[Diagnosis and therapy of breast carcinoma--an interdisciplinary challenge]

Screening studies in patients older than 50 years show a reduction of mortality and an increase of early stages. Newly diagnosed breast cancer confronts the patient and the clinician with multiple treatment decisions. Breast conserving surgery has become standard therapy for early breast cancer. Key elements in the selection of patients for treatment with local or transferred tissue or mastectomy include preoperative mammography, careful pathologic evaluation of the needle or core biopsy specimen, and an assessment of the patients desires in order to balance the risk of local recurrence against preservation of a cosmetically acceptable breast. MR-mammography and sonography complement mammography to define the extent of the disease preoperatively. This review examines some of the local treatment options, the choice between breast conserving treatment and mastectomy, how best to treat the axilla, the optimal sequencing of local and systemic therapy. Breast conserving therapy with radiation has been recognized as a standard strategy, because of the low incidence of local failure and minimal postoperative deformity compared with that of quadrantectomy without radiation. High-dose chemotherapy is being evaluated in the treatment of metastatic and high-risk primary breast cancer.