The Guidelines were prepared by an international expert panel on behalf of the Association of Breast Surgery. The majority of women who have a relative with breast cancer are not themselves at significantly increased risk. The Guidelines propose a management strategy, including genetic assessment, chemo-prevention, risk reducing surgery and radiological screening, based on risk assessment of the individual. The Guidelines are based on evidence where available, or on consensus statements from surgeons, radiologists, geneticists and clinical psychologists.

Women with familial predisposition for breast and ovarian cancer represent a small group of patients with very high risk for developing breast and/ or ovarian cancer before the age of 50 years. The individual breast cancer risk can be assessed by genetic counselling and can be specified by genetic diagnostics. As part of the gynaecological consultation, adequate preventive measures are offered. Psycho-oncological counselling may help in decision making. For hereditary carcinomas, counselling is still not considered as a routine medical care, even though basic and routine preventive measures are insufficient for this group of high risk patients. Within the last years, 12 specialized centres in Germany have developed a patient care concept for women with a familial risk for breast and ovarian cancer. Establishment of these centres for familial breast and ovarian cancer and use of evidence-based medical care was initiated in a nationwide interdisciplinary joint research project and supported by the German Cancer AiD. These measures were integrated in a quality assurance concept for structure, process and result optimization. Thus, all requirements for introducing these services into routine patient management have been fulfilled.

In this report, the Association of Directors of Anatomic and Surgical Pathology (ADASP) provides guidelines for the reporting of lymphoid neoplasms. The World Health Organization Classification of Tumors of the Haematopoietic and Lymphoid Tissues is the preferred international standard for diagnostic criteria (disease definition) and nomenclature. Ancillary studies are often required, and the Association recommends that immunophenotypic and genotypic information be integrated into the final report, to the extent possible.

The general practitioner should encourage women aged 50-75 who are eligible for the national screening program for the early detection of breast cancer to participate. When any abnormalities are seen on the mammogram, the general practitioner should refer the woman for further investigations and inform her about the procedure to be followed. In the case of a lump, a mammogram or ultrasound examination of the breasts is indicated, unless the abnormality disappears during a different phase of the woman's menstrual cycle. Local pain and brown or bloody discharge from the nipples also necessitate further investigation. Women with a greater than 20% risk of ever developing breast cancer during their life based on a positive family history for breast cancer have an indication for periodic examination of the breasts and a mammogram before they are 50. If the risk is greater than 30%, consultation with a clinical geneticist can be suggested.

The new guideline is an adaptation to recent developments in the genetics of breast cancer. Hereditary and familial breast cancer may give rise to many questions in women coping with family members with the disease. Recommendations are given in a clear and succinct way. It is regrettable that breast self examination is not recommended anymore as it is not considered to be of evidence-based value. This may be true, but, particularly in young women, it is often the only way to detect breast cancer. In case of suspicion of a malignancy the patient should be referred to a surgeon who is dedicated to the diagnosis and treatment of breast cancer, and who is part of a multidisciplinary breast cancer group.

Breast cancer risk factor analysis allows the identification of women at very high risk for the future development of breast cancer. Many of the known risk factors are either not modifiable or are not reasonably modifiable because of social implications or other potential health benefits (eg, those associated with hormone replacement therapy). Thus, effective strategies to decrease the risk of breast cancer are needed. The recent demonstration that the use of tamoxifen for 5 years decreases the future risk of breast cancer by approximately 49% provides the opportunity for a risk-reduction intervention. Women taking tamoxifen must be monitored for the occurrence of well-defined toxicities, including hot flashes and, more rarely, endometrial carcinoma, thromboembolic disease, and cataract formation. Strategies are available for the management of tamoxifen toxicity. In special circumstances, such as in carriers of BRCA1 or BRCA2 mutations, the risk of future breast cancer is very high, and the performance of a bilateral prophylactic mastectomy may be considered. Women considering bilateral prophylactic mastectomy should undergo multidisciplinary consultation so that they may make a fully informed decision. The panel strongly encourages patients and health care providers to participate in clinical trials to test new strategies for decreasing the risk of breast cancer. Only through the accumulated experience gained from well-designed, prospective clinical trials will additional advances in the reduction of breast cancer risk be realized.

The "Standards, Options and Recommendations" (SOR) project, started in 1993, is a collaboration between the Federation of French cancer centers (FNCLCC), the 20 French cancer centers, and specialists from French public universities, general hospitals and private clinics. The main objective is the development of clinical practice guidelines to improve the quality of health care and the outcome of cancer patients. The methodology is based on a literature review and critical appraisal by a multidisciplinary group of experts, with feedback from specialists in cancer care delivery.

The recommendations concerning tumor and bone marrow handling for the evaluation of molecular-biologic and molecular-genetic and immunologic markers presented in this paper were developed by the SIOP Europe Neuroblastoma Pathology and Biology and Bone Marrow Group. Although the Guidelines were developed for neuroblastic tumors (neuroblastoma, ganglioneuroblastoma and ganglioneuroma), they are applicable to all other tumor entities as well. The paper is subdivided in three main parts. The Pathology Guidelines give an overview about the handling, sectioning and securing of tumor material in case of resectable and non-resectable neuroblastic tumors. The Guidelines encompass open biopsies, tru cut biopsies, fine needle aspirations, and bone marrow aspiration. The importance of the pathologic evaluation for the interpretation of the molecular-genetic and molecular-biologic results, which also includes the exact determination of the tumor cell content is stressed. Besides this, recommendations concerning tumor material obtained after cytotoxic therapy, immunohistologic and immuno-cytologic issues and lymph node examination are addressed. In the Biology Guidelines, the different methods for MYCN, chromosome 1p36 investigations and DNA content measurements are discussed and DNA probes are recommended. Furthermore, specified definitions and a common terminology already used in the SIOP Europe Neuroblastoma Group are presented. In the Bone Marrow Guidelines, recommendations concerning the methods to be employed are given and the most important pitfalls are demonstrated. Both the use of standardized methods and the application of a common language will, it is hoped, contribute to the quality and reliability of collected data and thus to a better comparability between and among research reports. These improvements should prove to be of great value for the affected patients.