@article{LoebLinsmeierHerbertetal.2023, author = {L{\"o}b, Sanja and Linsmeier, Eva and Herbert, Saskia-Laureen and Schlaiß, Tanja and Kiesel, Matthias and Wischhusen, J{\"o}rg and Salmen, Jessica and Kranke, Peter and Quenzer, Anne and Kurz, Florian and Weiss, Claire and Gerhard-Hartmann, Elena and W{\"o}ckel, Achim and Diessner, Joachim}, title = {Prognostic effect of HER2 evolution from primary breast cancer to breast cancer metastases}, series = {Journal of Cancer Research and Clinical Oncology}, volume = {149}, journal = {Journal of Cancer Research and Clinical Oncology}, number = {8}, doi = {10.1007/s00432-022-04486-0}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-324068}, pages = {5417-5428}, year = {2023}, abstract = {Purpose Therapeutic options for breast cancer (BC) treatment are constantly evolving. The Human Epidermal Growth Factor 2 (HER2)-low BC entity is a new subgroup, representing about 55\% of all BC patients. New antibody-drug conjugates demonstrated promising results for this BC subgroup. Currently, there is limited information about the conversion of HER2 subtypes between primary tumor and recurrent disease. Methods This retrospective study included women with BC at the University Medical Centre Wuerzburg from 1998 to 2021. Data were retrieved from patients' records. HER2 evolution from primary diagnosis to the first relapse and the development of secondary metastases was investigated. Results In the HR-positive subgroup without HER2 overexpression, HER2-low expression in primary BC was 56.7 vs. 14.6\% in the triple-negative subgroup (p < 0.000). In the cohort of the first relapse, HER2-low represented 64.1\% of HR-positive vs. 48.2\% of the triple-negative cohort (p = 0.03). In patients with secondary metastases, HER2-low was 75.6\% vs. 50\% in the triple negative subgroup (p = 0.10). The subgroup of HER2-positive breast cancer patients numerically increased in the course of disease; the HER2-negative overall cohort decreased. A loss of HER2 expression from primary BC to the first relapse correlated with a better OS (p = 0.018). No clinicopathological or therapeutic features could be identified as potential risk factors for HER2 conversion. Conclusion HER2 expression is rising during the progression of BC disease. In view of upcoming therapeutical options, the re-analysis of newly developed metastasis will become increasingly important.}, language = {en} } @article{HerbertHirzleBartmannetal.2023, author = {Herbert, Saskia-Laureen and Hirzle, Paula and Bartmann, Catharina and Schlaiß, Tanja and Kiesel, Matthias and Curtaz, Carolin and L{\"o}b, Sanja and W{\"o}ckel, Achim and Diessner, Joachim}, title = {Optimized process quality in certified breast centers through adherence to stringent diagnostic and therapeutic algorithms effects of structural as well as socio-demographic factors on start of therapy}, series = {Archives of Gynecology and Obstetrics}, volume = {307}, journal = {Archives of Gynecology and Obstetrics}, number = {4}, doi = {10.1007/s00404-022-06666-2}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-324057}, pages = {1097-1104}, year = {2023}, abstract = {Purpose An increasing incidence of breast cancer can be observed worldwide. Since a delay of therapy can have a negative impact on prognosis, timely cancer care is an important quality indicator. By receiving treatment at a certified breast cancer center, the patient has the best chance of treatment in accordance with guidelines and the best prognosis. The identification of risk factors for a delay of therapy is of central importance and should be the basis for a continuous optimization of treatment at breast cancer centers. Methods This retrospective study included women with breast cancer (primary diagnosis, relapse, or secondary malignancy) at the University Hospital W{\"u}rzburg in 2019 and 2020. Data were retrieved from patients' records. Correlations and regression analyses were performed to detect potential risk factors for treatment delay. Results Patients who received the histological confirmation of breast cancer at an external institution experienced a later therapy start than those patients who received the histological confirmation at the University Hospital W{\"u}rzburg itself. (35.7 vs. 32.2 days). The interval between histological confirmation and the first consultation at the University Hospital W{\"u}rzburg correlated statistically significant with age, distress and distance to the hospital. Conclusion Patients with an in-house diagnosis of breast cancer are treated more quickly than those whose diagnosis was confirmed in an external institution. We identified factors such as increased age, greater distance to the hospital as well as increased distress to prolong the time until start of oncological treatment. Intensified patient care should be offered to these subgroups.}, language = {en} } @article{CurtazReifschlaegerStraehleetal.2022, author = {Curtaz, Carolin J. and Reifschl{\"a}ger, Leonie and Str{\"a}hle, Linus and Feldheim, Jonas and Feldheim, Julia J. and Schmitt, Constanze and Kiesel, Matthias and Herbert, Saskia-Laureen and W{\"o}ckel, Achim and Meybohm, Patrick and Burek, Malgorzata}, title = {Analysis of microRNAs in exosomes of breast cancer patients in search of molecular prognostic factors in brain metastases}, series = {International Journal of Molecular Sciences}, volume = {23}, journal = {International Journal of Molecular Sciences}, number = {7}, issn = {1422-0067}, doi = {10.3390/ijms23073683}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-284476}, year = {2022}, abstract = {Brain metastases are the most severe tumorous spread during breast cancer disease. They are associated with a limited quality of life and a very poor overall survival. A subtype of extracellular vesicles, exosomes, are sequestered by all kinds of cells, including tumor cells, and play a role in cell-cell communication. Exosomes contain, among others, microRNAs (miRs). Exosomes can be taken up by other cells in the body, and their active molecules can affect the cellular process in target cells. Tumor-secreted exosomes can affect the integrity of the blood-brain barrier (BBB) and have an impact on brain metastases forming. Serum samples from healthy donors, breast cancer patients with primary tumors, or with brain, bone, or visceral metastases were used to isolate exosomes and exosomal miRs. Exosomes expressed exosomal markers CD63 and CD9, and their amount did not vary significantly between groups, as shown by Western blot and ELISA. The selected 48 miRs were detected using real-time PCR. Area under the receiver-operating characteristic curve (AUC) was used to evaluate the diagnostic accuracy. We identified two miRs with the potential to serve as prognostic markers for brain metastases. Hsa-miR-576-3p was significantly upregulated, and hsa-miR-130a-3p was significantly downregulated in exosomes from breast cancer patients with cerebral metastases with AUC: 0.705 and 0.699, respectively. Furthermore, correlation of miR levels with tumor markers revealed that hsa-miR-340-5p levels were significantly correlated with the percentage of Ki67-positive tumor cells, while hsa-miR-342-3p levels were inversely correlated with tumor staging. Analysis of the expression levels of miRs in serum exosomes from breast cancer patients has the potential to identify new, non-invasive, blood-borne prognostic molecular markers to predict the potential for brain metastasis in breast cancer. Additional functional analyzes and careful validation of the identified markers are required before their potential future diagnostic use.