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Was ist neu? Risikofaktoren Hormonelles Ungleichgewicht, Gynäkomastie, Lifestyle-Faktoren und genetische Veränderungen (insbesondere BRCA2-Mutationen) zählen zu den Hauptrisikofaktoren für das Mammakarzinom beim Mann. Prognose Die Brustkrebserkrankungen von Männern gehen mit einer schlechteren Prognose einher als die der Frauen. Diagnostik Zur Abklärung eines suspekten Befunds in der männlichen Brust sollten nach Anamnese und klinischer Untersuchung eine Mammasonografie und Mammografie durchgeführt werden. Therapie Die Behandlung wird in enger Anlehnung an das Vorgehen bei der Brustkrebserkrankung der Frau durchgeführt. Es steht eine Vielzahl an medikamentösen Therapiemöglichkeiten zur Verfügung. Einige sind jedoch nur als Off-Label-Use anzuwenden, da eine Zulassung beim Mann fehlt. Nachsorge Die Nachsorge erfolgt nach einem standardisierten Nachsorgeschema analog dem weiblichen Mammakarzinom. Bei positiver Familienanamnese für das Mammakarzinom und/oder Ovarialkarzinom erfolgt die Beratung und Testung gemäß den Kriterien des Deutschen Konsortiums Familiärer Brust- und Eierstockkrebs.

Background/Aims: Macromastia can cause physical and psychological problems. Conservative treatments such as physiotherapy and painkillers lead to substantial long-term costs, without any proven medical benefit. In contrast, surgical treatment with reduction mammoplasty leads to improvements in nearly all respects. This study analyzed the costs of reduction mammoplasty and calculated an incremental cost-utility ratio for the treatment. Patients and Methods: The data on 76 patients who underwent reduction mammoplasty between 2008 and 2016 were collected using a two-part questionnaire (preoperative and postoperative) as well as the patients’ files. Topics examined besides demographic data included physician visits, medical imaging, integrative medical procedures, remedial procedures, rehabilitation and convalescent measures, drug intake, medical aids, exercise activity, and sick leave days before and after surgery. The data were used to calculate costs per year after surgical treatment for symptomatic macromastia. Costs of surgery, including the process of obtaining insurance reimbursement and postoperative complications, were taken into account to calculate the one-time costs of reduction mammoplasty. Results: The patients’ quality of life and satisfaction with the breasts improve after surgery. The one-time costs of reduction mammoplasty per patient amount to EUR 5,885, and the annual costs after surgery are EUR 200. The incremental cost-utility ratio for surgical treatments shows a saving of EUR 380 per quality-adjusted life-year (QALY) gained. Conclusions: These results show that reduction mammoplasty is a treatment that not only improves a patient’s quality of life but also saves money in the longer term in comparison with expensive and ineffective conservative treatment for macromastia.

ZUSAMMENFASSUNGViele Publikationen machten das onkologische Jahr 2019/2020 wieder zu einem spannenden und hoffnungsvollen Jahr im Bereich der Senologie und der Gynäkologischen Onkologie. Die großen onkologischen Kongresse ESMO und das San Antonio Breast Cancer Symposium fanden im Herbst 2019 noch in gewohnter Form statt, während das ASCO Annual Meeting im Mai 2020 aufgrund der weltweiten Corona-Pandemie als virtueller Kongress stattfand.Weiterhin sind individuelle Therapiekonzepte im Sinne einer personalisierten Medizin der richtungsweisende Trend. Therapieentscheidungen basieren neben individuellen Patientenfaktoren zunehmend auf der Grundlage molekularpathologischer und genetischer Tumoreigenschaften. Zielgerichtete Tumortherapien verdrängen immer mehr die „klassischen“ Chemotherapien oder ergänzen diese zum Beispiel als Erhaltungstherapie nach Ansprechen auf eine Chemotherapie. Die Tumortherapien müssen sich nicht mehr „nur“ an ihrer antitumorösen Wirksamkeit wie Overall survival (OS) oder Progression free survival (PFS) messen lassen, sondern auch an ihrer Verträglichkeit für die Patienten, dem Nebenwirkungsspektrum und der Lebensqualität der Patienten.Der folgende Artikel soll gegliedert in Mammakarzinom, Ovarialkarzinom, Zervixkarzinom und Endometriumkarzinom einen Überblick über die neuesten Entwicklungen und aktuellsten wissenschaftlichen Daten des jeweiligen Malignoms vermitteln. Die wichtigsten Key Massages sind am Ende des jeweiligen Abschnittes zusammengefasst.

