Severity and duration of menopausal symptoms after risk-reducing salpingo-oophorectomy.

OBJECTIVES: To reduce the risk of ovarian cancer, women with BRCA1/2 mutations are advised to undergo risk-reducing salpingo-oophorectomy (RRSO) at a premenopausal age. Premenopausal RRSO results in acute menopause and is associated with various menopausal symptoms. This study investigates the severity and duration of subjective menopausal symptoms after premenopausal RRSO and associated factors. METHODS: We included 199 women who had undergone RRSO before age 52 in this cross-sectional study. The Menopause Rating Scale (MRS) was used to measure the level of psychological, somato-vegetative and urogenital symptoms (no/little, mild, moderate, or severe). Uni- and multivariate logistic regressions were performed to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs) for having moderate or severe symptoms as compared to having no or mild symptoms. Duration of symptoms was investigated by calculating the time since RRSO. RESULTS: Sixty-nine percent (137/199) of the included women reported moderate or severe symptoms on the MRS, a mean of 7.9 years after RRSO. Fifty-seven percent (94/137) of these women reported severe urogenital symptoms, and about one-quarter reported severe psychological and/or somato-vegetative symptoms. Only psychological symptoms tended to improve over time (>=10 years). A personal history of breast cancer was independently associated with having moderate or severe menopausal symptoms (OR = 3.4; 95%CI = 1.6-7.1). CONCLUSIONS: The majority of women report moderate or severe menopausal symptoms, even 10 years after surgical menopause, and breast cancer survivors especially. To improve quality of life, follow-up care after RRSO should focus on these symptoms and be accessible for many years after RRSO.

Results of a pilot programme of mammographic breast cancer screening in the Western Cape.

BACKGROUND: Mammographic screening programmes are now established in developing countries. We present an analysis of the first screening programme in sub-Saharan Africa. METHODS: Women aged > or = 40 years were identified at three primary healthcare centres in the Western Cape Province, South Africa, and after giving informed consent underwent mammography at a mobile unit. After a single reading, patients with American College of Radiology Breast Imaging Reporting and Data System (BIRADS) 3 - 5 lesions were referred to a tertiary centre for further management. RESULTS: Between 1 February 2011 and 31 August 2012, 2 712 screening mammograms were performed. A total of 261 screening mammograms were reported as BIRADS 3 - 5 (recall rate 9.6%). Upon review of the 250 available screening mammograms, 58 (23%) were rated benign or no abnormalities (BIRADS 1 and 2) and no further action was taken. In 32 women, tissue was acquired (biopsy rate for the series 1.2%); 10 cancers were diagnosed (biopsy malignancy rate 31%). For the entire series of 2 712 screening mammograms, the cancer diagnosis rate was 3.7/1 000 examinations. Of 10 cancers diagnosed at screening, 5 were TNM clinical stage 0, 2 stage I and 3 stage II. CONCLUSIONS: The low cancer detection rate achieved, and the technical and multiple administrative problems experienced do not justify installation of a screening programme using the model utilised in this series.

[Detailed results of orbital and optic nerve decompression]. / Detaillierte Ergebnisse nach Orbita- und Optikusdekompressionen.

Orbital complications of various pathogenesis include impairment or loss of vision inhibition of globe motility and exophthalmos, and are treated best by an interdisciplinary team. Preoperative strategy should include information about underlying diseases, since success of treatment is related to diagnosis. To analyse our postoperative results we examined four groups of cases: injuries, tumors, infections and mucoceles. Diseases were located in the orbit or paranasal sinuses and produced similar symptoms. But prognosis and results of surgical treatment produced significant differences. The best improvement in vision was seen after treatment of inflammatory processes or after post-traumatic optic nerve decompression. An 88% improvement in globe motility and diplopia was seen in patients undergoing treatment for mucoceles, while a 95% improvement was found following transethmoidal surgery for inflammations of the paranasal sinuses. Overall results represent current trends for indications for surgical techniques employed to treat orbital and paranasal sinus disease.