}, language = {en} } @article{CurtazKieselMeybohmetal.2022, author = {Curtaz, Carolin J. and Kiesel, Ludwig and Meybohm, Patrick and W{\"o}ckel, Achim and Burek, Malgorzata}, title = {Anti-hormonal therapy in breast cancer and its effect on the blood-brain barrier}, series = {Cancers}, volume = {14}, journal = {Cancers}, number = {20}, issn = {2072-6694}, doi = {10.3390/cancers14205132}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-290320}, year = {2022}, abstract = {Simple Summary Anti-hormonal therapie regimes are well established in oncological treatments in breast cancer. In contrast there is limited knowledge of their effects on metastatic brain metastases in advanced breast cancer and their ability to cross the blood brain-barrier. In this review, we point out the usual antihormonal therapy options in the primary disease, but also in metastatic breast cancer. In addition, we explain the epidemiological facts of brain metastases, as well as the basics of the blood-brain barrier and how this is overcome by metastase. Last but not least, we deal with the known anti-hormonal therapy options and present clinical studies on their intracerebral effect, as well as the known basics of their blood-brain barrier penetration. Not all common anti-hormonal therapeutics are able to penetrate the CNS. It is therefore important for the treating oncologists to use substances that have been proven to cross the BBB, despite the limited data available. Aromataseinhibitors, especially letrozole, probably also tamoxifen, everolimus and CDK4/6 inhibitors, especially abemaciclib, appear to act intracerebrally by overcoming the blood-brain barrier. Nevertheless, further data must be obtained in basic research, but also health care research in relation to patients with brain metastases. Abstract The molecular receptor status of breast cancer has implications for prognosis and long-term metastasis. Although metastatic luminal B-like, hormone-receptor-positive, HER2-negative, breast cancer causes brain metastases less frequently than other subtypes, though tumor metastases in the brain are increasingly being detected of this patient group. Despite the many years of tried and tested use of a wide variety of anti-hormonal therapeutic agents, there is insufficient data on their intracerebral effectiveness and their ability to cross the blood-brain barrier. In this review, we therefore summarize the current state of knowledge on anti-hormonal therapy and its intracerebral impact and effects on the blood-brain barrier in breast cancer.}, language = {en} } @article{MerzenichBaakenSchmidtetal.2022, author = {Merzenich, Hiltrud and Baaken, Dan and Schmidt, Marcus and Bekes, Inga and Schwentner, Lukas and Janni, Wolfgang and Woeckel, Achim and Bartkowiak, Detlef and Wiegel, Thomas and Blettner, Maria and Wollschl{\"a}ger, Daniel and Schmidberger, Heinz}, title = {Cardiac late effects after modern 3D-conformal radiotherapy in breast cancer patients: a retrospective cohort study in Germany (ESCaRa)}, series = {Breast Cancer Research and Treatment}, volume = {191}, journal = {Breast Cancer Research and Treatment}, number = {1}, issn = {0167-6806}, doi = {10.1007/s10549-021-06412-3}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-308606}, pages = {147-157}, year = {2022}, abstract = {Purpose Radiotherapy (RT) was identified as a risk factor for long-term cardiac effects in breast cancer patients treated until the 1990s. However, modern techniques reduce radiation exposure of the heart, but some exposure remains unavoidable. In a retrospective cohort study, we investigated cardiac mortality and morbidity of breast cancer survivors treated with recent RT in Germany. Methods A total of 11,982 breast cancer patients treated between 1998 and 2008 were included. A mortality follow-up was conducted until 06/2018. In order to assess cardiac morbidity occurring after breast cancer treatment, a questionnaire was sent out in 2014 and 2019. The effect of breast cancer laterality on cardiac mortality and morbidity was investigated as a proxy for radiation exposure. We used Cox Proportional Hazards regression analysis, taking potential confounders into account. Results After a median follow-up time of 11.1 years, there was no significant association of tumor laterality with cardiac mortality in irradiated patients (hazard ratio (HR) for left-sided versus right-sided tumor 1.09; 95\% confidence interval (CI) 0.85-1.41). Furthermore, tumor laterality was not identified as a significant risk factor for cardiac morbidity (HR = 1.05; 95\%CI 0.88-1.25). Conclusions Even though RT for left-sided breast cancer on average incurs higher radiation dose to the heart than RT for right-sided tumors, we found no evidence that laterality is a strong risk factor for cardiac disease after contemporary RT. However, larger sample sizes, longer follow-up, detailed information on individual risk factors and heart dose are needed to assess clinically manifest late effects of current cancer therapy.