ZUSAMMENFASSUNGIm onkologischen Jahr 2018/2019 gab es im Bereich der Senologie und der gynäkologischen Onkologie zahlreiche Studienergebnisse, die zu neuen Arzneimittelzulassungen und zu Änderungen und Ergänzungen bestehender Therapiekonzepte führten. Die personalisierte Medizin ist weiter auf dem Vormarsch, molekularbiologische und genetische Eigenschaften fließen zunehmend in die Therapieentscheidung mit ein.Neue Therapiekonzepte werden in neoadjuvanter und adjuvanter Behandlungsintention überprüft. Doch auch die Weiterentwicklung bestehender Therapiekonzepte und der Einsatz neuer Therapeutika in Patientenkollektiven mit fortgeschrittener Tumorerkrankung mit zahlreichen Vortherapien rücken weiter in den Fokus. Die Lebensqualität der Patientinnen, die Verträglichkeit der geprüften Therapie und auch die Toxizitäten bekommen zunehmend eine höhere Gewichtung in der Bewertung von Studienergebnissen. Die kritische Überprüfung von Therapieschemata mit der Fragestellung, welche Patientinnen möglicherweise übertherapiert werden und die Deeskalation im Bereich der Therapieintensität und Therapiedauer schreiten voran.Der folgende Artikel soll gegliedert in Mammakarzinom, Ovarialkarzinom, Zervixkarzinom und Endometriumkarzinom einen Überblick über die neuesten Entwicklungen und aktuellsten wissenschaftlichen Daten des jeweiligen Malignoms vermitteln. Die wichtigsten Key Massages sind am Ende des jeweiligen Abschnittes zusammengefasst.

ZusammenfassungIn den letzten Jahren haben sich Diagnostik und Therapie im Bereich der gynäkologischen Onkologie und Senologie stetig weiterentwickelt. Dennoch ist das Versterben an einer Krebserkrankung in den hoch entwickelten Ländern eine der häufigsten Todesursachen der Frau 1. Maßnahmen zur Primärprävention sind daher von hoher Bedeutung, um die Morbidität und Mortalität von Krebserkrankungen zu senken.

PURPOSE Oral anticancer drugs (eg, kinase inhibitors) play an important role in cancer therapy. However, considerable challenges regarding medication safety of oral anticancer drugs have been reported. Randomized, controlled, multicenter studies on the impact of intensified clinical pharmacological/pharmaceutical care on patient safety and patient treatment perception are lacking. METHODS Patients were eligible for the randomized, multicenter AMBORA study, if they were newly started on any of the oral anticancer drugs approved in 2001 or later without restriction to certain tumor entities. Patients were randomly assigned to receive either standard of care (control group) or an additional, intensified clinical pharmacological/pharmaceutical care, which included medication management and structured patient counseling, over a period of 12 weeks (intervention group). Primary end points were the number of antitumor drug–related problems (ie, side effects and unresolved medication errors) and patient treatment satisfaction with the oral anticancer therapy after 12 weeks measured with the Treatment Satisfaction Questionnaire for Medication, category convenience. RESULTS Two hundred two patients were included. Antitumor drug–related problems were significantly lower in the intervention compared with the control group (3.85 v 5.81 [mean], P < .001). Patient treatment satisfaction was higher in the intervention group (Treatment Satisfaction Questionnaire for Medication, convenience; 91.6 v 74.4 [mean], P < .001). The hazard ratio for the combined end point of severe side effects (Common Terminology Criteria for Adverse Events ≥ 3), treatment discontinuation, unscheduled hospital admission, and death was 0.48 (95% CI, 0.32 to 0.71, P < .001) in favor of the intervention group. CONCLUSION Treatment with oral anticancer drugs is associated with a broad range of medication errors and side effects. An intensified clinical pharmacological/pharmaceutical care has considerable, positive effects on the number of medication errors, patient treatment perception, and severe side effects.

