Skip to main content

Mammakarzinom—Standards der Versorgung heute und morgen

Breast cancer—current and future standards of care

Zusammenfassung

Das Mammakarzinom ist eine der häufigsten Krebserkrankungen in unserer Gesellschaft. Inzidenz, Risikofaktoren, Prävention, Früherkennung, Heilungsrate nach Diagnosestellung und Prognose nach Metastasierung unterliegen einem steten Wandel. Riskofaktoren sind die Verlängerung der hormonellen Exposition, das zunehmende Alter bei der ersten Geburt, fettreiche Ernährung, fehlende körperliche Aktivität und längere Lebenserwartung. Eine medikamentöse Prävention kann in Zukunft vielleicht in manchen Situationen das Erkrankungsrisiko senken. Vorstufen und Frühformen des Mammkarzinoms können durch eine geeignete Früherkennung (Mammographie-Screening) entdeckt werden. Die mammakarzinombedingte Mortalität kann dadurch nachweislich erheblich gesenkt werden.

Die Prognose nach Diagnosestellung hat sich v. a. durch den Einsatz effektiverer adjuvanter Therapieformen verbessert. Eine adäquate Behandlung des Primärtumors durch Operation und ggf. Bestrahlung soll die lokale Ausbreitung des Tumors kontrollieren. Die Entwicklung neuer Medikamente in der Chemotherapie und in der endokrinen Therapie und mehr Wissen über ihren Einsatz gewährleisten eine effektivere und z. T. auch nebenwirkungsärmere adjuvante Behandlung.

Abstract

Breast cancer is one of the most frequently occurring cancers in our society. Incidence, risk factors, prevention, early detection, cure rate at primary diagnosis and prognosis after metastasis may change and influence the mortality.

Major risk factors for developing breast cancer include prolonged hormonal exposure, increasing age at first delivery, nutritional factors, lack of physical activity, and extended life expectancy. Available pharmaceutical agents for prevention may perhaps decrease the disease risk in many precarious situations. Pre-invasive lesions and early stages of breast cancer can be detected by an adequate screening (mammography screening), and thus, breast cancer-related mortality can be substantially reduced.

Once the diagnosis has been determined, the prognosis has improved due in large part to more effective forms of adjuvant therapy. Adequate treatment of the primary tumour, and if necessary irradiation, is aimed at controlling local spread of the tumour. New cytotoxic and endocrine drugs and more knowledge on how best to employ them will ensure more effective adjuvant treatment, perhaps even with fewer side effects.

This is a preview of subscription content, access via your institution.

Literatur

  1. 1.

    Becker N, Wahrendorf J (1997) Krebsatlas der Bundesrepublik Deutschland 1981–1990. Springer, Berlin Heidelberg. http://www.dkfz.de/epi/Home_d/Programm/AG/Praevent/Krebshom/main/deutsch/frame5.htm

  2. 2.

    Ries LAG, Eisner MP, Kosary CL, Hankey BF, Miller BA, Clegg L, Mariotto A, Feuer EJ, Edwards BK (2004) (eds) SEER Cancer Statistics Review, 1975–2001, National Cancer Institute, Bethesda, MD. http://seer.cancer.gov/csr/1975_2001/

  3. 3.

    Peto R, Boreham J, Clarke M, Davies C, Beral V (2000) UK and USA breast cancer deaths down 25% in year 2000 at ages 2069 years Volume Correspondence. Lancet 355:20

    Google Scholar 

  4. 4.

    Hsieh CC, Trichopoulos D, Katsouyanni K, Yuasa S (1990) Age at menarche, age at menopause, height and obesity as risk factors for breast cancer: associations and interactions in an international case-control study. Int J Cancer 46:796–800

    Google Scholar 

  5. 5.

    Monninkhof EM, van der Schouw YT, Peeters PH (1999) Early age at menopause and breast cancer: are leaner women more protected? A prospective analysis of the Dutch DOM cohort. Breast Cancer Res Treat 55:285–291

    Google Scholar 

  6. 6.

    Beral V (2003) Million Women Study Collaborators. Breast cancer and hormone-replacement therapy in the Million Women Study. Lancet 362:419–427

    Article  PubMed  Google Scholar 

  7. 7.

    Fournier A, Berrino F, Riboli E, Avenel V, Clavel-Chapelon F (2004) Breast cancer risk in relation to different types of hormone replacement therapy in the E3N-EPIC cohort. Int J Cancer [Epub ahead of print]

  8. 8.

    Collaborative Group on Hormonal Factors in Breast Cancer (2002) Breast cancer and breastfeeding: collaborative reanalysis of individual data from 47 epidemiological studies in 30 countries, including 50302 women with breast cancer and 96973 women without the disease. Lancet 360:187–195, review

    Google Scholar 

  9. 9.

