European Society Of Mastology Research Articles

Oncoplastic breast surgery in Europe.

Oncoplastic breast surgery (OPS) has become an integral part of breast cancer surgery for both breast conservation and mastectomies. In recent years, the emphasis on early detection and the advances in systemic and locoregional therapy has improved prognosis leading to an increased focus on survivorship and quality of life issues including patients' short and long-term aesthetic appearance as a key part of the surgical management. There is a significant variation across Europe in the type of specialist performing breast cancer surgery and the provision of OPS as such. In the traditional model, breast cancer care was provided by gynecologists in some countries, general surgeons, surgical oncologists, and breast surgeons in others. However recently, surgeons throughout Europe have extended their skill-base to include level 1 and 2 OPS and implant- and pedicle-flap based breast reconstruction. For breast surgeons to become proficient in these techniques, a standardized level of training and expertise is needed. The European Society of Mastology (EUSOMA) set standards for a specialist health professional in the field of breast cancer, the European Union of Medical Specialists (UEMS) examinations and the global curriculum that was developed by the American Society of Surgical Oncology (SSO) and the European Society of Surgical Oncology (ESSO) aims to improve standards of OPS practice across Europe. The new generation of breast surgeons, therefore, should be equipped with the necessary skill set to provide high quality OPS while keeping abreast of novel technologies and techniques aiming to provide patients with excellent long-term quality of life.

Influencia de la creación de una Unidad de Mama en los parámetros quirúrgicos y criterios de calidad del tratamiento quirúrgico del cáncer de mama

ObjectivesThe European Society of Mastology (EUSOMA) has proposed quality criteria in the diagnosis and treatment of breast cancer and recommends the evaluation of breast units applying these criteria. In our centre, coinciding with the accreditation of the breast unit by the Spanish Society of Senology and Breast Pathology in 2000, two surgeons were assigned to work full-time in breast cancer. The objective of this study was to evaluate the effects of the surgeons’ secondment to breast disease on the surgical parameters and the quality criteria related to surgical treatment. Material and methodsWe performed a retrospective study that included patients treated for breast cancer between 1990 and 2010, divided into two periods, A; 1990-1999 and B; 2000-2010. We evaluated demographic data, diagnoses, treatment, postoperative complications, follow-up, recurrence, and the 10 quality criteria related to surgical treatment proposed by EUSOMA. ResultsThe series consisted of 1,881 women who underwent surgery for breast cancer: 671 in period A and 1210 in B. There were significant differences between the two periods in postoperative stay (9.8 vs. 2.7 days) and postoperative complications (17.4% vs. 10%). Significant improvement was found in period B in 6 of the 10 criteria evaluated. ConclusionsAssigning two surgeons to work full-time in a breast unit reduced complications and postoperative hospital stay, and improved the quality criteria that assess complete diagnosis, indication and treatment of axillary lymph nodes and postoperative follow-up.

Quality indicators at a breast cancer (BC) unit in a Uruguayan university hospital according to the requirements of European Society of Breast Cancer specialists.

e18209 Background: Although clear guidelines for BC management have been developed and widespread, there are many variations between centers, with impact in clinical outcomes. Quality indicators to assess care allows comparison with standards and monitoring changes post intervention. The objective is to evaluate quality indicators in BC care at our Breast Unit. Methods: Retrospective analysis of women diagnosed and treated for BC from June 2014 through June 2016 .The European Society of Mastology (EUSOMA) guidelines for quality assurance in BC and diagnosis (published in 2010 and up dated in 2013 ) were used in order to asses quality of care Results: 103 patients treated for BC were included in the study. Median age was 54 years old, ductal carcinoma: 76,5 %, histological grade I-II: 74 %; stage 0-II: 72%, axillary metastasis: 39 %, progesterone receptor/estrogen receptors+ (RE/RP+): 64 %, HER2+: 27 %. Quality criteria associated to preoperative diagnosis, pathology analysis, surgical treatment, radiotherapy and oncologic treatment were met. Conclusions: Quality indicators allows BC evaluation from established standards, giving objective and reproducible information, helpful to plan process optimization. Care received by patients seen at the Hospital de Clinicas BC Unit during the referred period met all indicators suggested by the European Society of Mastology. [Table: see text]