Purpose Symptomatic macromastia causes physical and psychological problems that can lead to restrictions in the patients’ social and working lives and a reduced quality of life. Associated medical treatments also have a considerable impact on health-care costs. Several studies have assessed these costs, but the total disease costs of macromastia have never been evaluated on the basis of real-world data. Methods The data for 76 patients who underwent reduction mammoplasty between 2008 and 2016 were collected using a two-part questionnaire (preoperative and postoperative), as well as the patient files. Topics surveyed, besides demographic data, included physician visits, medical imaging, medical procedures, medical treatments, rehabilitation and convalescent measures, drug intake, medical aids, exercise activity, and sick leave days before surgery, to calculate the costs per year of conservative treatment of symptomatic macromastia. Results The mean time from start of symptoms to surgery was 11.82 years. The data for this group of patients with symptomatic macromastia show that costs per patient amount to €1677.55 per year. These costs include medical consultation, radiological imaging, medical treatments and procedures, physical therapy and rehabilitation, medication, special brassieres, exercise classes costs for sick leave due to problems with macromastia, and travel expenses. Conclusions These results show that considerable health-care costs arise due to macromastia with conservative treatment. Overall, macromastia costs €1677.55 per patient/year. In particular, lost productivity due to sick days and the costs of physiotherapy are factors driving the high costs.

Background: Risk factors for ipsilateral breast cancer tumor recurrence (IBTR) are well established and include grading, nodal status, and receptor status. Little is known about the influence of the local distance between the primary tumor and recurrences on changes in tumor characteristics and prognosis. Methods: In a retrospective setting, we analyzed primary breast cancers and their recurrences. Localizations of primary and recurrent breast cancer were recorded to calculate the relative distance in pixels. Analysis was performed regarding tumor characteristics, relative distance between both, and their impact on breast cancer prognosis. Results: In a cohort of 142 patients with ipsilateral recurrence, no statistically significant difference could be shown in the change in tumor characteristics depending on distance. Progesterone receptor (PR) and estrogene receptor (ER) status changed in 22.7% and 14.9% of cases, respectively. human epidermal growth factor receptor 2 (ERBB2, HER2) status changed in 18.3% of cases. Survival was in accordance with the literature, with luminal-A-like tumors as best and triple negative breast cancers (TNBC) as worst prognosis. With a threshold of 162 pixels, the survival was significantly better in the group with shorter distance. Conclusion: Change in tumor characteristics from primary breast cancer to recurrence occurs more often in PR than ER. In contrast to other work, in this dataset, recurrences with a larger distance to the primary tumor had a worse prognosis in univariate analysis. A Cox model might indicate the possibility that this influence is independent of other risk factors.

Background: The usefulness of clinical breast examination (CBE) in general and in breast cancer screening programs has been a matter of debate. This study investigated whether adding vision-impaired medical tactile examiners (MTEs) improves the predictiveness of CBE for suspicious lesions and analyzed the feasibility and acceptability of this approach. Methods: The prospective study included 104 patients. Physicians and MTEs performed CBEs, and mammography and ultrasound results were used as the gold standard. Sensitivity and specificity were calculated and logistic regression models were used to compare the predictive value of CBE by physicians alone, MTEs alone, and physicians and MTEs combined. Results: For CBEs by physicians alone, MTEs alone, and both combined, sensitivity was 71, 82, and 89% and specificity was 55, 45, and 35%, respectively. Using adjusted logistic regression models, the validated areas under the curve were 0.685, 0.692, and 0.710 (median bootstrapped p value (DeLong) = 0.381). Conclusion: The predictive value for a suspicious breast lesion in CBEs performed by MTEs in patients without prior surgery was similar to that of physician-conducted CBEs. Including MTEs in the CBE procedure in breast units thus appears feasible and could be a way of utilizing their skills.

