Risk of contralateral second primary breast cancer according to hormone receptor status in Germany.

INTRODUCTION: Hormone receptor (HR) status has become an established target in treatment strategies of breast cancer. Population-based estimates of contralateral breast cancer (CBC) incidence by HR subtype in particular are limited. The aim of this study was to provide detailed data on CBC incidence for Germany. METHODS: Invasive breast cancer data were extracted on 49,804 women yielding 594 second primaries from the cancer registries of the Federal States of Brandenburg and Saarland and the area of Munich for the period from 1998 to 2007. Multiple imputation was used on missing values for HR status. We estimated standardized incidence ratios (SIRs) with 95% confidence intervals (95%CIs). RESULTS: SIR estimates of CBC among women diagnosed with an invasive first primary breast cancer (FBC) of any HR subtype ranged from 1.0 to 1.5 in the three registries. Pooling three registries' data, the SIR of HR-positive CBC was 0.7 (95%CI: 0.6 to 0.8) among women with HR-positive FBC. For those women with HR-negative FBC, the SIR of HR-negative CBC was 8.9 (95%CI: 7.1 to 11.1). Among women with FBC diagnosed before the age of 50 years, incidence of CBC was increased, especially for HR-negative FBC (SIR: 9.2; 95%CI: 7.1 to 11.9). CONCLUSIONS: HR status of the first primary and age at first diagnosis is relevant for predicting risk of CBC. Particularly, patients with HR-negative FBC had elevated risks.

Population-based hormone receptor-specific incidence trends of breast cancer in Germany.

OBJECTIVES: Several countries reported a drop in prescription of hormone replacement therapy (HRT) in the 2000s, followed by decreases in breast cancer incidence among postmenopausal women aged 50-69 years. The aim of this study was to provide hormone receptor specific incidence rates of breast cancer in Germany. METHODS: Breast cancer data were extracted from the cancer registries of the Federal States of Brandenburg and Saarland and the area of Munich for the period from 1998 to 2007. We obtained nationwide data on HRT prescription in 1998-2007 from health insurances. Multiple imputation was used on missing values for the receptor status. Age-standardized (European standard population) and age-specific rates were calculated. RESULTS: The age-standardized incidence rates in breast cancer were virtually constant over the entire period in all regions. In particular, no substantial changes over time occurred within the age- and receptor-specific analyses. In the same period we observed a drop in HRT use, starting in 1999 and leveling off in 2004. The incidence trends of carcinoma in situ of the female breast increased during the study period. CONCLUSIONS: In our data, we did not observe an association between the decline in HRT prescription and breast cancer incidence among women aged from 50 to 69 years. The lack of temporal changes in breast cancer incidence may be explained by introduction of opportunistic and organized mammography screening and low absolute levels of HRT prescription in Germany.

[Efficacy of psychological interventions on pain coping strategies in orthopedic rehabilitation of chronic low back pain]. / Wirksamkeit psychologischer Interventionen auf die Schmerzverarbeitung innerhalb einer orthopädischen Rehabilitation von chronischen Rückenschmerzen.

BACKGROUND: Within an intervention study in chronic low back pain patients treated in medical inpatient rehabilitation, a multimodal intervention program was implemented at a rehabilitation clinic (sponsored by VDR, 02508). The aim of the treatment was to reduce dysfunctional, particularly suppressive pain coping patterns. METHODS: The study was aimed as a controlled study. Data were collected before and after rehabilitation as well as follow-up. 404 persons were included. Pain-related cognitions and coping behaviour were analysed by means of Kiel Pain Inventory. RESULTS: The differences between groups were greater in the cognitive and emotional scales than in the behavior scales. Behavioral changes of the suppressive pain coping patterns in the intervention group appeared temporally delayed. DISCUSSION: The effectivity of inpatient rehabilitation can be increased and stabilised up to 0,2 difference of effect size compared to control group by a more specific intensive and interdisciplinary therapy.

[Psychological comorbidity in subacute and chronic tinnitus outpatients]. / Tinnitusbelastung und psychische Komorbidität bei ambulanten subakuten und chrionischen Tinnituspatienten.

