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Prevention strategies Summary: Around one quarter of primary breast cancers are induced by genetic alterations. Next to the BRCA1 and 2 genes which are highly associated with breast and ovarian cancer there are further genes leading to increased breast and ovarian cancer risk. Depending on the extent of the causal involvement of the respective gene mutation monogenic inheritance will be differentiated from oligo-and polygenic inheritances, where multiple low penetrance genes can also finally induce cancer. Some hereditary syndromes are also associated with an increased breast cancer risk, e.g. the Li-Fraumeni-Syndrome (p53-mutation) with a breast cancer lifetime-risk of around 50%. Furthermore the Cowden-Syndrome showing a PTEN-mutation (lifetime-risk 25%) and the Lynch-Syndrome (AfLH1, MSH2, MSH6 and PMS2-qene defect) with a 25% lifetime-risk for ovarian cancer and 25-69% lifetime-risk for a endometrial cancer are some of the well-known cancer syndromes. RAD51C- And 0-gene mutations are responsible for a lifetime-risk for breast cancer of around 30%. A high number of involved genes makes risk estimation difficult especially with low penetrance genes. The following pages will discuss and review possible prevention strategies against breast- And ovarian cancer. Before starting especially operative interventions an intensive information and informed consent of the patient is mandatory.

Watermann D.,Frauenklinik
Gynakologische Praxis | Year: 2017

Defining the axillary lymph node status is an important issue in breast cancer diagnosis, staging, therapy and follow up. The lymph nodes size was important in the past, although it is only suitable in marked metastasis. Modern high definition ultrasound systems allow a differentiated evaluation of the lymph nodes internal architecture. Therefore, nowadays the lymph nodes form and echogenicity as well as the pattern of the medulla and the cortex are assessed to differentiate between benign and metastatic nodes. Nevertheless, ultrasound alone is often not sufficient, therefore ultrasound guided minimal invasive biopsies, like fine needle aspiration and core biopsy, have to be used frequently.

Von Minckwitz G.,German Breast Group | Eidtmann H.,Universitats Frauenklinik | Rezai M.,Luisenkrankenhaus | Fasching P.A.,Friedrich - Alexander - University, Erlangen - Nuremberg | And 19 more authors.
New England Journal of Medicine | Year: 2012

BACKGROUND: Bevacizumab, a monoclonal antibody against vascular endothelial growth factor A, has shown clinical efficacy in patients with human epidermal growth factor receptor 2 (HER2)-negative metastatic breast cancer. We evaluated the efficacy, measured according to the rate of pathological complete response (absence of invasive and intraductal disease in the breast and the axillary lymph nodes), and the safety of adding bevacizumab to neoadjuvant chemotherapy in patients with early-stage breast cancer. METHODS: We randomly assigned 1948 patients with a median tumor size of 40 mm on palpation to receive neoadjuvant epirubicin and cyclophosphamide followed by docetaxel, with or without concomitant bevacizumab. Patients with untreated HER2-negative breast cancer were eligible if they had large tumors, hormone-receptor-negative disease, or hormone-receptor-positive disease with palpable nodes or positive findings on sentinel-node biopsy, and no increased cardiovascular or bleeding risk. RESULTS: Overall, the rates of pathological complete response were 14.9% with epirubicin and cyclophosphamide followed by docetaxel and 18.4% with epirubicin and cyclophosphamide followed by docetaxel plus bevacizumab (odds ratio with addition of bevacizumab, 1.29; 95% confidence interval, 1.02 to 1.65; P = 0.04); the corresponding rates of pathological complete response were 27.9% and 39.3% among 663 patients with triple-negative tumors (P = 0.003) and 7.8% and 7.7% among 1262 patients with hormone-receptor-positive tumors (P = 1.00). Breast-conserving surgery was possible in 66.6% of the patients in both groups. The addition of bevacizumab, as compared with neoadjuvant therapy alone, was associated with a higher incidence of grade 3 or 4 toxic effects (febrile neutropenia, mucositis, the hand-foot syndrome, infection, and hypertension) but with a similar incidence of surgical complications. CONCLUSIONS: The addition of bevacizumab to neoadjuvant chemotherapy significantly increased the rate of pathological complete response among patients with HER2-negative early-stage breast cancer. Efficacy was restricted primarily to patients with triple-negative tumors, in whom the pathological complete response is considered to be a reliable predictor of long-term outcome. (Funded by Sanofi-Aventis and Roche, Germany; number, NCT00567554.) Copyright © 2012 Massachusetts Medical Society.

