The paper describes different types of atypical hyperplasia of the breast. It analyzes numerous works dealing with the evaluation of atypical ductal and lobular hyperplasias as a risk factor for breast cancer. The similar analysis has been also carried out in a cohort of women with a family history. The current capabilities of visual, cytological, morphological, and molecular biological diagnosis of atypical hyperplasias are considered. Modern-day guidelines for the treatment policy and monitoring of treated patients are given. The role and place of different chemoprevention options for this cohort of patients are considered. Whether preventive surgery may and should be performed particularly in a cohort of women with a family history is determined.

Breast cancer (BC) is one of the most common cancer among women worldwide. In 2005, the International Diabetes Federation (International Diabetes Federation) declared metabolic syndrome is one of the main problems of modern medicine, as it increases the total mortality and the prevalence has reached pandemic levels. Several studies have shown that the metabolic disorders associated with metabolic syndrome, affect the carcinogenesis of BC. Improving the efficiency of chemotherapy in patients with type 2 diabetes taking biguanides compared with patients who used other hypoglycemic agents, it has become a premise for the study of the possible antitumor mechanism of action of metformin. Therefore, adequate correction of metabolic disturbances caused by metabolic syndrome may be an additional area of special treatment, as well as a measure of primary and secondary prevention of BC. Improving the efficiency of tumor therapy in patientswith type 2 diabetes taking biguanides compared with patients who used other hypoglycemic agents, it has become a prerequisite for the study of the possible antitumor mechanism of action of metformin. This paper presents the results of studying the effect of metformin on the effectiveness of neoadjuvant systemic therapy for BC patients with the metabolic syndrome.

In Russia, breast cancer (BC) occupies a leading place in the pattern of cancers, the incidence of which is 20.9 %, among the female population; in 2013 there were 60,717 new cases, including women under the age of 40 years (15 %). While considering the history of the development of breast surgery from the operation performed by W. S. Halsted to its technique modified by J. L. Madden and the identification of sentinel lymph nodes, we can observe improved quality of life in patients in reference to the lower rate of the manifestation of lymphedemas. However, patients who have undergone this or that mastectomy are observed to have lower self-appraisal scores, a change in their professional sphere, irritability and apprehensiveness Thus, the decreased rate of the manifestation of lymphedema and obvious postoperative traumatization are not the only components of quality of life in patients with BC. According to the data obtained by E. Frank et al. (1978), G.P. Maguire et al. (1978), and F. Meerwein (1981), removal of the breast itself leads to a woman’s loss of femininity, attractiveness, and sexiness, which was also confirmed and reported by L. Aerts et al. (2014). In this connection, classical radical mastectomy begins to give way to organ-sparing treatment. Taking into account that psychotherapy and external prosthetics do not alleviate the above problems and that there are always women with established BC who have contraindications to organ-sparing treatment, breast reconstructive plastic operations arouse more and more interest. Reconstruction of the breast implies restoration of both its shape and contours to be maximally brought closer to its preoperative level. However, with regard to cancer alertness to breast reconstructive surgery, not only aesthetic requirements are imposed. The next step in improving quality of life in patients with BC was the emergence and development of breast-sparing mastectomies, the first point of these operations were skin-sparing radical mastectomies that were first described and performed by B. A. Tothu P. Lappert in 1991. In 1997 G. W. Carlson proposed to classify incisions for skin-sparing mastectomy successfully used to the present day. The investigation conducted by R. M. Simmons et al. (1999) indicated that skin-sparing mastectomy did not result in an increase in the incidence of local recurrences. The types of skin incisions, which were offered by G. W. Carlson in 1997 and used by R. M. Simmons in 1999, imply the preservation of the inframammary crease and a major portion of a skin graft, on the one hand, and the removal of the nipple-areolar complex (NAC), on the other hand, which in turn diminishes the final aesthetic result. B. Gerber et al. were the first to describe NAC preservation for BC. As regards the rate of local recurrences after NAC-sparing mastectomies, the vast majority of investigations performed in the past 10–15 years allude to the fact that NAC involvement is not more than 25 %. A. M. Munhoz in turn proposed a classification of incisions during NAC-saving mastectomies. In spite of all advantages of NAC-sparing mastectomies, their results are not always predictable. Main problems, such as wound healing difficulties or ischemic necrosis, are associated with the larger number of postoperative complications. Transfer of the patient’s own flaps does not always presume skin- or NAC-sparing mastectomy, as the possibility exists of preserving the skin on the most transferable flap. However, ruling out a patch symptom during subcutaneous or skin-sparing radical mastectomy considerably improves the aesthetic result of a performed operation. Taking into consideration that the incision types offered by G. W. Carlson and A. M. Munhoz depend on the site of a tumor, the surgical visibility problem is of relevance: visible postoperative scars, a difference in the skin texture, or restored NAC, all cause the women less satisfied. Thus, by achieving good results in restoring the contours, shape, volume, and symmetry of the breast, a visible postoperative scar is the only element that reveals a performed operation for BC.

