Markers of bone resorption were significantly increased during pregnancy. In contrast to bone resorption, markers of bone formation showed an increase as well as a decrease during pregnancy indicating a state of high bone turnover. This might coincide with the change in bone mineral density that was observed in some, but not all, studies using "dual-energy x-ray absorptiometry" (DXA) as well as "quantitative ultrasonometry" (QUS).

Background: Breast care nurses (BCNs) are specialized caregivers in certified breast cancer center teams. The impact of a BCN’s work remains unknown. Patients and Methods: The role of BCN care was evaluated in a post-discharge mail survey of 360 patients. Results: A total of 207 (87%) of 237 (66%) returned questionnaires were analyzed; 171 (83%) patients had BCN contact, 36 (17%) did not. The mean global quality of life scores (EORTC-QLQ-C30) were 66.3 for women with contact to a BCN versus 62.5 for women without such contact (p < 0.05). Women with a BCN contact had better results than women without (p < 0.001) for the following parameters: receipt of information material (84 vs. 64%), information about hospital procedures (93 vs. 72%) and treatment plan (91 vs. 63%), and knowledge of own tumor hormone receptor status (83 vs. 53%). Medication adherence correlated with the knowledge about the tumor hormone receptor status and was significantly higher in women having contact with a BCN (79 vs. 56%). The high recommendation rate (81%) reflects the high level of satisfaction with BCNs. A qualitative analysis of comments and suggestions identified aspects to improve BCN services. Conclusions: BCN improve satisfaction and treatment adherence in breast cancer patients.

Die multifaktorielle Erkrankung Osteoporose zählt heute mit 5 ± 6 Mio. Betroffenen in der BRD zu einer der häufigsten Erkrankungen der postmenopausalen Frau und weist trotz eines erweiterten Spektrums diagnostischer und therapeutischer Möglichkeiten weiterhin eine deutlich zunehmende Inzidenz auf. Hieraus ergibt sich die Notwendigkeit zur frühzeitigen Identifikation von Risikopatienten sowie die Einleitung individuell angepasster Präventionsmaûnahmen. Dazu zählen neben der Motivation zur knochenstoffwechselgesunden Ernährungsweise bzw. Lebensstil die regelmäûige körperliche Aktivität sowie ggf. eine Kalziumund Vitamin-D-Supplementierung. Zusätzlich steht mit der Östrogen-/Gestagen-Substitution eine weltweit anerkannte, wirkungsvolle und kostengünstige Therapie im Rahmen der Osteoporoseprävention zu Verfügung. Eine groûe Anzahl von Studien hat in den vergangenen 20 Jahren den positiven Einfluss der Östrogene auf den Knochenstoffwechsel sowie die Messergebnisse der Knochendichte an frakturrelevanten Messorten belegt. Hierbei besteht eine Dosis-Wirkung-Beziehung, wobei auch nach langjähriger Substitution kein Wirkungsverlust auftritt und auch bei Beginn der Substitution im hohen Alter noch ein positiver Effekt nachweisbar ist. In Bezug auf die Reduktion osteoporosebedingter Frakturen hat sich in einer Reihe von groûen Fall-Kontroll-und Kohortenstudien sowie in einer kleinen AbstractThe multifactorial disease of osteoporosis is one of the most frequent diseases, affecting about 5 ± 6 Mio. postmenopausal women in Germany, today. In spite of the introduction of new technologies of fracture risk assessment and new pharmacological opportunities the incidence of fracture is still increasing. Therefore, early identification of women at high risk as well as early and individualised preventive measures are essential in the prevention of osteoporosis. Changes of dietary habits as well as lifestyle including an increase in physical activity are of up most importance. In addition to Calcium and Vitamin D supplementation, hormone replacement therapy (HRT) is accepted as the first line and cost effective pharmacological treatment for the prevention of osteoporosis. Numerous cross sectional, case-control and prospective studies showing the effect of HRT on bone reabsorption and bone mineral density (BMD) have been published. HRT reduces bone turnover which is followed by an increase of BMD. A number of case-control and cohort studies as well as a few recent prospective studies have been investigating the effect of HRT on osteoporosis related fracture. These studies confirm that HRT leads to a significant decrease of osteoporosis related fracture (Hip fracture by > 25%). However, randomised, prospective studies are needed to underline the effect on osteoporosis related fracture. Although the effect of HRT on BMD is independent of Originalarbeit 436 Institutsangaben