ZusammenfassungIm Bereich der gynäkologischen Onkologie und Senologie gab es auch in diesem Jahr zahlreiche Publikationen und Kongressbeiträge, die Änderungen oder Ergänzungen zu bestehenden Therapiekonzepten mit sich bringen. Die personalisierte Medizin rückt weiter in den Fokus des allgemeinen Interesses und es findet eine Individualisierung der Therapieschemata statt, sodass Therapieentscheidungen nicht nur auf Grundlagen etablierter Charakteristika wie Tumorgröße und Nodalstatus basieren, sondern vielmehr molekularbiologische und genetische Eigenschaften zur Entscheidungsfindung hinzugenommen werden.Dabei werden entsprechende neue Therapiekonzepte nicht nur für Patientinnen mit vielfach vortherapierten, fortgeschrittenen und metastasierten Mammakarzinomen entwickelt, sondern sind Inhalt neoadjuvanter und adjuvanter Therapiestudien. Nach Jahren der Eskalation im Bereich der Therapieintensität und -dauer lässt sich zunehmend ein neuer Trend beobachten – die Überprüfung von Therapieschemata mit der Fragestellung, welche Patientinnen möglicherweise keinen Benefit bezüglich des rezidivfreien und des Gesamtüberlebens durch die Behandlung haben und bezüglich der Morbidität von einer Deeskalation einer Therapie profitieren.Traditionell zeigen sich im Bereich der gynäkologischen Onkologie weniger Neuerungen als im Bereich der Senologie. Im letzten Jahr hat sich jedoch auch hier einiges getan. So befassten sich jüngst publizierte Studien bezüglich des Ovarialkarzinoms nicht nur mit der Fragestellung, ob auch hier eine Deeskalation der operativen Therapie möglich ist, z. B. durch eine Selektionierung der Patientinnen nach Risikofaktoren und Verzicht auf eine Lymphonodektomie. Eine Studie zur sekundären, operativen Tumorlastreduktion bei Ovarialkarzinomrezidiv wurde ebenso publiziert wie eine Studie, die ein neoadjuvantes Therapiekonzept mit sekundärer operativer Tumorlastreduktion untersucht hat. Im Bereich der Systemtherapien kommen neben den selektiven PARP-Inhibitoren, die bereits beim platinsensiblen Ovarialkarzinomrezidiv zugelassen sind (Olaparib, Niraparib), weitere Studien zu späteren Therapielinien und zu Kombinationstherapien, beispielsweise mit Therapien aus dem Bereich der Immunonkologie (PD-L1-Antikörper).Beim Zervixkarzinom präsentieren neue Daten Möglichkeiten der Deeskalation des operativen Vorgehens beim frühen Zervixkarzinom mittels der pelvinen Sentinelnodebiopsie. Aktuell läuft eine weitere große internationale Studie, um die Daten zu validieren (SENTICOL III-Studie). Im Bereich der Immunonkologie wurden erste Daten zum Einsatz von PD-L1-Antikörpern beim fortgeschrittenen Zervixkarzinom berichtet.Bei Patientinnen mit einem fortgeschrittenen Endometriumkarzinom steht die Diskussion des Vorteiles einer postoperativen Radiatio versus einer Radiochemotherapie im Fokus laufender Studien.

Rationale and Objectives This study compared a novel photon-counting breast computed tomography (pcBCT) system with digital mammography (DM) and digital breast tomosynthesis (DBT) systems. For this reason, surgical specimens were examined with all three techniques and rated by three observers. Materials and Methods A total of 30 surgical specimens were investigated with DM, DBT, and pcBCT; the associated images were shown to three experienced radiologists. Findings (22 microcalcifications and 23 mass lesions) were recorded and compared to the results of the pathological examination. Sensitivity and specificity for detection of microcalcifications and lesions were calculated and displayed using receiver operating characteristic curves. Results Sensitivity for microcalcifications was 82% for DM, 70% for DBT, and 85% for pcBCT. Specificity for microcalcifications was 71% for DM, 75% for DBT, and 83% for pcBCT. Sensitivity for lesions was 45% for DM, 62% for DBT, and 65% for pcBCT. Specificity for lesions was 76% for DM, 62% for DBT, and 76% for pcBCT. Conclusions pcBCT showed a comparable or superior performance compared to the clinically approved DM and DBT systems. Mass lesion detectability can be increased further by the use of contrast media.