}, language = {en} } @article{BartmannFischerHuebneretal.2021, author = {Bartmann, Catharina and Fischer, Leah-Maria and H{\"u}bner, Theresa and M{\"u}ller-Reiter, Max and W{\"o}ckel, Achim and McNeill, Rhiannon V. and Schlaiss, Tanja and Kittel-Schneider, Sarah and K{\"a}mmerer, Ulrike and Diessner, Joachim}, title = {The effects of the COVID-19 pandemic on psychological stress in breast cancer patients}, series = {BMC Cancer}, volume = {21}, journal = {BMC Cancer}, doi = {10.1186/s12885-021-09012-y}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-265802}, year = {2021}, abstract = {Background: The majority of breast cancer patients are severely psychologically affected by breast cancer diagnosis and subsequent therapeutic procedures. The COVID-19 pandemic and associated restrictions on public life have additionally caused significant psychological distress for much of the population. It is therefore plausible that breast cancer patients might be particularly susceptible to the additional psychological stress caused by the pandemic, increasing suffering. In this study we therefore aimed to assess the level of psychological distress currently experienced by a defined group of breast cancer patients in our breast cancer centre, compared to distress levels preCOVID-19 pandemic. Methods: Female breast cancer patients of all ages receiving either adjuvant, neoadjuvant, or palliative therapies were recruited for the study. All patients were screened for current or previous COVID-19 infection. The participants completed a self-designed COVID-19 pandemic questionnaire, the Stress and Coping Inventory (SCI), the National Comprehensive Cancer Network (R) (NCCN (R)) Distress Thermometer (DT), the European Organization for Research and Treatment of Cancer (EORTC) QLQ C30, and the BR23. Results: Eighty-two breast cancer patients were included. Therapy status and social demographic factors did not have a significant effect on the distress caused by the COVID-19 pandemic. The results of the DT pre and during COVID-19 pandemic did not differ significantly. Using the self-designed COVID-19 pandemic questionnaire, we detected three distinct subgroups demonstrating different levels of concerns in relation to SARS-CoV-2. The subgroup with the highest levels of concern reported significantly decreased life quality, related parameters and symptoms. Conclusions: This monocentric study demonstrated that the COVID-19 pandemic significantly affected psychological health in a subpopulation of breast cancer patients. The application of a self-created "COVID-19 pandemic questionnaire"could potentially be used to help identify breast cancer patients who are susceptible to increased psychological distress due to the COVID-19 pandemic, and therefore may need additional intensive psychological support.}, language = {en} } @article{KaemmererKlementJoosetal.2021, author = {K{\"a}mmerer, Ulrike and Klement, Rainer J. and Joos, Fabian T. and S{\"u}tterlin, Marc and Reuss-Borst, Monika}, title = {Low carb and ketogenic diets increase quality of life, physical performance, body composition, and metabolic health of women with breast cancer}, series = {Nutrients}, volume = {13}, journal = {Nutrients}, number = {3}, issn = {2072-6643}, doi = {10.3390/nu13031029}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-234209}, year = {2021}, abstract = {Breast cancer (BC) patients often ask for a healthy diet. Here, we investigated a healthy standard diet (SD), a low carb diet (LCD), and a ketogenic diet (KD) for BC patients during the rehabilitation phase. KOLIBRI was an open-label non-randomized one-site nutritional intervention trial, combining inpatient and outpatient phases for 20 weeks. Female BC patients (n = 152; mean age 51.7 years) could select their diet. Data collected were: Quality of life (QoL), spiroergometry, body composition, and blood parameters. In total 30, 92, and 30 patients started the KD, LCD, and SD, respectively. Of those, 20, 76, and 25 completed the final examination. Patients rated all diets as feasible in daily life. All groups enhanced QoL, body composition, and physical performance. LCD participants showed the most impressive improvement in QoL aspects. KD participants finished with a very good physical performance and muscle/fat ratio. Despite increased cholesterol levels, KD patients had the best triglyceride/high-density lipoprotein (HDL) ratio and homeostatic model assessment of insulin resistance index (HOMA-IR). Most metabolic parameters significantly improved in the LCD group. SD participants ended with remarkably low cholesterol levels but did not improve triglyceride/HDL or HOMA-IR. In conclusion, both well-defined KDs and LCDs are safe and beneficial for BC patients and can be recommended during the rehabilitation phase.}, language = {en} } @article{HerbertWoeckelKreienbergetal.2021, author = {Herbert, S. L. and W{\"o}ckel, A. and Kreienberg, R. and K{\"u}hn, T. and Flock, F. and Felberbaum, R. and Janni, W. and Curtaz, C. and Kiesel, M. and St{\"u}ber, T. and Diessner, J. and Salmen, J. and Schwentner, L. and Fink, V. and Bekes, I. and Leinert, E. and Lato, K. and Polasik, A. and Schochter, F. and Singer, S.}, title = {To which extent do breast cancer survivors feel well informed about disease and treatment 5 years after diagnosis?}, series = {Breast Cancer Research and Treatment}, volume = {185}, journal = {Breast Cancer Research and Treatment}, organization = {BRENDA study group}, issn = {0167-6806}, doi = {10.1007/s10549-020-05974-y}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-232356}, pages = {677-684}, year = {2021}, abstract = {Objective In this study, we investigated to which extent patients feel well informed about their disease and treatment, which areas they wish more or less information and which variables are associated with a need for information about the disease, medical tests and treatment. Methods In a German multi-centre prospective study, we enrolled 759 female breast cancer patients at the time of cancer diagnosis (baseline). Data on information were captured at 5 years after diagnosis with the European Organisation for Research and Treatment of Cancer (EORTC) Information Module (EORTC QLQ-INFO24). Good information predictors were analysed using linear regression models. Results There were 456 patients who participated at the 5-year follow-up. They reported to feel well informed about medical tests (mean score 78.5) and the disease itself (69.3) but relatively poorly about other services (44.3) and about different places of care (31.3). The survivors expressed a need for more information concerning: side effects and long-term consequences of therapy, more information in general, information about aftercare, prognosis, complementary medicine, disease and therapy. Patients with higher incomes were better informed about medical tests (β 0.26, p 0.04) and worse informed with increasing levels of fear of treatment (β - 0.11, p 0.02). Information about treatment was reported to be worse by survivors > 70 years old (β -0.34, p 0.03) and by immigrants (β -0.11, p 0.02). Survivors who had received additional written information felt better informed about disease, medical tests, treatment and other services (β 0.19/0.19/0.20/0.25; each p < 0.01). Conclusion Health care providers have to reconsider how and what kind of information they provide. Providing written information, in addition to oral information, may improve meeting those information needs.