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Background: Hemangiosarcomas of the breast represent a rare disease of the breast mainly occurring as secondary neoplasias with a latency of 5-10 years after primary treatment of breast cancer and are associated with an unfavourable prognosis. Radiation therapy, which is integrated within the concept of breast conserving therapy ranks as the main risk factor., Patients and Methods: In this report we describe the clinical course of 4 patients including their molecular genetic pattern and give a summary of the actual literature., Results: Hemangiosarcomas occur as a secondary neoplasm with a latency of 5-10 years after primary treatment of breast cancer and have an unfavorable prognosis. A genetic predisposition is assumed, but we could not find a significant role of tumor suppressor genes BRCA1, BRCA2 or p53 in our patients., Conclusion: Due to limited data available for these tumors, recommendations for therapy include radical tumor resection achieving wide free margins and inconsistent regimens of chemo- and/or immunetherapy modalities. In the majority these are based on systemic therapy regimens for other cutaneous sarcomas, such as Kaposi's sarcoma. Efforts should be taken for a nation-wide systematic registration of all cases of post-irradiation hemangiosarcomas.

Purpose: Bilateral prophylactic mastectomy and oophorectomy are currently the most effective prevention options for female carriers of the BRCA1 or BRCA2 gene. However, especially the mastectomy procedure is very invasive and is chosen rarely among high risk women in Germany. Little is known about how women cope with this surgery and their long-term satisfaction., Methods: Face-to-face interviews were conducted with two BRCA1 mutation carriers, who had undergone prophylactic mastectomy in their twenties 9 and 16 years ago. The process of decision making and long-term satisfaction were analysed using Mayring's qualitative content analysis., Results: Both high risk women had a significant family history of breast and ovarian cancer. They were repeatedly confronted with uncontrollable courses of disease in their relatives who died of breast cancer between the age of 20 and 30 and left small children behind. Although both women experienced different decision making and peri- and post-operative complications, both were satisfied with the decision for prophylactic surgery and showed no regret., Discussion: Deciding to obtain genetic testing pushed women towards further decision making concerning prophylactic surgery in case they carry a mutation. Information about carrier status reduced uncertainty even if the result was adverse. Both high risk women experienced a decrease in cancer related anxiety which may have heightened tolerance for quality of life related impairments. Implications for counseling are described.