Das BMS wurde initiiert, um basierend auf dem Allparteienbeschluss von 2003 ein flächendeckendes Qualitätsgesichertes Programm für Mammographiescreening, basierend auf dem dezentralen Gesundheitssystem und den EU-Leitlinien zu realisieren.

In Bavaria since the 1st April 2003 we have been conducting a high quality mammography-screening carried out in individual practises (BMS). We have used the European and the S 3 guidelines. The best diagnosis is an early diagnosis of the breast carcinoma to save human life. Because of this and the high mortality rate due to this disease it is essential to have a mammogram screening program. There is no single one ideal way of constructing a screening program, it is always based on compromise within the particular health care-systems. Arising problems cannot be avoided, it is only possible when all parties work closely together that the BMS works properly.

Bis Ende 2005 soll flächendeckend in Deutschland ein Mammographiescreening eingeführt werden. Ziel des Mammographiescreenings ist die Senkung der Brustkrebsmortalität durch Früherkennung des Mammakarzinoms in günstigeren Stadien. Gleichzeitig wird erwartet, dass mehr Brusterhaltung, weniger invasive Therapien (z.B: Chemotherapie) und durch strenge Qualitätskontrolle weniger Operationen bei gutartigen Veränderungen vorkommen.

In Bayern läuft seit dem 01.04.2003 ein qualitätsgesichertes, flächendeckendes Mammographiescreening mit dezentralem Charakter (BMS). Zugrunde liegen die Empfehlungen der European Guidelines sowie der S-3-Leitlinie.

Entsprechend dem Allparteienbeschluss soll bis Ende 2005 das Mammographie-screening flächendeckend in Deutschland eingeführt werden. Gleichzeitig wird und wurde seitens der Politik immer gefordert, das dezentrale Gesundheitssystem zu respektieren.

Objective: Chest wall irradiation after mastectomy for breast cancer is now usually reserved for patients with extensive carcinomatous lymphangiosis or positive surgical margins. However, recent studies suggest that the reduced risk for local recurrence following radiotherapy of the chest wall might improve the survival of these patients. We studied the influence of chest wall irradiation on local recurrence and overall survival rates in patients with breast cancer treated with mastectomy.Methods: We reviewed 1964 patients with pT(1-2) breast cancer treated with mastectomy since 1963. Patients treated before 1979 routinely received chest wall irradiation while those treated after 1979 received irradiation only if there was histologic evidence of extensive carcinomatous lymphangiosis or positive surgical margins. The groups were compared with Kaplan-Meier analysis and the log-rank test.Results: Patients, who received adjuvant radiotherapy had a significantly lower rate of local recurrence regardless of the nodal status. Ten years after primary diagnosis, 98% of patients who received irradiation are free of local recurrence, compared with 86 % of those who did not (p < 0.001). In patients with negative nodes, there was no difference in survival between patients who received irradiation and those who did not. In patients with positive nodes, patients who received irradiation had poorer overall survival than those who did not, probably due to more advanced disease.Conclusions: These data indicate that adjuvant radiotherapy after mastectomy for breast cancer decreases the rate of local recurrence but without improving overall survival.

PURPOSE: There is an urgent need for markers that can predict the efficacy of adjuvant chemotherapy in patients with solid tumors. This study was designed to evaluate whether monitoring of micrometastases in bone marrow can predict the response to systemic chemotherapy in breast cancer. PATIENTS AND METHODS: Bone marrow aspirates of 59 newly diagnosed breast cancer patients with either inflammatory (n = 23) or advanced (> four nodes involved) disease (n = 36) were examined immunocytochemically with the monoclonal anticytokeratin (CK) antibody A45-B/B3 (murine immunoglobulin G 1 ; Micromet, Munich, Germany) before and after chemotherapy with taxanes and anthracyclines. RESULTS: Of 59 patients, 29 (49.2%) and 26 (44.1%) presented with CK-positive tumor cells in bone marrow before and after chemotherapy, respectively. After chemotherapy, less than half of the previously CK-positive patients (14 of 29 patients; 48.3%) had a CK-negative bone marrow finding, and 11 (36.7%) of 30 previously CK-negative patients were CK-positive. At a median follow-up of 19 months (range, 6 to 39 months), Kaplan-Meier analysis of 55 assessable patients revealed a significantly reduced overall survival (P = .011; log-rank test) if CK-positive cells were detected after chemotherapy. In multivariate analysis, the presence of CK-positive tumor cells in bone marrow after chemotherapy was an independent predictor for reduced overall survival (relative risk = 5.0; P = .016). CONCLUSION: The cytotoxic agents currently used for chemotherapy in high-risk breast cancer patients do not completely eliminate CK-positive tumor cells in bone marrow. The presence of these tumor cells after chemotherapy is associated with poor prognosis. Thus, bone marrow monitoring might help predict the response to systemic chemotherapy.

