Brustkrebs: Mortalitätsreduktion durch Früherkennung und adjuvante Therapie

Zusammenfassung

Die auch in Deutschland zu beobachtende Mortalitätsreduktion des Mammakarzinoms ist im Wesentlichen auf die Erfolge der adjuvanten Therapie zurückzuführen, da in dem entsprechenden Beobachtungszeitraum (1990–2004) kein flächendeckendes Mammografie-Früherkennungsprogramm existent war. Somit ist mit der Einführung des Screeningprogramms ein weiterer Fortschritt zu erwarten. Insbesondere die Einführung von Brustzentren mit der Definition entsprechender struktureller und qualitativer Vorgaben sowie die Implementierung und konsequente Anwendung von Leitlinien hat die Therapie auf eine evidenzbasierte Grundlage gestellt. Der Paradigmenwandel in der Systemtherapie des Mammakarzinoms ist gekennzeichnet von den molekularbiologischen Erkenntnissen und der Entwicklung entsprechend zielgerichtet einzusetzender neuer Substanzen. Voraussetzung für den optimalen Einsatz dieser Substanzen ist jedoch die qualitätsgesicherte, pathohistologische Bestimmung des entsprechenden Targets sowie die Identifikation neuer prognostischer und prädiktiver Marker. Dieser Entwicklung müssen auch die Studienkonzepte Rechnung tragen, da die empirische Herangehensweise den modernen Ansprüchen in der Onkologie nicht länger gerecht wird.

Abstract

The reduction of breast cancer mortality, which is also observable in Germany, is mainly attributed to the improvement in adjuvant therapy, since a nationwide breast cancer screening program has not been implemented for this period (1990–2004). However, further improvement will be expected after the introduction of a screening program. Notably, the implementation of breast units associated with predefined structural and qualitative demands, as well as the assembly and use of guidelines has changed treatment on an evidence based approach. The paradigm shift in adjuvant therapy is hallmarked by molecular findings and the development of appropriate targeting drugs. An essential prerequisite for the optimal use of those drugs, however, is a quality managed assessment of the respective target, as well as the identification of new predictive and prognostic markers. New study concepts have to account for this progress, since empirical strategies do not longer meet the modern requirements of oncology.

Schlüsselwörter

Mammakarzinom - adjuvante Therapie - Prävention - Früherkennung

Key words

breast cancer - adjuvant therapy - prevention - early detection

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