Interdisziplinäre S3-Leitlinie für die Diagnostik, Therapie und Nachsorge des Mammakarzinoms

1 Informationen zu dieser Kurzversion

1.1 Herausgeber

Leitlinienprogramm Onkologie der AWMF, Deutschen Krebsgesellschaft e. V. und Deutschen Krebshilfe e. V.

Office: c/o Deutsche Krebsgesellschaft e. V.

Kuno-Fischer-Straße 8

14 057 Berlin

[e-mail]

www.leitlinienprogramm-onkologie.de

1.2 Finanzierung der Leitlinie

Diese Leitlinie wurde von der Deutschen Krebshilfe im Rahmen des Onkologischen Leitlinienprogramms gefördert.

1.3 Federführende Fachgesellschaften

Deutsche Krebsgesellschaft e. V. (DKG)

Deutsche Gesellschaft für Gynäkologie und Geburtshilfe (DGGG)

1.4 Kontakt

Leitlinienkoordination:

Prof. Dr. Rolf Kreienberg

Universitätsfrauenklinik

Prittwitzstr. 43

89 075 Ulm

Tel.: [phone]

Fax: [phone]

E-Mail: [e-mail]

1.5 Weitere Dokumente zu dieser Leitlinie

Bei diesem Dokument handelt es sich um die Kurzversion der S3-Leitlinie zur Diagnostik, Therapie und Nachsorge des Mammakarzinoms, welche über folgende Seiten zugänglich ist:

• http://www.leitlinienprogramm-onkologie.de/OL/leitlinien.html

• http://www.awmf.org/leitlinien/aktuelle-leitlinien.html)

• http://www.krebsgesellschaft.de/wub_
  llevidenzbasiert,120 884.html

• http://www.krebshilfe.de

• http://www.dggg.de

• http://www.senologie.org

Neben der Kurzversion gibt es folgende ergänzende Dokumente:

• Langfassung

• Leitlinienreport

• Patientenleitlinie Früherkennung von Brustkrebs

• Patientenleitlinie Brustkrebs 1: Die Ersterkrankung und DCIS – Eine Leitlinie für Patientinnen

• Patientenleitlinie Brustkrebs 2: Die fortgeschrittene Erkrankung, Rezidiv und Metastasierung

• Gartlehner G. et al. Vergleichende Wirksamkeit und Sicherheit von alleiniger Sentinel-Lymphknoten-Biopsie oder kompletter Axilladissektion bei Sentinel-positivem Mammakarzinom: Systematische Übersichtsarbeit. 2011

• Ärztliches Zentrum für Qualität in der Medizin (ÄZQ). Synopse evidenzbasierter Leitlinien-Empfehlungen zur Diagnostik, Therapie und Nachsorge des Mammakarzinoms. Berlin: 2011

Eine Leitlinien-App „onkologische Leitlinien“ ist unter http://itunes.apple.com/de/app/leitlinien-onkologie/id453 786 520?mt = 8 bzw. https://play.google.com/store/apps/details?id = de.dkg.app&
feature = apps_topselling_free#?t = W251bGws
MSwyLG51bGwsImRlLmRrZy5hcHAiXQ abrufbar. Die Inhalte dieser Leitlinie werden voraussichtlich in diesem Jahr eingestellt werden.

1.6 Verantwortlichkeiten

1.6.1 Autoren der Leitlinie

Steuergruppe

Name	Stadt
Prof. Dr. Rolf Kreienberg	Ulm
Prof. Dr. Ute-Susann Albert	Marburg
Dr. Markus Follmann, MPH MSc	Berlin
Prof. Dr. Ina Kopp	Marburg
Prof. Dr. Thorsten Kuhn	Esslingen
PD Dr. Achim Wockel	Ulm
Dipl. math. oec. Thomas Zemmler	Ulm

