Introduction. In the last ten years, it became obvious that on the molecular level breast cancer is a group of heterogenous tumors. The current objective of routine clinical practice of treatment prescription includes accurate disease prognosis for every individual patient and conviction that the risk of breast cancer recurrence after adjuvant hormone therapy without adjuvant chemotherapy doesn’t increase.

The study objective is to evaluate how clinical use of risk associated with cell density can in practice improve prognosis of recurrence risk in patients with breast cancer after standard clinical and pathomorphological examinations.

Materials and methods. The article analyzes therapy results using data from the cumulative cancer registry of breast cancer diagnosis and treatment of the N.N. Petrov National Medical Research Oncology Center in 2000–2009. The database includes information on diagnosis, treatment, and survival of 5106 patients with breast cancer. Archived material (from 2000 to 2009) from paraffin blocks of the “targeted group” for methods of molecular and genetic profiling was poured into recipient blocks, stained with corresponding antibodies such as widely used ER, PR, HER2/neu, Ki-67 markers as well as poorly studied markers: cell density, р53, CK5/6, CK14, CD4/CD8, p63, EGFR, FOXP3, AR, FOX1.

Results. The study of 1118 patients with stage T1–2N0M0 breast cancer has shown that analysis of risk associated with cell density allows to predict disease outcome. Correlation between the marker and the grade of histological malignancy is more rare than for Ki-67 determined in this patient group. As a result, determination of cell density is an additional method to increase objectivity and accuracy of breast cancer prognosis.

Conclusions. Automated cell density analysis for breast cancer is almost fully operator-independent which increases accuracy and objectivity of the results. Cell density in breast cancer lower than 3000 cells/mm² is a favorable prognostic factor.

Knowledge of anthracycline antibiotics’ (AAs) pathogenesis and main risk factors allowed to develop various methods of prevention and early detection of cardiotoxicity as well as to create several guidelines on decreasing the risk of its development. Traditional AAs are a crucial option in treatment of metastatic breast cancer including their repeated prescription. However, their application is significantly limited by various manifestations of toxicity, especially cumulative cardiotoxicity. The most promising is use of pegylated liposomal pharmaceutical formulations of AAs. Among these formulations, pegylated liposomal doxorubicin almost fully lacks anthracycline cardiotoxicity because due to its unique formulation it accumulates almost exclusively in tumor tissue.

The review considers a new oral targeted drug palbociclib and its place in treatment of luminal (estrogen receptor-positive) HER2– metastatic breast cancer. The results of randomized clinical trials have shown that inclusion of palbociclib in various hormone therapy regimens for treatment of HER2– metastatic breast cancer with expression of estrogen receptors allows to significantly improve clinical outcomes and increase survival, objective response rate and its duration, as well as clinical benefit rate (CBR). Addition of palbociclib to letrozole in the 1st line hormone therapy or to fulvestrant in patients with progression at/after previous endocrine therapy increased progression-free survival in all groups irrespective of clinical characteristics, tumor progression, or expression of molecular markers mediating development of hormone resistance. The main adverse events associated with palbociclib were neutropenia, leukopenia and thrombocytopenia, but overall hematological toxicity was manageable, and the therapy itself was safe. This strategy received a “breakthrough therapy designation” from the experts and combines proven effectiveness and satisfactory tolerability, allows to maintain high quality of life, and should be prescribed to patients with luminal HER2– metastatic breast cancer.

One of the first and foremost tasks of the Russian Association of Oncological Mammology (RAOM) is to develop clinical guidelines on diagnosis and treatment of breast cancer taking into account international experience. The guidelines must also be applicable in all regions of the Russian Federation allowing all Russian specialist to be informed about the latest strategies of diagnosis and treatment.

These clinical guidelines are based on the following consensus documents:

• St. Gallen Expert Panel (2011, 2013),

• Expert Panel of the IX International Conference “White Nights – 2012”,

• Expert Panel of the RAOM (2013),

• International consensus on treatment of metastatic breast cancer ABC 1,

• NCCN (2014)  and ESMO (2011) practical guidelines,

as well as the results of large international randomized studies conducted in partnership with Russian oncological centers.

The guidelines take into account the results of the analysis of a cumulative database on breast cancer treatment methods performed at

• N.N. Petrov National Medical Research Oncology Center, Ministry of Health of Russia,

• Saint  Petersburg City Clinical Oncological  Dispensary.

