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Aktuelle Studien haben die Möglichkeiten der Therapie eines prämenopausalen Mammakarzinoms verändert und die Therapieleitlinien der internationalen und nationalen senologischen Gesellschaften ergänzt. Bei prämenopausalen Patientinnen mit niedrigem Rezidivrisiko ohne Chemotherapie bleibt Tamoxifen erste Wahl, wobei bei guter Verträglichkeit nach 5 Jahren die Verlängerung der Therapie mit Tamoxifen auf weitere 5 Jahre erwogen werden kann (individuelle, risikoadaptierte Entscheidung). Sollte die Patientin nach der TAM-Therapie in der Postmenopause sein, wäre eine Therapie mit Aromatasehemmer (AI) für weitere 5 Jahre empfehlenswert. Bei prämenopausalen Patientinnen mit hohem Rezidivrisiko, die eine Chemotherapie benötigen und nach der Chemotherapie noch prämenopausal sind, ist die Therapie mit Exemestan + Ovarian Function Suppression (OFS) (GnRH-Analoga) für 5 Jahre vorteilhaft (auch für Patientinnen mit einer Kontraindikation gegen Tamoxifen (TAM) [z.?B. Thrombosen] optional). Bei Unverträglichkeit oder intolerablen Nebenwirkungen stellt die Kombination TAM + OFS eine Alternative dar. Für Patientinnen mit niedrigem Risiko und Kinderwunsch kann auch eine zeitreduzierte Therapieoption mit TAM + GnRH-Analogon Goserelin ± Zoledronsäure für 3 Jahre besprochen werden (ABCSG 12). Des études récentes ont modifié les possibilités dans le traitement du cancer du sein préménopausique et complété les directives thérapeutiques des sociétés internationales et nationales de sénologie. Le tamoxifène reste l’option de première intention chez les patientes préménopausiques ayant un faible risque de récidive sans chimiothérapie. Si le tamoxifène a été bien toléré pendant 5 ans, ce traitement peut alors être poursuivi 5 ans de plus (décision au cas par cas, adaptée au risque individuel). Chez les patientes ayant atteint la postménopause à la fin du traitement par le tamoxifène, un traitement par un inhibiteur de l’aromatase (IA) est recommandé les 5 années suivantes. Chez les patientes préménopausiques qui ont un risque élevé de récidive, ont besoin d’une chimiothérapie et n’ont pas encore atteint la ménopause à la fin de la chimiothérapie, un traitement de 5 ans par l’exémestane + SFO (suppression de la fonction ovarienne, analogues de la GnRH) est un bon choix (c’est aussi une option chez les patientes pour lesquelles le tamoxifène [TAM] est contre-indiqué [p.ex. thromboses]). Lors d’intolérance au traitement ou d’effets indésirables inacceptables, l’association TAM + SFO est une alternative. Chez les patientes à faible risque qui souhaitent encore avoir un enfant, on peut envisager une option thérapeutique de durée réduite par TAM + goséréline (analogue de la GnRH) ± acide zolédronique sur 3 ans (ABCSG 12).

Aktuelle Studien haben die Möglichkeiten der Therapie eines prämenopausalen Mammakarzinoms verändert und die Therapieleitlinien der internationalen und nationalen senologischen Gesellschaften ergänzt. Bei prämenopausalen Patientinnen mit niedrigem Rezidivrisiko ohne Chemotherapie bleibt Tamoxifen erste Wahl, wobei bei guter Verträglichkeit nach 5 Jahren die Verlängerung der Therapie mit Tamoxifen auf weitere 5 Jahre erwogen werden kann (individuelle, risikoadaptierte Entscheidung). Sollte die Patientin nach der TAM-Therapie in der Postmenopause sein, wäre eine Therapie mit Aromatasehemmer (AI) für weitere 5 Jahre empfehlenswert. Bei prämenopausalen Patientinnen mit hohem Rezidivrisiko, die eine Chemotherapie benötigen und nach der Chemotherapie noch prämenopausal sind, ist die Therapie mit Exemestan + Ovarian Function Suppression (OFS) (GnRH-Analoga) für 5 Jahre vorteilhaft (auch für Patientinnen mit einer Kontraindikation gegen Tamoxifen (TAM) [z.?B. Thrombosen] optional). Bei Unverträglichkeit oder intolerablen Nebenwirkungen stellt die Kombination TAM + OFS eine Alternative dar. Für Patientinnen mit niedrigem Risiko und Kinderwunsch kann auch eine zeitreduzierte Therapieoption mit TAM + GnRH-Analogon Goserelin ± Zoledronsäure für 3 Jahre besprochen werden (ABCSG 12). Current studies have changed the options for treatment of premenopausal breast cancer and extended the treatment guidelines of international and national senologic societies. In premenopausal female patients with a low risk of recurrence without chemotherapy, tamoxifen (TAM) is still the method of choice, whereby in cases of good tolerability after 5 years, an extension of treatment with TAM for a further 5 years can be considered (individual risk-adapted decision). If the patient is in the menopause following TAM treatment, treatment with an aromatase inhibitor (AI) for a further 5 years is recommended. In premenopausal patients with a high risk of recurrence who need chemotherapy and following chemotherapy are still in the premenopausal period, treatment with exemestane plus ovarian function suppression (OFS) with gonadotropin releasing hormone (GnRH) analogs for 5 years is advantageous and even optional for patients with contraindications for TAM, e.g. thrombosis. In cases of intolerability or severe side effects the combination of TAM with OFS is an alternative. For patients with low risk and a desire for children, a time reduced treatment option of TAM + the GnRH analog goserelin with or without zoledronic acid for 3 years can also be discussed (Austrian Breast Cancer Study Group, ABCSG 12).