E1. What the past is telling us about the future

Having had the honour and the pleasure of working with Emmanuel van der Schueren and of assisting him as his secretary general when he was president of European Organisation for Research and Treatment of Cancer (EORTC) and president of the European Society of Mastology (EUSOMA), it gives me even more pleasure to be here today and to share with you what I believe I have learnt in more than 30 years of research and clinical practice in the field of breast cancer. Being a surgeon, I probably feel more comfortable than any other colleague in this room in saying that the first message which comes from the past and tells us something important about the future is that breast-cancer management is not (only) breast-cancer surgery. Women who are still treated in centres where doctors believe that the cure for breast cancer is mastectomy are really unlucky, not only because they miss the opportunity to preserve a comfortable body image, but mostly because they miss the benefit of the multidisciplinary treatment of their disease. In the past we thought of cancer as an external entity coming to invade our bodies, and medicine’s answer was to ‘destroy’. To destroy with surgery, with radiotherapy and with chemotherapy. To destroy the tumour, mostly, nearly ignoring the rest of the patient’s body and mind. Now we have learnt that what we have to do is gently to reduce the tumour presence, to oppose its growth, antagonise its proliferation, and induce the apoptosis of its cells, from the maximum tolerated action to the minimum effective one. I believe that surgeons have played an important role in this cultural revolution [1]. In the past we were also absolutely convinced that the maxim ‘the earlier the better’ was undeniable, and we have sometimes promoted breast-cancer screening like a religion (despite the fact that most of us are definitively non-religion-oriented). Anti-screening scientists and researchers have also reacted against this approach, sometimes with excessive furore, generating unnecessary antibodies and preventing an objective analysis of the facts and figures. I believe we should in the future continue to seek for an early detection of breast cancer, but we cannot ignore the fact that screening might not actually reduce mortality in certain conditions, as for example in the incidence of advanced breast cancers [2]. How about technology? Is technology always good by definition, as we tended to believe in the past? Probably not. Those who belong to my generation may remember the disappointment at the failure of thermography as a safe, non-x-ray method for diagnosing breast cancer. And those belonging to the current generation are witnessing the downsides of indiscriminate use of MRI: since only 25% of positive findings by magnetic resonance imaging (MRI) represent malignancy, surgical planning should not be routinely based on this exam [3] if we do not wish to go back to the past and to justify ‘the current resurgence in mastectomy’ [4]. How about biology? Is it still relevant to debate whether breast cancer is a local or a systemic disease? Since scientific evidence has proved the efficacy of postoperative radiation therapy after breast-conserving surgery and of adjuvant medical treatment, ‘the era in which surgery was the sole treatment for primary breast cancer [has] come to an end’ [4]. Pathology reports were once a few lines long, now they often need more than a page. The possible combinations of the various parameters (grading, lymph-node status, hormonal receptors, vascular invasion, size, Her2 test, etc) are so many that no patient actually has the same disease as her roommate, and doctors and nurses have to make constant efforts to personalise their communication and treatment plans. Classifications which have been important in the past, such as the tumour-node-metastasis (TNM) system, are becoming less and less meaningful because they are too rigid, and we have learnt that rigidity does not pay. Who would still decide the surgical operation on the basis of the T without also taking into consideration the size of the breast? The old dogma was always mastectomy for any tumour larger than 2.5 cm. Now we have finally become capable of evaluating the tumour/breast size ratio and performing conservative surgery even for a 3-cm tumour if the breast size of the patient allows it, while we find it more appropriate to perform a nipple-sparing subcutaneous mastectomy for a 1.5 cm tumour in a small breast. Still, what is probably most important in what the past is telling us about the future is that breast-cancer management must involve teamwork. The omniscient and

The breast care nurse: the care specialist in breast centres

In Europe, breast cancer is the most common form of cancer in women; 26.5 per cent of all new malignant diseases and 17.5 per cent of all cancer deaths are due to this type of cancer. In Germany, approximately every tenth woman is diagnosed with breast cancer during her lifetime. In order to increase the quality of life of breast cancer patients, the European Society of Mastology (EUSOMA) requires the availability of, and an integration of qualified and specialized care into the interdisciplinary team. Thus, in Germany, a new type of job profile for 'breast nurse' as a qualified care specialist has to be established and has to be oriented towards the international standards of a breast care nurse (BCN). The Charité's Academy of Health--in cooperation with the Interdisciplinary Breast Centre of the Charité--has offered a career advisory service curriculum for the BCN since 2006 in accordance with the EUSOMA guidelines. In three courses, 45 BCNs have been trained. In the first refresher seminar in May 2009, the BCNs were given an opportunity to exchange with fellow BCNs their experiences. We were able to set up a new curriculum to train nurses as BCNs as to improve the quality of care for breast cancer patients and to orientate the training towards the international standards of a BCN qualification.

