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Background: The recommendation to perform an elective bilateral salpingo-oophorectomy (BSO) at the time of a hysterectomy for a benign condition is complex., Aim: This survey evaluated the effect of three factors on BSO: the patient's age, her menopausal status, and the presence of a family history of breast cancer., Materials and Method: We conducted an anonymous written survey, sent to 1513 gynaecologists, evaluating their attitude towards performing a prophylactic BSO concomitantly with a hysterectomy. We used a clinical vignette of a patient presenting a large and painful fibroid. We modified three factors: her age (either 44 or 49 years old), menopausal status (pre-menopausal or peri-menopausal), the absence or presence of a breast cancer family history. We randomly sent one case to each gynaecologist, who was asked whether he/she would perform a BSO., Results: The recommendation to perform a BSO varied between 2% and 81%, in relation to the different cases (χ(2): 151; p<0.001). On average, a five year difference in the patients' age (44 years vs 49 years) was associated with a 40% increase in proceeding a BSO. Being peri-menopausal vs being pre-menopausal, was associated with a 20% increase in suggesting a BSO. Having had a mother, diagnosed with breast cancer, was associated with a 10% increase of BSO., Conclusion: The physicians' recommendation to perform an elective bilateral salpingo-oophorectomy at the time of a hysterectomy, is strongly influenced by the patients' age, and to a lesser extent by her menopausal status, or a family history of breast cancer., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)

Background: Preoperative diagnosis has become the standard in breast cancer (BC) management. Recently, ultrasound guided core needle biopsy (CNB) and stereotactic needle core biopsy have replaced fine needle aspiration cytology. Epithelial cell displacement (DE) occurs frequently after core needle biopsy (CNB) for breast cancer diagnosis., Aim: Systematically review (between 1900 and 2008) the clinical significance of DE after CNB in BC patients, and associated risk factors (delay between biopsy and surgery, needle passes, duration of the procedure, tumor size, histological type, tumor grade, margins, type of surgery, and of adjuvant treatment)., Materials and Methods: We selected 15 studies: 9 assessed the rate of DE after CNB and 6 the impact of CNB on outcome endpoints., Results: We found 3 prospective and 12 retrospective studies. However these had numerous biases such as insufficient power, confounding factors, selection of cases and controls, surrogate endpoints, heterogeneity of measured displacement. Malignant DE on surgical specimens occurred in 22% of the patients. A short interval between CNB and surgical excision increased the risk of detecting displaced cells. No increase in local recurrence was reported after CNB. Contradictory results were found in terms of sentinel node metastases. Only one study evaluated overall survival data and reported no worse survival in patients with preoperative CNB., Conclusion: Although data are limited, no increased morbidity has been associated with iatrogenic seeding after CNB.

Aim: To evaluate the prevalence and type of menopausal treatments used by breast cancer survivors. To assess factors that impaired the quality of life of these patients., Material and Methods: A questionnaire assessing quality of life was sent to 325 breast cancer patients. A 66% valid response rate was obtained. Among these responses, 169 women were postmenopausal. The following results concern these patients only., Results: Forty-five women were using some treatment to alleviate certain menopausal symptoms (26.6%). More than half of the patients used no therapy to alleviate menopausal symptoms, either because they had no symptoms (n = 43; 25.4%), they feared breast cancer recurrence (n = 24; 14.2%), they were advised not to use a treatment (n = 27; 16%), it had been shown to be inefficient (n = 5; 3%), or because of contraindication (n = 3; 1.8%). In this survey, 62.3% of postmenopausal women affected by breast cancer suffered from hot flushes (n = 94), of which half were severe (n = 46). Among women suffering from hot flushes, a third used various products to alleviate their symptoms (n = 30). Younger women suffered more often from vasomotor symptoms than did older women (p < 0.000). Current users of aromatase inhibitors suffered more from sexual disorders than did non-users (p < 0.001). They had more often an unsatisfactory sexual life (p < 0.01), more vaginal dryness (p = 0.01) and a decreased libido (p < 0.02) compared to non-users., Conclusion: More than 50% of postmenopausal women suffered from climacteric symptoms such as hot flushes, but few were taking a treatment to alleviate these symptoms.

About 10% of breast cancers occur in women who are younger than 40 years of age. For many of them, the breast cancer diagnosis will occur when they are still planning pregnancy. Most breast cancers are diagnosed at an early stage of the disease, i.e. stage I or II, which is associated with a high survival rate (5 years-survival ranging between 97% and 79% respectively) (1). Many of these patients will use adjuvant endocrine therapy. This treatment has no direct impact on their fertility, but postpones a possible pregnancy, since pregnancy is contra-indicated during Tamoxifen treatment. On the other hand, chemotherapy increases the risk of premature ovarian failure, of early menopause, and of definitive sterility. This may result in an increased risk of depression and impaired quality of life. Furthermore, those women who remain fertile will often be advised to avoid pregnancy in the near future, in order to ensure the absence of breast cancer recurrence. Nevertheless, fertility decreases with age. Possible strategies, which permit optimal treatment of breast cancer and maintain the possibility of pregnancy, should be systematically discussed with the patient as soon as possible during treatment planning (2). Gynecologists and surgeons should encourage such patients to participate in multi-center studies evaluating strategies to preserve their fertility. Life continues after cancer; the prospect of pregnancy and child birth are part of a positive project.