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In Germany, the nationwide population-based mammography screening program (MSP) was introduced in 2005 and is full-running since 2010. By 2014, incidence rates for invasive breast cancer were very similar to those of the pre-screening era. Therefore, the ongoing effect of the MSP on breast cancer surgery rates can now be investigated. We analyzed population-based breast-conserving (BCS) and mastectomy (MET) surgery rates (per 100,000) among women aged < 50, 50–69 (eligible for the MSP), and 70+ years among women with in situ and invasive breast cancer during 2005–2015. For invasive breast cancer, both BCS and MET rates slightly increased in the age group < 50 years (38.3 in 2005 vs 42.5 in 2015 and 15.7 vs 18.2, respectively). In contrast, MET rates considerably decreased among women aged 50–69 and 70+ years (92 vs 65.4 and 155.4 vs 122.1, respectively), while BCS rates increased in both age groups (210.6 vs 254.4 and 147.2 vs 187, respectively). For in situ breast cancer, MET rates slightly increased in all age groups. BCS rates slightly increased in women aged < 50, but nearly doubled for women aged 50–69 (26.9 vs 49.1) and markedly increased in the 70+ age group (11.5 vs 16.1). During and after the implementation of MSP, there was a strong shift towards BCS within the screening-eligible age group and for women aged 70+. Women with invasive breast cancer in these age groups may profit from screening with a decline of MET rates in favor of BCS rates at the expense of higher surgery rates for in situ breast cancer. [ABSTRACT FROM AUTHOR]

Background: Atrial fibrillation (AF) is caused by different mechanisms but current treatment strategies do not target these mechanisms. Stratified therapy based on mechanistic drivers and biomarkers of AF have the potential to improve AF prevention and management outcomes. We will integrate mechanistic insights with known pathophysiological drivers of AF in models predicting recurrent AF and prevalent AF to test hypotheses related to AF mechanisms and response to rhythm control therapy.Methods: We will harmonise and combine baseline and outcome data from 12 studies collected by six centres from the United Kingdom, Germany, France, Spain, and the Netherlands which assess prevalent AF or recurrent AF. A Delphi process and statistical selection will be used to identify candidate clinical predictors. Prediction models will be developed in patients with AF for AF recurrence and AF-related outcomes, and in patients with or without AF at baseline for prevalent AF. Models will be used to test mechanistic hypotheses and investigate the predictive value of plasma biomarkers.Discussion: This retrospective, harmonised, individual patient data analysis will use information from 12 datasets collected in five European countries. It is envisioned that the outcome of this analysis would provide a greater understanding of the factors associated with recurrent and prevalent AF, potentially allowing development of stratified approaches to prevention and therapy management. [ABSTRACT FROM AUTHOR]

Aims: The early repolarization pattern (ERP) has been shown to be associated with arrhythmias in patients with short QT syndrome, Brugada syndrome, and ischaemic heart disease. Catecholaminergic polymorphic ventricular tachycardia (CPVT) is an inherited arrhythmia syndrome and related to malignant ventricular tachyarrhythmias in a structurally normal heart. The aim of this study was to evaluate the prevalence of ERP and clinical events in patients with CPVT.Methods and Results: Digitalized resting 12-lead ECGs of patients were analysed for ERP and for repolarization markers (QT and Tpeak-Tend interval). The ERP was diagnosed as 'notching' or 'slurring' at the terminal portion of QRS with ≥0.1 mV elevation in at least two consecutive inferior (II, III, aVF) and/or lateral leads (V4-V6, I, aVL). Among 51 CPVT patients (mean age 36 ± 15 years, 11 males), the ERP was present in 23 (45%): strictly in the inferior leads in 9 (18%) patients, in the lateral leads in 9 (18%) patients, and in infero-lateral leads in 5 (10%) patients. All patients with ERP were symptomatic at presentation (23 of 23 patients with ERP vs. 19 of 28 patients without ERP, P = 0.003). Syncope was also more frequent in patients with ERP (18 of 23 patients with ERP vs. 11 of 28 patients without ERP, P = 0.005).Conclusion: A pathologic ERP is present in an unexpected large proportion (45%) of patients and is associated with an increased frequency of syncope. In patients with unexplained syncope and ERP at baseline, exercise testing should be performed to detect CPVT. [ABSTRACT FROM AUTHOR]

