Contraception after breast cancer: a retrospective review of the practice among French gynecologists in the 2000's.

PURPOSE OF INVESTIGATION: To describe the French practices regarding contraception after breast cancer in the 2000's. MATERIALS AND METHODS: A total of 2,500 forms were sent to gynecologists practicing in France. Inclusion criteria were premenopausal patients who had a history of breast cancer and who had been prescribed contraception after diagnosis. Between June 1, 2002 and January 1, 2003, 197 evaluable responses were retrieved. RESULTS: The median age of the sample was 38.5 years. The most commonly used form of contraception was an intrauterine device (n = 144, 73.1%). Hormonal contraception was prescribed for 42 patients (21.3%), and other methods were used in 29 patients (14.7%) (Condoms n = 14, tubal sterilization n = 7, and others n = 8). Recurrence occurred in 27 patients (13%); 2.9% in the progestin group, 16.3% in the IUD group, and 14.8% with the other methods). CONCLUSIONS: It is necessary to evaluate current contraception practices after breast cancer to evaluate the efficacy and safety of contraception in these patients.

[Hormone replacement therapy in breast cancer patients: a study of 230 patients, with a case-control study]. / Thérapeutique hormonale substitutive après cancer du sein: une étude de 230 patientes, avec cas-témoins.

OBJECTIVES: After recalling the classical contra-indication of hormone replacement therapy (HRT) concerning patients with a personal history of breast cancer (BC), and arguments that may be opposed, the authors report the present results of a prospective study undertaken in the Center of Breast Diseases in Saint-Louis hospital in Paris since February 1992. PATIENTS AND METHODS: By April 2001, 230 patients had been included. A free interval of 2 years at least since the treatment of the primary BC has been observed. The reasons for prescribing HRT were vasomotor troubles (flushes, nightly sweats) or a dyspareunia, which were severe and not controlled by non-hormonal treatments. There was also an indication of a major osteoporotic or cardiovascular danger. In fact, many of these patients had a premature, artificial, chemo-induced menopause. The HRT most often used was an estro-progestin association (estradiol + a progestin compound) given either continuously or with a 5-d interruption each month. The mean duration of treatment was 2.5 years. RESULTS: Results, concerning the improvement of menopause troubles, were remarkable in the great majority of troubles. HRT had to be stopped in 39 cases, reading as follows: 17 cases for relapses (seven local, six in the contro-lateral breast and four metastases (7%)). Also, 22 patients (9%) interrupted their HRT for serious side-effects. A case-control study did not show any significant difference between with and without HRT patients concerning the overall survival without relapse. DISCUSSION AND CONCLUSIONS: Quality of life of patients was often substantially improved, and a deleterious effect on the cancer disease was not found. Our results are in agreement with the literature from other countries. However, one must be cautious. In such circumstances, HRT must be prescribed with the informed consent of the patients and delivered in appropriate hospital and university centers. It is wished that large randomised prospective studies may be undertaken.

Progestins and risk of breast cancer. Much ado about nothing?

In vivo and in vitro studies; epidemiological and statistical publications concerning a possible carcinogenic effect of progesterone--and progestins--raise a question mark. Too many contradictions exist in experimental and clinical studies. A very small increased risk of breast cancer with estrogen therapy has been shown; however bias are often present. It is not clearly demonstrated that the adjunction of progestin to estrogen significantly increases the risk, nor that it brings about a protective effect. Some recent works seem to indicate that continuous estroprogestin replacement therapy might be deleterious, while a sequential regimen would be not. This is to be confirmed. The results of the Women's Health Initiative Study have been analyzed. The data and conclusions of the medical literature should be interpreted very cautiously.

[Retrospective multivariate analysis of radio-pathological correlations of nonpalpable breast lesions. Experience of the Hospital Saint-Louis]. / Analyse rétrospective multivariée de la corrélation radio-anatomopathologique de lésions infracliniques du sein. Expérience de l'hôpital Saint-Louis.

