoSoE (2005) Guidelines for the management of symptomatic breast disease. Eur J Surg Oncol 31:S1–S21

    Google Scholar 

  • Wolff A, Hammond M, Schwartz J, Hagerty K, Allred D, Cote R, Dowsett M, Fitzgibbons P, Hanna W, Langer A, McShane L, Paik S, Pegram M, Perez E, Press M, Rhodes A, Sturgeon C, Taube S, Tubbs R, Vance G, vanD V, Wheeler T, Hayes D (2007) American Society of Clinical Oncology/College of American Pathologists guideline recommendations for human epidermal growth factor receptor 2 testing in breast cancer. J Clin Oncol 25:145. doi:10.1200/JCO.2007.11.4363

    Article  Google Scholar 

  • WHO (2003) Pathology and genetics of tumours of the breast and female genital organs. In: Tavassoli F, Devilee P (eds) World Health Organization (WHO) classification of tumours. IACR Press, Lyon, pp 9–112

    Google Scholar 

  • World Health Organization (WHO) (2002) National Cancer Control Programs: policies and managerial guidelines, 2nd edn. Health and Development Networks (HDN), Geneva, Italy

    Google Scholar 

Download references

Acknowledgments

The project: Update of the Guideline: Early Detection of Breast Cancer in Germany—Model Project for the Updating of Stage-3-Guidelines in Germany, Funding Code: 107374 was funded by the German Cancer Aid and the German Society of Senology and was developed independent of any funding from government or industry. Individuals contributing to the Guideline signed declarations on possible conflicts of interests. We thank A. Rost and I. Striesow for secretarial and organizational support.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Ute-Susann Albert.

Additional information

Dedication: In memory of Klaus-Dieter Schulz, in highest respect for his contributions to improve breast health care, founder of the guideline task force Concerted Action Early Detection of Breast Cancer in Germany (“Konzertierte Aktion Brustkrebs-Früherkennung in Deutschland”) in 1999, who passed away on 29 September 2007.

The original German version of this paper has been published in Geburtsh Frauenheilk 2008; 68:251–261.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Albert, US., Altland, H., Duda, V. et al. 2008 update of the guideline: early detection of breast cancer in Germany. J Cancer Res Clin Oncol 135, 339–354 (2009). https://doi.org/10.1007/s00432-008-0450-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00432-008-0450-y

Keywords

Navigation