    Abou-Dakn M, Scheele M, Strecker JR (2003) Does breast-feeding prevent breast cancer? Zentralbl Gynakol 125:48–52, review

    Google Scholar 

  10. 10.

    Lahmann PH, Hoffmann K, Allen N et al. (2004) Body size and breast cancer risk: findings from the European Prospective Investigation into Cancer And Nutrition (EPIC). Int J Cancer 111:762–771

    Google Scholar 

  11. 11.

    Guenel P, Cyr D, Sabroe S, Lynge E, Merletti F, Ahrens W, Baumgardt-Elms C, Menegoz F, Olsson H, Paulsen S, Simonato L, Wingren G (2004) Alcohol drinking may increase risk of breast cancer in men: a European population-based case-control study. Cancer Causes Control 15:571–580

    Google Scholar 

  12. 12.

    Bernstein L, Henderson BE, Hanisch R, Sullivan-Halley J, Ross RK (1994) Physical exercise and reduced risk of breast cancer in young women. J Natl Cancer Inst 86:1403–1408

    Google Scholar 

  13. 13.

    Fisher B, Jeong JH, Dignam J, Anderson S, Mamounas E, Wickerham DL, Wolmark N (2001) Findings from recent National Surgical Adjuvant Breast and Bowel Project adjuvant studies in stage I breast cancer. J Natl Cancer Inst Monogr. 30:62–66

    Google Scholar 

  14. 14.

    Veronesi U, Maisonneuve P, Rotmensz N et al. (2003) Italian Tamoxifen Study Group. Italian randomized trial among women with hysterectomy: tamoxifen and hormone-dependent breast cancer in high-risk women. J Natl Cancer Inst 95:160–165

    Google Scholar 

  15. 15.

    Powles T, Eeles R, Ashley S, Easton D, Chang J, Dowsett M, Tidy A, Viggers J, Davey J (1998) Interim analysis of the incidence of breast cancer in the Royal Marsden Hospital tamoxifen randomised chemoprevention trial. Lancet 352:98–101

    Google Scholar 

  16. 16.

    Cuzick J, Forbes J, Edwards R, Baum M, Cawthorn S, Coates A, Hamed A, Howell A, Powles T, IBIS investigators (2002) First results from the International Breast Cancer Intervention Study (IBIS-I): a randomised prevention trial. Lancet 360:817–824

    Google Scholar 

  17. 17.

    Cuzick J (2003) Aromatase inhibitors in prevention--data from the ATAC (arimidex, tamoxifen alone or in combination) trial and the design of IBIS-II (the second International Breast Cancer Intervention Study). Recent Results Cancer Res 163:96–103, discussion 264–266, review

    Google Scholar 

  18. 18.

    Tabar L, Yen MF, Vitak B, Chen HH, Smith RA, Duffy SW (2003) Mammography service screening and mortality in breast cancer patients: 20-year follow-up before and after introduction of screening. Lancet 361:1405–1410

    Google Scholar 

  19. 19.

    Perlet C, Heinig A, Prat X, Casselman J, Baath L, Sittek H, Stets C, Lamarque J, Anderson I, Schneider P, Taourel P, Reiser M, Heywang-Kobrunner SH (2002) Multicenter study for the evaluation of a dedicated biopsy device for MR-guided vacuum biopsy of the breast. Eur Radiol 12:1463–1470

    Google Scholar 

  20. 20.

    Early Breast Cancer Trialists‘ Collaborative Group (2002) Multi-agent chemotherapy for early breast cancer. Cochrane Database Syst Rev 1:CD000487, review

    Google Scholar 

  21. 21.

    Early Breast Cancer Trialists‘ Collaborative Group (2001) Tamoxifen for early breast cancer. Cochrane Database Syst Rev:CD000486, review

    Google Scholar 

  22. 22.

    Early Breast Cancer Trialists‘ Collaborative Group (2000) Ovarian ablation for early breast cancer. Cochrane Database Syst Rev 3:CD000485, review

    Google Scholar 

  23. 23.

    Early Breast Cancer Trialists‘ Collaborative Group (2002) Radiotherapy for early breast cancer. Cochrane Database Syst Rev 2:CD003647, review

    Google Scholar 

  24. 24.

    Roggel F, Hocke S, Lindemann K, Sinz S, Welk A, Bosl M, Pabst M, Nusser N, Braun S, Schmitt M, Harbeck N (2003) Minimal residual disease in breast cancer and gynecological malignancies: phenotype and clinical relevance. Recent Results Cancer Res 162:89–100, review

    Google Scholar 

  25. 25.