Stampanoni M.,Paul Scherrer Institute | Stampanoni M.,ETH Zurich | Wang Z.,Paul Scherrer Institute | Thuring T.,Paul Scherrer Institute | And 7 more authors.
Investigative Radiology | Year: 2011

Objectives: Phase-contrast and scattering-based X-ray imaging are known to provide additional and complementary information to conventional, absorption-based methods, and therefore have the potential to play a crucial role in medical diagnostics. We report on the first mammographic investigation of 5 native, that is, freshly dissected, breasts carried out with a grating interferometer and a conventional X-ray tube source. Four patients in this study had histopathologically proven invasive breast cancer. One male patient, without the presence of any malignant formations within the resected breast, was included as a control specimen. MATERIALS AND METHODS:: We used a Talbot-Lau grating setup installed on a conventional, low-brilliance X-ray source; the interferometer operated at the fifth Talbot distance, at a tube voltage of 40 kVp with mean energy of 28 keV, and at a current of 25 mA. The device simultaneously recorded absorption, differential phase and small-angle scattering signals from the native breast tissue. These quantities were then combined into novel color-and high-frequency-enhanced radiographic images. Presurgical images (conventional mammography, ultrasonography, and magnetic resonance imaging) supported the findings and clinical relevance was verified. RESULTS:: Our approach yields complementary and otherwise inaccessible information on the electron density distribution and the small-angle scattering power of the sample at the microscopic scale. This information can be used to potentially answer clinically relevant, yet unresolved questions such as unequivocally discerning between malignant and premalignant changes and postoperative scars and distinguishing cancer-invaded regions within healthy tissue. CONCLUSIONS:: We present the first ex vivo images of fresh, native breast tissue obtained from mastectomy specimens using grating interferometry. This technique yields improved diagnostic capabilities when compared with conventional mammography, especially when discerning the type of malignant conversions and their breadth within normal breast tissue. These promising results advance us toward the ultimate goal, using grating interferometry in vivo on humans in a clinical setting. © 2011 by Lippincott Williams & Wilkins.

Scharl A.,Frauenklinik | Kuhn T.,Frauenklinik | Papathemelis T.,Frauenklinik | Salterberg A.,Sana Clinics
Geburtshilfe und Frauenheilkunde | Year: 2015

The probability of healing breast cancer has been greatly improved in recent decades through the introduction and optimisation of multi-modal therapies and interdisciplinary treatments. Today, in addition to surgery or radiation, most patients receive a systemic treatment. To prevent excessive treatment, patients whose prognosis is so good that certain adjuvant therapies can be foregone or reduced must be identified. A lack of compliance with therapy, especially in the endocrine therapies stretching over years, is a further problem. As only treatments that are also carried out can improve chances of survival, efforts to improve compliance must be intensified. Studies show that lifestyle changes influence the efficiency of medication on the one hand, and on the other hand can also by themselves achieve a relevant improvement of the prognosis. Therefore, it is time not only to treat the tumour, but to also focus on the patient as a whole in therapeutic interventions. © Georg Thieme Verlag KG Stuttgart ·.

Vaginal bleeding and/or pain during early pregnancy are a diagnostic challenge in order to define the integrity and localization of the pregnancy. The combination of serial human chorionic gonadotropin beta (HCG beta) testing and vaginal sonography enables the early discrimination between an ongoing pregnancy, an abortion and an ectopic pregnancy. These diagnostic tools have provided a significant reduction of mortality in cases of ectopic pregnancy. The currently available diagnostic measures allow selection of the optimal individual treatment including the options of watchful waiting, expectant management, surgical intervention and medicinal therapy. Besides the excellent diagnostic and therapeutic possibilities, the psychological strain in women with early pregnancy loss also has to be taken into account. © 2015, Springer-Verlag Berlin Heidelberg.

