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Rosato V, Bosetti C, Talamini R, Levi F, Montella M, Giacosa A, Negri E, La Vecchia C. Metabolic syndrome and the risk of breast cancer in postmenopausal women. Ann Oncol 2011; 22:2687-2692. [DOI: 10.1093/annonc/mdr025] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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Bjørge T, Lukanova A, Tretli S, Manjer J, Ulmer H, Stocks T, Selmer R, Nagel G, Almquist M, Concin H, Hallmans G, Jonsson H, Häggström C, Stattin P, Engeland A. Metabolic risk factors and ovarian cancer in the Metabolic Syndrome and Cancer project. Int J Epidemiol 2011; 40:1667-77. [PMID: 21984693 DOI: 10.1093/ije/dyr130] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND No studies have so far evaluated the impact of the metabolic syndrome (MetS) as an entity on ovarian cancer risk. The authors aimed to examine the association between factors in the MetS, individually and combined, and risk of ovarian cancer incidence and mortality. METHODS Altogether, 290,000 women from Austria, Norway and Sweden were enrolled during 1974-2005, with measurements taken of height, weight, blood pressure and levels of glucose, cholesterol and triglycerides. Relative risks (RRs) of ovarian cancer were estimated using Cox regression for each MetS factor in quintiles and for standardized levels (z-scores), and for a composite z-score for the MetS. RRs were corrected for random error in measurements. RESULTS During follow-up, 644 epithelial ovarian cancers and 388 deaths from ovarian cancer were identified. There was no overall association between MetS and ovarian cancer risk. Increasing levels of cholesterol [RR 1.52, 95% confidence interval (95% CI) 1.01-2.29, per 1-U increment of z-score] and blood pressure (RR 1.79, 95% CI 1.12-2.86) conferred, however, increased risks of mucinous and endometrioid tumours, respectively. In women below the age of 50 years, there was increased risk of ovarian cancer mortality for MetS (RR 1.52, 95% CI 1.00-2.30). Increasing levels of BMI (RR 1.17, 95% CI 1.01-1.37) conferred increased risk of ovarian cancer mortality in women above the age of 50 years. CONCLUSION There was no overall association between MetS and ovarian cancer risk. However, increasing levels of cholesterol and blood pressure increased the risks of mucinous and endometrioid tumours, respectively. Increasing levels of BMI conferred an increased risk of ovarian cancer mortality in women above the age of 50 years.
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Affiliation(s)
- Tone Bjørge
- Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway.
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Musonda P, Burbos N, Duncan TJ, Crocker SG, Morris EP, Nieto JJ. Comparing the performance of two clinical models in estimating the risk of endometrial cancer in symptomatic postmenopausal women. Eur J Obstet Gynecol Reprod Biol 2011; 159:433-8. [PMID: 21975177 DOI: 10.1016/j.ejogrb.2011.09.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2011] [Revised: 06/29/2011] [Accepted: 09/01/2011] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The aim of this study was to internally evaluate the accuracy measures of the two newly developed predictive models, called DEFAB and DFAB, used to estimate the risk of endometrial cancer in postmenopausal women presenting with vaginal bleeding. STUDY DESIGN Prospective study including postmenopausal women presenting with vaginal bleeding. RESULTS Over a 46-month-period, 3795 postmenopausal women presented with vaginal bleeding and were included in the study. A total of 221 (6%) women were diagnosed with endometrial carcinoma. The DEFAB predictive model incorporates known risk factors such as presence of Diabetes, Endometrial thickness measurement on transvaginal ultrasonography, Frequency of bleeding, Age, and Body mass index. The DFAB model is based on the above clinical characteristics excluding the ultrasonography result. For the recommended cut-off values, there was no evidence (p-value=0.221) of a difference in the diagnostic ability with respect to sensitivity, specificity, area under receiver operating curve, positive predictive value and negative predictive value. There was strong evidence (p-value<0.0001) to suggest that the diagnostic ability of DEFAB and DFAB agree as evidenced by the excellent Kappa statistic 0.950 (95% CI 0.940-0.960). We found strong evidence (p-value<0.0001) that the variables incorporated in both predictive models simultaneously correctly classify an individual to either having cancer or not having cancer with respect to logistic discriminant analysis. CONCLUSION We recommend that these two predictive models can be used interchangeably.
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Affiliation(s)
- Patrick Musonda
- Medical Statistician, School of Medicine, Health Policy & Practice, University of East Anglia, Norwich NR4 7TJ, United Kingdom.
