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I063 VULVAR PATHOLOGY IN CHILDHOOD
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Invited presentations and presentations by organisations and societies / International Journal of Gynecology & Obstetrics 119S3 (2012) S161–S260
medical instructions, technique protocols). In the meantime, the continent’s scientific societies should issue clear and strict guidelines in this area. Additionally, the accreditations of ultrasound practitioners may be a prerequisite. • A health system should be implemented that allows ultrasounds to be extended to rural areas, and at the same time their excessive use in certain urban communities should be curtailed. I061 IMPACT OF REPRODUCTIVE GENETIC TESTS ON LOW-RESOURCE COUNTRIES E. Castelazo Morales The impact of reproductive genetic testing in women of underdeveloped countries is not known, because it is not available to the greater part of the population. Despite wide historical, political, social and ethno-cultural differences among the people in developing countries, it is expected that the judicious use of reproductive genetic testing will be possible when other aspects of health and quality of life are resolved, in addition it is also anticipated that for the majority of the population, reproductive genetic tests constitute an accepted way to prevent suffering and death as a result of genetic diseases. The incorporation of these techniques must always bear in mind the rights of individuals to make their own decisions regarding reproduction with complete and adequate respect for human dignity. On the basis of what has been commented, the importance is manifest of what all these scientific breakthroughs and progress mean for society and its traditional development. Today, respect for dignity and self-determination of each individual are perceived as values that awaken a special sensitivity in the social community and that also reflect from the legal vantage point. On the contrary, being aware that the scientific discoveries in human genetics should invite the entire community – not just the actors, the scientists – to reflect upon such important steps for humanity and then adopt in consequence, within this framework, complete respect for the individual and for timely policy, social and legal decisions. I062 NEWS IN BREAST CANCER MEDICAL TREATMENTS M. Castiglione. Breast Center and Oncogynecology, University Hospital, Geneva, Switzerland Breast cancer continues to be the most frequent malignancy in Western women and its incidence is constantly increasing in most of the European countries and in the US. During the last few years knowledge on biology of tumor diseases and also of breast cancer has performed tremendous steps allowing for the understanding of some of the cellular pathways leading to malignancy. In breast cancer the discovery of the human epidermal growth factor receptor (HER) family of receptors has allowed the development of targeted treatments in patients with the subtype of breast cancer showing these characteristics. Some drugs as Trastuzumab and Lapatinib are already widely used in the adjuvant setting as well as in the metastatic situation, whereas other drugs are just ready to enter wide clinical use (Pertutumab, TDM1). Many more are in different phases of clinical development. Most breast cancers are hormone dependent but in the course of the disease nearly all develop an endocrine resistance and some, despite expression of hormone receptors, are primarily hormone-resistant. Understanding the mechanism of resistance development is one of the targets of research in breast cancer. Cross-talk between the estrogen receptor (ER) and the phosphoinositide-3-kinase (PI3K)/Akt/ mammalian target of rapamycin (mTOR) pathways is a mechanism of resistance to endocrine therapy, and blockade of both pathways enhances antitumor activity in preclinical models. Preclinically, everolimus, an oral inhibitor of mTOR, has been shown to reverse
resistance to tamoxifen. Results from clinical trials using this compound together with tamoxifen or aromasin will be presented. Angiogenesis has been shown to be implicated in tumor growth. Bevacizumab has been shown to have a certain activity in breast cancer but at the price of high toxicity. New compounds targeting this mechanism of tumor development are in the pipeline and will also be discussed. Great progress is ongoing in the understanding of cellular mechanisms of malignancy and this knowledge should allow pursuing the development of new treatments, more targeted and possibly more effective and less toxic than the classical chemo- and hormonal therapies for breast cancer. I063 VULVAR PATHOLOGY IN CHILDHOOD A. Caussade The objective of this review is to remember the most common vulvar disorders in children. Many pediatricians and family practitioners often practice the palpation