Our guidelines are based on methods that are available everywhere in the Russian Federation, treatment schemes and drugs are presented in accordance with the marketing authorization of the Ministry of Health of Russia, drug therapy takes into account biological subtypes of breast cancer, different courses of the disease as well as nonuniform situation with drug availability in various regions of the Russian Federation.

Obviously, such materials cannot serve as a direct guide for action (every patient’s disease is different), but they can lend a helping hand to a doctor striving to treat patients according to the latest achievements of modern oncology.

All-Russian non-governmental organization Russian Association of Oncological Mammology. President of the RAOM, corresponding member of the RAS, Prof. V.F. Semiglazov; Vice-President of the RAOM, corresponding member of the RAS, Prof. G.M. Manikhas; Executive Director of the RAOM R.M. Paltuev, PhD.

Introduction. Pregravid preparation plays a main role in solving issues with recurrent miscarriage and preterm delivery. Detection of etiologic factors of miscarriage with development of preventive strategies seems reasonable.

Study objective was to optimize the assessment and treatment algorithms of threatening miscarriage in the I  trimester of pregnancy with subchorionic hematoma formation.

Materials and methods. 113 women with subchorionic hematoma were examined in gestational age 4 to 12 weeks. Monitoring of pregnancy till delivery was conducted.

Results. The role of the combination of coagulation system genes polymorphisms (II  and V coagulation factors, plasminogen activator inhibitor-1,  methylenetetrahydrofolatereductase) and  altered  level  of  autoantibodies against thyroglobulin in  increased probability of miscarriage was shown.

Conclusion. Identification of high risk patients for pregnancy loss in the first trimester by the combination of coagulation system genes polymorphisms and antibody marker of thyroiditis together with a personified therapy approach contribute to the prolongation of pregnancy and reduce the frequency of repeated miscarriage.

Introduction. Cervical cancer is the 4th most common cancer among women. The main screening method for cervical cancer is cytological examination of the cervical epithelium. This method allows to evaluate the level of cervical dysplasia (malignant potential) but it has several limitations and flaws. Development and implementation of new methods of molecular and genetic analysis in clinical practice can increase informational value of the traditional cytological examination and therefore objectivity in choosing treatment options.

Objective is to develop and verify a new method of differential diagnosis of severe intraepithelial dysplasia and invasive cervical cancer.

Materials and methods. The method is based on analysis of small non-coding RNA molecules (miRNAs) extracted from the material of traditional Pap smears. Based on literature search, 18 “marker” microRNA molecules were chosen and their expression levels were estimated in 166 samples of Pap smears from cervical canals with different cytological diagnoses. The analysis was performed using reverse transcription polymerase chain reaction.

Results. Estimation of ratios between expression levels of miRNA pairs: 126/375; 20а/375; 126/145 allows to differentiate with high confidence borderline states of severe intraepithelial dysplasia and invasive cervical carcinoma (coefficients of quantitative interpretation of the error curve were 0.8, 0.75, 0.72, respectively).

Conclusions. Analysis of miRNAs in Pap smear samples is a promising additional method of cervical cancer diagnosis. The method is objective and can be proposed as a supporting technique in cases when cytological examination doesn’t allow to differentiate between borderline pathological states of the cervical epithelium. Implementation of the method in clinical practice requires methodological optimization and additional validation using more clinical material.

Introduction. The main method of treatment of endometrial cancer, the most common oncological disease, is surgery. Introduction of high-tech operations into gynecological practice promoted active use of laparoscopy in treatment of malignant tumors of the endometrium.

Objective. To evaluate effectiveness of video endoscopic surgery in treatment of endometrial cancer.

Materials and methods. In the period from 2010 to 2016, 1127 patients with endometrial cancer underwent surgery using video endoscopic complex with high resolution cameras at the N.N. Petrov National Medical Research Oncology Center, Ministry of Health of Russia.

Results.  Using video endoscopic technology, excision of the uterus with appendages was performed in 588 (52.3 %) patients, excision of the uterus with appendages and pelvic lymph node dissection was performed in 523 (46.4 %) patients including 16 (1.4 %) patients with serous and papillary serous forms of endometrial cancer who also underwent omentectomy. No intraoperative complications were observed. In the majority of patients, postoperative period was characterized by early activization, satisfactory intestinal peristalsis on day 1, minimal complications, absence of contraindications for adjuvant beam therapy.

Conclusion. Video endoscopic technology is a modern method of surgical treatment allowing to perform the full scope of planned radical surgical intervention in patients with endometrial cancer irrespectively of age and concomitant disorders with minimal traumatization, risk of intraand postoperative complications as well as favorable and fast rehabilitation period.