Despite current advances in antibody-based immunotherapy of breast and colorectal cancer, we have recently shown that the actual target cells (e.g., tumor cells disseminated to bone marrow) may express a heterogeneous pattern of the potential target antigens. Tumor antigen heterogeneity may therefore represent an important limitation of the efficacy of monospecific antibody therapy. To measure the efficacy of such a monospecific approach, we analyzed the elimination of tumor cells coexpressing the epithelial cell adhesion molecule (EpCAM) under therapy with murine monoclonal antibody 17-1A (Edrecolomab) directed against EpCAM. In bone marrow aspirates from 10 breast cancer patients with metastatic (n = 8) and locoregional recurrence (n = 2), tumor cells were identified with the antibody A45-B/B3 directed against the epithelial differentiation marker cytokeratin (CK) and simultaneously typed for EpCAM expression using the antibody 17-1A. Patients were treated with a single dose of 500 mg of Edrecolomab and monitored by bone marrow analyses before and at days 5-7 after antibody treatment. In all 10 patients, we assessed a marked reduction in the mean numbers of both CK+ cells (73 versus 15; P = 0.003, t test) and EpCAM+/CK+ cells (17 versus 1; P = 0.003, t test) per 10(6) bone marrow cells. Complete elimination of EpCAM+ cells was possible in four patients. We conclude that Edrecolomab can be used in breast cancer patients to target isolated EpCAM+/CK+ cancer cells. Using CK-based immunoassays, we reliably detected residual tumor cells in bone marrow and typed EpCAM expression. This allowed us to monitor the cytotoxic elimination of such cells after Edrecolomab application. Selection of EpCAM-/ CK+ tumor clones showed that further antibodies directed against tumor-associated antigens are warranted to improve the efficacy of monospecific approaches.

Background: Mammography is the gold standard of breast diagnostics. Completely new radiological developments are not to be expected in the near future. Thus, additive methods for mammography such as sonography, Doppler sonography, MRI, and scintigraphy are being increasingly employed. In this study, the mammography findings were compared with breast scintigraphy to define the limitations of both methods. The goal of the employing additional diagnostical methods besides mammography is to reduce the number of "open" biopsies.Patients and Methods: The histological findings of 1206 breast operations (in 1035 women) were analysed retrospectively. The indication to operate was based on a pathological mammographic or clinical finding. One hundred and forty patients with unclear mammographic findings were subjected to additional breast scintigraphy with (99m)Technetium prior to the planned operations.Results: In 619 operations, a malignant diagnosis was obtained (51.3%); the other 587 operations resulted in benign findings (48.7%). This is about a 1:1 ratio of benign to malignant final diagnosis from the operative breast biopsy. Histological benign findings included 242 (41.2%) fibrotic-cystic mastopathies and 168 (28.8%) fibroadenomas. These findings had been detected by mammography or clinical examination, but could not be clearly defined as benign and thus resulted in the necessity to operate. The additive implementation of breast scintigraphy resulted in a pre-operative diagnosis of 32 of 34 histologically confirmed mastopathic findings. The additive scintigraphy also resulted in a pre-operative diagnosis of 8 of 11 histologically confirmed fibroadenomas. The results of the breast scintigraphy thus had a higher specificity of 86% compared to normal mammography (specificity 47.9%); the sensitivity, however, was lower (79%) than that of mammography (90%). The results of breast scintigraphy for therapy monitoring of women with inflammatory breast cancer who received primary chemotherapeutic treatment correlated well with the clinical signs of remission and histological findings. Mammography and MRI failed to be of use in these cases.Conclusions: The enthusiastic reports from the USA concerning breast scintigraphy e.g. including suggestions on its implementation as a diagnostic method alone without mammography, cannot be confirmed as yet by German studies. Scintigraphy is still too new compared to the well-established mammography, so that experience an using this method must still be gained. However, breast scintigraphy is a useful complementary method for interdisciplinary breast diagnostics and may lead to a reduction of the necessity for "open" biopsies.

