Abstract:
BACKGROUND:Breast cancer is the most common cancer in women. The German S3 guideline of 2012 has now been updated to take account of advances in the early detection, diagnostic evaluation, treatment, and follow-up care of this disease. METHODS:The updating process was based on the adaptation of identified source guidelines and on reviews of the scientific evidence. A systematic search in multiple literature databases was carried out, and the full texts of the selected articles were evaluated. Suggested recommendations were then proposed by interdisciplinary working groups and modified and graded in a nominal consensus procedure. RESULTS:The value of mammographic screening is confirmed in the updated guideline. As for the diagnostic evaluation of breast cancer, computed tomography is recommended for staging in patients with a high risk of recurrence, in addition to conventional methods. As for surgical treatment, the evidence supporting locoregional surgery for primary breast cancer now affords an opportunity for de-escalation: complete resection yields the best outcome, but a safety margin of several millimeters is not necessary. Axillary dissection is no longer recommended except in certain defined situations. Radiotherapeutic approaches consist of hypofractionated applications. Adjuvant systemic therapy is indicated for patients in certain high-risk situations defined by a constellation of factors including tumor grade, patient age, node status, Ki-67 antigen expression, hormone receptor status, and human epidermal growth factor receptor 2 (HER2) status. All patients with hormone receptor-positive breast cancer should receive endocrine therapy. The indication for chemotherapy and/or anti-HER2 therapy should be determined in consideration of the expected benefit and side effects. CONCLUSION:Consistent implementation of the recommendations in the newly updated guideline can help lessen morbidity and mortality from breast cancer. The actual extent to which breast cancer guidelines are implemented should be a topic of future research.
journal_name
Dtsch Arztebl Intjournal_title
Deutsches Arzteblatt internationalauthors
Wöckel A,Albert US,Janni W,Scharl A,Kreienberg R,Stüber Tdoi
10.3238/arztebl.2018.0316subject
Has Abstractpub_date
2018-05-04 00:00:00pages
316-323issue
18issn
1866-0452pii
arztebl.2018.0316journal_volume
115pub_type
杂志文章abstract:BACKGROUND:Recent years have seen a marked increase in laser-pointerrelated injuries, which sometimes involve severe retinal damage and irreversible visual impairment. These injuries are often caused by untested or incorrectly classified devices that are freely available over the Internet. METHODS:We reviewed pertinen...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章
doi:10.3238/arztebl.2017.0831
更新日期:2017-12-08 00:00:00
abstract:BACKGROUND:Multi-center observational studies in surgery can yield important findings, as long as they are appropriately designed and monitored and employ modern methods of statistical analysis. METHODS:In a multi-center quality assurance study carried out in 346 German hospitals from 2000 to 2004, data were collected...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章
doi:10.3238/arztebl.2011.0041
更新日期:2011-01-01 00:00:00
abstract:BACKGROUND:Habitually shortened nighttime sleep is a common phenomenon in childhood and adolescence, sometimes associated with chronic sleep reduction (CSR). CSR is associated with impairments of performance ability and emotional well-being. The extent to which children and adolescents in Germany suffer from CSR is unc...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章
doi:10.3238/arztebl.2020.0661
更新日期:2020-10-02 00:00:00
abstract:INTRODUCTION:The range of indications for vitreoretinal surgery has widened in recent years, and intraocular gas application is frequently performed as part of retinal surgery, with the aim of achieving long-acting tamponade. METHODS:Selective literature review. RESULTS:An intraocular gas bubble containing perfluorop...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章
doi:10.3238/arztebl.2008.0108
更新日期:2008-02-01 00:00:00
abstract:BACKGROUND:The histomorphological changes of lung damage in severe coronavirus disease 2019 (COVID-19) have not yet been adequately characterized. In this article, we describe the sequence of pathological changes in COVID-19 and discuss the implications for approaches to treatment. METHODS:Standardized autopsies were ...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章
doi:10.3238/arztebl.2020.0500
更新日期:2020-07-20 00:00:00
abstract:BACKGROUND:Stroke is the third most common cause of death in industrialized countries, accounting for more than 10% of deaths over age 65. Most strokes are due to arteriosclerosis. Regular physical activity lowers arterial blood pressure and body weight and improves glucose and lipid metabolism, thereby slowing the dev...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章,meta分析,评审
doi:10.3238/arztbl.2009.0715
更新日期:2009-10-01 00:00:00
abstract:BACKGROUND:Abdominal and thoracic aortic aneurysms are diagnosed in 40 and 10 to 15 out of 100 000 persons per year, respectively. Fenestrated (fEVAR) and branched (bEVAR) stent grafts have been developed for abdominal juxtarenal and thoracoabdominal aneurysms. We discuss the patency and complication rates of fEVAR and...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章,meta分析,评审