}, language = {en} } @article{WischnewskySchwentnerDiessneretal.2021, author = {Wischnewsky, Manfred and Schwentner, Lukas and Diessner, Joachim and De Gregorio, Amelie and Joukhadar, Ralf and Davut, Dayan and Salmen, Jessica and Bekes, Inga and Kiesel, Matthias and M{\"u}ller-Reiter, Max and Blettner, Maria and Wolters, Regine and Janni, Wolfgang and Kreienberg, Rolf and W{\"o}ckel, Achim and Ebner, Florian}, title = {BRENDA-Score, a hghly significant, internally and externally validated prognostic marker for metastatic recurrence: analysis of 10,449 primary breast cancer patients}, series = {Cancers}, volume = {13}, journal = {Cancers}, number = {13}, issn = {2072-6694}, doi = {10.3390/cancers13133121}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-241064}, year = {2021}, abstract = {Background Current research in breast cancer focuses on individualization of local and systemic therapies with adequate escalation or de-escalation strategies. As a result, about two-thirds of breast cancer patients can be cured, but up to one-third eventually develop metastatic disease, which is considered incurable with currently available treatment options. This underscores the importance to develop a metastatic recurrence score to escalate or de-escalate treatment strategies. Patients and methods Data from 10,499 patients were available from 17 clinical cancer registries (BRENDA-project. In total, 8566 were used to develop the BRENDA-Index. This index was calculated from the regression coefficients of a Cox regression model for metastasis-free survival (MFS). Based on this index, patients were categorized into very high, high, intermediate, low, and very low risk groups forming the BRENDA-Score. Bootstrapping was used for internal validation and an independent dataset of 1883 patients for external validation. The predictive accuracy was checked by Harrell's c-index. In addition, the BRENDA-Score was analyzed as a marker for overall survival (OS) and compared to the Nottingham prognostic score (NPS). Results: Intrinsic subtypes, tumour size, grading, and nodal status were identified as statistically significant prognostic factors in the multivariate analysis. The five prognostic groups of the BRENDA-Score showed highly significant (p < 0.001) differences regarding MFS:low risk: hazard ratio (HR) = 2.4, 95\%CI (1.7-3.3); intermediate risk: HR = 5.0, 95\%CI.(3.6-6.9); high risk: HR = 10.3, 95\%CI (7.4-14.3) and very high risk: HR = 18.1, 95\%CI (13.2-24.9). The external validation showed congruent results. A multivariate Cox regression model for OS with BRENDA-Score and NPS as covariates showed that of these two scores only the BRENDA-Score is significant (BRENDA-Score p < 0.001; NPS p = 0.447). Therefore, the BRENDA-Score is also a good prognostic marker for OS. Conclusion: The BRENDA-Score is an internally and externally validated robust predictive tool for metastatic recurrence in breast cancer patients. It is based on routine parameters easily accessible in daily clinical care. In addition, the BRENDA-Score is a good prognostic marker for overall survival. Highlights: The BRENDA-Score is a highly significant predictive tool for metastatic recurrence of breast cancer patients. The BRENDA-Score is stable for at least the first five years after primary diagnosis, i.e., the sensitivities and specificities of this predicting system is rather similar to the NPI with AUCs between 0.76 and 0.81 the BRENDA-Score is a good prognostic marker for overall survival.}, language = {en} } @article{StanglRauchRauhetal.2021, author = {Stangl, Stephanie and Rauch, Sebastian and Rauh, J{\"u}rgen and Meyer, Martin and M{\"u}ller-Nordhorn, Jacqueline and Wildner, Manfred and W{\"o}ckel, Achim and Heuschmann, Peter U.}, title = {Disparities in Accessibility to Evidence-Based Breast Cancer Care Facilities by Rural and Urban Areas in Bavaria, Germany}, series = {Cancer}, volume = {127}, journal = {Cancer}, number = {13}, doi = {10.1002/cncr.33493}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-239854}, pages = {2319 -- 2332}, year = {2021}, abstract = {Background Breast cancer (BC), which is most common in elderly women, requires a multidisciplinary and continuous approach to care. With demographic changes, the number of patients with chronic diseases such as BC will increase. This trend will especially hit rural areas, where the majority of the elderly live, in terms of comprehensive health care. Methods Accessibility to several cancer facilities in Bavaria, Germany, was analyzed with a geographic information system. Facilities were identified from the national BC guideline and from 31 participants in a proof-of-concept study from the Breast Cancer Care for Patients With Metastatic Disease registry. The timeframe for accessibility was defined as 30 or 60 minutes for all population points. The collection of address information was performed with different sources (eg, a physician registry). Routine data from the German Census 2011 and the population-based Cancer Registry of Bavaria were linked at the district level. Results Females from urban areas (n = 2,938,991 [ie, total of females living in urban areas]) had a higher chance for predefined accessibility to the majority of analyzed facilities in comparison with females from rural areas (n = 3,385,813 [ie, total number of females living in rural areas]) with an odds ratio (OR) of 9.0 for cancer information counselling, an OR of 17.2 for a university hospital, and an OR of 7.2 for a psycho-oncologist. For (inpatient) rehabilitation centers (OR, 0.2) and genetic counselling (OR, 0.3), women from urban areas had lower odds of accessibility within 30 or 60 minutes. Conclusions Disparities in accessibility between rural and urban areas exist in Bavaria. The identification of underserved areas can help to inform policymakers about disparities in comprehensive health care. Future strategies are needed to deliver high-quality health care to all inhabitants, regardless of residence.