Background and Objective: Guidelines for the treatment of early-onset breast cancer have been proposed in several countries, but to date, their impact on outcomes is unverified. The objective of this study was to evaluate the association between guideline-adherent versus nonadherent treatment and recurrence-free survival (RFS) and overall survival (OAS) in early-onset breast cancer patients. Methods: A total of 1,778 patients were included in the study, of whom 111 were 35 years or younger and 1,667 were between 36 and 55 years. RFS and OAS were compared between the two groups, with respect to multiple parameters. All survival data were adjusted for tumor characteristics and analyzed with respect to guideline adherence according to the German Step 3 guidelines. Results: Statistically significant differences between the two groups (<35 years, 36–55 years) were observed with regard to breast surgery (p = 0.002) and hormone therapy (p = 0.006). Both groups were treated identically in terms of guideline adherence concerning axillary dissection (p = 0.9), radiation therapy (p = 0.7) and chemotherapy (p = 0.556). Young breast cancer patients whose treatment adhered to guideline recommendations had increased RFS and OAS [RFS: p = 0.030, hazard ratio (HR) 2.95, 95% confidence interval (CI) 1.11–7.83; OAS: p ≤ 0.001, HR 2.92, 95% CI 2.01–4.23]. Conclusion: Guideline-adherent treatment for early-onset breast cancer patients significantly improves OAS and RFS and should therefore be demanded for all patients.

Background: To date, few studies have investigated whether the implementation of national breast cancer guidelines fulfills the goal to optimize the national standard of care. Therefore, we aimed to evaluate retrospectively the guideline-related 13-year data on breast cancer patients treated at our institution. Patients and Methods: In a retrospective cohort study, the records of a total of 2,231 patients with primary breast cancer treated during the period of 1992–2005 at the Department of Obstetrics and Gynecology, University of Ulm, Germany, were analyzed. Based on the German national Step 3 (S3) guideline, a model was created to classify groups according to therapy ‘conforming’ and ‘non-conforming’ to guideline recommendations. Results: In 2005, 70.2% of all patients included received both surgical and systemic adjuvant therapies conforming to the guideline. Guideline-conforming treatment was accompanied with significant advantages in terms of recurrence-free survival (RFS) and overall survival (OAS) rates. Conclusions: It has to be demanded that breast cancer patients are treated in con-formity with the S3 guidelines. The reasons for a treatment not conforming to the guidelines should be analyzed for the detection of barrier factors, in order to optimize adherence to the guidelines and therefore to prolong RFS and OAS.

In conclusion, young breast cancer patients still have a poor prognosis. Even after adjustment of the data, OAS and RFS showed a worse prognosis. Normal prognostic factors like tumor size, axillary lymph node involvement, and grading can therefore be not the explanation for the more aggressive disease progress within early onset breast cancer patients.

The transobturatorial vaginal tape procedure is associated with little complication rate. Bladder perforation, urethral invasion, vaginal erosion, postoperative bladder retention, de novo incontinence and retropubic pain and haematoma are the most reported complications. The aim of this article is to present an uncommon complication in a patient operated by transobturator vaginal tape with an inside-outside route.

Hintergrund: Die Entwicklung und Implementierung der S3-Leitlinie "Diagnostik, Therapie und Nachsorge beim Mammakarzinom" soll die nationale Versorgungssituation optimieren und dient schon heute als Grundlage für die Zertifizierung von deutschen Brustzentren sowie der externen, vergleichenden Qualitätssicherung anhand von leitlinienbasierten Qualitätsindikatoren, obwohl eine Beeinflussung patientenrelevanter Outcomes durch die Implementierung der Leitlinie bislang nicht untersucht wurde. Methoden: In einer retrospektiven Kohortenstudie wurden die Fälle von insgesamt 3976 Patientinnen mit primärem Mammakarzinom der Unifrauenklinik Ulm und benachbarter, kooperierender zertifizierter Brustzentren in Deutschland aus dem Zeitraum 2001-2005 analysiert. Auf der Grundlage der S3-Leitlinie wurde ein Berechnungsmodell entwickelt, welches eine Gruppenzuordnung zu "leitlinienkonformer" und "nicht konformer" Therapie ermöglicht. Ergebnisse: Insgesamt wurden 2063 der 3976 Patientinnen komplett leitliniengerecht behandelt. Bei der Therapie von 1913 Patientinnen kam es zu mindestens einer Leitlinienverletzung. Die Variable "leitlinienkonforme Behandlung" hatte dabei einen signifikanten Einfluss auf das rezidivfreie Überleben und das Gesamtüberleben (p = 0,0001). Je höher die Anzahl einzelner Abweichungen von Leitlinienempfehlungen war, desto niedriger war das Gesamtüberleben (p = 0,0001). Schlussfolgerung: Patientinnen mit Mammakarzinom sollten leitlinienkonform behandelt werden. Abweichungen und Barrierefaktoren müssen zukünftig evaluiert werden, um eine weitere Optimierung der Konformität zu erzielen. Abstract ! Purpose: The German "Step 3" (S3) interdisciplinary evidence-based consensus guidelines with recommendations for the "Diagnosis, Therapy, and Follow-up of Breast Cancer" were developed and implemented to optimize the national standard of care. Currently, these guidelines provide a basis for certifying breast centers in Germany and serve as guideline-based quality indicators for external comparative quality assurance. To date, no studies have investigated how guideline adherence impacts patient-relevant outcomes. Therefore, we aimed to analyze the impact of national guideline adherence on patient-relevant outcomes. Methods: In a retrospective cohort study, a total of 3976 patients first diagnosed with primary breast cancer between 2001-2005 and treated at the and local affiliated certified breast centers were analyzed according to a model created to classify patients into groups according to "guideline adherence" and "guideline non-adherence" of therapy. Results: A total of 2063 of the 3976 patients were treated in full in adherence with guideline recommendations. Violation of at least one guideline recommendation was registered in the therapy of 1913 patients. A comparison of these two groups showed that guideline-adherent treatment had a significant impact on recurrence-free survival and overall survival (p = 0.0001). The greater the number of variations in guideline adherence, the lower the overall survival (p = 0.00...