8078 INVITED Bowel problems: The role of a nurse endoscopist in the diagnosis of bowel cancer in a surgical outpatient clinic

Patients diagnosed with breast cancer have many needs that for a start include the expectation of cure. Where cure is unlikely there is always a place for hope and spiritual support. Furthermore whether dealing with the early stages or with the advanced disease patients require symptomatic control that encompasses pain relief, control of nausea and vomiting and psychological distress.To achieve all of these goals there is a need that goes beyond the role of scientific medicine. This position papers describes the guidelines for the use of complimentary and alternative medicine (CAM) developed by a workshop on behalf of the European Society of Mastology (EUSOMA).

Lymphedema in breast cancer survivors: Assessment and information provision in a specialized breast unit

Objective Assessment and adequate treatment of lymphedema is required by the European Society of Mastology. The purpose of our study was the evaluation of self-reported incidences of lymphedema in breast cancer survivors and the effect of providing the patients with information about lymphedema on the extent to which lymph-drainage massage services and compression garments were used. Methods A total of 742 breast cancer survivors were analysed in this questionnaire-based survey. The associations between lymphedema and the patients’ medical history; morbidity located in the breast, axilla, and arm; the amount of information the patients had received concerning lymphedema; and the extent to which lymph-drainage massage services and compression garments were analyzed. Results 31.67% of the patients stated to have lymphedema. Radiotherapy was identified as a significant risk factor. Pain, paresthesia, and functional limitations were associated with the occurrence of lymphedema. The only independent positive predictive factor found to be associated with the use of lymph-drainage massage services (OR 5.74) was the provision of information about the condition. Conclusions Self-reported assessment of lymphedema is feasible. The observed lymphedema incidence of approximately 30% may be able to serve as a basis for benchmarking in quality-assurance procedures at breast centers. Practice implications Control mechanisms are required to assess if the indication for lymphdrainage is adequate and the compliance to this subject is sufficient.

Background to Eusoma guidelines and statements

The European Society of Mastology (Eusoma) is committed in writing and diffusing guidelines on Breast Cancer, aiming at harmonising the quality of Breast Cancer care throughout Europe.To achieve this Eusoma organises scientific meetings, “workshops” or “Consensus meeting”, inviting European experts from the different disciplines involved in the multidisciplinary management of Breast Cancer patients, to give their contribution in drafting “guidelines” or “consensus statements”.In this regard Eusoma Executive Committee members found it appropriate to define the rules to organise its scientific meetings and to write the documents resulting from these meetings, i.e guidelines or statements.This will guarantee an homogeneity in the meeting organisations and in drawing up the scientific documents.

The role of complementary and alternative medicine in the management of early breast cancer: Recommendations of the European Society of Mastology (EUSOMA)

Patients diagnosed with breast cancer have many needs that for a start include the expectation of cure. Where cure is unlikely there is always a place for hope and spiritual support. Furthermore whether dealing with the early stages or with the advanced disease patients require symptomatic control that encompasses pain relief, control of nausea and vomiting and psychological distress.To achieve all of these goals there is a need that goes beyond the role of scientific medicine. This position papers describes the guidelines for the use of complimentary and alternative medicine (CAM) developed by a workshop on behalf of the European Society of Mastology (EUSOMA).

Role of complementary and alternative medicine in the care of patients with breast cancer: Report of the European Society of Mastology (EUSOMA) Workshop, Florence, Italy, December 2004

The aim of the European Society of Mastology (EUSOMA) Workshop, Florence, Italy, December 2004, was to produce guidelines on the use of complementary and alternative medicine (CAM) for breast cancer. The widespread use of CAM has to be acknowledged and the reasons for this understood. Deficiencies in the practice of conventional medicine that lead to the adoption of CAM need to be addressed. At the same time, CAM use for breast cancer should be quality controlled, avoiding double standards in evaluation, whilst recognising the problems of CAM research. These guidelines, which appear in an accompanying paper, aim to help oncologists and cancer patients alike.

EUSOMA accreditation of breast units

EUSOMA (European Society of Mastology) is the organisation representing Breast Cancer Specialists in all disciplines, covering all aspects of breast cancer from risk and prevention, through diagnosis and treatment of the primary tumour, follow-up, treatment of recurrent and advanced disease, pathology, reconstruction, psychology and audit. EUSOMA Guidelines have been published on several aspects of breast cancer and are on service provision as well as giving clinical guidance and providing the basis for audit.