}, language = {en} } @article{BartmannJanakiRamanFloeteretal.2018, author = {Bartmann, Catharina and Janaki Raman, Sudha R. and Fl{\"o}ter, Jessica and Schulze, Almut and Bahlke, Katrin and Willingstorfer, Jana and Strunz, Maria and W{\"o}ckel, Achim and Klement, Rainer J. and Kapp, Michaela and Djuzenova, Cholpon S. and Otto, Christoph and K{\"a}mmerer, Ulrike}, title = {Beta-hydroxybutyrate (3-OHB) can influence the energetic phenotype of breast cancer cells, but does not impact their proliferation and the response to chemotherapy or radiation}, series = {Cancer \& Metabolism}, volume = {6}, journal = {Cancer \& Metabolism}, number = {8}, doi = {10.1186/s40170-018-0180-9}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-175607}, year = {2018}, abstract = {Background: Ketogenic diets (KDs) or short-term fasting are popular trends amongst supportive approaches for cancer patients. Beta-hydroxybutyrate (3-OHB) is the main physiological ketone body, whose concentration can reach plasma levels of 2-6 mM during KDs or fasting. The impact of 3-OHB on the biology of tumor cells described so far is contradictory. Therefore, we investigated the effect of a physiological concentration of 3 mM 3-OHB on metabolism, proliferation, and viability of breast cancer (BC) cells in vitro. Methods: Seven different human BC cell lines (BT20, BT474, HBL100, MCF-7, MDA-MB 231, MDA-MB 468, and T47D) were cultured in medium with 5 mM glucose in the presence of 3 mM 3-OHB at mild hypoxia (5\% oxygen) or normoxia (21\% oxygen). Metabolic profiling was performed by quantification of the turnover of glucose, lactate, and 3-OHB and by Seahorse metabolic flux analysis. Expression of key enzymes of ketolysis as well as the main monocarboxylic acid transporter MCT2 and the glucose-transporter GLUT1 was analyzed by RT-qPCR and Western blotting. The effect of 3-OHB on short- and long-term cell proliferation as well as chemo- and radiosensitivity were also analyzed. Results: 3-OHB significantly changed the oxygen consumption rate (OCR) and extracellular acidification rate (ECAR) in BT20 cells resulting in a more oxidative energetic phenotype. MCF-7 and MDA-MB 468 cells had increased ECAR only in response to 3-OHB, while the other three cell types remained uninfluenced. All cells expressed MCT2 and GLUT1, thus being able to uptake the metabolites. The consumption of 3-OHB was not strongly linked to mRNA overexpression of key enzymes of ketolysis and did not correlate with lactate production and glucose consumption. Neither 3-OHB nor acetoacetate did interfere with proliferation. Further, 3-OHB incubation did not modify the response of the tested BC cell lines to chemotherapy or radiation. Conclusions: We found that a physiological level of 3-OHB can change the energetic profile of some BC cell lines. However, 3-OHB failed to influence different biologic processes in these cells, e.g., cell proliferation and the response to common breast cancer chemotherapy and radiotherapy. Thus, we have no evidence that 3-OHB generally influences the biology of breast cancer cells in vitro.}, language = {en} } @article{HarterHaukeHeitzetal.2017, author = {Harter, Philipp and Hauke, Jan and Heitz, Florian and Reuss, Alexander and Kommoss, Stefan and Marm{\´e}, Frederik and Heimbach, Andr{\´e} and Prieske, Katharina and Richters, Lisa and Burges, Alexander and Neidhardt, Guido and de Gregorio, Nikolaus and El-Balat, Ahmed and Hilpert, Felix and Meier, Werner and Kimmig, Rainer and Kast, Karin and Sehouli, Jalid and Baumann, Klaus and Jackisch, Christian and Park-Simon, Tjoung-Won and Hanker, Lars and Kr{\"o}ber, Sandra and Pfisterer, Jacobus and Gevensleben, Heidrun and Schnelzer, Andreas and Dietrich, Dimo and Neunh{\"o}ffer, Tanja and Krockenberger, Mathias and Brucker, Sara Y. and N{\"u}rnberg, Peter and Thiele, Holger and Altm{\"u}ller, Janine and Lamla, Josefin and Elser, Gabriele and du Bois, Andreas and Hahnen, Eric and Schmutzler, Rita}, title = {Prevalence of deleterious germline variants in risk genes including \(BRCA1/2\) in consecutive ovarian cancer patients (AGO-TR-1)}, series = {PLoS ONE}, volume = {12}, journal = {PLoS ONE}, number = {10}, doi = {10.1371/journal.pone.0186043}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-173553}, year = {2017}, abstract = {Background Identification of families at risk for ovarian cancer offers the opportunity to consider prophylactic surgery thus reducing ovarian cancer mortality. So far, identification of potentially affected families in Germany was solely performed via family history and numbers of affected family members with breast or ovarian cancer. However, neither the prevalence of deleterious variants in \(BRCA1/2\) in ovarian cancer in Germany nor the reliability of family history as trigger for genetic counselling has ever been evaluated. Methods Prospective counseling and germline testing of consecutive patients with primary diagnosis or with platinum-sensitive relapse of an invasive epithelial ovarian cancer. Testing included 25 candidate and established risk genes. Among these 25 genes, 16 genes (\(ATM\), \(BRCA1\), \(BRCA2\), \(CDH1\), \(CHEK2\), \(MLH1\), \(MSH2\), \(MSH6\), \(NBN\), \(PMS2\), \(PTEN\), \(PALB2\), \(RAD51C\), \(RAD51D\), \(STK11\), \(TP53\)) were defined as established cancer risk genes. A positive family history was defined as at least one relative with breast cancer or ovarian cancer or breast cancer in personal history. Results In total, we analyzed 523 patients: 281 patients with primary diagnosis of ovarian cancer and 242 patients with relapsed disease. Median age at primary diagnosis was 58 years (range 16-93) and 406 patients (77.6\%) had a high-grade serous ovarian cancer. In total, 27.9\% of the patients showed at least one deleterious variant in all 25 investigated genes and 26.4\% in the defined 16 risk genes. Deleterious variants were most prevalent in the \(BRCA1\) (15.5\%), \(BRCA2\) (5.5\%), \(RAD51C\) (2.5\%) and \(PALB2\) (1.1\%) genes. The prevalence of deleterious variants did not differ significantly between patients at primary diagnosis and relapse. The prevalence of deleterious variants in \(BRCA1/2\) (and in all 16 risk genes) in patients <60 years was 30.2\% (33.2\%) versus 10.6\% (18.9\%) in patients \(\geq\)60 years. Family history was positive in 43\% of all patients. Patients with a positive family history had a prevalence of deleterious variants of 31.6\% (36.0\%) versus 11.4\% (17.6\%) and histologic subtype of high grade serous ovarian cancer versus other showed a prevalence of deleterious variants of 23.2\% (29.1\%) and 10.2\% (14.8\%), respectively. Testing only for \(BRCA1/2\) would miss in our series more than 5\% of the patients with a deleterious variant in established risk genes. Conclusions 26.4\% of all patients harbor at least one deleterious variant in established risk genes. The threshold of 10\% mutation rate which is accepted for reimbursement by health care providers in Germany was observed in all subgroups analyzed and neither age at primary diagnosis nor histo-type or family history sufficiently enough could identify a subgroup not eligible for genetic counselling and testing. Genetic testing should therefore be offered to every patient with invasive epithelial ovarian cancer and limiting testing to \(BRCA1/2\) seems to be not sufficient.