Aktuelle Kontroversen in der Prävention und Therapie des Mammakarzinoms – Chancen und Gefahren

Neue Möglichkeiten zur Diagnostik, Prävention oder Therapie bieten immer Chancen und Risiken zugleich. So sind durch die Aufdeckung der Ursachen des erblichen Mamma- und Ovarialkarzinoms eine Genanalyse und eine darauf basierende Risikoprädiktion möglich geworden. Dies geht mit neuen Herausforderungen einher. Einerseits bietet sich die Möglichkeit der Einführung passgenauer und risikoadaptierter Präventionsprogramme. Zum anderen bergen sie die Gefahr einer antizipatorischen Medikalisierung und Inanspruchnahme nicht evidenzbasierter Screeningmaßnahmen, die drastischen prophylaktischen Operationen Vorschub leisten könnten.

Die Bisphosphonate sind seit langem ein wichtiger Bestandteil in der Therapie von ossären Metastasen beim Mammakarzinom. Mittlerweile konnte in verschiedenen Studien auch ein verbessertes klinisches Outcome durch die adjuvante Gabe von Bisphosphonaten demonstriert werden. Aufgrund der inkonsistenten Datenlage ist jedoch der routinemäßige Einsatz von Bisphosphonaten zur Metastasenprävention immer noch Gegenstand aktueller Diskussionen.

New options for the diagnosis, prevention and therapy are always accompanied by both chances and dangers. Thus the discovery of the causes of hereditary breast and ovarian cancer has made possible a gene analysis and an associated risk prediction. This is accompanied by new challenges. On the one hand it offers the opportunity to introduce tailor-made and risk-adapted prevention programs. On the other hand, is carries the risk of an anticipatory medicalization and utilization of non-evidence-based screening measures that, in turn, could pave the way drastic prophylactic interventions.

Bisphosphonates have for a long time been an important component of the therapy for bone metastases of breast cancer. In the meantime various trials have also demonstrated an improved clinical outcome after the adjuvant administration of bisphosphonates. However, due to the inconsistency of the available data, the routine use of bisphosphonates for the prevention of metastases is still a subject of hot discussion.

Key words

Breast cancer - risk communication - risk-adapted prevention - BRCA1/2 mutation analysis - bisphosphonate - bone metastases - adjuvant bisphosphonate therapy - metastasis prevention

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