of testes during examination of boys during the exam in infancy, but it is different, with the vulvar exam in girls. Sometimes little girls just could be examined when they grow, and go to the gynecologist during the first pelvis exam. This practice, precludes an early detection in vulvar problems. Pruritus and itching, is the most common symptom in little children and frequently manifest important diseases that could be early treated. We will review, the most common vulvar disorders, including vulvovaginitis, dermatitis, lichen sclerosus, labial adhesions, and other common problems. The etiology and treatments can be very different in children, so the dosage and their management, are different and therefore, very important. I064 MENSTRUAL PROBLEMS IN ADOLESCENTS AND IMPROVING QUALITY OF LIFE: THE PANASIAN EXPERIENCE S.S.C. Chan Menarche represents a developmental milestone of puberty in girls. While some regard menarche and menstruation as natural, some do not and may even have negative feelings on them. Cultural belief and education plays a role on it. Menstrual disorders are the most common gynecological problem of adolescents. The reported prevalence of dysmenorrhea was 60–90%, abnormal menstrual cycle length was 60–90% in first year of menstruation and in 10–15% persists for 3 to 5 years; and menorrhagia was 10–20% in different Asian populations. The prevalence of different menstrual disorders is similar to the findings in many other regions of the world. Some important causes of amenorrhea or oligomenorrhea include polycystic ovarian syndrome, excessive stress and weight loss, eating disorder and premature ovarian failure; apart from certain types of congenital genital tract anomaly for primary amenorrhea. Most of the dysmenorrhea is primary dysmenorrhea, but some suffer from endometriosis or pelvic infection. While menorrhagia is mostly due to dysfunctional uterine bleeding, bleeding disorders have to be ruled out. Although menstrual disorders are so common, only 6–15% of adolescents seek medical advice; despite their daily activities, school attendance, concentration at school and quality of life are being affected. Obstacles in health-seeking include inadequate knowledge on menstruation, anxiety about embarrassing questions, and opinion of family member. Education to adolescent girls on managing menstrual symptoms and the benefit of available effective treatment may improve their quality of life. And education should also be extended to parents and school peer leaders.
Invited presentations and presentations by organisations and societies / International Journal of Gynecology & Obstetrics 119S3 (2012) S161–S260
medical instructions, technique protocols). In the meantime, the continent’s scientific societies should issue clear and strict guidelines in this area. Additionally, the accreditations of ultrasound practitioners may be a prerequisite. • A health system should be implemented that allows ultrasounds to be extended to rural areas, and at the same time their excessive use in certain urban communities should be curtailed. I061 IMPACT OF REPRODUCTIVE GENETIC TESTS ON LOW-RESOURCE COUNTRIES E. Castelazo Morales The impact of reproductive genetic testing in women of underdeveloped countries is not known, because it is not available to the greater part of the population. Despite wide historical, political, social and ethno-cultural differences among the people in developing countries, it is expected that the judicious use of reproductive genetic testing will be possible when other aspects of health and quality of life are resolved, in addition it is also anticipated that for the majority of the population, reproductive genetic tests constitute an accepted way to prevent suffering and death as a result of genetic diseases. The incorporation of these techniques must always bear in mind the rights of individuals to make their own decisions regarding reproduction with complete and adequate respect for human dignity. On the basis of what has been commented, the importance is manifest of what all these scientific breakthroughs and progress mean for society and its traditional development. Today, respect for dignity and self-determination of each individual are perceived as values that awaken a special sensitivity in the social community and that also reflect from the legal vantage point. On the contrary, being aware that the scientific discoveries in human genetics should invite the entire community – not just the actors, the scientists – to reflect upon such important steps for humanity and then adopt in consequence, within this framework, complete respect for the individual and for timely policy, social and legal decisions. I062 NEWS IN BREAST CANCER MEDICAL TREATMENTS M. Castiglione. Breast Center and Oncogynecology, University Hospital, Geneva, Switzerland Breast cancer continues to be the most frequent