Guideline-compatible treatment of breast cancer patients: the status quo in schleswig-holstein

Dtsch Arztebl Int. 2008 May;105(18):337-43. doi: 10.3238/arztebl.2008.0337. Epub 2008 May 2.


Introduction: It is unclear whether the care of breast cancer patients complies with the German breast cancer guideline and achieves the appropriate standard of care. For this reason the guideline's requirements were compared with the empirically determined health care provision in the German state of Schleswig-Holstein.

Methods: The OVIS-study is based on a postal questionnaire survey of medical care in 1927 breast cancer patients between 02/2003 to 02/2005. Statements such as "should be carried out" and "mandatory procedure" were cross-referenced with specific reference ranges.

Results: Locally invasive tumors were rare (pT 3/4: 8%). Preoperatively, 95% of patients received mammography, 78% breast ultrasound, 92% a chest x-ray, and 81% an abdominal ultrasound. 71% of all patients had breast conserving treatment, of whom 96% had irradiation of the remaining breast tissue. Axilla lymph node dissection was reported for 91%, axillary irradiation for 36%, and a systemic therapy for 95%.

Discussion: Local quality indicators comply in general with the German guideline. The high rate of axillary irradiation could be viewed as inadequate provision.

Keywords: breast cancer; diagnosis; guideline; quality assurance; treatment.