Vertreter der Fachgesellschaften

Fachgesellschaft	Name	Stadt
Arbeitsgemeinschaft Deutscher Tumorzentren (ADT)	Prof. Dr. Dieter Hölzel	München
Arbeitsgemeinschaft für Psychoonkologie (PSO)	Prof. Dr. Joachim Weis	Freiburg
Arbeitsgemeinschaft für Ultraschalldiagnostik in Gynäkologie und Geburtshilfe (ARGUS)	Prof. Dr. Helmut Madjar	Wiesbaden
Arbeitsgemeinschaft Gynäkologische Onkologie (AGO)	Prof. Dr. Jens Blohmer Prof. Dr. Anton Scharl	Berlin Amberg
Arbeitsgemeinschaft Internistische Onkologie (AIO)	Dr. Norbert Marschner	Freiburg
Arbeitsgemeinschaft Radiologische Onkologie (ARO)	Prof. Dr. Jürgen Dunst Prof. Dr. Rainer Souchon	Lübeck Tübingen
Arbeitsgemeinschaft Supportive Masnahmen in der Onkologie, Rehabilitation und Sozialmedizin (ASORS)	Prof. Dr. Hans Helge Bartsch Prof. Dr. Günter Emons Prof. Dr. Hartmut Link	Freiburg Göttingen Kaiserslautern
Arbeitsgemeinschaft Prävention und integrative Medizin in der Onkologie (PRiO)	Dr. Jutta Hübner	Frankfurt
Berufsverband der Frauenärzte e. V.	Dr. Klaus König	Steinbach
BQS Institut für Qualität und Patientensicherheit	Dr. Sven Bungard	Düsseldorf
Bundesverband Deutscher Pathologen e. V.	Prof. Dr. Werner Schlake	Gelsenkirchen
Chirurgische Arbeitsgemeinschaft für Onkologie (CAO‑V)	Prof. Dr. Martin Angele	München
Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin (DEGAM)	Prof. Dr. Erika Baum Dr. Brigitte Ernst	Marburg Regensburg
Deutsche Gesellschaft für Gynäkologie und Geburtshilfe (DGGG)	Prof. Dr. Bernd Gerber Prof. Dr. Nadia Harbeck	Rostock München
Deutsche Gesellschaft für Hämatologie und Onkologie (DGHO)	Prof. Dr. Kurt Possinger	Berlin
Deutsche Gesellschaft für Palliativmedizin (DGP)	Dr. Jan Gärtner Dr. Christina Gerlach	Köln Mainz
Deutsche Gesellschaft für Pathologie (DGP)	Prof. Dr. Manfred Dietel Prof. Dr. Hans Kreipe PD. Dr. Annette Lebeau	Berlin Hannover Lübeck, Hamburg
Deutsche Gesellschaft für Radioonkologie (DEGRO)	Prof. Dr. Wilfried Budach	Düsseldorf
Deutsche Gesellschaft für Rehabilitationswissenschaften (DGRW) e. V.	Prof. Dr. Hans Helge Bartsch Dr. Kerstin Knauth	Freiburg Ratzeburg
Deutsche Gesellschaft für Senologie (DGS)	Prof. Dr. Wolfgang Janni Prof. Dr. Christoph Thomssen	Ulm Halle
Deutsche Gesellschaft für Ultraschall in der Medizin e. V. (DEGUM)	Prof. Dr. Friedrich Degenhardt	Bielefeld
Deutsche Röntgengesellschaft (DRG)	Prof. Dr. Ulrich Bick	Berlin
Deutscher Verband für Physiotherapie, Zentralverband der Physiotherapeuten/Krankengymnasten (ZVK)	Ulla Henscher Hannelore Ruppert	Hannover Köln
Konsortium für familiären Brust- und Eierstockkrebs	Prof. Dr. Rita Schmutzler	Köln
Frauenselbsthilfe nach Krebs	Hilde Schulte	Neukirchen
Gesellschaft der Plastischen, Rekonstruktiven und Ästhetischen Chirurgie (DGPRÄC)	Prof. Dr. Christoph Heitmann Dr. Mario Marx	München Radebeul
Konferenz Onkologischer Kranken- und Kinderkrankenpflege (KOK)	Kerstin Paradies	Hamburg
Tumorregister München (TRM)	Prof. Dr. Jutta Engel	München
Women’s Health Coalition e. V. (WHC)	Irmgard Naß-Griegoleit	Darmstadt