Adecuación de las unidades de mama españolas a los criterios de EUSOMA

The optimal treatment of breast cancer consists of a multidisciplinary approach in specialized units, benefitting patients and leading to more rational resource use. Based on these premises, the European Society of Mastology (EUSOMA) drew up recommendations designed to provide all European countries with high-quality multidisciplinary teams. We present and analyze the results obtained from a survey of breast cancer units in 241 Spanish hospitals performed by the Breast Diseases Group of the Spanish Association of Surgeons. Breast disease was treated in general surgery departments in 131 hospitals and Spanish surgeons showed strong interest in continuing training (41.2% had a postgraduate degree in mastology). Multidisciplinary discussions at weekly intervals took place in 95 hospitals (73.6%) hospitals for planning a diagnostic and therapeutic course of action specific for each patient. Written protocols for diagnosis and treatment were used in 119 departments (90.8%) and quality control measures were applied in 83 (63.4%). We stress the need for mandatory requirements in Spain for breast cancer units, preferably adapted to the EUSOMA criteria, which are accepted by the relevant committee of the European Parliament. Through its Breast Diseases Group, the Spanish Association of Surgeons should be involved in accreditation standards for breast surgeons and should promote adequate specialization programs.

Likelihood of malignancy in breast lesions characterised by ultrasound with a combined diagnostic score

To determine the positive predictive value of breast ultrasound (US) categories and US features, isolated and in combination, 398 consecutive sonographically diagnosed breast tumours with histologic or cytologic diagnosis were reviewed. Tumour characterisation and the sonographer’s diagnoses were recorded prospectively using the diagnostic classification of the European Society of Mastology (EUSOMA) (U2 = probably benign lesion, U3 = an abnormality present of indeterminate significance, U4 = features suspicious of malignancy). In addition, based on the likelihood of malignancy of each US characteristic, a diagnostic score was developed. These two measures were compared. US-guided biopsy revealed 338 benign and 60 (55 invasive and 5 noninvasive) malignant lesions. EUSOMA and diagnostic score classifications did not differ significantly. If all breast tumours classified U3 and U4 were to be tested, every second biopsy (48.3%) would have revealed a carcinoma with a negative predictive value of 99.3%. The frequency of carcinoma in sonographically benign lesions (U2 or score 1) was 0.7 and 2.2%, respectively, an incidence similar to that with mammographic lesions classified as BI-RADS 3 (Breast Imaging Reporting and Data System, probably benign, short interval follow-up suggested). Thus, given that clinical symptoms and real-time imaging influence the sonographer’s interpretation, the proposed diagnostic score can improve the diagnostic accuracy of the breast sonogram with the result of reducing invasive testing and maintaining a high detection rate. (E-mail: E.Baez@uni-muenster.de)

Aplicación de los criterios de EUSOMA en las unidades funcionales de mama de los países miembros de la Unión Europea

All the countries of the European Union face similar challenges when providing adequate and high quality treatment in oncology. A working party was established to consider what should comprise a specialist service and the Requirements of a Breast Unit, published in 2000, represent the opinion of the European Society of Mastology (EUSOMA) on the standards required for creating high quality Breast Cancer Units across Europe. We studied the application of the mandatory requisites and general recommendations of EUSOMA: critical mass, or minimum number of patients, core team (composition and specific training), quality assurance, and application of diagnostic and treatment protocols. A thorough literature search was performed and was completed with information from search tools, the web pages of scientific societies, national associations for the fight against cancer, and health ministries of the countries belonging to the European Union. We also analyzed the latest reports of the European Parliamentary Committee for breast cancer. Distinct approaches to the multidisciplinary management of breast disease can be found in the United Kingdom, Sweden, Italy, France and Spain. A common European standard would be useful to improve the care provided to patients.

Report on the 4th European Breast Cancer Conference, Hamburg, Germany, 16-20 March 2004.

The 4th European Breast Cancer Conference, organized under the auspices of the European Organization for Research and Treatment of Cancer Breast Cancer Group, of the European Breast Cancer Coalition (Europa Donna) and of the European Society of Mastology (EUSOMA), was held in Hamburg, Germany on 16–20 March 2004. The leading theme of the conference was partnership among scientists, clinicians, carers, advocates and patients. The present article provides a brief description of the most important conference presentations on molecular biology, epidemiology, prevention, pathology, diagnosis and treatment at all stages of breast cancer.