    Baum M, Buzdar A, Cuzick J, Forbes J, Houghton J, Howell A, Sahmoud T (2003) The ATAC (Arimidex, Tamoxifen Alone or in Combination) Trialists‘ Group. Anastrozole alone or in combination with tamoxifen versus tamoxifen alone for adjuvant treatment of postmenopausal women with early-stage breast cancer: results of the ATAC (Arimidex, Tamoxifen Alone or in Combination) trial efficacy and safety update analyses. Cancer 98:1802–1810

    Google Scholar 

  26. 26.

    Coombes RC, Hall E, Gibson LJ et al. (2004) Intergroup Exemestane Study. A randomized trial of exemestane after two to three years of tamoxifen therapy in postmenopausal women with primary breast cancer. N Engl J Med 350:1081–1092

    Google Scholar 

  27. 27.

    Goss PE, Ingle JN, Martino S et al. (2003) A randomized trial of letrozole in postmenopausal women after five years of tamoxifen therapy for early-stage breast cancer. N Engl J Med 349:1793–1802

    Article  CAS  PubMed  Google Scholar 

  28. 28.

    Boccardo F (2004) Switching trial of adjuvant tamoxifen with an aromatase inhibitor in postmenopausal patients with breast cancer. Clin Breast Cancer Suppl 1:S13–17

    Google Scholar 

  29. 29.

    Levine MN, Bramwell VH, Pritchard KI et al. (1998) Randomized trial of intensive cyclophosphamide, epirubicin, and fluorouracil chemotherapy compared with cyclophosphamide, methotrexate, and fluorouracil in premenopausal women with node-positive breast cancer. National Cancer Institute of Canada Clinical Trials Group. J Clin Oncol 16:2651–2658

    CAS  PubMed  Google Scholar 

  30. 30.

    French Adjuvant Study Group (2001) Benefit of a high-dose epirubicin regimen in adjuvant chemotherapy for node-positive breast cancer patients with poor prognostic factors: 5-year follow-up results of French Adjuvant Study Group 05 randomized trial. J Clin Oncol 19:602–611

    Google Scholar 

  31. 31.

    Hutchins L, Green S, Ravdin P et al. (1998) CMF versus CAF with and without tamoxifen in high-risk node.negative breast cancer patients and a natural history follow-up study in low-risk node-negative patients: first results of Intergroup Trial INT 002; Proc. ASCO, abstr. # 2

  32. 32.

    Piccart MJ, Di Leo A, Beauduin M et al. (2001) Phase III trial comparing two dose levels of epirubicin combined with cyclophosphamide with cyclophosphamide, methotrexate, and fluorouracil in node-positive breast cancer. J Clin Oncol 19:3103–3110

    CAS  PubMed  Google Scholar 

  33. 33.

    Henderson IC, Berry DA, Demetri GD et al. (2003) Improved outcomes from adding sequential Paclitaxel but not from escalating Doxorubicin dose in an adjuvant chemotherapy regimen for patients with node-positive primary breast cancer. J Clin Oncol 21:976–983

    Google Scholar 

  34. 34.

    Mamounas EP, Bryant J, Lembersky BC, Fisher B, Atkins JN, Fehrenbacher L, Raich PC, Yothers G, Soran N (2003) Wolmark. Paclitaxel (T) following doxorubicin/cyclophosphamide (AC) as adjuvant chemotherapy for node-positive breast cancer: Results from NSABP B-28. Proc Am Soc Clin Oncol 22:4, abstr. 12

    Google Scholar 

  35. 35.

    Nabholtz JM, Pienkowski T, Mackey J et al. (2002) Phase III trial comparing TAC (docetaxel, doxorubicin, cyclophosphamide) with FAC (5-fluorouracil, doxorubicin, cyclophosphamide) in the adjuvant treatment of node positive breast cancer (BC) patients: interim analysis of the BCIRG 001 study. Proc Am Soc Clin Oncol 21, abstr. # 141

    Google Scholar 

  36. 36.

    Thomssen C, Untch M, Behrens K, Kahlert S, Sattler D, Oberlechner E, Kuhn W, Lebeau A, Dettmer P, Konecny G, Jaenicke F (2000) Randomized trial on dose-intense adjuvant chemotherapy with epirubicin and cyclophosphamide in high-risk breast cancer patients. Breast Cancer Research and Treatment 64, abstr. 319

    Google Scholar 

  37. 37.

    Citron ML, Berry DA, Cirrincione C, Hudis C et al. (2003) Randomized trial of dose-dense versus conventionally scheduled and sequential versus concurrent combination chemotherapy as postoperative adjuvant treatment of node-positive primary breast cancer: first report of Intergroup Trial C9741/Cancer and Leukemia Group B Trial 9741. J Clin Oncol 21:1431–1439

    Article  PubMed  Google Scholar 

  38. 38.

