Breast cancer: Disease management program is largely consistent with guidelines

DMPs are revised regularly

After being commissioned by the Federal Joint Committee (G-BA), IQWiG systematically searched for new guidelines, assessed their methodological quality, and extracted relevant recommendations from these guidelines. In a next step these recommendations were compared with the specifications for the German DMP.

A need for revision may arise if new studies provide new evidence on a disease and its treatment. It is therefore legally specified that a DMP must be revised at regular intervals. It is the Institute's responsibility to firstly identify differences between the guideline recommendations and the DMP. It is then the G-BA'sresponsibility to examine whether these differences should actually lead to a revision of the DMP.

26 relevant guidelines identified

IQWiG was able to include a total of 26 guidelines in its investigation. Six of these guidelines comprehensively address the care of patients with breast cancer. Seven guidelines exclusively deal with early breast cancer, four further guidelines with advanced breast cancer (stage IV). The remaining nine guidelines address specific aspects such as radiotherapy, breast reconstruction or adjuvant systematic treatment.

Supplementations desirable

As IQWiG determined, there are several health-care aspects for which the recommendations of the DMP should be revised. Among other aspects, this applies to diagnostics and measures in primary therapy: The guidelines address the performance of a magnetic resonance imaging (MRI) scan in specific therapeutic indications, explicitly advising against routine MRI scans. With regard to radiotherapy for breast cancer, the guidelines provide recommendations on hypofractionated radiotherapy -- an aspect currently not considered by the DMP.