malignancy in Western women and its incidence is constantly increasing in most of the European countries and in the US. During the last few years knowledge on biology of tumor diseases and also of breast cancer has performed tremendous steps allowing for the understanding of some of the cellular pathways leading to malignancy. In breast cancer the discovery of the human epidermal growth factor receptor (HER) family of receptors has allowed the development of targeted treatments in patients with the subtype of breast cancer showing these characteristics. Some drugs as Trastuzumab and Lapatinib are already widely used in the adjuvant setting as well as in the metastatic situation, whereas other drugs are just ready to enter wide clinical use (Pertutumab, TDM1). Many more are in different phases of clinical development. Most breast cancers are hormone dependent but in the course of the disease nearly all develop an endocrine resistance and some, despite expression of hormone receptors, are primarily hormone-resistant. Understanding the mechanism of resistance development is one of the targets of research in breast cancer. Cross-talk between the estrogen receptor (ER) and the phosphoinositide-3-kinase (PI3K)/Akt/ mammalian target of rapamycin (mTOR) pathways is a mechanism of resistance to endocrine therapy, and blockade of both pathways enhances antitumor activity in preclinical models. Preclinically, everolimus, an oral inhibitor of mTOR, has been shown to reverse
resistance to tamoxifen. Results from clinical trials using this compound together with tamoxifen or aromasin will be presented. Angiogenesis has been shown to be implicated in tumor growth. Bevacizumab has been shown to have a certain activity in breast cancer but at the price of high toxicity. New compounds targeting this mechanism of tumor development are in the pipeline and will also be discussed. Great progress is ongoing in the understanding of cellular mechanisms of malignancy and this knowledge should allow pursuing the development of new treatments, more targeted and possibly more effective and less toxic than the classical chemo- and hormonal therapies for breast cancer. I063 VULVAR PATHOLOGY IN CHILDHOOD A. Caussade The objective of this review is to remember the most common vulvar disorders in children. Many pediatricians and family practitioners often practice the palpation of testes during examination of boys during the exam in infancy, but it is different, with the vulvar exam in girls. Sometimes little girls just could be examined when they grow, and go to the gynecologist during the first pelvis exam. This practice, precludes an early detection in vulvar problems. Pruritus and itching, is the most common symptom in little children and frequently manifest important diseases that could be early treated. We will review, the most common vulvar disorders, including vulvovaginitis, dermatitis, lichen sclerosus, labial adhesions, and other common problems. The etiology and treatments can be very different in children, so the dosage and their management, are different and therefore, very important. I064 MENSTRUAL PROBLEMS IN ADOLESCENTS AND IMPROVING QUALITY OF LIFE: THE PANASIAN EXPERIENCE S.S.C. Chan Menarche represents a developmental milestone of puberty in girls. While some regard menarche and menstruation as natural, some do not and may even have negative feelings on them. Cultural belief and education plays a role on it. Menstrual disorders are the most common gynecological problem of adolescents. The reported prevalence of dysmenorrhea was 60–90%, abnormal menstrual cycle length was 60–90% in first year of menstruation and in 10–15% persists for 3 to 5 years; and menorrhagia was 10–20% in different Asian populations. The prevalence of different menstrual disorders is similar to the findings in many other regions of the world. Some important causes of amenorrhea or oligomenorrhea include polycystic ovarian syndrome, excessive stress and weight loss, eating disorder and premature ovarian failure; apart from certain types of congenital genital tract anomaly for primary amenorrhea. Most of the dysmenorrhea is primary dysmenorrhea, but some suffer from endometriosis or pelvic infection. While menorrhagia is mostly due to dysfunctional uterine bleeding, bleeding disorders have to be ruled out. Although menstrual disorders are so common, only 6–15% of adolescents seek medical advice; despite their daily activities, school attendance, concentration at school and quality of life are being affected. Obstacles in health-seeking include inadequate knowledge on menstruation, anxiety about embarrassing questions, and opinion of family member. Education to adolescent girls on managing menstrual symptoms and the benefit of available effective treatment may improve their quality of life. And education should also be extended to parents and school peer leaders.