Abstract
The common menopausal symptoms of a growing number of women treated for breast cancer poses difficult therapeutic decisions to the Gynaecologist. It has been extensively demonstrated that hormonal replacement therapy (HRT) is the most effective treatment of such symptoms, as well as protecting women from cardiovascular disease, osteoporosis and increased mortality related to these disorders. However, breast cancer is classically considered a contraindication to HRT. In this paper we review the existing evidence regarding the influence of HRT on breast cancer. A computerized bibliographical search (MEDLINE) of literature in the English-language literature published in the last 15 years was conducted, followed by a hand search of references found in these papers. Evidence on the response of breast cancer cells to HRT is derived from animal studies, tissue growth system experiments, indirect epidemiological data and clinical data. While the bulk of experimental evidence points towards a proliferative effect of estrogen on breast cancer cells, almost all clinical reports have found no adverse effects of HRT on these patients. In our opinion, currently existing evidence does not justify the denial of HRT to breast cancer patients whose quality of life is at stake. Such is the case of women with intense menopausal symptoms unresponsive to alternative therapies. This opinion is shared by numerous other authors and a small number of eminent institutions. We believe it is safer to avoid HRT, in asymptomatic women as long-term regimens would be needed for protection against cardiovascular disease and osteoporosis, and the risks of such regimens have yet to be evaluated. We also believe that large randomized trials are now ethically justified and greatly needed to obtain safer data on this subject.

Abstract
Background: Breast cancer is the most frequent malignant tumor and the leading cause of cancer death in women in Portugal. Due to its relation to an increase in distant metastasis and subsequent death, loco-regional relapse is one major concern in breast cancer women. Several classic prognostic factors as tumour size, nodal stage, histological grade, HER2 status and hormonal receptors have been identified as the most important factors for determining loco-regional relapse, disease free and overall survival. However, there is heterogeneity in prognosis and tumor behaviour in patients with identical disease staging and a similar pattern of expression of known molecular markers, hence the need to discover new prognostic factors. One of the possibilities is P-cadherin, already described by researchers as a possible independent marker of prognosis in breast cancer. The aim of this work was to study in a retrospective series of patients the correlation of P-cadherin expression with loco-regional recurrence in breast cancer women. Material and methods: We analyzed the clinical records of 1432 consecutive patients with breast cancer and treated in a University Hospital over a 10 year period. Patients with loco-regional relapse (n=101) without prior or simultaneous distant disease were selected as case group. Control group consisted of patients with more than 10 years follow-up and without disease progression. For both groups demographic, clinical, pathological and molecular markers were analyzed. Tissue micro-arrays were constructed to study P-cadherin expression from 86 tumors with available paraffin embedded blocks. Results: Mean time to recurrence was 41 months and mean survival time after recurrence was 33 months, with a 5-year survival rate of 55%. Tumour size, nodal status and histological grade were identified as independent markers of prognosis. P-cadherin was associated with higher histological grades and hormone negative tumours. P-cadherin was identified as an independent prognostic marker for disease free survival, but not for overall survival. Conclusion: P-cadherin was related to other known factors of worse prognosis and had an independent relation to disease-free survival. P-cadherin might constitute a novel therapeutic target, but its real biological value is yet to be determined. Doubt persists whether it is an independent marker of tumour behaviour or only a surrogate marker of a set of clinical and molecular features related with worse prognosis.

Abstract
The cosmetic result after breast surgery is an important marker in clinical studies. Most authors used subjective scales to judge breast cosmesis. However, inter-observer discrepancies are very high and the use of such subjective scales for prospective trials is highly disputed. In this study we present for the first time a new invented breast symmetry index This BSI is calculated by subtracting the size and the shape between both breasts (frontal view and side view). The BSI is measured with a software system called breast analysing too( (BAT (c))) from digital. photographs. The photographs of 27 patients have been analysed with this software by different physicians to evolve inter-observer reproducibility. The Harris scale for subjective cosmetic analyses has been correlated with the BSI. In our study the inter-observer reproducibility was excellent (Pearson correlation r = 0.9; p < 0.05) and the 1351 was able to significantly differentiate between good and bad cosmesis (BSI values from 0%d to 30%d is good, BSI > 30%d is bad cosmesis). Thus the BSI may be used for clinical studies.

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