Outdated breast cancer treatment costs lives

Cologne, Germany - Breast CancerOne in eight women in Germany is diagnosed with breast cancer in the course of her life. With some 57,000 new cases each year, mastocarcinoma is thus the most common form of cancer among women. And the disease is still fatal 40 per cent of the time.

Many patients could live longer, though, if only they received more effective treatment via the latest medical knowledge and improved interdisciplinary cooperation among doctors.

Unlike patients in many other countries, breast cancer sufferers in Germany are generally treated close to home and outside of specialised cancer centres, noted Professor Peter Mallmann of the University of Cologne's Department of Gynaecology and Obstetrics.

Some of these women die because their treatment is not in accordance with "evidence-based guidelines," the recommended therapies of which rest on verified scientific findings.

Germany's so-called BRENDA project on the quality of breast cancer care under evidence-based guidelines, which is funded by the Federal Ministry of Education and Research, found that only about half of the country's breast cancer patients were treated under the guidelines.

Patients younger than 35 and older than 75 are particularly likely to receive treatment deviating from the latest recommendations.

This happens despite the indisputable benefits of therapy following the guidelines. Patients who receive ideal treatment live longer, according to Professor Rolf Kreienberg of the Department of Gynaecology and Obstetrics at the University of Ulm, the doctor who heads BRENDA. Following successful therapy, these patients also took longer to develop a subsequent tumour, he said.

Breast cancer therapy consists of various components: the breast operation, removal of lymph nodes from the armpit, radiation therapy, chemotherapy, and hormonal therapy.

Decisions must be made every step of the way, and mistakes are always possible. The greater the deviations from ideal therapy, the lower the chances of survival. BRENDA data showed that eight in 10 patients treated under the guidelines had no new tumour after five years. For women not treated under the guidelines, the figure was six in 10.

At present, there are some 160 certified breast cancer centres in Germany. Kreienberg, an oncologist and the director of one of them, estimated that about 250 were needed for all of the country's breast cancer patients to receive the best therapy possible.

Interdisciplinary cooperation among doctors is a key element in optimal therapy for cancers including that of the breast. An example is the interdisciplinary tumour consultation at the University Hospital of Cologne's Centre for Integrated Oncology (CIO), where a patient sits opposite three doctors: her surgeon, radiation therapist, and medical oncologist. The four of them devise an appropriate therapy plan.

Consultation is available not only to the university hospital's patients, but to anyone who has been diagnosed with cancer and would like a second opinion from the CIO's specialists, noted Professor Juergen Wolf, the centre's medical director. Consultations are offered for cancers including that of the pancreas, liver, lungs, and intestines. (dpa)