Nationwide screening program for breast and cervical cancers in Hungary: special challenges, outcomes, and the role of the primary care provider.

INTRODUCTION: Breast and cervical cancers are both common malignancies in Hungarian women. The aim of this study was to evaluate the impact of nationwide screening programs on the incidence and mortality of breast and cervical cancers and to assess the role of primary care providers in this context. MATERIALS AND METHODS: Published records from 2000-2011 on breast and cervical cancer screening activities in Hungary were reviewed. Previously unpublished data from the Hungarian National Cancer Registry were also included in this review. Hungarian outcomes were compared to international results. RESULTS: A nationwide screening program for breast cancer was established in Hungary in 2001. A similar program for cervical cancer was subsequently initiated in 2003. As of 2009, 50% of the population at risk took advantage of breast cancer screening, while the exact participation rate for cervical cancer screening could not be established due to deficiencies of reporting by private gynecologists. The Health Visitors Cervical Screening Program, a new initiative within the context of the nationwide cervical screening program, based on involvement of local primary care providers, had encouraging results which substantially raised participation rates. However, deficiencies were identified regarding flow of information between service providers, patients, and family physicians. There was a slight reduction in the incidence of breast cancer and a more pronounced reduction in the incidence of cervical cancer, as well as a reduction in mortality for both breast and cervical cancers associated with these screening initiatives. CONCLUSION: The inclusion of primary care providers may benefit nationwide screening programs by raising participation rates in the target population.

Bilateral juvenile fibroadenosis of the breast: management with subcutaneous mastectomy and silicone implant placement.

Bilateral fibroadenosis is a rare, benign disorder, affecting adolescents or women of childbearing age. Choosing the most optimal therapy that manages both the physical and psychological aspects of the disease is a challenge. The goals of the treatment are complete resection of the lesions with optimal cosmesis. Options range from cryoablation, ultrasound-guided vacuum-assisted eradication and simple excision of the lesions to subcutaneous mastectomy with reconstruction. We present a case of a 25-year-old woman with 37 complex fibroadenomas affecting both breasts who was treated with nipple-sparing subcutaneous mastectomy and silicone implant reconstruction to both the surgeons' and patient's satisfaction.

Relations between anthropometric parameters and sexual activity of Hungarian men.

In the last decades, there were visible achievements in the evaluation of sexuality-related problems and issues regarding sexual life. However, there are limited reliable and comparable data on the average values of sexual activity and its relation to anthropometric parameters in different populations and age cohorts. This study tries to examine the association between anthropometric parameters and male sexual activity. A clinical population of 1146 male patients between 25 and 45 years of age attending an outpatient clinic of andrology in Budapest (Hungary) was examined and questioned in a medical setting. Age, body height, weight, body mass index (BMI) and self-reported sexual activity were the main outcome measures. The patients were allotted into age groups (25-29, 30-39 and 40-45 years), the youngest group showing the highest coital activity. Although obesity and overweight were present in 61% of the study population, no connections between BMI and sexual activity were apparent. Comparing less active persons with those reporting at least two intercourses per week, significant difference was found between body height groups. Men below 170 cm reported higher activity than men over 180 cm. Despite the fact that the prevalence of obesity among younger generations is increasing, it has had no visible influence on the sexual activity of this age cohort as yet. Our data suggest that sexual activity was not clearly related to other anthropometric parameters, and depends mainly on the characteristics of the population examined. There is a great need for large-scale studies worldwide on larger representative samples, using similar methods, to acquire reliable data from other nations and different age groups.

HE4--a novel promising serum marker in the diagnosis of ovarian carcinoma.

Biomarkers have a wide range of applications in the management of several cancers. To date serum markers have been the most extensively used biomarkers in everyday practice but few markers are elevated in preclinical or premalignant disease, limiting their importance for estimating risk or for screening. Human epididymis protein-4 (HE4) is a novel serum marker which is more sensitive in the prediction of risk of ovarian malignancy than CA125 alone in patients with a pelvic mass. HE4 in combination with CA125 appears to be an effective tool for the early detection of recurrence or monitoring the response to therapy. Risk of Ovarian Malignancy Algorithm, utilizing the dual marker combination of HE4 and CA125, can be used to stratify both postmenopausal and premenopausal women into high- and low-risk groups, allowing for an effective triage of women to appropriate institutions for their care. A review of HE4 and its feasibility as a novel diagnostic tool in the management of epithelial ovarian cancer is presented.