Although mammography screening programs do not include ultrasound examinations, some diagnostic units do provide women with both mammography and ultrasonography. This article is concerned with estimating the risk of a breast cancer patient diagnosed in a hospital-based mammography unit having a tumor that is visible on ultrasound but not on mammography. A total of 1,399 women with invasive breast cancer from a hospital-based diagnostic mammography unit were included in this retrospective study. For inclusion, mammograms from the time of the primary diagnosis had to be available for computer-assisted assessment of percentage mammographic density (PMD), as well as Breast Imaging Reporting and Data System (BIRADS) assessment of mammography. In addition, ultrasound findings were available for the complete cohort as part of routine diagnostic procedures, regardless of any patient or imaging characteristics. Logistic regression analyses were conducted to identify predictors of mammography failure, defined as BIRADS assessment 1 or 2. The probability that the visibility of a tumor might be masked at diagnosis was estimated using a regression model with the identified predictors. Tumors were only visible on ultrasound in 107 cases (7.6%). PMD was the strongest predictor for mammography failure, but age, body mass index and previous breast surgery also influenced the risk, independently of the PMD. Risk probabilities ranged from 1% for a defined low-risk group up to 40% for a high-risk group. These findings might help identify women who should be offered ultrasound examinations in addition to mammography.

Introduction For decades, conventional galactography was the only imaging technique capable of showing the mammary ducts. Today, diagnosis is based on a multimodal concept which combines high-resolution ultrasound with magnetic resonance (MR) mammography and ductoscopy/galactoscopy and has a sensitivity and specificity of up to 95%. This study used tomosynthesis in galactography for the first time and compared the synthetic digital 2D full-field mammograms generated with this technique with the images created using the established method of ductal sonography. Both methods should be able to detect invasive breast cancers and their precursors such as ductal carcinoma in situ (DCIS) as well as being able to identify benign findings. Material and Methods Five patients with pathological nipple discharge were examined using ductal sonography, contrast-enhanced 3D galactography with tomosynthesis and the synthetic digital 2D full-field mammograms generated with the latter method. Evaluation of the images created with the different imaging modalities was done by three investigators with varying levels of experience with complementary breast diagnostics (1, 5 and 15 years), and their evaluations were compared with the histological findings. Results All 3 investigators independently evaluated the images created with ductal sonography, contrast-enhanced 3D galactography with tomosynthesis, and generated synthetic digital 2D full-field mammograms. Their evaluations were compared with the histopathological assessment of the surgical specimens resected from the 5 patients. There was 1 case of invasive breast cancer, 2 cases with ductal carcinoma in situ and 2 cases with benign findings. All 3 investigators made more mistakes when they used the standard imaging technique of ductal sonography to diagnose suspicious lesions than when they used contrast-enhanced galactography with tomosynthesis and the generated synthetic digital 2D full-field mammograms. Conclusion This is the first time breast tomosynthesis was used in galactography (galactomosynthesis) to create digital 3-dimensional images of suspicious findings. When used together with the generated synthetic digital 2D full-field mammograms, it could be a useful complementary procedure for the diagnosis of breast anomalies and could herald a renaissance of this method. Compared with high-resolution ductal ultrasound, the investigators achieved better results with contrast-enhanced galactography using tomosynthesis and the generated synthetic digital 2D full-field mammograms, as confirmed by histopathological findings.

Although mammography screening programs do not include ultrasound examinations, some diagnostic units do provide women with both mammography and ultrasonography. This article is concerned with estimating the risk of a breast cancer patient diagnosed in a hospital-based mammography unit having a tumor that is visible on ultrasound but not on mammography. A total of 1,399 women with invasive breast cancer from a hospital-based diagnostic mammography unit were included in this retrospective study. For inclusion, mammograms from the time of the primary diagnosis had to be available for computer-assisted assessment of percentage mammographic density (PMD), as well as Breast Imaging Reporting and Data System (BIRADS) assessment of mammography. In addition, ultrasound findings were available for the complete cohort as part of routine diagnostic procedures, regardless of any patient or imaging characteristics. Logistic regression analyses were conducted to identify predictors of mammography failure, defined as BIRADS assessment 1 or 2. The probability that the visibility of a tumor might be masked at diagnosis was estimated using a regression model with the identified predictors. Tumors were only visible on ultrasound in 107 cases (7.6%). PMD was the strongest predictor for mammography failure, but age, body mass index and previous breast surgery also influenced the risk, independently of the PMD. Risk probabilities ranged from 1% for a defined low-risk group up to 40% for a high-risk group. These findings might help identify women who should be offered ultrasound examinations in addition to mammography.