Breast Cancer Advocacy across Europe through the work and development of EUROPA DONNA, the European Breast Cancer Coalition

Advocacy—the art of representing or promoting a cause or purpose on behalf of oneself or others—can include influencing policy, affecting legislation and changing attitudes. This is not an easy concept in some European countries and indeed the word ‘advocacy’ is not capable of direct translation into some languages. This is one of the challenges that EUROPA DONNA, the European Breast Cancer Coalition, has had to address to present its raison d’etre during its short life as Europe’s breast cancer advocacy organisation. Advocacy by women advocating for women’s health began in many countries during the second half of the twentieth century. Breast cancer advocacy as we know it has been around since the early 1990s but organisations by and for breast cancer patients and those close to them go back much further than that, starting in the United States. ‘Reach to Recovery’ [1] was founded in 1952 as a support group for women who had had mastectomies and continues today as an international organisation. In the 1970s organisations such as ‘Y Me’ and the Susan Komen Foundation [2] began to add a political dimension to the provision of breast cancer information and support, and around this time wellknown women such as Betty Ford, Happy Rockefeller and Shirley Temple Black began to speak out about having the disease. This raised awareness, enabling public discussion, and as a result women increasingly felt able to identify themselves publicly as breast cancer patients and survivors. NABCO (The National Alliance of Breast Cancer Organisations) was founded in 1986 and The National Breast Cancer Coalition (NBCC) in 1991. The idea of campaigning politically for better services and for significantly more research to be carried out came in the wake of the effective advocacy activities of AIDS activists in the 1980s, and, in the United States, women began to adopt the same tactics in relation to breast cancer [3]. In European countries, too, small groups were forming to offer support and better services in all aspects of breast cancer. For example in the United Kingdom, the Women’s Nationwide Cancer Control Campaign (WNCCC) was formed in 1965 and Breast Cancer Care (previously The Mastectomy Association) in 1968, in Sweden, The Swedish Association for Breast Cancer Societies (BRO) around 1975, and in Italy, ANDOS in 1976, to mention just four. Also, in the early 1990s, Professor Umberto Veronesi, breast cancer surgeon in Milan, Italy, saw the power of women’s advocacy for breast cancer in the United States, diverting $4m from the defence budget into breast cancer research. Professor Veronesi felt that the women of Europe should also have a say in their breast cancer journey and he set about exploring how to start this initiative. After one or two unsuccessful early approaches, he spoke to a group of women at a meeting in Venice. Following this it was planned to launch a new organisation at the European Society of Mastology (EUSOMA) [4] meeting in Paris in February 1993. Having heard of this possibility, several women working in the breast cancer field in Europe attended this meeting. They heard the proposal and offered to take up the challenge, but made it very clear that this had to be a women’s organisation run by women. This was accepted and a small steering group was formed under the leadership of Gloria Freilich from the United Kingdom. Thus EUROPA DONNA (ED), the European Breast

An economic evaluation of the optimal workload in treating surgical patients in a breast unit

A breast unit is a cancer centre specialised in the diagnosis and treatment of patients with breast cancer. The high level of specialised skills involved in running a breast unit makes it an expensive pattern of care. The European Society of Mastology (EUSOMA) recommends a minimum caseload of 150 cases sufficient to maintain expertise for each team member and to ensure cost-effective working of the breast unit. Specific economic analysis evaluating main diagnostic services (radiology and pathology) and treatment are needed. The present study assesses the activity level at which the breast unit represents good value for money in surgically-treated patients. Cost assessment is realised by defining a cost function according to the following assumptions: cost function input is personnel costs and technical equipment and output is the number of newly diagnosed cases of primary breast cancer admitted to the breast care unit each year. The increase from 50 new cancer cases per year to 100 will reduce average costs by almost 50%. Cost reduction is important up to a volume of 200 new cases per year. For economic investment to be justified, it is desirable that intake rises to at least 200 new cases per year. Our result is in-line with the EUSOMA recommendation.