Primary systemic therapy in breast cancer--an update for gynecologic oncologists.

Primary systemic - or neoadjuvant - chemotherapy (PST) is the standard of care in locally advanced breast cancer and it has also become an option in primary operable disease for patients who are candidates for adjuvant systemic chemotherapy. There are several advantages of administering PST: tumor downstaging--improving the chance of breast conserving surgery; in vivo assessment of tumor sensitivity to the chosen therapeutic regimen; and, early control of micrometastatic disease. On the other hand, the rate of tumor response can be used as a surrogate prognostic marker and for rapid screening of efficiency of new drugs. PST initially referred to systemic chemotherapy, but in recent years endocrine--and now multiple targeted therapies--are available in most of the countries within the confines of clinical trials.

Granular cell tumour of the breast: case series and review of the literature.

Granular cell tumours (GCTs) are uncommon rare neoplasms that may occur in any part of the body. Approximately 5-8% of granular cell tumours occur within the breast. Although nearly always benign in behaviour, granular cell tumours of the breast can often mimic breast malignancies both clinically and on the basis of imaging techniques. This article reports five cases of benign granular cell tumours appearing in the breast, mimicking a malignant breast lesion. In addition to reporting the cases, the relevant literature was reviewed.

Possible association of folic acid supplementation during pregnancy with reduction of preterm birth: a population-based study.

OBJECTIVE: Periconceptional folic acid or multivitamin supplementation is recommended for prospective pregnant women to prevent neural-tube defects. The question is whether it is worth continuing these supplementations after the first trimester of pregnancy or not. Thus the possible fetal growth promoting and/or preterm birth reducing effect of vitamin supplements in the second and mainly in the third trimester was studied. STUDY DESIGN: Comparison of birth outcomes of singletons born to primiparous pregnant women with prospectively and medically recorded vitamin supplement in the population-based data set of the Hungarian Case-Control Surveillance of Congenital Abnormalities (HCCSCA), 1980-1996 contained 6293, 169, and 311 primiparae with folic acid alone, multivitamins and folic acid+multivitamin supplementation, respectively, and their data were compared to the data of 7319 pregnant women without folic acid and folic acid-containing multivitamin supplementation as reference. RESULTS: Mean gestational age was 0.3 week longer and mean birth weight was by 37 g higher in the group of folic acid alone, than in the reference group (39.2 weeks; 3216 g). The rate of preterm births (7.6%) was significantly lower compared with the reference sample (11.8%), but the rate of low birth weight newborns did not show significant reduction. Folic acid alone in the third trimester associated with 0.6 week longer gestational age and a more significant reduction in the rate of preterm births (4.8%). CONCLUSIONS: Minor increase in mean birth weight after high dose of folic acid supplementation during pregnancy would not be expected to result in too large babies; however, the significant reduction in the rate of preterm births may have great public health benefit.

[Clinico-pathology of lobular breast cancer]. / A lobularis emlörákok klinikopatológiája.

997 operations were performed because of malignant breast lesions at the National Institute of Oncology during a two-years period (1990-1991). Histologically 94 tumours proved to be invasive lobular cancer. Comparable data were available for 89 patients; a questionnaire was used for data collection. Analysing these cases, the authors discuss the clinicopathology of lobular cancer and current practice in its treatment. The mean age of the patients was 57.1 years, which in accordance with the literature. No synchronous contralateral tumour was observed in the studied patient group. 4.9% of the cases proved to be multifocal, what is considerably less than that reported in the literature. It is a frequent matter of debate in many papers whether mastectomy should be indicated if the multicentricity of the tumour is only suspected. The features of the studied group may also emphasise this question, and further investigation is needed for moderating the surgical radicality. The rate of large tumours and the mean tumour diameter was lower than suggested by the literature. The rate of positive axillary lymph nodes was higher than in reports of other centres. The authors underline the necessity of axillary block-dissection even in case of operations with decreased radicality. Beside lymph node metastases, invasive lobular cancer produces haematogenous metastases with a higher probabilty than other breast cancers. This observation is supported by our study, too.