}, language = {en} } @article{SteinWollschlaegerKreienbergetal.2016, author = {Stein, Roland Gregor and Wollschl{\"a}ger, Daniel and Kreienberg, Rolf and Janni, Wolfgang and Wischnewsky, Manfred and Diessner, Joachim and St{\"u}ber, Tanja and Bartmann, Catharina and Krockenberger, Mathias and Wischhusen, J{\"o}rg and W{\"o}ckel, Achim and Blettner, Maria and Schwentner, Lukas}, title = {The impact of breast cancer biological subtyping on tumor size assessment by ultrasound and mammography - a retrospective multicenter cohort study of 6543 primary breast cancer patients}, series = {BMC Cancer}, volume = {16}, journal = {BMC Cancer}, number = {549}, doi = {10.1186/s12885-016-2426-7}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-161050}, year = {2016}, abstract = {Background Mammography and ultrasound are the gold standard imaging techniques for preoperative assessment and for monitoring the efficacy of neoadjuvant chemotherapy in breast cancer. Maximum accuracy in predicting pathological tumor size non-invasively is critical for individualized therapy and surgical planning. We therefore aimed to assess the accuracy of tumor size measurement by ultrasound and mammography in a multicentered health services research study. Methods We retrospectively analyzed data from 6543 patients with unifocal, unilateral primary breast cancer. The maximum tumor diameter was measured by ultrasound and/or mammographic imaging. All measurements were compared to final tumor diameter determined by postoperative histopathological examination. We compared the precision of each imaging method across different patient subgroups as well as the method-specific accuracy in each patient subgroup. Results Overall, the correlation with histology was 0.61 for mammography and 0.60 for ultrasound. Both correlations were higher in pT2 cancers than in pT1 and pT3. Ultrasound as well as mammography revealed a significantly higher correlation with histology in invasive ductal compared to lobular cancers (p < 0.01). For invasive lobular cancers, the mammography showed better correlation with histology than ultrasound (p = 0.01), whereas there was no such advantage for invasive ductal cancers. Ultrasound was significantly superior for HR negative cancers (p < 0.001). HER2/neu positive cancers were also more precisely assessed by ultrasound (p < 0.001). The size of HER2/neu negative cancers could be more accurately predicted by mammography (p < 0.001). Conclusion This multicentered health services research approach demonstrates that predicting tumor size by mammography and ultrasound provides accurate results. Biological tumor features do, however, affect the diagnostic precision.}, language = {en} } @article{DiessnerWischnewskyBlettneretal.2016, author = {Diessner, Joachim and Wischnewsky, Manfred and Blettner, Maria and H{\"a}usler, Sebastian and Janni, Wolfgang and Kreienberg, Rolf and Stein, Roland and St{\"u}ber, Tanja and Schwentner, Lukas and Bartmann, Catharina and W{\"o}ckel, Achim}, title = {Do Patients with Luminal A Breast Cancer Profit from Adjuvant Systemic Therapy? A Retrospective Multicenter Study}, series = {PLoS ONE}, volume = {11}, journal = {PLoS ONE}, number = {12}, doi = {10.1371/journal.pone.0168730}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-178217}, year = {2016}, abstract = {Background Luminal A breast cancers respond well to anti-hormonal therapy (HT), are associated with a generally favorable prognosis and constitute the majority of breast cancer subtypes. HT is the mainstay of treatment of these patients, accompanied by an acceptable profile of side effects, whereas the added benefit of chemotherapy (CHT), including anthracycline and taxane-based programs, is less clear-cut and has undergone a process of critical revision. Methods In the framework of the BRENDA collective, we analyzed the benefits of CHT compared to HT in 4570 luminal A patients (pts) with primary diagnosis between 2001 and 2008. The results were adjusted by nodal status, age, tumor size and grading. Results There has been a progressive reduction in the use of CHT in luminal A patients during the last decade. Neither univariate nor multivariate analyses showed any statistically significant differences in relapse free survival (RFS) with the addition of CHT to adjuvant HT, independent of the nodal status, age, tumor size or grading. Even for patients with more than 3 affected lymph nodes, there was no significant difference (univariate: p = 0.865; HR 0.94; 95\% CI: 0.46-1.93; multivariate: p = 0.812; HR 0.92; 95\% CI: 0.45-1.88). Conclusions The addition of CHT to HT provides minimal or no clinical benefit at all to patients with luminal A breast cancer, independent of the RFS-risk. Consequently, risk estimation cannot be the initial step in the decisional process. These findings-that are in line with several publications-should encourage the critical evaluation of applying adjuvant CHT to patients with luminal A breast cancer.}, language = {en} } @article{DiessnerWischnewskyStueberetal.2016, author = {Diessner, Joachim and Wischnewsky, Manfred and St{\"u}ber, Tanja and Stein, Roland and Krockenberger, Mathias and H{\"a}usler, Sebastian and Janni, Wolfgang and Kreienberg, Rolf and Blettner, Maria and Schwentner, Lukas and W{\"o}ckel, Achim and Bartmann, Catharina}, title = {Evaluation of clinical parameters influencing the development of bone metastasis in breast cancer}, series = {BMC Cancer}, volume = {16}, journal = {BMC Cancer}, number = {307}, doi = {10.1186/s12885-016-2345-7}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-161173}, year = {2016}, abstract = {Background The development of metastases is a negative prognostic parameter for the clinical outcome of breast cancer. Bone constitutes the first site of distant metastases for many affected women. The purpose of this retrospective multicentre study was to evaluate if and how different variables such as primary tumour stage, biological and histological subtype, age at primary diagnosis, tumour size, the number of affected lymph nodes as well as grading influence the development of bone-only metastases. Methods This retrospective German multicentre study is based on the BRENDA collective and included 9625 patients with primary breast cancer recruited from 1992 to 2008. In this analysis, we investigated a subgroup of 226 patients with bone-only metastases. Association between bone-only relapse and clinico-pathological risk factors was assessed in multivariate models using the tree-building algorithms "exhausted CHAID (Chi-square Automatic Interaction Detectors)" and CART(Classification and Regression Tree), as well as radial basis function networks (RBF-net), feedforward multilayer perceptron networks (MLP) and logistic regression. Results Multivariate analysis demonstrated that breast cancer subtypes have the strongest influence on the development of bone-only metastases (χ2 = 28). 