Zusammenfassung
In fast allen aktuellen Richtlinien der Deutschen Medizinischen Fachgesellschaften wie der S3-Leitlinie der Deutschen Krebsgesellschaft (DKG), den Leitlinien der Arbeitsgemeinschaft für Gynäkologische Onkologie (AGO), sowie der Deutschen Gesellschaft für Senologie und den Empfehlungen der Amerikanischen Krebsgesellschaft (ASCO) werden regelmäßige bildgebende und laborchemische Untersuchungen in der Nachsorge bei Patientinnen mit Mammakarzinom weiterhin ausdrücklich nicht empfohlen [1]
[2]
[3]
[4]
[5]. Eine Ausnahme bildet hier die aktuelle Leitlinie der Deutschen Gesellschaft für Hämatologie und Onkologie (DGHO, [6]). Diese Ablehnung der aufwändigeren Kontrollen steht allerdings im Widerspruch zu anerkannten Richtlinien zur Nachsorge anderer Krebserkrankungen [7], so dass die bisherigen Argumente für eine lediglich symptomorientierte Nachsorge hinterfragt werden müssen. Insgesamt scheint die symptomorientierte Nachsorge für Patientinnen mit kleinen, nodal negativen Primärtumoren und einer entsprechend hohen Heilungschance [8] ausreichend zu sein, während für Patientinnen mit hoher Rückfallgefahr systematische Nachsorge-Untersuchungen auch bei Symptomfreiheit nach Meinung der Autoren zu empfehlen sind.
Abstract
Nearly all national (AGO, DKG) and international guide lines (e. g. ASCO) for follow-up of breast cancer patients do not explicitly recommend regular laboratory and radiological/ultrasound screening procedures. According to these guide lines, follow-up should be focused on the breast, only patients with possibly tumour related symptoms should be screened for metastatic disease. The rejection of more time-consuming and costlier follow-up examinations remains a contradiction to established follow-up guide lines for other solid tumours. In addition, treatment options for metastatic breast cancer disease have improved continuously over the last years. However, treatment options are considerably limited in advanced disease, if e. g. symptoms like dyspnoea or jaundice are already present at first diagnosis of metastatic disease. Therefore we will review available data of older studies as well as discuss arguments for a systematic surveillance in high-risk breast cancer patients. Overall, symptom guided follow-up seems to be adequate for patients with small primary tumours, no lymph node involvement and therefore a high curative probability, whereas in the authors' opinion systematic surveillance should be recommended for high risk patients even in the absence of symptoms. All patients, however, should be fully informed about the possibility of metastatic disease development and should be enabled to select the quality of their postoperative follow-up.
Schlüsselwörter
Mammakarzinom - Nachsorge - asymptomatisch - Leitlinien
Key words
breast cancer - surveillance - asymptomatic - follow-up - guide lines
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A. Welt
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