Biomedical subjects
Publications and source records attributed to K Ebeling.
Principles of prophylaxis and early diagnosis are reviewed and recommendations about therapy and follow-up are given, licensed by an expert committee.
The paper is the summary of a workshop and contains guidelines for prophylaxis, early detection, treatment and follow-up of endometrial cancer recommended by the Central Institute of Cancer Research as well as the Medical Associations of the German Democratic Republic.
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The use of combined oral contraceptives has been shown in a number of studies to alter a women's risk of developing some kinds of cancer. Specifically, a 50% reduction in the risk of both ovarian and endometrial cancer has been demonstrated. This protective effect appears to persist for some time after oral contraceptives are stopped. Combined oral contraceptives do not appear to effect substantially the overall risk of developing breast cancer, although some data suggest that selected subgroups of women may be at a greater risk of developing breast cancer if oral contraceptives are used at specific times in a woman's reproductive life, especially if used for long periods of time. However, the data are not entirely consistent on this issue. The effect of oral contraceptives on the risk of developing cervical cancer is also not entirely clear, although the data available suggest a slightly increased risk of intraepithelial cervical cancer with prolonged use of oral contraceptives.
This paper describes the introduction of a cervical cancer screening programme in the German Democratic Republic after conclusions were drawn from two pilot studies. The pilot studies were carried out to decide between two organizational structures: computerized monitoring, such as invitations to participate, versus full integration of the programme into the basic gynaecological health care system. Since similarly high attendance rates were obtained in the two systems, the recommendation for the GDR as a whole was to conform with the noncomputerized system. This programme has been implemented in Berlin, capital of the GDR, for ten years. Incidence decreased rapidly among women of all ages (33% lower than at the beginning) and for women aged 40-49 (58% lower). Mortality rates for women of all ages are now 37% lower, and for women of ages 50-59, 57% lower. A comparison of incidence in the screened and unscreened population shows that nonparticipants have a relative risk of 3.0 for developing the disease and of 11.3 for dying from the disease. In an analysis of the failures of screening, the cervical smears of 184 previously screened cancer cases were re-examined. In 48% no reason for failure was found. Possibilities for improving the results further, including a screening registry, are discussed.
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The WHO classification of epithelial tumors of the uterine cervix is recommended. Cytology is more suitable as colposcopy as screening method. The best method for diagnosis is cone biopsy. Dysplasia and carcinoma in situ may be treated stepwise, whereas invasive carcinoma must be operated on radically by abdominal route or irradiated.
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The incidence of cervical cancer in Berlin, capital of the GDR, decreased in the period 1970-78 from 52.4 to 38.9 per 100.000. The percentage of the curable stage I increased from 46% to approximately 60%. A remarkable increase of surgical treatment till old ages characterizes the treatment situation. In younger ages clearly the surgical treatment dominates. In stage I a the combined surgical-radiotherapy was replaced by the surgical treatment, the percentage of the sole radiotherapy remained constant. In stage I b the percentage of the combined treatment amounts to more than 50% as yet and of the radiation alone to 10%. A relative 5-year survival rate risen from 70% in 1970/71 to 82% in 1973/74 has been observed.
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The Hospital based Cancer Registry working at the Central Institute for Cancer Research, Academy of Sciences of GDR is demonstrated. The paper describes its organization, the data collected, its activities and benefit for research and clinical practice.
The use of oral contraceptives containing chlormadinone acetate in 1972 by women of 13 districts (out of 15) of the GDR has been related to the incidence of cancer of breast, corpus uteri, and ovary during the period 1961 to 1980. Cancer incidence was represented by cohort parameters showing the risk of the cohorts in relation to each other. No statistically significant association between the two events was noted. Although not significant, our data are consistent with an elevated relative risk for breast cancer of 1.3 and a decreased risk for ovarian cancer of 0.5.