29.9 \% of patients with luminal A or luminal B (ABC-patients) and 11.4 \% with triple negative BC (TNBC) or HER2-overexpressing tumours had bone-only metastases (p < 0.001). Five different mathematical models confirmed this correlation. The second important risk factor is the age at primary diagnosis. Moreover, BC subcategories influence the overall survival from date of metastatic disease of patients with bone-only metastases. Patients with bone-only metastases and TNBC (p < 0.001; HR = 7.47 (95 \% CI: 3.52-15.87) or HER2 overexpressing BC (p = 0.007; HR = 3.04 (95 \% CI: 1.36-6.80) have the worst outcome compared to patients with luminal A or luminal B tumours and bone-only metastases. Conclusion The bottom line of different mathematical models is the prior importance of subcategories of breast cancer and the age at primary diagnosis for the appearance of osseous metastases. The primary tumour stage, histological subtype, tumour size, the number of affected lymph nodes, grading and NPI seem to have only a minor influence on the development of bone-only metastases.}, language = {en} } @article{HarterBernatzScholzetal.2015, author = {Harter, Patrick N. and Bernatz, Simon and Scholz, Alexander and Zeiner, Pia S. and Zinke, Jenny and Kiyose, Makoto and Blasel, Stella and Beschorner, Rudi and Senft, Christian and Bender, Benjamin and Ronellenfitsch, Michael W. and Wikman, Harriet and Glatzel, Markus and Meinhardt, Matthias and Juratli, Tareq A. and Steinbach, Joachim P. and Plate, Karl H. and Wischhusen, J{\"o}rg and Weide, Benjamin and Mittelbronn, Michel}, title = {Distribution and prognostic relevance of tumor-infiltrating lymphocytes (TILs) and PD-1/PD-L1 immune checkpoints in human brain metastases}, series = {Oncotarget}, volume = {6}, journal = {Oncotarget}, number = {38}, doi = {10.18632/oncotarget.5696}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-137107}, pages = {40836 -- 40849}, year = {2015}, abstract = {The activation of immune cells by targeting checkpoint inhibitors showed promising results with increased patient survival in distinct primary cancers. Since only limited data exist for human brain metastases, we aimed at characterizing tumor infiltrating lymphocytes (TILs) and expression of immune checkpoints in the respective tumors. Two brain metastases cohorts, a mixed entity cohort (n = 252) and a breast carcinoma validation cohort (n = 96) were analyzed for CD3+, CD8+, FOXP3+, PD-1+ lymphocytes and PD-L1+ tumor cells by immunohistochemistry. Analyses for association with clinico-epidemiological and neuroradiological parameters such as patient survival or tumor size were performed. TILs infiltrated brain metastases in three different patterns (stromal, peritumoral, diffuse). While carcinomas often show a strong stromal infiltration, TILs in melanomas often diffusely infiltrate the tumors. Highest levels of CD3+ and CD8+ lymphocytes were seen in renal cell carcinomas (RCC) and strongest PD-1 levels on RCCs and melanomas. High amounts of TILs, high ratios of PD-1+/CD8+ cells and high levels of PD-L1 were negatively correlated with brain metastases size, indicating that in smaller brain metastases CD8+ immune response might get blocked. PD-L1 expression strongly correlated with TILs and FOXP3 expression. No significant association of patient survival with TILs was observed, while high levels of PD-L1 showed a strong trend towards better survival in melanoma brain metastases (Log-Rank p = 0.0537). In summary, melanomas and RCCs seem to be the most immunogenic entities. Differences in immunotherapeutic response between tumor entities regarding brain metastases might be attributable to this finding and need further investigation in larger patient cohorts.}, language = {en} } @article{DiessnerBruttelSteinetal.2014, author = {Diessner, J. and Bruttel, V. and Stein, R. G. and Horn, E. and H{\"a}usler, S. F. M. and Dietl, J. and H{\"o}nig, A. and Wischhusen, J.}, title = {Targeting of preexisting and induced breast cancer stem cells with trastuzumab and trastuzumab emtansine (T-DM1)}, series = {Cell Death \& Disease}, volume = {5}, journal = {Cell Death \& Disease}, issn = {2041-4889}, doi = {10.1038/cddis.2014.115}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-119884}, pages = {e1149}, year = {2014}, abstract = {The antibody trastuzumab (Herceptin) has substantially improved overall survival for patients with aggressive HER2-positive breast cancer. However, about 70\% of all treated patients will experience relapse or disease progression. This may be related to an insufficient targeting of the CD44(high)CD24(low) breast cancer stem cell subset, which is not only highly resistant to chemotherapy and radiotherapy but also a poor target for trastuzumab due to low HER2 surface expression. Hence, we explored whether the new antibody-drug conjugate T-DM1, which consists of the potent chemotherapeutic DM1 coupled to trastuzumab, could improve the targeting of these tumor-initiating or metastasis-initiating cells. To this aim, primary HER2-overexpressing tumor cells as well as HER2-positive and HER2-negative breast cancer cell lines were treated with T-DM1, and effects on survival, colony formation, gene and protein expression as well as antibody internalization were assessed. This revealed that CD44(high)CD24(low)HER2(low) stem cell-like breast cancer cells show high endocytic activity and are thus particularly sensitive towards the antibody-drug conjugate T-DM1. Consequently, preexisting CD44(high)CD24(low) cancer stem cells were depleted by concentrations of T-DM1 that did not affect the bulk of the tumor cells. Likewise, colony formation was efficiently suppressed. Moreover, when tumor cells were cocultured with natural killer cells, antibody-dependent cell-mediated cytotoxicity was enhanced, and EMT-mediated induction of stem cell-like properties was prevented in differentiated tumor cells. Thus our study reveals an unanticipated targeting of stem cell-like breast cancer cells by T-DM1 that may contribute to the clinical efficacy of this recently approved antibody-drug conjugate.