DÄ internationalArchive1-2/2019Rationally Incomprehensible
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The recommendations published in this article (1) are not rationally comprehensible—with considerable consequences for the women affected:

  • The authors claim that “by screening women aged between 50 and 69 years (approximately 10 rounds), up to eight lives can be saved out of 1000 currently healthy participants,” and that “the rate of follow-up visits for repeat imaging of what ultimately proves to be a benign finding is around 2% in Europe.” However, the most recent meta-analysis (2) cited by the authors (1) describes a breast cancer–specific mortality reduction of 12.5 from 10 000 (!) women. The cumulative rates for false-positive mammography findings during ten years were between 42% and 61%, and the estimates of overdiagnosis, between 11% and 22%.
  • Postoperative radiotherapy of the regional lymph nodes significantly reduces the risk of relapse (especially for distant metastases), if axillary lymph node involvement was primarily diagnosed (3). But how is it supposed to be reliably diagnosed if this measure is taken after neoadjuvant chemotherapy? How should location and number of affected regional lymph nodes be differentiated if only a sentinel node biopsy was performed?

DOI: 10.3238/arztebl.2019.0009b

Prof. Dr. rer. nat. Dr. med. Dipl. math. Clemens F. Hess

Klinik für Strahlentherapie und Radioonkologie
der Universitätsmedizin Göttingen

cfhess@med.uni-goettingen.de

Conflict of interest statement

The author declares that no conflict of interest exists.

1.
Wöckel A, Albert US, Janni W, Scharl A, Kreienberg R, Stüber T: Clinical practice guideline: The screening, diagnosis, treatment, and follow-up of breast cancer. Dtsch Arztebl Int 2018; 115: 316–23 VOLLTEXT
2.
Nelson HD, Pappas M, Cantot A, Griffin J, Daeges M, Humphrey L: Harms of breast cancer screening: systematic review to update the 2009 U.S. preventive services task force recommendation. Ann Intern Med 2016; 164: 256–67 CrossRef MEDLINE
3.
Budach W, Kammers K, Boelke E, Matuschek C: Adjuvant radiotherapy of regional lymph nodes in breast cancer—a meta-analysis of randomized trials. Radiat Oncol 2013; 8: 267 CrossRef MEDLINE PubMed Central
1.Wöckel A, Albert US, Janni W, Scharl A, Kreienberg R, Stüber T: Clinical practice guideline: The screening, diagnosis, treatment, and follow-up of breast cancer. Dtsch Arztebl Int 2018; 115: 316–23 VOLLTEXT
2.Nelson HD, Pappas M, Cantot A, Griffin J, Daeges M, Humphrey L: Harms of breast cancer screening: systematic review to update the 2009 U.S. preventive services task force recommendation. Ann Intern Med 2016; 164: 256–67 CrossRef MEDLINE
3.Budach W, Kammers K, Boelke E, Matuschek C: Adjuvant radiotherapy of regional lymph nodes in breast cancer—a meta-analysis of randomized trials. Radiat Oncol 2013; 8: 267 CrossRef MEDLINE PubMed Central

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