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Friedenreich CM, Biel RK, Lau DCW, Csizmadi I, Courneya KS, Magliocco AM, Yasui Y, Cook LS. Case-control study of the metabolic syndrome and metabolic risk factors for endometrial cancer. Cancer Epidemiol Biomarkers Prev 2011; 20:2384-95. [PMID: 21921255 DOI: 10.1158/1055-9965.epi-11-0715] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Metabolic syndrome may predict endometrial cancer risk better than diabetes, hypertension, dyslipidemia, dysglycemia, or weight alone, but few studies have examined this issue. METHODS We conducted a population-based case-control study in Alberta, Canada (2002-2006) that included 515 incident endometrial cancer cases and 962 frequency age-matched controls. Data were collected through in-person interviews, anthropometric measurements, and 8-hour fasting bloods drawn either pre- or postsurgery. Bloods were analyzed using quantitative colorimetric or absorbance-based assays (ELISA), specific to metabolic syndrome markers. Metabolic syndrome was defined using harmonized guidelines requiring presence of ≥ 3 of the following risk factors: waist circumference ≥ 88 cm, triglycerides ≥ 150 mg/dL, high-density lipoprotein cholesterol <50 mg/dL, treatment of previously diagnosed hypertension, and fasting blood glucose ≥ 100 mg/dL. OR and 95% CIs for endometrial cancer risk with presence of metabolic syndrome and individual metabolic syndrome components were estimated using logistic regression analysis. RESULTS Metabolic syndrome was significantly more prevalent among cases (62%) than controls (38%). A statistically significant increased risk for endometrial cancer was observed for metabolic syndrome (OR = 1.53; 95% CI: 1.17-2.00), as well as for some of the individual components of metabolic syndrome including waist circumference ≥ 88 cm (OR = 1.57; 95% CI: 1.18-2.08), hypertension (OR = 1.57; 95% CI: 1.18-2.09), and fasting blood glucose ≥ 100 mg/dL (OR = 1.31; 95% CI: 1.03-1.67). Some evidence for effect modification by menopausal status and body mass index was also found. CONCLUSION Metabolic syndrome is clearly associated with increased endometrial cancer risk. IMPACT Targeting the entire metabolic syndrome may optimize endometrial cancer risk reduction.
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Affiliation(s)
- Christine M Friedenreich
- Department of Population Health Research, Division of Cancer Care, Alberta Health Services-Cancer Care Tom Baker Cancer Centre, 1331-29 Street N.W. Calgary, Alberta T2N 4N2, Canada.
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Assimes TL, Suissa S. Age at incident treatment of hypertension and risk of cancer: a population study. Cancer Causes Control 2011; 20:1811-20. [PMID: 19533392 DOI: 10.1007/s10552-009-9374-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2008] [Accepted: 06/03/2009] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine the effect of treated hypertension on the risk of cancer. METHODS Population based external comparison study using the Saskatchewan Health databases. RESULTS A total of 42,270 subjects were followed for a median of 17.9 years after initiating antihypertensives for hypertension. The effect of hypertension on the risk of cancer varied significantly by age (interaction p < 0.001). Compared with the general population, subjects under 60 years at the time of initiation of antihypertensives had a significantly increased risk of cancer (RR 1.34, 95% CI 1.18–1.52 adjusted for age, sex, and calendar year) while subjects over 60 had a significantly decreased risk (RR 0.88, 95% CI 0.78–0.98). Similar results were obtained for cancer death outcomes. In each subgroup, relative risks across most cancer sites were similar in magnitude and direction. Results were essentially unchanged when analyses were restricted to cancers diagnosed after the first 10 years of follow-up. CONCLUSIONS The effect of treated hypertension on cancer risk varies by the age at incident treatment of hypertension.These findings are not a result of reverse causality or detection bias. However, they may in part be a consequence of residual confounding and/or reflect the type of hypertension being treated.
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Affiliation(s)
- Themistocles L Assimes
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Falk Cardiovascular Research Building, 300 Pasteur Drive, Stanford, CA 94305-5406, USA.