The "painful vulva" is a rather common and important gynaecological entity. In spite of the fact that a comprehensive history and clinical examination using the colposcope will lead to a correct diagnosis in practice this problem remains underdiagnosed. A broad spectrum of medical and alternative treatment methods is available for the management of generalized vulvodynia. Localized and provoked vulvodynia or vulvar vestibulitis syndrome usually asks for a different approach. Whereas medical treatment is rarely successful surgical excision and careful reconstruction of the area involved will most often solve the problem.

Roos T.,Frauenklinik
Therapeutische Umschau | Year: 2016

Preterm birth rates of 5 % to 11 % in western industrialized countries reflect a persisting obstetrical problem. Prematurity is the leading cause of perinatal morbidity and mortality. Sequelae in infants can be severe with lifelong health impact. No single cause accounts for prematurity, but rather a variety of different and, in part, interacting reasons lead to the ‚preterm birth syndrome‘. Little is known about the causes of preterm birth. Although infections have been identified as important, different mechanisms in the pathogenesis remain unclear. Preterm labor and preterm premature rupture of membranes leading to spontaneous preterm birth account for 75 % of prematurity, whereas 25 % is related to iatrogenic preterm delivery. Iatrogenic preterm birth may be due to various maternal causes leading to reduced maternal and/or fetal health. Some promotors of preterm birth syndrome are identified, and different factors appear to be protective. Certain maternal disease, lifestyle and nutrition are accessible to early interventions which may prolong a future pregnancy. Patient's history can identify pregnancies at high risk for preterm birth. Systematic adaption of evidence-based techniques for detection (vaginal Cervix ultrasound) and prevention (progesterone therapy) allow for reduction of preterm birth. After onset of the sequence leading to spontaneous preterm birth, tocolytics may mostly delay delivery for 48 hours, only. Systematic use of RDS-prophylaxis and early patient transfer to a perinatal center may reduce perinatal mortality and morbidity by 50 %. However, many sequelae remain. Prevention of preterm birth by systematic use of known options in preconception care hold promise to reduce preterm birth. © 2016 Hogrefe.

Hornung R.,Frauenklinik
Therapeutische Umschau | Year: 2011

Endometrial cancer is the most common genital malignant tumor in women in industrial countries. The typical symptoms are postmenopausal bleeding or metrorrhagia. Following anamneses, clinical examination and transvaginal sonography, histological confirmation is obtained by dilation and curettage. Hysterectomy, bilateral salpingo-oophorectomy and according to tumor stage pelvic and paraaortic lymphadenectomy are the mainstay of surgical treatment that is performed more and more often by laparoscopy. Adjuvant pelvic external beam radiation or vaginal brachytherapie are added if indicated. In certain situations adjuvant chemotherapy is necessary. Follow-up by clinical examination and transvaginal sonography are reasonable for the first few postoperative years. © 2011 by Verlag Hans Huber, Hogrefe AG, Bern.

The vaginal and abdominal operation strategies with autologous tissue established for decades show acceptable results with moderate side effects but an up to 30 % relapse due to the existing connective tissue insufficiency. In recent years established methods employing alloplastic and biological meshes have in particular significantly increased the anatomical success rate. However, in addition to only moderate subjective improvements, new and sometimes serious side effects, such as mesh arrosion up to 20 %, pain syndromes, dyspareunia, infections, obstructions and urinary urgency syndrome can occur. Current guidelines confirm the use of meshes in relapse situations and in individual exceptional primary cases; however, there is no scientifically-based evidence for a general application in primary prolapse situations. Improved training of surgeons, refined diagnostics and individual comprehensive informed consent on the planned operation and possible alternatives as well as testing materials in randomized studies before becoming commercially available, all make valuable contributions to an improvement in postoperative results and a reduction of complications and side effects. © 2014 Springer-Verlag.

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