The aim of this study was to investigate the potential effects of pomegranate seed oil (PGS) on menopausal symptoms.

The aims of this study were to assess chemotherapy treatment characteristics, neutropenic event (NE) occurrence and related risk factors in breast cancer patients in Western Europe.Six retrospective audits of breast cancer chemotherapy were combined into a dataset of 2,860 individuals. NEs were defined as neutropenia-related hospitalisation, dose reduction ≥15% or dose delay ≥7 days. Summation dose intensity (SDI) was calculated to compare different types of chemotherapy regimens on a single scale. Risk factors of NE occurrence and of low relative dose intensity (RDI) ≤85% were identified by multiple logistic regression.Patient populations were comparable between audits. Until 1998, cyclophosphamide, methotrexate and fluorouracil regimens were most frequently used, but thereafter, anthracycline-based regimens were most common. NEs occurred in 20% of the patients and low RDI in 16%. NE occurrence predicted low RDI and was associated with higher age, bigger body surface area, lower body mass index, regimen type, more chemotherapy cycles planned, normal to high SDI, concomitant radiotherapy and year of treatment. First cycle NE occurrence predicted NEs from cycle 2 onwards. A risk score using age, SDI, number of planned chemotherapy cycles and concomitant radiotherapy differentiated patients with increasing NE risk (9–37%). An alternative score version not using concomitant radiotherapy performed moderately less well.NEs occurred frequently in this combined dataset and they affected treatment delivery. Identifying patients at high NE risk enables targeted prophylaxis and may avoid dose limitations.

The immunohistochemnichally determined receptor status, as well as first-generation risk factors (tumor size, lymph node status, histologic grading including subfactors, tumor histology, and biochemically determined receptor status) were prospectively analyzed in 288 cases of primary breast cancer for their impact on recurrence-free survival (RFS) and overall survival (OS) after a median observation period of 41 months.

Tumor samples of 240 patients with primary breast cancer were biochemically and immunohistochemically investigated for estrogen receptors (ER) and, in 130 of the samples, for progesterone-receptors (PgR) in order to examine reasons for discordant findings. The biochemical (DCCA) and immunohistochemical assays (ICA) yielded positivity in 71% for ER, and in 44% for PgR. Concordant ER-DCCA and ER-ICA results were obtained in 84%; two thirds of the discordant ER-findings manifested as DCCA-neg/ICA-pos. Concordance in the case of PgR amounted to 72%, and of the discordances 60% were DCCA-neg/ICA-pos. Significant association with postmenopausal status existed only for ER positivity in ICA (p=0.01), whereas ER-DCCA, PgR-DCCA and PgR-ICA were all more or less independent of the menopausal status. The frequency of discordances was independent of menopausal status. Discordance for ER-assays increased significantly near the respective cut-off point; this was not unequivocally true for PgR-assays. The correlation of tumor types of sparse cellularity, as well as prominent stroma content (‘scirrhous carcinoma’) with increased frequency of the constellation DCCA-neg/ICA-pos was of borderline significance for PgR (p=0.06), but not for ER. The percentage of discordant ER-findings, figuring as DCCA-neg/ICA-pos, was statistically significantly increased in locally advanced breast cancer (p=0.03). Fibrocystic disease in peritumoral breast tissue had no impact on receptor-assay discordance. In any case, the models derived from theoretical thought, laboratory data and singular observations can only in part explain the discordance in steroid receptor values measured with different methods.

The conversion of plasminogen to active plasmin is thought to be a crucial step in the process of extracellular matrix degradation associated with metastatic spread. Activation of plasminogen is initiated by urokinase plasminogen activator (uPA). The binding of uPA to the uPA cell surface receptor (uPA-R) accelerates plasmin generation from plasminogen and localizes uPA activity to the cell surface.

Recent reports consider99mTc-tetrofosmin scintigraphy to be a powerful new diagnostic tool for discriminating malignant from benign breast disease. We report on a woman suffering from histologically confirmed axillary metastases of a primary unknown, occult carcinoma, whose origin was suspected within the breast. All the diagnostic procedures performed to discover any lesion failed or were inconclusive. The primary cancer was clearly visualized, however, in the right breast by means of99mTc-tetrofosmin scintigraphy.Conclusion.We suggest that99mTc-tetrofosmin scintigraphy is a powerful method to detect breast cancer, especially when other diagnostic imaging procedures are inconclusive.