Fragestellung: Die Mammographie ist Goldstandard in der gesamten Mammadiagnostik. Grundlegende Neuentwicklungen in der Röntgendiagnostik der Mamma sind nicht zu erwarten. Dafür etablieren sich additive Methoden wie Sonograpie, Doppler- und Power-Dopplersonographie, MRT, Szintigraphie u. a. Um die Grenzen der Methoden zu definieren,werden die Ergebnisse von Mammographie und Szintigraphie dargestellt.Durch gezielten Einsatz additiver Mammadiagnostik sollte die Zahl offener Biopsien weiter reduziert werden.

Die Mammographie ist die empfindlichste apparative Untersuchungsmethode beim Brustkrebs. Mit ihr ist es möglich, klinisch okkulte Karzinome zu entdecken.

From 1970 to 1987, 331 breast cancer patients of the Department of Gynaecology of the University of Erlangen were treated by conservative breast surgery. Adjuvant radiotherapy of the remaining breast was applied to only one-third of the patients. 30 patients (9.8%) had a local recurrence. This study analyses the 21 patients with local recurrence after breast conserving therapy, treated afterwards again in our hospital. 60% of the recurrences occurred within 2 years after the primary treatment. In 18 cases, the recurrences were located in the vicinity of the segmental resection area, in 3 cases the recurrences were diagnosed as new second primaries in the ipsilateral breast. 19 of the 21 recurrences were diagnosed by palpation, 2 cases were detected by mammography examination only. The palpable recurrences could only be shown in the mammography in 14 cases. We conclude, that for patients with breast conserving therapy, a mammographic examination need not be increased in frequency, but a quarterly examination by palpation should be extended over more than 2 years.

From 1970 to 1987, 331 breast cancer patients of the Department of Gynaecology of the University of Erlangen were treated by conservative breast surgery. Adjuvant radiotherapy of the remaining breast was applied to only one-third of the patients. 30 patients (9.8 %) had a local recurrence. This study analyses the 21 patients with local recurrence after breast conserving therapy, treated afterwards again in our hospital. 60 % of the recurrences occurred within 2 years after the primary treatment.In 18 cases, the recurrences were located in the vicinity of the segmental resection area, in 3 cases the recurrences were diagnosed as new second primaries in the ipsilateral breast. 19 of the 21 recurrences were diagnosed by palpation, 2 cases were detected by mammography examination only. The palpable recurrences could only be shown in the mammography in 14 cases. We conclude, that for patients with breast conserving therapy, a mammographic examination need not be increased in frequency, but a quarterly examination by palpation should be extended over more than 2 years.

: From 1970 to 1987, 331 breast cancer patients of the Department of Gynaecology of the University of Erlangen were treated by conservative breast surgery. Adjuvant radiotherapy of the remaining breast was applied to only one-third of the patients. 30 patients (9.8%) had a local recurrence. This study analyses the 21 patients with local recurrence after breast conserving therapy, treated afterwards again in our hospital. 60% of the recurrences occurred within 2 years after the primary treatment. In 18 cases, the recurrences were located in the vicinity of the segmental resection area, in 3 cases the recurrences were diagnosed as new second primaries in the ipsilateral breast. 19 of the 21 recurrences were diagnosed by palpation, 2 cases were detected by mammography examination only. The palpable recurrences could only be shown in the mammography in 14 cases. We conclude, that for patients with breast conserving therapy, a mammographic examination need not be increased in frequency, but a quarterly examination by palpation should be extended over more than 2 years.