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Aims This is an official interdisciplinary guideline published and coordinated by the German Society for Gynecology and Obstetrics (DGGG), the Austrian Society for Gynecology and Obstetrics (OEGGG) and the Swiss Society for Gynecology and Obstetrics (SGGG). The guideline was developed for use in German-speaking regions and is backed by numerous professional societies and organizations. The aim of this guideline is to provide an evidence- and consensus-based overview of the diagnostic approach and the management of hormonal contraception based on a systematic evaluation of the relevant literature. Methods To compile this S3-guideline, a systematic search for evidence was carried out in PubMed and the Cochrane Library to adapt existing guidelines and identify relevant reviews and meta-analyses. A structured evaluation of the evidence was subsequently carried out on behalf of the Guidelines Commission of the DGGG, and a structured consensus was achieved based on consensus conferences attended by representative members from the different specialist societies and professions. Recommendations Evidence-based recommendations about the advice given to women requesting contraception were compiled. The guideline particularly focuses on prescribing contraceptives which are appropriate to womenʼs individual needs, take account of her personal circumstances, and have few or no side effects.

Background: Decision-making for or against neoadjuvant or adjuvant chemotherapy in postmenopausal patients with hormone receptor-positive breast cancer does not follow any clear guidelines, and some patients may unnecessarily undergo chemotherapy and be exposed to the associated toxicity. The aim of this study was to identify the patient population for whom this issue may bear relevance. Methods: Patients being treated with letrozole in the prospective multicenter noninterventional EvAluate-TM study were recruited. The percentage of patients receiving chemotherapy and factors associated with chemotherapy administration were identified. Results: In all, 3,924 (37.4%) patients received chemotherapy before treatment with letrozole. Of these, 293 (20%) underwent neoadjuvant therapy. Younger age was predictive for both adjuvant and neoadjuvant therapy. Overall, decisions in favor of administering chemotherapy are more likely to be made in patients with a higher body mass index (BMI), and neoadjuvant chemotherapy is administered at a higher rate in women with a lower BMI. Concomitant medication influenced the overall decision-making regarding chemotherapy, irrespective of whether it was given on a neoadjuvant or adjuvant basis. Conclusion: There is an ongoing debate as to whether all of the many patients who receive chemotherapy actually benefit from it. Neoadjuvant chemotherapy is frequently administered in this patient population, and this should encourage further research to resolve current clinical and research issues.