}, language = {en} } @article{DiessnerBruttelBeckeretal.2013, author = {Diessner, Joachim and Bruttel, Valentin and Becker, Kathrin and Pawlik, Miriam and Stein, Roland and H{\"a}usler, Sebastian and Dietl, Johannes and Wischhusen, J{\"o}rg and H{\"o}nig, Arnd}, title = {Targeting breast cancer stem cells with HER2-specific antibodies and natural killer cells}, series = {American Journal of Cancer Research}, volume = {3}, journal = {American Journal of Cancer Research}, number = {2}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-128633}, pages = {221-220}, year = {2013}, abstract = {Breast cancer is the most common cancer among women worldwide. Every year, nearly 1.4 million new cases of breast cancer are diagnosed, and about 450.000 women die of the disease. Approximately 15-25\% of breast cancer cases exhibit increased quantities of the trans-membrane receptor tyrosine kinase human epidermal growth factor receptor 2 (HER2) on the tumor cell surface. Previous studies showed that blockade of this HER2 proto-oncogene with the antibody trastuzumab substantially improved the overall survival of patients with this aggressive type of breast cancer. Recruitment of natural killer (NK) cells and subsequent induction of antibody-dependent cell-mediated cytotoxicity (ADCC) contributed to this beneficial effect. We hypothesized that antibody binding to HER2-positive breast cancer cells and thus ADCC might be further improved by synergistically applying two different HER2-specific antibodies, trastuzumab and pertuzumab. We found that tumor cell killing via ADCC was increased when the combination of trastuzumab, pertuzumab, and NK cells was applied to HER2-positive breast cancer cells, as compared to the extent of ADCC induced by a single antibody. Furthermore, a subset of \(CD44^{high}CD24^{low}HER2^{low}\) cells, which possessed characteristics of cancer stem cells, could be targeted more efficiently by the combination of two HER2-specific antibodies compared to the efficiency of one antibody. These in vitro results demonstrated the immunotherapeutic benefit achieved by the combined application of trastuzumab and pertuzumab. These findings are consistent with the positive results of the clinical studies, CLEOPATRA and NEOSPHERE, conducted with patients that had HER2-positive breast cancer. Compared to a single antibody treatment, the combined application of trastuzumab and pertuzumab showed a stronger ADCC effect and improved the targeting of breast cancer stem cells.}, language = {en} } @phdthesis{Schneider2010, author = {Schneider, Christine Miriam}, title = {Lebensqualit{\"a}t und Langzeitfolgen mehr als zw{\"o}lf Jahre nach der Diagnose Brustkrebs}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-54134}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2010}, abstract = {Untersuchung von LQ und Korrelaten der LQ bei Brustkrebslangzeit{\"u}berlebenden sowie der physischen wie psychischen Langzeitfolgen einer Brustkrebserkrankung.}, subject = {Lebensqualit{\"a}t}, language = {de} } @phdthesis{Scheuch2003, author = {Scheuch, Stephanie}, title = {Die Wertigkeit der klinischen, apparativen und laborchemischen Untersuchungen in der Nachsorge des Mammakarzinoms}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-5707}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2003}, abstract = {Im Mittelpunkt der Diskussion zur Nachsorge des Mammakarzinoms stehen das intensive Nachsorgeregime mit klinischer Untersuchung und routinem{\"a}ßigem Gebrauch von bildgebenden Suchverfahren (R{\"o}ntgenaufnahmen, Szintigraphie, Sonographie) sowie laborchemischer Untersuchungen einschließlich Tumormarker gegen{\"u}ber dem minimalen Nachsorgeregime mit klinischer Untersuchung, routinem{\"a}ßiger Mammographie und Gebrauch weiterer apparativer Verfahren nur bei symptomatischen Patienten oder klinischem Tumorverdacht. Anhand von 701 Patientinnen mit Brustkrebs und beendeter Prim{\"a}rtherapie sowie Metastasenfreiheit zu Studienbeginn wurden in der vorliegenden prospektiven Arbeit die einzelnen klinischen, bildgebenden und laborchemischen Untersuchungen in der Nachsorge hinsichtlich ihrer Effizienz bei der Entdeckung einer Reaktivierung bewertet. Allgemeine Ergebnisse waren, dass nur wenige Patientinnen von sich aus Beschwerden angaben. Schon deshalb sollte großer Wert auf die Anamnese und die klinische Untersuchung gelegt werden. Die Beschwerden waren nur f{\"u}r 1/3 der Patientinnen ein Grund, sich fr{\"u}hzeitig vorzustellen. Die Patientinnen sollten ermuntert werden, Auff{\"a}lligkeiten dem Arzt mitzuteilen und in diesem Fall nicht bis zum n{\"a}chsten vorgegebenen Nachsorgetermin warten. Ein lokoregionales bzw. kontralaterales Rezidiv wurde bei insgesamt 43 Patientinnen nachgewiesen. Zu 88\% konnte das Rezidiv durch Auff{\"a}lligkeiten in der klinischen Untersuchung vermutet und mit nachfolgenden weiterf{\"u}hrenden Untersuchungen gesichert werden. Bei 5 Patientinnen (12\% der Rezidive) wurde das Rezidiv allein durch die routinem{\"a}ßig durchgef{\"u}hrte Mammographie erkannt. Von den 48 Patientinnen mit Metastasierung wurde die Reaktivierung bei 58\% durch entsprechende Symptome der Patientinnen oder durch die klinische Untersuchung vermutet und in weiterf{\"u}hrenden Untersuchungen gesichert. Durch Untersuchungen, die aufgrund erh{\"o}hter Tumormarker, aufgrund eines Anstiegs der alkalischen Phosphatase oder anderer Enzyme bzw. aufgrund eines Lokalrezidivs zur Fernmetastasensuche veranlasst wurden, konnten 42\% der Metastasierungen gesichert werden. Bei Betrachtung der einzelnen Untersuchungen l{\"a}sst sich bez{\"u}glich ihrer Effizienz, eine Reaktivierung zu entdecken, folgendes feststellen: Von den Untersuchungen, die ohne klinische Selektion routinem{\"a}ßig oder bei Symptomen zus{\"a}tzlich durchgef{\"u}hrt wurden, zeigte die R{\"o}ntgenaufnahme des Thorax die gr{\"o}ßte Effizienz, gefolgt von den klinischen Untersuchungen der Brust/ Brustwand bzw. der Axilla und der Mammographie. Von den Laborparametern war das CA 15-3 am effizientesten. Insgesamt war die Effizienz der Laborparameter jedoch gering. Einschr{\"a}nkend ist zu sagen, dass alle Patientinnen mit Metastasierung im Thoraxbereich auch entsprechende Befunde/ Symptome hatten, die Anlass zur R{\"o}ntgenaufnahme des Thorax gaben. Von den Untersuchungen, die nur nach klinischer/ radiologischer/ laborchemischer Selektion und zum Teil in sehr seltenen F{\"a}llen durchgef{\"u}hrt wurden, waren die Punktionszytologien/ Stanzbiopsien am effizientesten, gefolgt von der Skelettszintigraphie und dem CT. Diesen folgten die Lebersonographie, die Sonographie der Mamma, R{\"o}ntgenaufnahmen des Skeletts und das Blutbild. Den Ergebnissen dieser Untersuchung zufolge scheint beim Mammakarzinom eine Nachsorge, die auf einer sorgf{\"a}ltigen Anamnese, eingehender Beurteilung des lokoregion{\"a}ren Bereichs, gr{\"u}ndlicher k{\"o}rperlicher Untersuchung und routinem{\"a}ßigem Einsatz der Mammographie beruht, gerechtfertigt. Nur bei sich daraus ergebendem klinischen Verdacht auf eine Reaktivierung erscheinen weiterf{\"u}hrende Untersuchungen indiziert, da - unselektioniert eingesetzt- ihre Effizienz gering ist.}, language = {de} }