The curative role of radiotherapy in the treatment of operable breast cancer

The last quarter of the twentieth century has brought about sweeping changes in the loco-regional treatment of breast cancer. Randomised trials have consistently established that survival rates after conservation surgery and breast irradiation are equivalent to those observed after modified radical mastectomy [1]. Moreover, during the same period the use of mammography in asymptomatic women has led to a relative increase in small tumours, ideally suitable for breast conservation. As a consequence, the use of conservation surgery has risen progressively during the 1980s and 1990s, with a corresponding increase in the importance of breast irradiation. In addition, recent meta-analyses of randomised trials have established that breast cancer mortality can be significantly reduced by loco-regional radiotherapy (RT), and that the increased intercurrent mortality observed in older trials was caused by an excess in cardiovascular deaths, presumably avoidable, associated with the earlier techniques [2,3]. Newer trials of postmastectomy radiotherapy (PMRT) have demonstrated a clear survival improvement, without excess cardiac morbidity, leading to an increased confidence in the use of adjuvant loco-regional RT [4,5]. The extent of the swing to conservative surgery varies amongst geographical regions, depending, at least in part, on the availability of radiotherapy services. With the increasing diffusion of medical technology throughout Europe, this factor will probably assume a decreasing importance for the choice of primary breast cancer therapy. In urban areas with a high socio-economic standard, it is likely that mastectomy will come to be practised in a dwindling minority of patients. According to the Geneva Tumour Registry, the proportion of all curative breast operations that were conservative rose from 3% before 1985, to 51% in 1990, then to 67% since 1998 (Registre genevois des tumeurs, unpublished data, 2000). As a consequence, patients currently requiring mastectomy are likely to have larger tumours and positive lymph nodes, and will frequently be considered for PMRT. In such a setting, a substantial majority of primary breast cancer patients will therefore receive RT as part of their initial treatment. These changes come at a time when the prevalence of breast cancer is increasing significantly due, at least partly, to the ageing of the European population. For Geneva, an increase of more than 50% in the number of new breast cancer cases is projected for the period between 2000 and 2010 (Registre genevois des tumeurs, unpublished data, 1998). The demand for radiotherapy services required to treat breast cancer patients may thus be expected to increase substantially. Accordingly, the European Society of Mastology (EUSOMA) believes that a position paper regarding the use of RT in breast cancer is timely and useful. This document discusses the indications for adjuvant RT in operable breast cancer (clinical stages T0-3, N0-1, M0), the technical principles for its proper execution, and where possible, notions of its optimal co-ordination with other treatment modalities. As the breast cancer literature is vast, analysis was necessarily restricted to data having a high likelihood of being reliable, making every effort to draw conclusions likely to be pertinent to

Including breast cancer in the political agenda

In a developed continent, where women are at a one in ten lifetime risk of breast cancer, you may well consider that access to accurate i n f o r m a t i o n , a p p r o p r i a t e screening and optimal treatment are basic rights of women. However, these services are not offered to all European women. In a European collaborative project (Eurocare 2), marked differences in access, medical expertise and quality of equipment among the 17 participating countries were highlighted. This provided the stimulus for the creation of a European Breast Cancer Coalition, which was named Europa Donna; its website can be accessed via the ‘Cancerworld’ homepage. Although the diverse socio-cultural setting of Europe and surrounding countries precluded an exact reproduction of the US-based National Breast Cancer Coalition, the intentions of Europa Donna are similar to its American counterpart. From ten main aims, which include the promotion of breast awareness and information on treatment options, provision of appropriate care with adequate followup, as well as health professional training and equipment checks, each country decides which to accept and strive for, based on the importance of these issues at a local level. Europa Donna hopes to represent issues and concerns surrounding breast cancer at the highest political levels, on a national and European scale. In terms of the political activities undertaken by Europa Donna, the information given on their website is limited to a brief list of the meetings which have been organised with various political groups. Little detail is provided on the content or outcome of these meetings. Thus far, together with the Breast Cancer Cooperative Group of the European Organisation for Research and Treatment of Cancer (EORTCBCCG) and the European Society of Mastology (EUSOMA), Europa Donna has organised the largest European forum for breast cancer: the European Breast Cancer Conference (EBCC). At the second EBCC meeting (Brussels, Belgium; 26 – 30 September 2000), the Brussels Statement was agreed upon. This consensus lays down the position of the three European bodies in relation to breast-cancer screening and care, and it is hoped that the objectives will be met through political lobbying and the mobilisation of health-care providers, researchers and the health industry. This website provides a limited amount of insight into the political lobbying being undertaken by Europa Donna at a European level. Although the tone is upbeat, it is disappointing that so little information on advocacy and lobbying is available here. Perhaps as the coalition develops and produces results, the website will develop into a more useful source of information on a group with such worthy, if ambitious, goals. Mona Okasha

European Society of Mastology Consensus Conference on Breast Cancer Screening: Report of the Evaluation Committee

On 4 February 1993, the European Society of Mastology (EUSOMA) convened a meeting of experts in Paris to evaluate the current evidence on the value and hazards of breast cancer screening. The Committee consisted of individuals from different countries throughout Europe and from different disciplines. We summarise here the deliberations and conclusions of the Committee.