OBJECTIVES: : In Germany, development of clinical pathways in routine health care settings is a slow process. Our main objectives were: 1) to introduce proper clinical pathways of breast cancer (BC) management in a large hospital in Munich, Germany, 2) to identify problems in the implementation process of clinical pathways, and 3) to suggest steps for further improvement of clinical pathway strategies. METHODS: : In collaboration with healthcare professionals (HCPs) working in a large Munich hospital, we developed a clinical pathway algorithm for management of BC patients and introduced it to that hospital for implementation. Then we developed a standardized checklist to measure the success of the clinical pathways program based on various clinical indicators, reported by HCPs involved in BC management. And finally, we compared health economics data of two groups of patients with primary diagnosis of BC: intervention group (n=45), which was managed according to our clinical pathway in 2004, and comparator group (n=56), which was managed in 2003 prior to introduction of clinical pathways. RESULTS: : Mean duration of hospitalization in intervention group was slightly higher compared to comparator group (9.08 vs. 8.75, respectively), but approximately 51% of patients in intervention group were discharged from the hospital within 7-8 days compared to 40% in comparator group. About 73% of patients in intervention group have been admitted 1 day prior to operative treatment, compared to 93% of patients in comparator group. By means of a survey we learned, that only a small percentage (up to 17%) of HCPs in that hospital were aware of the detailed processes of clinical pathways. CONCLUSIONS: Clinical pathways are important tools in that they optimize health care processes and can potentially lead to cost savings through optimal care. However, proper training and active involvement of HCPs in the implementation of clinical pathway processes is important.