doi:10.3238/arztebl.2015.0816
更新日期:2015-11-27 00:00:00
abstract:BACKGROUND:Isolated non-compaction cardiomyopathy (NCCM) was first described in 1984. This disorder, a primary genetic cardiomyopathy, is now attracting increased attention. METHOD:The current state of the epidemiology, pathogenesis, pathophysiology, clinical features, diagnosis, treatment, and prognosis of NCCM are d...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章,评审
doi:10.3238/arztebl.2010.0206
更新日期:2010-03-01 00:00:00
abstract:BACKGROUND:The effects of rectal surgery on patients' postoperative quality of life (QOL) and sexual function has been little studied to date. The present study aims to address this issue. METHODS:519 patients who had undergone surgery for rectal cancer from January 1997 to January 2003 were included in the study. The...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章
doi:10.3238/arztebl.2010.0123
更新日期:2010-02-01 00:00:00
abstract:BACKGROUND:Because of the changing dietary habits of an aging population, hyperuricemia is frequently found in combination with other metabolic disorders. Longstanding elevation of the serum uric acid level can lead to the deposition of monosodium urate crystals, causing gout (arthritis, urate nephropathy, tophi). In G...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章,评审
doi:10.3238/arztebl.2009.0549
更新日期:2009-08-01 00:00:00
abstract:BACKGROUND:Surgical site infections (SSI) are among the most common healthcare- associated infections. The aim of our explorative study was to determine how selected climatic factors are associated with SSI rates. METHODS:SSI rates were calculated for operative procedures included in the surgi- cal site infection surv...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章
doi:10.3238/arztebl.2019.0529
更新日期:2019-08-05 00:00:00
abstract:BACKGROUND:Early gastro-esophageal cancer is staged as m1 to m3 depending on the infiltration of the anatomical layers of the mucosa or, analogously, as sm1 to sm3 depending on the depth of infiltration into the submucosa. The risk of lymph node metastases is low in mucosal carcinoma but increases with the depth of inf...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章,评审
doi:10.3238/arztebl.2018.0513
更新日期:2018-08-06 00:00:00
abstract:BACKGROUND:Recent years have seen major changes in the diagnosis and treatment of solid intraocular tumors, mainly owing to an improved molecular biological understanding of their pathogenesis, new therapeutic approaches for the local treatment of tumors in children, and long-term follow-up observations in clinical tri...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章,评审
doi:10.3238/arztebl.2018.0106
更新日期:2018-02-16 00:00:00
abstract:BACKGROUND:Because the course of Legg-Calvé-Perthes disease (LCPD) is highly variable, its appropriate diagnostic evaluation and treatment are still debated. METHODS:The authors selectively review the literature, present their own study findings, and discuss the guidelines of the German Society for Orthopedics and Ort...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章,评审
doi:10.3238/arztebl.2009.0517
更新日期:2009-07-01 00:00:00
abstract:BACKGROUND:Avulsed frontal teeth often cannot be saved because of improper or lack of initial treatment. The result is a need for multiple interventions over the patient's lifetime, which also carry a high financial cost. METHODS:We explored the subject of lost anterior teeth in young patients with a PubMed search bas...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章,评审
doi:10.3238/arztebl.2011.0565
更新日期:2010-08-01 00:00:00
abstract:BACKGROUND:Familial hypercholesterolemia (FH) is a congenital disorder of lipid metabolism characterized by a marked elevation of the plasma concentration of LDL (low-density lipoprotein) cholesterol beginning in childhood and by the early onset of coronary heart disease. It is among the commonest genetic disorders, wi...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章,评审
doi:10.3238/arztebl.2014.0523
更新日期:2014-08-04 00:00:00
abstract:BACKGROUND:The randomized, controlled trial (RCT) is the gold standard of scientific evidence for the attribution of clinical effects (benefits and harms) to medical interventions. Many different designs for RCTs have been developed in order to counter legitimate critical objections and to better adapt the trials to th...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章,评审
doi:10.3238/arztebl.2017.0635
更新日期:2017-09-22 00:00:00
abstract:BACKGROUND:The treatment options for bcr-abl positive chronic myelogenous leukemia (CML) include chemotherapy, immune therapy, allogeneic stem cell transplantation, and molecular therapy. The tyrosine kinase inhibitor imatinib was approved for the treatment of CML in 2002. Data from clinical trials allow a comparison o...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章,meta分析,评审
doi:10.3238/arztebl.2010.0114
更新日期:2010-02-01 00:00:00