Background: The German Mammography Screening Program (German MSP) is population-based and intended for women aged 50-69 years (approximately 10.5 million). The program started in 2005 and was implemented within 5 years. This article describes the implementation, structure, and screening process, and presents the results of initial examinations for the prevalence phase. Methods: Data were collected annually from invitation centers (invitation, attendance), screening units (performance, outcomes), and cancer registries (incidence). Results: In 2009, 92% of all annually eligible women were invited; 50% of the annually eligible population participated. The total cancer detection rate in the period of 2005-2009 was 8.1/1,000; the corresponding recall rate was 5.9%. 19.6% of detected cancers were ductal carcinoma in situ; 76.7% of invasive cancers were ≤ 20 mm in size, 30.2% were ≤ 10 mm, and 75.3% were nodenegative. During the implementation period, incidence increased by 37 and 56% in the old and new federal states, respectively. Incidence rates decreased following the prevalence phase. Conclusion: The German MSP was successfully implemented. The results of the prevalence phase meet the target values of the European guidelines. Proper functioning of the program is also verified by its effects on breast cancer incidence. To draw reliable conclusions regarding the long-term effects of the program, results from the routine screening rounds have to be awaited. [ABSTRACT FROM AUTHOR]

The aim of this study was to assess the association between the introduction of the nationwide mammography screening program (MSP) and breast cancer surgery rates in Germany 2005-2009. We used nationwide DRG hospitalization files (2005-2009) and analyzed surgery rates for the treatment of invasive and in situ breast cancer in Germany. We used actual numbers of screened women to model the influence of the introduction of the MSP on surgery rates. During 2005 through 2009, the rate of breast-conserving surgery for invasive and in situ breast cancer increased among all age groups. However, rate increases for invasive and in situ breast surgery were largest among women aged 50-69 years (invasive: rate difference [per 100,000] 95.1, 95 % CI 90.7; 99.5; in situ: rate difference 34.4, 95 % CI 32.6; 36.2). Mastectomy rates generally showed little change over time. Conditional on a 70 % participation in the MSP, our model predicts that the estimated increase of mastectomy rates for invasive and in situ breast cancer among women aged 50-69 years during the introductory phase of the MSP would be 4.2 (95 % CI −0.2; 8.6) and 6.1 per 100,000 (95 % CI 5.0; 7.1), respectively. The introduction of the nationwide MSP shows markedly rising rates of breast conserving surgery for women aged 50-69 years with invasive and in situ breast cancer. This increase is expected as a consequence of the first screening round. The model-based estimate for the increase of mastectomy rates, assuming a 70 % MSP participation, is lower than the reported increases observed in MSP in other countries. [ABSTRACT FROM AUTHOR]

Background: The incidence of sudden cardiac death in persons under age 40 is roughly 3 per 100 000 persons per year in Germany and North America. Many of these deaths are found to be due to hereditary heart diseases, often a primary structural heart disease associated with arrhythmia or else a primary arrhythmia syndrome in a structurally normal heart. Such diseases are usually of autosomal dominant inheri -tance, often affect otherwise healthy persons, and can generally be well treated if recognized early. Patients commonly have affected relatives who are still asymptomatic. Methods: This review is based on articles up to May 2010 that were retrieved by a selective search of the Medline database via PubMed, with additional consideration of the relevant European and American guidelines and the German Law on Genetic Diagnosis. Results and conclusion: Hereditary arrhythmia syndromes are now found in more than half of all initially unexplained cases of sudden cardiac death in young persons. Among such cases, the hereditary arrhythmia syndrome is primary in 70% and caused by an arrhythmogenic structural heart disease in 30%. In addition to autopsy findings, a thorough family history, relevant medical findings obtained during life (if available), the examination of relatives, and directed molecular testing where appropiate enabled establishing the diagnosis. Arrthymia syndromes that can cause sudden death are often detectable during life if physicians and the public are appropriately sensitized. [ABSTRACT FROM AUTHOR]

Extremes of the electrocardiographic QT interval, a measure of cardiac repolarization, are associated with increased cardiovascular mortality. We identified a common genetic variant influencing this quantitative trait through a genome-wide association study on 200 subjects at the extremes of a population-based QT interval distribution of 3,966 subjects from the KORA cohort in Germany, with follow-up screening of selected markers in the remainder of the cohort. We validated statistically significant findings in two independent samples of 2,646 subjects from Germany and 1,805 subjects from the US Framingham Heart Study. This genome-wide study identified NOS1AP (CAPON), a regulator of neuronal nitric oxide synthase, as a new target that modulates cardiac repolarization. Approximately 60% of subjects of European ancestry carry at least one minor allele of the NOS1AP genetic variant, which explains up to 1.5% of QT interval variation. [ABSTRACT FROM AUTHOR]