Experten

Name	Stadt
Prof. Dr. Matthias W. Beckmann	Erlangen
Prof. Dr. Andreas Buck	Würzburg
Prof. Dr. Jutta Engel	München
Anita Feller	Göttingen
Prof. Dr. Max Geraedts	Witten
Andrea Hahne	Bad Münder
Prof. Dr. Sylvia Heywang-Köbrunner	München
Prof. Dr. Christian Jackisch	Offenbach
Dr. Monika Klinkhammer-Schalke	Berlin
Prof. Dr. Nicolai Maass	Aachen
Prof. Dr. rer. Nat. Alfons Meindl	München
Prof. Dr. Volker Möbus	Frankfurt
Karen Pottkämper	Göttingen
Kerstin Rhiem, PD Dr.	Köln
Prof. Dr. Andreas Schneeweiss	Heidelberg
Prof. Dr. Ingrid Schreer	Kiel
Dr. Nicole Skoetz	Köln
Prof. Dr. Michael Untch	Berlin
Prof. Dr. Gunter von Minckwitz	Neu-Isenburg
Prof. Dr. Uwe Wagner	Marburg

1.6.2 Gruppenleiter, Arbeitsgruppen und Reviewer

Kapitel/Themenkomplex		Sprecher, (Reviewer), Arbeitsgruppe
Kapitel 3 Allgemeines
3.1	Patientinneninformation und ‑aufklärung	Albert, (Wöckel) , Ernst, König, Kreienberg, Naß-Griegoleit, Schulte, Weis
3.2	Früherkennung, Mammografie-Screening	Schreer, (Albert) , Baum, Bick, Degenhardt, Engel, Heywang-Köbrunner, Hölzel, König, Madjar, Schmutzler
3.3	Frauen mit erhöhtem Risiko für Brustkrebs	Schmutzler, (Bick) , Albert, Hahne, Lebeau, Madjar, Meindl, Rhiem, Schreer
Kapitel 4 Lokoregional begrenzte Primärerkrankung
4.1	Generelle diagnostische und therapeutische Konzepte	Steuergruppe
4.2	Prätherapeutische Ausbreitungsdiagnostik bei Patientinnen mit auffälligen bzw. suspekten Befunden der Mamma	Kühn, (Albert) , Bick, Degenhardt, Kreienberg, Kreipe, Lebeau, Madjar, Schreer
4.3	Präinvasive Neoplasien	Kreipe/Beckmann, (Lebeau/Dietel) , Albert, Harbeck, Kühn, Marx, Schlake, Schreer, Souchon
4.4	Operative Therapie des invasiven Karzinoms	Blohmer, (Kühn) , Angele, Budach, Dietel, Engel, Kreienberg, Lebeau, Marx, Scharl, Souchon, Wagner
4.5	Pathomorphologische Untersuchung	Lebeau, (Kreipe/Dietel) , Harbeck, Janni, Schlake, Thomssen
4.6	Adjuvante Strahlentherapie des Mammakarzinoms	Souchon/Dunst, (Thomssen) , Blohmer, Budach, Hölzel, Kühn, Untch
4.7	Systemische adjuvante Therapie (endokrine, Chemo-, Antikörpertherapie)
4.7.1	Auswahl der adjuvanten Therapie und Risikoeinstufung	Kreienberg, Gerber, Harbeck, Possinger, Thomssen
4.7.2	Endokrine Therapie	Possinger, (Maass) , Emons, Scharl
4.7.3	Chemotherapie	Harbeck, (Möbus) , Janni, Possinger
4.7.4	Neoadjuvante (primär systemische) Therapie (NACT oder PST)	Gerber, (v. Minckwitz) , Marschner, Untch
4.7.5	Antikörpertherapie	Thomssen, (Schneeweiss) , Jackisch
4.7.6	Bisphosphonate	Possinger, (Maass) , Emons, Scharl
4.8	Management von primär lokal/lokoregional fortgeschrittenen Tumoren	Steuergruppe
Kapitel 5 Das rezidivierte oder metastasierte Mammakarzinom
5.1	Definition und Prognose	Steuergruppe
5.2	Diagnostik des lokalen/lokoregionalen Rezidivs	Bick, (Scharl) , Blohmer, Buck, Degenhardt, Madjar
5.3	Therapie des lokalen/lokoregionalen Rezidivs	Dunst, (Kühn) , Angele, Blohmer, Dietel, Heitmann, Marx, Gerber
5.4	Fernmetastasen	Marschner, (Emons) , Angele, Dunst, Harbeck, Possinger, Thomssen
Kapitel 6 Behandlung, Betreuung, Begleitung
6.1	Generelles Konzept	Steuergruppe
6.2	Psychosoziale Aspekte und Psychoonkologie	Weis/Beckmann, (Scharl) , Albert, Bartsch, Ernst, Faller, König, Naß-Griegoleit, Schulte
6.3	Supportivtherapie	Link, (Follmann) , Baum, Emons, Henscher, Ruppert, Skoetz
6.4	Rehabilitation	Bartsch, (Schulte) , Baum, Henscher, Knauth, Ruppert
6.5	Nachsorge mit Rezidiv- und Metastasendiagnostik und Therapiebegleitung	Janni, (Beckmann) , Hölzel, König, Naß-Griegoleit, Paradies, Schulte, Souchon, Thomssen, Weis
6.6	Palliativmedizin	Gärtner, (Schulte) , Beckmann, Gerlach, Naß-Griegoleit
6.7	Komplementäre Medizin	Hübner, Naß-Grigoleit, Schulte, Albert, Wöckel
6.8	Dokumentation	Engel, Hölzel, Klinkhammer-Schalke, Pottkämper
Kapitel 7 Versorgungskoordination und Qualitätsmanagement		Wagner, (Kopp) , Albert, Beckmann, Bungard, Engel, Ernst, Follmann, Geraedts, Hölzel, Klinkhammer-Schalke, Lebeau, Souchon, Thomssen, Pottkaemper, Feller, Wesselmann, Wöckel

