The two Brustzentrum Bodensee (Lake Constance Breast Centre) sites at the Hospital in Constance and the Women’s Hospital in Friedrichshafen have a principal goal: to enable the best possible early detection of all types of breast cancer, to reduce the morbidity and mortality of breast cancer patients and to increase survival rates by offering ultra-modern breast cancer prevention measures.
With around 50,000 cases per year, breast cancer is the most common cancer amongst women in Germany. 29 per cent of these cases are newly diagnosed cancers; the median age of disease onset is around 64. This makes breast cancer one of the most common diseases in Germany. A Germany-wide breast cancer-screening programme was launched in Germany between 2005 and 2008. Since then, all women between 50 and 60 are offered mammographic screens at specialised centres such as those in Constance and Friedrichshafen every two years; around 54 per cent of all women take part in the screening. Since the introduction of the breast cancer-screening programme in Germany, the number of breast cancer incidences has nearly doubled. The Brustzentrum Bodensee treats around 180 breast cancer patients per year. Ductal breast cancer accounts for 70 to 80 per cent of all breast cancers; lobular breast cancer accounts for 10 to 15 per cent and the less frequent types of breast cancer for around 10 per cent.
Dr. Hans-Christian Fricke, senior physician in the Women's Hospital in Constance that is under the overall management of PD Dr. Stefan Rimbach, is convinced that the nationwide breast cancer-screening programme is extremely beneficial for women. Fricke and his colleagues at the hospital in Friedrichshafen focus on the integral examination of their patients in order to guarantee the best treatment possible. There are good reasons why patients are examined in an ultra-modern setting, with a meticulously planned examination and treatment regime from the very first day of admission. Dr. Fricke explains: "As the quality management officer at the Women's Hospital in Constance, I have been involved in all certification processes since 2006. A lot of work is required to prepare the hospital for both external and internal audits. The Women's Hospital in Constance was certified according to ISO 9001 in 2000. In 2006, we began preparing a case management handbook under the leadership of the hospital's chief physician PD Dr. Rimbach. This handbook deals with all issues related to the treatment and care of patients admitted to the Breast Centre." The handbook is 160 pages long and is available to the entire hospital team. "We were inspected by external certification physicians on behalf of OnkoZert in Neu-Ulm and LGA Interzert, and we became an officially certified breast centre. (ed. note: OnkoZert is an independent institute that runs the certification system to inspect organ cancer centres and oncological centres and determine whether their services are in conformance with the ‘DKG/DGS requirements of breast centres'.)
"Our entitlement to hold this certificate is subject to an annual re-inspection," explained Dr. Fricke. Although both hospitals have their own quality management officer, the Bodensee Brustzentrum as a whole has a central quality management officer, a post that has been held by Dr. Fricke for the last two years.
Terms such as schedule and case management sound rather technical given the fact that they refer to female patients admitted to the Breast Centre. However, they are terms that patients and their relatives can rely on, as they signify that medical services have been quality certified. Dr. Hans-Christian Fricke: "The procedure is always very similar: the patient is referred to the centre by her treating physician, where she makes an appointment with our secretary whose job consists exclusively of providing customer service to breast cancer patients. When the patient comes to see us for the first time, we will meticulously evaluate the mammographies that she brings with her, and a physician from Dr. Rimbach's team will take a biopsy. The punch biopsy, which is usually removed with the help of ultrasound, will then undergo histological testing. The patient usually returns to the centre two days later to discuss the results of the histological investigations.
When these investigations indicate the presence of breast cancer, gynaecologists from Friedrichshafen and Constance meet for one of their weekly tumour conferences to discuss the patient's file. These meetings, usually held on Mondays, also involve colleagues from the fields of radiology, pathology and psychooncological consultants. The tumour conference participants will jointly look at the images on high-resolution screens, each of which costs between 10 and 20,000 euros. Dr. Fricke is convinced that the nationwide breast-screening programme has very positive results since the cancer is detected at a very early stage before it has spread (metastasised) to other organs, predominantly to the lymph nodes, the liver or the skeleton. When breast cancer is detected at an early stage, the teams from the Friedrichshafen and Constance hospitals are able to remove the cancerous tissue in about 70 to 80 per cent of breast cancer patients admitted to the centre without having to remove the breast. Once the punch biopsy results are available, the doctors will determine the exact schedule for surgery and which preliminary examinations are required. In another tumour conference, which usually takes place after the tumour has been surgically removed and as soon as the final histological findings are available, the doctors will agree on further treatment options that are needed such as radiotherapy and chemotherapy. Many patients are also given antihormone therapy (by way of infusion) to suppress selected hormones. The patient will then be informed which therapies she needs after the surgical resection of tumour tissue.
A weekly video conference is an excellent example of the progress made in the cooperation between the two women's hospitals on either side of Lake Constance. Backed by German Telekom who suggested the idea to the Constance Women's Hospital, the doctors participating in the video conference can now exchange their opinions and findings much quicker. Regional gynaecologists are also invited to take part in the tumour conferences and are automatically provided with any finding related to their respective patients.
The majority of patients who undergo surgery can leave the hospital after around one week and they are then given radio- and chemotherapy on an outpatient basis. "We treat breast cancer patients for around six months, starting from the day of diagnosis to final treatment. After that, the patients come to the hospital for follow-up care every three months." Follow-up care and rehabilitation clearly show that the holistic approach chosen by the Breast Centre is very effective. "Our patients are not left to fight the disease on their own, we help prepare them for any crises that may arise."
Dr. Fricke makes a point of specifically highlighting an important aspect of the treatment of breast cancer patients. “The type of medical treatment, which is both verifiable and applied according to specific quality standards, which the Breast Centre offers its patients is key in the continuous improvement of therapeutic quality. This type of scientifically validated, guideline-conform medical treatment guarantees the continuous improvement of therapies offered to breast cancer patients. This guarantee is based, amongst other things, on the fact that, since 2006, all patient statistics are entered into the ODSeasy tumour documentation system and transferred to the West German Breast Centre (WBC), where the data are stored. “This enables true benchmarking among all certified German breast centres, of which there are around 200 in Germany, and more than 50 in Baden-Württemberg. The benchmarking provides reliable data on the effectiveness of therapies. The analysis of data is a reliable indicator of the services we offer and the areas where improvements are still possible." Dr. Fricke believes that the high relative survival rate in Germany of more than 80 per cent, a statistic which is also applicable to the Breast Centre in Constance and Friedrichshafen, is the result of strict conformance with valid guidelines. This includes the written agreement of the Breast Centre to promote research projects in the field of breast diseases as well as breast health, for example by participating in clinical trials. However, the findings obtained in clinical trials will only benefit patients if treating personnel are given effective further training. For this reason, the Breast Centre offers regular training at the centre, for both medical and non-medical staff. Contracts with self-help groups also contribute to the Breast Centre’s success.The Breast Centre and its senior executives also attach great importance to providing women with information about breast diseases and breast health. These services are supported by continuous public relations work which will become even more effective with the Breast Centre’s new website, to be launched around the end of September 2010.
Further information:Brustzentrum BodenseeKlinikum Friedrichshafen/Klinikum KonstanzContact 2010:PD Dr. Stefan RimbachKlinikum KonstanzLuisenstraße 778462 KonstanzTel.: +49 (0)7531 801-1601Email: brustzentrum(at)klinikum-konstanz.de