Is primary surgery of breast cancer patients consistent with German guidelines? Twelve-year trend of population-based clinical cancer registry data.

ABSTRACT

This population-based analysis aimed to describe the 12-year trend of primary surgery following the introduction of national guidelines for the management of breast cancer in Germany, thus the implementation of breast-conserving surgery (BCS) for pT1/2-tumours and the implementation of sentinel lymph node biopsy (SLNB). Cancer registry data from 72 742 breast cancer patients diagnosed between 1999 and 2010 in four different regions in Germany were used. Descriptive statistics and multivariate logistic regression analysis were conducted. Between 1999 and 2010, rates of BCS for pT1/2-tumours rose from 60.5% to 79.9%, rates of SLNB increased rapidly from 0.4% to 79.0%. Both surgical therapies were already adherent to the respective guidelines, although some regional differences could be observed in 1999-2003, the chance of BCS was 2.6-fold higher [odds ratio (OR) 2.6] in the western regions than in the eastern regions, but this difference decreased over time (2004-2007 OR 1.6; 2008-2010 OR 1.2). A similar pattern was observable for SLNB in 1999-2003, the chance of receiving SLNB was 4.4-fold higher in the western regions, but these rates converged (2004-2007 OR 3.7; 2008-2010 OR 1.5). The further increase of BCS- and SLNB rates after publication of guidelines and the reduction of regional differences may also be attributable to guideline implementation.