Reconstructive surgery for breast cancer are an integral method of rehabilitation of cancer patients. Breast reconstruction may be delayed and instantaneous. The article presents a description of the thoraco-epigastric flap for breast reconstruction in cancer. The operation involves the replacement of the remote volume (after radical resection of the breast) and the breast skin adjacent tissues adjacent to the inframammary crease from the side of the anterior abdominal wall. Surgery is indicated when the tumor in the lower parts of the breast, closest to the skin, in combination with small size breast cancer. The article presents a clinical example of this operation. Described in detail the operation, received a good cosmetic result. The advantage of the application of thoraco-epigastric flap is in the simplicity of the technique of its execution, good blood supply, donor wound is easily sutured due to the possible wide separating cellular adjacent skin and subcutaneous tissue. The disadvantage of this method is limited and the need for careful monitoring of perforating branches of the upper epigastric artery. Thus, thoraco-epigastric flap, can be applicable when performing reconstructive operations for breast cancer in compliance with the necessary requirements for the formation of the flap and the correct attitude to feeding the flap vessels, and virtually eliminates possible complications with the healing of the flap. Undoubtedly, reconstructive plastic surgery for breast cancer, during the testimony and technical capabilities, are an essential component of surgical treatment.

The use of tissue expanders thanks to its simplicity and efficacy is the most common method of breast reconstruction today. However,
the common problem during this procedure is lack of the inframammary crease (IMC) that is disrupted during radical treatment for cancer, which prevents the achievement of symmetry with the contralateral breast. IMC is an important component of the attractive aesthetically normal appearance of the breast, since it plays a considerable role in the formation and maintenance of its shape; it is one of the most important elements of the natural manifestation of breast ptosis and ensures the lower support for subpectorally located endoprostheses, which keeps them from malposition. If the IMC is slightly pronounced, asymmetrically located, or displaced in the postoperative period, it virtually negatively affects all other contours, including the shape of the upper and lower poles, the position of the breast on the chest, and the degree of symmetry with the contralateral breast. Thus, the development and mastering of the surgical techniques, which reconstruct properly and hold the position of this structure, is an urgent component of successful reconstructive surgery. This paper analyzes the significance of IMC for reconstruction of the breast and also reviews current methods for its restoration.

As is known, the HER-2-expressing biological subtype of breast cancer (BC) is characterized by an aggressive course and has a poor
prognosis in the absence of specific treatment. Before the emergence of trastuzumab, 5-year overall survival in patients with the disseminated forms of BC was 20 % (median survival, 16–29 months), out of whom only 2–5 % were long-term survivors. Addition of trastuzumab, a humanized monoclonal antibody that binds selectively to HER-2 receptor on the surface of tumor cells, to first-line chemotherapy for HER-2-positive metastatic BC caused a considerable enhancement of therapeutic efficiency. When trastuzumab is incorporated into chemotherapy for metastatic BC, median progression-free survival and overall survival were 7.4 and 25.1 months (4.6 and 20.3 months without trastuzumab), respectively. Kadcyla® (T-DM1), an antibody-drug conjugate, represents a new approach to treating HER-2-positive metastatic BC. T-DM1 is characterized by the innovative and selective mechanism of action on the HER-2-positive tumor cells. Through this mechanism, T-DM1 leads to a double antitumor effect: a trastuzumab-mediated anti-HER-2 effect and a cytotoxic effect due to the selective transport of the potent antimitotic agent DM1 into the cytoplasm. This mechanism of action enhances the efficiency of antitumor therapy and reduces toxicity. Kadcyla® has been approved in the Russian Federation, as well as by the European Medicines Agency and the United States Food and Drug Administration as monotherapy in HER-2-positive inoperable locally advanced or metastatic BC patients previously treated with taxanes and / or trastuzumab.