1.6.3 Methodische Begleitung

1. durch das Leitlinienprogramm Onkologie

   • Prof. Dr. Ina Kopp, Marburg (AWMF)

   • Dr. Markus Follmann, MPH MSc, Berlin (DKG)

2. durch externe Auftragnehmer:

   • Ärztliches Zentrum für Qualität in der Medizin (ÄZQ), Berlin

   • Donau-Universität Krems, Department für Evidenzbasierte Medizin und Klinische Epidemiologie

   • Deutsches Cochrane Zentrum, Cochrane Haematological Malignancies Group

3. durch die federführende Fachgesellschaft:

   • Deutsche Krebsgesellschaft e. V. (DKG)

   • Deutsche Gesellschaft für Gynäkologie und Geburtshilfe (DGGG)

1.7 Verwendete Abkürzungen

Abkürzung	Erläuterung
ACR	American College of Radiology
ADH	(intra-)duktale atypische Hyperplasie
AI	aromatase inhibitor
APBI	accelerated partial breast irradiation
ASCO	American Society of Clinical Oncology
BET	brusterhaltende Therapie
BI-RADS	breast imaging reporting and data system
CAD	Computerassistierte Detektion
CAP	College of American Pathologists
CISH	Chromogene-in-situ-Hybridisierung
DCIS	Duktales Carcinoma in situ
DFS	disease free survival
DGS	Deutsche Gesellschaft für Senologie
DKG	Deutsche Krebsgesellschaft
EBM	Evidenzbasierte Medizin
EORTC	European Organisation for Research an Treatment of Cancer
FISH	Fluoreszenz-in-situ-Hybridisierung
FN	febrile Neutropenie
HER2	Human Epidermal Growth Factor Receptor 2
ITC	isolierte Tumorzellen
IORT	Intraoperative Radiotherapie
KM‑MRT	Kontrastmittel Magnetresonanztomografie
LCIS	Lobuläres Carcinoma in situ
LIN	lobuläre Neoplasie
LOE	Level of Evidence
MRM	modifizierte radikale Mastektomie
MRT	Magnetresonanztomografie
NACT	neoadjuvante Chemotherapie
NCCN	National Comprehensive Cancer Network
NHSBSP	National Coordinating Group for Breast Screening Pathology
Abkürzung	Erläuterung
NICE	National Institute for Health and Clinical Excellene
NOS	not otherwise specified
NZGG	New Zealand Guidelines Group
OS	overall survival
PBI	partial breast irradiation (Teilbrustbestrahlung)
pCR	pathologische Komplettremission
PCR	Polymerase chain reaction
SLNB	Sentinel Lymph Node Biopsy
RT	Radiotherapie
UDH	intraduktale Hyperplasie
UICC	Union internationale contre le cancer
WHO	World Health Organization

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