    Möbus VJ, Untch M, Du Bois A, Lueck HJ, Thomssen C, Kuhn W, Kurbacher C, Nitz U, Kreienberg R, Jackisch C (2004) Dose-dense sequential chemotherapy with epirubicin(E), paclitaxel (T) and cyclophosphamide (C) (ETC) is superior to conventional dosed chemotherapy in high-risk breast cancer patients (= 4 +LN). First results of an AGO-trial. Proc Am Soc Oncol 22 [Suppl 15]:513

    Google Scholar 

  39. 39.

    Giordano SH, Buzdar AU, Smith TL, Kau SW, Yang Y, Hortobagyi GN (2004) Is breast cancer survival improving? Cancer 100:44–52

    Google Scholar 

  40. 40.

    Rack B, Janni W, Gerber B, Strobl B, Schindlbeck C, Klanner E, Rammel G, Sommer H, Dimpfl T, Friese K (2003) Patients with recurrent breast cancer: does the primary axillary lymph node status predict more aggressive tumor progression? Breast Cancer Res Treat 82:83–92

    Google Scholar 

  41. 41.

    Thomssen, Harbeck N, Henselmann B, Prechtl A, Dettmar P, Ulm K, Schmitt M, Graeff H, Jänicke F (1997) Improved estimation of the prognosis in patients with metastatic breast cancer by using the tumorbiological factor PAI-1. Eur Soc Gyn

  42. 42.

    Thomssen C, Janicke F, Harbeck N (2003) Clinical relevance of prognostic factors in axillary node-negative breast cancer. Onkologie 26:438–445, review

    Google Scholar 

  43. 43.

    Jänicke F, Prechtl A, Thomssen C, Harbeck N, Meisner C, Untch M, Sweep CG, Selbmann HK, Graeff H, Schmitt M, German N0 Study Group (2001) Randomized adjuvant chemotherapy trial in high-risk, lymph node-negative breast cancer patients identified by urokinase-type plasminogen activator and plasminogen activator inhibitor type 1. J Natl Cancer Inst 93:913–920

    Google Scholar 

  44. 44.

    Harbeck N, Schmitt M, Kates RE, Kiechle M, Zemzoum I, Jänicke F, Thomssen C (2002) Clinical utility of urokinase-type plasminogen activator and plasminogen activator inhibitor-1 determination in primary breast cancer tissue for individualized therapy concepts. Clin Breast Cancer 3:196–200, review

    Google Scholar 

  45. 45.

    van ‚t Veer LJ, Dai H, van de Vijver MJ et al. (2002) Gene expression profiling predicts clinical outcome of breast cancer. Nature 415:530–536

    Article  PubMed  Google Scholar 

  46. 46.

    Sotiriou C, Neo SY, McShane LM, Korn EL, Long PM, Jazaeri A, Martiat P, Fox SB, Harris AL, Liu ET (2003) Breast cancer classification and prognosis based on gene expression profiles from a population-based study. Proc Natl Acad Sci USA 100:10393–10398, Epub

    Google Scholar 

  47. 47.

    Maier S, Nimmrich I, Marx A, Eppenberger-Castori S, Jaenicke F, Paradiso A, Spyratos F, Foekens J, Schmitt M, Harbeck N (2004) DNA methylation profile predicts risk of recurrence in tamoxifen-treated, node-negative breast cancer patients. J Clin Oncol, ASCO Annual Meeting Proceedings 22 [Suppl]:2004:525

  48. 48.

    Leitlinie zur Diagnostik und Therapie von Mammakarzinomen. Version 2004 Organkommission Mamma der Arbeitsgemeinschaft Gynäkologische Onkologie (AGO)(in Zusammenarbeit mit der ARO). http://www.ago-online.org

  49. 49.

    Interdisziplinäre S 3-Leitlinie für die Diagnostik und Therapie des Mammakarzinoms der Frau, 1. Aufl. Deutsche Krebsgesellschaft (Hrsg) Zuckschwerdt, München, 2004. http://www.krebsgesellschaft.de

Download references

Interessenkonflikt:

Der korrespondierende Autor weist auf eine Verbindung mit folgender Firma/Firmen hin: Pfizer, Novartis, Astra-Zeneca, Bristol-Myers Squibb, Sanofi-Aventis, Amgen (Vorträge, Advisory Board, Forschungsprojekte).

Author information

Affiliations

Authors

Corresponding author

Correspondence to C. Thomssen.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Thomssen, C. Mammakarzinom—Standards der Versorgung heute und morgen. Onkologe 11, 265–272 (2005). https://doi.org/10.1007/s00761-005-0835-3

Download citation

Schlüsselwörter

  • Mammakarzinom
  • Risikofaktoren
  • Screening
  • Adjuvante Therapie
  • Mortalität

Keywords

  • Breast cancer
  • Risk factors
  • Screening
  • Adjuvant therapy
  • Mortality