The article discusses the relationship between etiology and risk factors of fibrocystic disease (FCD) and breast cancer (BC), pathogenesis of FCD in connection with increasing risk of BC, assessment of BC risk in patients with FCD; pathogenetic treatment of FCD aimed for preventing BC; the use of the drug progestogel for the treatment of FCD and prevention of BC. FCD and BC have general etiology and the most risk factors are identical for the both pathologies. Multiple risk factors disturb hormonal balance in the organism of a woman, cause hyperestrogenism and epithelium hyperproliferation in the mammary tissue that results in the development of FCD and at presenceof congenital or acquired gene damage results in the development of BC. Decision value for the estimation of degree of a BC risk in patients with FCD has morphological research of mammary tissue got at a biopsy. The risk of developing BC for non-proliferative FCD does not rise or is minimal. Proliferative FCD without atypia or with atypia was associated with significantly increased BC risk in 2 or 4 times, correspondingly. The risk of developing BC for FCD with ductal or lobular carcinoma in situ is maximal and may be increased in 12 times. Progestogel is hormonal medicinal drug containing progesterone for local application. Results of undertaken studies and supervisions allow to conclude that progestogel is not only effective and safe drug for pathogenetic treatment of FCD and thus could be regarded as indirect factor to decrease BC risk.

The incidence of uterine myoma, including rapid-growing, in a population is sufficiently high and does not tend to decrease. Therefore, assessment of growth of uterine myoma is important for the early selection of adequate tactics of these patients. At the same time, there are no clear criteria for the practitioner to decide on the optimal amount of treatment. One approach to solving this problem is the development of new methods of diagnosis of clinical and morphological variants of uterine myoma. In this regard, we studied and compared features of the structures of solids menstrual content of markers of proliferation and apoptosis (APRIL and TRAIL) in patients with slow- (simple) and rapid-growing uterine myoma. The relationship between the clinical and morphological parameters, the rate of growth of uterine myoma, the levels of APRIL and TRAIL, and abnormal structures identified in menstrual secretions of patients using the method of boundary dehydration. The study included 111 women aged 31 to 56 years. They were divided into three groups: control, which included 41 patients without gynecological diseases; the second one, which included 40 patients with slow-growing and the third one – 30 patients with rapid-growing uterine myoma. Objective: to develop a combined approach to the diagnosis of rapid-growing uterine myoma by determining structural features of the biological fluid – menstrual flow, identifying them ligand induces proliferation (APRIL), and the ligand induces apoptosis (TRAIL). The study used сlinical, biochemical, statistical methods and the method boundary dehydration of biological fluids.

As it is known, the problem of intensification and optimization of pre-hospital diagnostics largely determines the success of treatment and is one of its most important items. It is this approach that gives an opportunity for effective, preserving organs, treatment and thus at most saves reproductive abilities of women. Nowadays the problem of screening precancerous and cancerous diseases of uterine body and appendages, which are increasing in population, is still unsolved. It is the necessity of regular prophylactic measures, in the aspect of forming the considered diseases, that consists in high chances of their elimination just when they are early revealed. The object of research is clinico-laboratory data of 176 patients consisted of 45 (25.6 %) women control group without tumors of reproductive organs, all the rest were divided into two groups: the first one consisted of 87 (49.4 %) patients with ovarian tumors (benignant and malignant) and the second group included 44 (25.0 %) patients with adnexitis.

Objective: to improve the diagnostics of the adnexis tumors by indentification structural and biochemical markers in menstrual discharges and endometrial washes. The study used сlinical, pathohystological, cytological, biochemical, statistical methods and the methods wedge-shaped dehydration of biological liquids, transvaginal echography.

Despite the high initial susceptibility of ovarian cancer (OC) to chemotherapy, the vast majority of patients with Stages III–IV of the disease have its recurrences. Chemotherapy is a main treatment for recurrent OC. In Russia, the rate of platinum-resistant recurrences after first-line chemotherapy is more than 50 %, which may be due to the high extent of a tumor process at the moment of diagnosis, to the low rate of optimal cytoreductive interventions, and to non-optimal treatment. Many oncologists refuse to treat patients with recurrent platinum-resistant OC since the existing Russian and foreign guidelines point to the low efficiency of current chemotherapy for this type of recurrences. At the same time, whether chemotherapy should be used to treat platinum-resistant recurrences must be decided by taking into account a set of clinical factors that along with the duration of a platinum-free interval are also predictors for the efficiency of chemotherapy. These predictors should include mainly the histological pattern of a tumor; an immediate response to previous lines of chemotherapy; the number of previously used anticancer drugs; a patient’s general condition; and her existing factors that can influence the tolerability of chemotherapy. This paper describes a clinical case of a long-term survival in an OC patient who has developed a platinum-resistant recurrence just after first-line chemotherapy. Incomplete cross-resistance of the tumor to other drugs when a platinum-resistance recurrence develops, as well as its high susceptibility to the re-use of platinum-resistant derivatives possibly due to the artificial increase of a platinum-free interval should be identified among the factors that have influenced the prediction of treatment in this patient.