Marcus Jannes1,2, Alexander König3, Martin Kolben4, Claudius Fridrich1, Verena Kirn1,2. 1. Breast Center at the Department of Obstetrics and Gynecology, Heilig Geist Krankenhaus/Teaching Hospital of the University of Cologne, Cologne, Germany. 2. Medical Faculty of the University of Cologne, Cologne, Germany. 3. Department of Obstetrics and Gynecology, University Hospital of the Ludwig-Maximilians University, Munich, Germany. 4. Praxis für Frauengesundheit, Gräfelfing, Germany.
Abstract
Introduction: The risk for metastasis at primary diagnosis of breast cancer is about 4%. The German guidelines give clear indications on when, who, and how to stage breast cancer patients. Ideally, this should be done via computerized axial tomography (CAT) scan of the thorax and abdomen and an additional bone scan. But daily practice shows that the way health-care providers handle staging recommendations can vary. To objectify adherence to guidelines we started a nation-wide survey. Methods: Between July and September 2020, we sent out a survey via email to all certified and noncertified breast centers and in addition to all Departments of Obstetrics and Gynecology in Germany. We asked for timing of staging, conditions that cause staging, and the applied method. In case we did not get any reply, we sent out a reminder. Results: A total of 220 certified breast centers, 28 noncertified breast centers, and 48 Departments of Obstetrics and Gynecology who care for breast cancer patients took part in our survey. A general pretherapeutic staging was performed in 16.4%, 39.3%, and 66.7% of all institutions and a general postoperative staging was performed in 4.1%, 0%, and 6.3% of each institutional type, respectively. In terms of the applied method, 75% of all certified breast centers used a CAT scan and bone scan, while 23.3% primarily used chest X-ray, ultrasound of the abdomen (27.7%), or MRI. As a potential reason for using X-ray and ultrasound, the presence of a "low-risk" breast cancer was mentioned. Summary: Although certified breast centers show the highest adherence to current guidelines, some still perform a general staging or do not use the recommended staging method. The low probability of primary metastatic breast cancer and the use of a reasonable exposure to radiation warrant a critical discussion.
Introduction: The risk for metastasis at primary diagnosis of breast cancer is about 4%. The German guidelines give clear indications on when, who, and how to stage breast cancer patients. Ideally, this should be done via computerized axial tomography (CAT) scan of the thorax and abdomen and an additional bone scan. But daily practice shows that the way health-care providers handle staging recommendations can vary. To objectify adherence to guidelines we started a nation-wide survey. Methods: Between July and September 2020, we sent out a survey via email to all certified and noncertified breast centers and in addition to all Departments of Obstetrics and Gynecology in Germany. We asked for timing of staging, conditions that cause staging, and the applied method. In case we did not get any reply, we sent out a reminder. Results: A total of 220 certified breast centers, 28 noncertified breast centers, and 48 Departments of Obstetrics and Gynecology who care for breast cancer patients took part in our survey. A general pretherapeutic staging was performed in 16.4%, 39.3%, and 66.7% of all institutions and a general postoperative staging was performed in 4.1%, 0%, and 6.3% of each institutional type, respectively. In terms of the applied method, 75% of all certified breast centers used a CAT scan and bone scan, while 23.3% primarily used chest X-ray, ultrasound of the abdomen (27.7%), or MRI. As a potential reason for using X-ray and ultrasound, the presence of a "low-risk" breast cancer was mentioned. Summary: Although certified breast centers show the highest adherence to current guidelines, some still perform a general staging or do not use the recommended staging method. The low probability of primary metastatic breast cancer and the use of a reasonable exposure to radiation warrant a critical discussion.
Authors: Anita Andreano; Paola Rebora; Maria Grazia Valsecchi; Antonio Giampiero Russo Journal: Breast Cancer Res Treat Date: 2017-04-01 Impact factor: 4.872
Authors: R Wolters; A C Regierer; L Schwentner; V Geyer; K Possinger; R Kreienberg; M B Wischnewsky; A Wöckel Journal: Eur J Cancer Date: 2011-07-07 Impact factor: 9.162
Authors: N Mittmann; J M Porter; J Rangrej; S J Seung; N Liu; R Saskin; M C Cheung; N B Leighl; J S Hoch; M Trudeau; W K Evans; K N Dainty; C DeAngelis; C C Earle Journal: Curr Oncol Date: 2014-12 Impact factor: 3.677
Authors: Demetrios Simos; Brian Hutton; Ian D Graham; Angel Arnaout; Jean-Michel Caudrelier; Sasha Mazzarello; Mark Clemons Journal: Springerplus Date: 2014-04-05
Authors: Ena Niño de Guzmán; Yang Song; Pablo Alonso-Coello; Carlos Canelo-Aybar; Luciana Neamtiu; Elena Parmelli; Javier Pérez-Bracchiglione; Montserrat Rabassa; David Rigau; Zuleika Saz Parkinson; Iván Solà; Adrián Vásquez-Mejía; Ignacio Ricci-Cabello Journal: Breast Cancer Res Treat Date: 2020-05-06 Impact factor: 4.872