abstract:BACKGROUND:Lung transplantation is the final treatment option in the end stage of certain lung diseases, once all possible conservative treatments have been exhausted. Depending on the indication for which lung transplantation is performed, it can improve the patient's quality of life (e.g., in emphysema) and/ or prolo...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章,meta分析,评审
doi:10.3238/arztebl.2014.0107
更新日期:2014-02-14 00:00:00
abstract:INTRODUCTION:Many psychotropic drugs can delay cardiac repolarization and thereby prolong the rate-corrected QT interval (QTc). A prolonged QTc often arouses concern in clinical practice, as it can be followed, in rare cases, by the life-threatening polymorphic ventricular tachyarrhythmia called torsade de pointes (TdP...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章,评审
doi:10.3238/arztebl.2011.0687
更新日期:2011-10-01 00:00:00
abstract:BACKGROUND:Numerous studies from around the world have shown a positive association between case numbers and the quality of medical care. The evidence to date suggests that conformity to guidelines for the treatment of patients with breast cancer is better in German hospitals that have higher case numbers. METHODS:We ...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章,多中心研究
doi:10.3238/arztebl.2015.0585
更新日期:2015-08-31 00:00:00
abstract:BACKGROUND:Prostatic cancer (PCa) is the most common cancer in men in Germany. The goal of this review is to define the indication for hormonal treatment in patients over age 70. METHODS:A selective search of the literature up to 2008 for the terms "prostate cancer", "androgen suppression and deprivation", "hormone th...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章,meta分析,评审
doi:10.3238/arztebl.2009.0242
更新日期:2009-04-01 00:00:00
abstract:BACKGROUND:Delirium is a common complication in elderly hospitalized patients. It prolongs the length of hospital stay, raises costs, increases the workload of the nursing staff, and may necessitate transfer of the patient to a nursing home. The risk of postoperative delirium is particularly high in elderly patients wi...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章
doi:10.3238/arztebl.2015.0289
更新日期:2015-04-24 00:00:00
abstract:BACKGROUND:The neuropsychiatric symptoms of dementia, including aggressiveness, agitation, depression, and apathy are often treated with psychotropic drugs and are a frequent reason for hospitalization, placing an economic burden on the health care system. International guidelines recommend syndrome-specific pharmacoth...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章,多中心研究
doi:10.3238/arztebl.2010.0320
更新日期:2010-05-01 00:00:00
abstract:BACKGROUND:Hoarseness (dysphonia) is the reason for about 1% of all consultations in primary care. It has many causes, ranging from self-limited laryngitis to malignant tumors of the vocal cords. METHODS:This review is based on literature retrieved by a selective search in PubMed employing the terms "hoarseness," "hoa...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章,评审
doi:10.3238/arztebl.2015.0329
更新日期:2015-05-08 00:00:00
abstract:BACKGROUND:Even in industrialized countries, health care is not as safe as it should be. The term "patient safety" denotes the non-occurrence of adverse events and the presence of measures to prevent them. METHODS:The literature was selectively reviewed to obtain information on the epidemiology and causes of preventab...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章,评审
doi:10.3238/arztebl.2010.0092
更新日期:2010-02-01 00:00:00
abstract:BACKGROUND:In Germany, public interest in a vegan diet is steadily growing. There are, however, no current data on the macro- and micronutrient status of vegans. METHODS:In a cross-sectional study entitled "The Risks and Benefits of a Vegan Diet" (RBVD), we investigated the dietary intake, basic laboratory parameters,...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章
doi:10.3238/arztebl.2020.0575
更新日期:2020-08-31 00:00:00
abstract:INTRODUCTION:Intermittent paradoxical closure of the vocal cords can induce major attacks of dyspnea. Such attacks, called "vocal cord dysfunction" (VCD), are an important element in the differential diagnosis of intractable bronchial asthma. METHODS:Selective review of the literature. RESULTS:The etiology of VCD is ...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章
doi:10.3238/arztebl.2008.0699
更新日期:2008-10-01 00:00:00
abstract:BACKGROUND:Many patients in German hospitals complain of inadequate treatment of their postoperative pain. Hospital-related structural and procedural variables may affect pain perception and patient satisfaction. We studied the association of individual variables with outcome quality. METHODS:Data from the years 2011 ...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章
doi:10.3238/arztebl.2017.0161
更新日期:2017-03-10 00:00:00
abstract:BACKGROUND:Recent years have seen a further decline in the nationwide case fatality rate after major trauma in Germany, but it has not been clear until now whether all centers providing trauma care achieve comparable results. We have attempted to answer this question using data from the trauma registry of the German So...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章,多中心研究
doi:10.3238/arztebl.2010.0463
更新日期:2010-07-01 00:00:00