Fragestellung: Nebenwirkungen der adjuvanten endokrinen Therapie des Mammakarzinoms kön-nen zu einer Beeinträchtigung der Lebensqualität und zu mangelnder Compliance führen. Ziel dieser nicht interventionellen Studie war die Erfassung des Einflusses der Therapie mit Exemestan nach Tamoxifenvorbehandlung auf die Lebensqualität der Patientinnen sowie die Erfassung der Verträglichkeit und Nebenwirkungen. Material und Methodik: In die nicht interventionelle Studie (NIS) wurden 924 postmenopausale Brustkrebspatientinnen aus 735 deutschen Zentren eingeschlossen, die eine adjuvante Switchtherapie mit Tamoxifen, gefolgt von Exemestan, erhielten. Im Verlauf einer 1-jährigen adjuvanten Behandlung mit Exemestan (25 mg p. o. täg-lich, Aromasin ® ) wurde die Lebensqualität mittels des IBCSG-(International-Breast-Cancer-StudyGroup-)QOL-Core-Fragebogens (IBCSG QOL Core, IBCSG QOL Module 24-26, SF-12) zur Selbstbeurteilung evaluiert. Des Weiteren wurden Verträglichkeit und Nebenwirkungen der Therapien erfasst. Ergebnisse: Im Verlauf der Exemestanbehandlung besserten sich alle Items des IBCSG-QOLCore-Fragebogens zur Erfassung der globalen und brustkrebsspezifischen QOL signifikant im Vergleich zur Vortherapie mit Tamoxifen. Außer-dem ergab die Analyse eine signifikante Besserung der mithilfe des SF-(Short-Form-)12-Fragebogens evaluierten körperlichen und mentalen Gesundheit. Die Verträglichkeit von Exemestan war bei 88,4 % der Patientinnen sehr gut oder gut. Die häufigsten Nebenwirkungen bestanden in Arthralgien (2,4%) und Knochenschmerzen (1,1 %). Mit Ausnahme der Gelenk-/Knochenschmerzen besserten sich im Verlauf der NIS alle im IBCSG-QOL-Module-24-26-Fragebogen erfassten endokrinen Nebenwirkungen signifikant. Gelenk-/Knochenschmerzen wurden nach 12 MonaAbstract ! Purpose: The side effects of adjuvant endocrine therapy for breast cancer can have a negative impact on patientsʼ quality of life (QoL) and reduce patient compliance. The purpose of this non-interventional trial was to evaluate the quality of life (QoL), adverse events and tolerance of therapy with exemestane after switching from tamoxifen to exemestane. Material and Methods: A total of 924 postmenopausal patients receiving exemestane after tamoxifen from 735 German centers participated in this non-interventional trial (NIT). During 1 year of exemestane treatment (25 mg p. o. daily, Aromasin ® ) QoL was assessed using the IBCSG (International Breast Cancer Study Group) QoL core questionnaires (IBCSG QOL modules 24-26, SF-12). Side effects and tolerance were evaluated. Results: Subjects receiving exemestane following 2-3 years of treatment with tamoxifen experienced a significant improvement in both general and breast cancer-related QoL during the first year on exemestane. A significant improvement in physical and mental health was assessed using the SF (Short Form) 12 questionnaire. Exemestane was considered safe and was generally well tolerated, with a low percentage of treatment-related adverse effects (AEs). The most common treatment-related AEs were arthralgia (2....

Background: Based on baseline bone mineral density (BMD), adjuvant chemotherapy or endocrine therapy for early breast cancer patients can lead to substantially increased fracture risk. A significant decrease of BMD &gt;10% after 2 years of chemotherapy (CT) and/or endocrine therapy (ET) has been reported. In recent studies, zoledronic acid (ZOL) produced an increase in BMD in premenopausal and postmenopausal patients with breast cancer (ABCSG-12, Z-FAST, ZO-FAST, etc). In addition, a significant increase in disease-free survival (DFS) with ZOL vs no ZOL was observed in most of these studies. Methods: The aim of 2 single-center, placebo-controlled, randomized studies—Probone I and Probone II—was to investigate the effect of adjuvant treatment with ZOL on BMD in premenopausal women with early breast cancer treated with CT and/or ET. Patients with hormone-receptor-negative (HR−) breast cancer (Probone I) were treated with (neo)adjuvant CT; patients with hormone-receptor-positive (HR+) breast cancer (Probone II) were treated with ET alone or in combination with (neo)adjuvant CT. Randomized patients received ZOL 4 mg or placebo IV every 3 months for 24 months. The primary objective was the change in BMD at the lumbar spine between baseline and month 24 (measured by dual-energy X-ray absorptiometry [DXA]). Secondary objectives included DFS; BMD at total hip, femur, and os calcis; quantitative ultrasonometry (QUS) at os calcis and phalanges; markers of bone turnover (C-telopeptide of type I collagen [CTX] and N-terminal propeptide of type I procollagen [P1NP]); endocrine hormones (follicle-stimulating hormone [FSH], estradiol, testosterone, sex hormone-binding globulin [SHBG], parathyroid hormone [PTH], vitamin D, anti-Müllerian hormone [AMH], inhibin A/B, etc); pathologic fractures; and safety and tolerability. Results: 70 HR+ and 11 HR− breast cancer patients have been enrolled into the studies. The last patient will have been treated for 24 months by the end of June 2011. Conclusions: The effects of ZOL on lumbar spine BMD at 24 months and secondary endpoints will be presented at the meeting. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P2-19-03.