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.

9044 Background: Due to the frequency of breast cancer, and to the high proportion of premenopausal women, contraception in survivors is a major concern. In contrast, literature data are dramatically nonexistent. Classical options included local methods, copper or hormonal (LNG) intrauterine devices (IUD). Little is known about the use of estroprogestins or progestative only contraception. The aim of this survey is to describe French current practice regarding contraception after breast cancer. Methods: A retrospective study was conducted between 1 June 2002 and 1 January 2003. Premenopausal patients with previous history of breast cancer, still menstruating, and consulting for contraception desire were included. 2,500 forms were sent to French gynecologist members of the GERM, FNCGM, and SFG, and 197 responses were obtained. Results: Median age was 38,6 years old. Tumor characteristics were invasive carcinoma (88%) versus in situ carcinoma (11.9%), N+ disease (18.9%) versus N-(48.6%), HR + (51.8%), HR- (15.1%). The main used contraception was intrauterine device (72.9%, n = 135), (copper 64.8%/ LNG 8.1%). Hormonal contraception was prescribed in 21.6%, (progestins n = 37 (20%) or estroprogestins, n = 3, (1.6%)). Condoms, local contraception or fallopian ligature were used in 11.8%. Ipsilateral (n = 13), contralateral (n = 2) or distant recurrence (n = 11) occurred in 26 patients (13%). The rates of relapse were respectively 3% in the progestin group, 7% in the LNG-IUD group, 17% with Cu-IUD, and 18% with the other methods (NS). No recurrence occurred in the estroprogestins group. Conclusions: To our knowledge, this study is the first one worldwide evaluating current contraception practice after breast cancer on a large cohort of patients. Due to the rareness of relapses, it is difficult to identify a correlation between contraception and relapse, though a trend to a lower frequency of recurrence (7%) was noted in the progestin group. Further data would be granted to evaluate efficacy and harmlessness of contraception in these patients. On behalf of the GERM (Groupe d'Etude et de Réflexion sur les Mastopathies), the SFG (Société Française de Gynécologie), and the FNCGM (Fédération Nationale des Collèges de Gynécologie Médicale). No significant financial relationships to disclose.

Notre but était d’objectiver l’efficacité de la kinésithérapie pelvi-périnéale pour la prise en charge des troubles du bas appareil urinaire des patients atteints de sclérose en plaques.La revue de la littérature a été effectuée via PubMed, PEDro, Scopus et Cochrane Library. Les termes utilisés étaient multiple sclerosis, bladder dysfunction, overactive bladder, detrusor hyperreflexia, urge incontinence, urgency, stress incontinence, pelvic floor muscle, biofeedback, PTNS, tibial nerve, bladder training, physical therapy, physiotherapy, conservative treatment et behavioral therapy.Six articles randomisés incluant 289 patients ont été sélectionnés. Quatre présentaient de bonnes qualités méthodologiques. Les paramètres qui étaient toujours significativement améliorés concernaient : le nombre d’épisodes d’incontinence urinaire (diminué de 64 % à 86 % après le traitement par rapport au début du traitement), la qualité de vie (p ≤ 0,001), la sévérité des symptômes irritatifs (diminuée de plus de 50 % après le traitement par rapport au début du traitement) et la nycturie (p = 0,035 à p < 0,001). La limitation d’activité, la restriction de participation, le débit maximum et le volume uriné ainsi que la pollakiurie n’étaient significativement améliorés que dans certaines études.La kinésithérapie pelvi-périnéale semblait efficace pour la prise en charge des problèmes du bas appareil urinaire des patients atteints modérément de la sclérose en plaques. Cependant, les résultats n’étaient basés que sur six études dont quatre de qualités méthodologiques satisfaisantes. Des recommandations sont difficiles à établir.To assess the effectiveness of conservative therapeutic approaches in a multiple sclerosis population.Review was performed in PubMed, PEDro, Scopus and Cochrane Library using combinations of the following keywords: multiple sclerosis; bladder dysfunction; overactive bladder; detrusor hyperreflexia; urge incontinence; urgency; stress incontinence; pelvic floor muscle; biofeedback; PTNS; tibial nerve; bladder training; physical therapy; physiotherapy; conservative treatment and behavioral therapy.Six randomized articles including 289 patients were selected. Four papers exhibited strong scores for the methodological quality assessment. The parameters always significantly improved concerned: number of incontinence episodes (decreased from 64% to 86% after treatment versus before treatment), quality of life (P ≤ 0.001), severity of irritative symptoms (decreased by more than 50% after treatment versus before treatment), and nocturia (P = 0.035 to P < 0.001). Activities and participation, maximum flow rate, mean voided volume and daytime frequency were not significantly improved in all trials.The physical therapy techniques could be effective for the treatment of urinary disorders in multiple sclerosis populations with mild disability. However, the analyses are based on six studies within only four showed good methodological quality. No strong conclusions regarding treatment approaches can be drawn from this review.

A CONTROVERSIAL SUBJECT: Several large randomised studies have demonstrated a reduction in mortality due to breast cancer of around 30% in women aged over 50, with the development of systematic mammography. There are data also suggesting an identical benefit in women aged 40 to 49, when screening is intensified. A recent meta-analysis has contradicted the results of randomised studies on screening, but this study is clearly debatable. THE SITUATION IN FRANCE: No randomised study has been organised. A national program is aimed at screening 7 400 000 women aged 50 to 74. THE KEY TO SUCCESS: The active participation of women, health professionals and public authorities is the fundamental condition for a well-organised mass screening.

Objectifs. – Après avoir rappelé la contre-indication classique du THS chez les femmes ayant un antécédent personnel de cancer du sein, et les arguments qui lui sont opposables, les auteurs rapportent les résultats actuels de l’étude prospective entreprise par le centre des maladies du sein de l’hôpital Saint-Louis à Paris depuis février 1992.

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.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, 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.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.

Purpose, - Several studies have demonstrated that systematic breast cancer screening increases overall survival. We report our experience regarding diagnosis of breast lesions detected using mammographyMethods. - 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. (C) 2000 Editions scientifiques et medicales Elsevier SAS.

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.

Background: The majority of studies and meta-analyses tend to show a very slight increase of risk of beast cancer in postmenopausal 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.

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.