PURPOSE: Several studies have demonstrated that systematic breast cancer screening increases overall survival. We report our experience regarding diagnosis of breast lesions detected using mammography. METHODS: Case reports of patients operated on in either 1992 or 1993 were retrospectively reviewed. A multivariate analysis of the clinico-pathological correlation was performed. RESULTS: Four hundred fifty seven patients representing on total 544 procedures, were included in the study. Mean age was 50.5 years (range 19-80 years). Most of the patients had no previous history of mammary lesion. Mammography was performed with prophylactic intent in more than 60% of the cases. Four hundred twelve (75.7%) benign lesions were diagnosed. Main lesions were: adenofibroma (15.7%), fibrocystic mastopathy (66.3%), adenosis (26.2%), ductal hyperplasia (23.9%), lobular hyperplasia (10.7%), and combined ductal and lobular hyperplasia (8.5%). Hyperplasia accompanied by cytonuclear atypia was observed in 49 (11%) cases. One hundred thirty two (24.3%) malignant lesions were reported, including 69 (52.3%) invasive carcinomas and 63 (47.7%) in situ carcinomas. Only nine axillary lymph node dissections were positive and 75 minimal breast cancers were diagnosed. The multivariate analysis showed that only radiological signs are a risk factor for cancer. The relative risk for cancer when focus of irregular and vermicular microcalcifications are diagnosed is 4.2 (2.0-8.5). It is 5.6 (2.5-12.5) in case of spiculated opacity. CONCLUSION: Exeresis following radiological prophylactic screening allows diagnosis of high-risk benign lesions and low-stage breast cancer. Radiological parameters are the most powerful predictive factors for malignancy.

[Causal interactions of estrogens and alcohol in cancer of the breast]. / Responsabilité croisée des estrogènes et de l'alcool dans le cancer du sein.

BACKGROUND: The majority of studies and meta-analyses tend to show a very slight increase of risk of beast cancer in post-menopausal women receiving hormone replacement therapy (HRT). Such results must however be interpreted in light of biases including intensive follow-up in women taking HRT and unknown or new parameters. DATA: Several publications have demonstrated an increased relative risk of breast cancer in women consuming alcohol. This increase rises linearly with the level of alcohol intake. To date, this parameter has been neglected in post-menopausal women taking HRT. Two studies have demonstrated a rise in breast cancer in women taking HRT who drink alcohol. No particular explanation is put forward. INTERPRETATION: Based on an experimental human study, E. Ginsburg has shown that there is a considerable and long-duration increase in estradiolemia in women on HRT who also drink alcohol. This hyperestradiolemia could exceed the promotion threshold of breast carcinogenesis. This new parameter must be taken into consideration as effective preventive measures can be implemented: convincing women taking HRT to limit their alcohol intake.

[Taxanes in the treatment of breast and ovarian cancers: current indications and results]. / Les taxanes dans le traitement des cancers du sein et de l'ovaire: indications actuelles et résultats.

Since the last years, taxanes are among the most active molecules in the treatment of advanced breast and ovarian cancers. Concerning the ovarian cancer, Paclitaxel in association with Cisplatinum is about to become the first line reference protocol. Studies are going on in order to define the association and the optimal way of administration. Concerning breast cancer, Docetaxel seems to provide the most interesting response rates after failures of anthracyclines. In France, randomised studies in adjuvant situation have started with this molecule.

[Breast cancer during pregnancy. Epidemiology--diagnosis--prognosis]. / Cancer du sein pendant la grossesse. Epidémiologie--diagnostic--prog- nostic.

The association "breast cancer and pregnancy" is rare. The hypervascularisation of the pregnant breast, the role of hormones, the immunological factors have been incriminated. The rate of diagnosis is often too late because of the changes in the pregnant breast. Among the investigations, besides mammogram, the interest of ultrasound examination especially cyto-punction is underlined. Prognosis appears more severe because the delay in diagnosis and the young age of patients. However that is true for N+ patterns, and not for N- cases. We detail the experience of the Centre des Maladies du Sein de l'Hôpital Saint-Louis which concerns 15 cases.