OBJECTIVES: The aim of the study is to assess psychosomatic symptoms and comorbidity in a group of tinnitus out-patients and their correlation with tinnitus distress. METHODS: 32 subacute (duration 3-12 months) and 71 chronic tinnitus patients participated in the study. Questionnaires were used to assess tinnitus distress (German version of the TQ, VAS), psychosomatic symptoms (SCL-90-R, BDI, BAI) coping strategies (KKG, FKV), social support (F-SOZU) and interpersonal problems (IIP-D). RESULTS: 56 % of subjects met the criteria for a disorder according to DSM-IV (CIDI). Compared to the general population, there is a particularly high comorbidity with anxiety and somatoform disorders. Tinnitus distress was related to depression (BDI), tinnitus loudness and disturbance of activities (59 % explained variance). There were no substantial differences between subacute and chronic tinnitus. CONCLUSIONS: The results stress the importance of diagnostic investigation of comorbidity and psychosomatic symptoms already at the subacute stage in tinnitus patients.

[Psychotherapeutic relationship and outcome in psychotherapy of personality disorders]. / Therapeutische Beziehung und Therapieerfolg bei der stationären Psychotherapie von Persouml;nlichkeitsstörungen.

OBJECTIVES: The study examines the predictive significance we of the quality of the individual therapeutic relationship for outcome in patients with personality disorders who underwent inpatient psychodynamic psychotherapy. METHODS: In a prospective study 254 patients with DSM IV Cluster B and C personality disorders were examined at several intervals in the course of inpatient psychotherapy with the Helping Alliance Questionnaire, the Symptom Check List SCL-90-R, the score for severity of impairment and with questionnaires on the form of therapy for patients and therapists. RESULTS: Independent of the outcome, patients classified individual psychotherapy as the most effective form of therapy. Successful patients also favoured group psychotherapy as being particularly effective; unsuccessful patients rated group psychotherapy as poor. Test results from patients in the dimensions therapeutic alliance and relationship in the Helping Alliance Questionnaire correlated significantly with the outcome of the therapy after just two weeks. CONCLUSIONS: The investigation supports a central role of the individual therapeutic relationship for the outcome of therapy in inpatient psychotherapy for personality disorders. The Helping Alliance Questionnaire is suitable for an effective monitoring of the inpatient therapy process.

[The incidence of pathological eating behaviour among schoolchildren in a large urban area]. / Zur Verbreitung pathologischen Essverhaltens unter Schülerinnen und Schülern einer Grossstadt.

Clinical experience and international epidemiological studies indicate an increase in pathological eating behaviour as well as a shift towards increasingly younger children. In order to study its frequency in Germany a large random sample, 2,844 pupils of the 10 th class level were contacted as part of a school medical examination to take part in a questionnaire study using the Eating Disorder Inventory. Age, gender, BMI and the type of school were also recorded. From the statistical description of healthy matching samples, gender-specific cut-off values were established and this methodical approach was discussed critically. Of the predominantly 15/16-year-old schoolchildren, 83 % took part in the study. Regardless of gender and type of school, more than 7% had an anorexic body weight and 10% of female and 2% of male pupils had bulimic eating behaviour.

[Symptomatics and life events by German eastern and western psychotherapy patients] / Symptomatik und Lebensereignisse bei ost- und westdeutschen Psychotherapiepatienten/innen.

The results of parallel comparative studies carried out on patients in psychotherapy in the University Clinics for Psychotherapy and Psychosomatics of Halle and Düsseldorf are presented in this paper. The investigation setting operationalized the constructs of symptomatics, cause attribution, treatment expectationns, events in life and assessment of emotional support. There are no differences between the two groups of people as far as symptomatics and image of oneself is concerned. However, patients in Halle experience a much higher number of critical events in their professional lives than the group in Düsseldorf. Although there was no difference in cause attribution in the two groups, the patients in Halle preferred in-clinic group therapy as a form of treatment whereas patients in Düsseldorf saw better opportunities to improve their situation in individual treatment as outpatients.