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Lipscombe L. Insulin, Insulin Resistance, and Cancer Associations. ENERGY BALANCE AND CANCER 2011. [DOI: 10.1007/978-1-4419-9911-5_5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Bjørge T, Lukanova A, Jonsson H, Tretli S, Ulmer H, Manjer J, Stocks T, Selmer R, Nagel G, Almquist M, Concin H, Hallmans G, Häggström C, Stattin P, Engeland A. Metabolic syndrome and breast cancer in the me-can (metabolic syndrome and cancer) project. Cancer Epidemiol Biomarkers Prev 2010; 19:1737-45. [PMID: 20615887 DOI: 10.1158/1055-9965.epi-10-0230] [Citation(s) in RCA: 131] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Few studies have assessed the metabolic syndrome (MetS) as an entity in relation to breast cancer risk, and results have been inconsistent. We aimed to examine the association between MetS factors (individually and combined) and risk of breast cancer incidence and mortality. METHODS Two hundred ninety thousand women from Austria, Norway, and Sweden were enrolled during 1974-2005, with measurements of height, weight, blood pressure, and levels of glucose, cholesterol, and triglycerides. Relative risks (RR) of breast cancer were estimated using Cox proportional hazards regression for each MetS factor in quintiles and for standardized levels (z-scores) and for a composite z-score for the MetS. RESULTS There were 4,862 incident cases of breast cancer and 633 deaths from breast cancer identified. In women below age 50, there was a decreased risk of incident cancer for the MetS (per 1-unit increment of z-score; RR, 0.83; 95% confidence interval, 0.76-0.90) as well as for the individual factors (except for glucose). The lowest risks were seen among the heaviest women. In women above age 60, there was an increased risk of breast cancer mortality for the MetS (RR, 1.23; 95% confidence interval, 1.04-1.45) and for blood pressure and glucose. The strongest association with mortality was seen for increased glucose concentrations. CONCLUSIONS The MetS was associated with a decreased risk of incident breast cancer in women below age 50 with high body mass index, and with an increased risk of breast cancer mortality in women above 60. IMPACT Lifestyle interventions as recommended for cardiovascular disease prevention may be of value to prevent breast cancer mortality in postmenopausal women.
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Affiliation(s)
- Tone Bjørge
- Department of Public Health and Primary Health Care, University of Bergen, N-5018 Bergen, Norway.
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Rosato V, Zucchetto A, Bosetti C, Dal Maso L, Montella M, Pelucchi C, Negri E, Franceschi S, La Vecchia C. Metabolic syndrome and endometrial cancer risk. Ann Oncol 2010; 22:884-889. [PMID: 20937645 DOI: 10.1093/annonc/mdq464] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Various studies reported direct associations between endometrial cancer risk and individual components of the metabolic syndrome (MetS), i.e. obesity, diabetes, hypertension, and dyslipidemia, but only a few epidemiological studies considered the association with MetS overall. METHODS We analyzed data from a case-control study including 454 women with incident endometrial cancer and 798 controls admitted to the same hospitals as cases for acute conditions. Different definitions of MetS were considered, including a combination of self-reported history of diabetes, drug-treated hypertension, drug-treated hyperlipidemia, and various measures of (central) obesity. Odds ratios (ORs) were computed from unconditional logistic regression models, adjusted for major confounding factors. RESULTS The multivariate ORs of endometrial cancer were 2.18 for type 2 diabetes, 1.77 for hypertension, 1.20 for hyperlipidemia, between 1.62 and 2.23 for various definitions of central obesity, and 3.83 for women with a body mass index (BMI) >30 kg/m(2). The risk of endometrial cancer was significantly increased for subjects with MetS, the ORs ranging between 1.67 and 2.77 when waist circumference was included in MetS definition, and 8.40 when BMI was considered instead. CONCLUSIONS This study indicates a direct association between various MetS components, besides overweight, with the risk of endometrial cancer.
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Affiliation(s)
- V Rosato
- Department of Epidemiology, Istituto di Ricerche Farmacologiche 'Mario Negri', Milan
| | - A Zucchetto
- Unit of Epidemiology and Biostatistics, Centro di Riferimento Oncologico, Aviano
| | - C Bosetti
- Department of Epidemiology, Istituto di Ricerche Farmacologiche 'Mario Negri', Milan
| | - L Dal Maso
- Unit of Epidemiology and Biostatistics, Centro di Riferimento Oncologico, Aviano; Department of Occupational Medicine, Sezione di Statistica Medica e Biometria 'Giulio A. Maccacaro', Università degli Studi di Milano, Milan, Italy
| | - M Montella
- Unit of Epidemiology, Istituto Nazionale Tumori 'Fondazione G. Pascale', Napoli, Italy
| | - C Pelucchi
- Department of Epidemiology, Istituto di Ricerche Farmacologiche 'Mario Negri', Milan
| | - E Negri
- Department of Epidemiology, Istituto di Ricerche Farmacologiche 'Mario Negri', Milan
| | - S Franceschi
- International Agency for Research on Cancer, Lyon, France
| | - C La Vecchia
- Department of Epidemiology, Istituto di Ricerche Farmacologiche 'Mario Negri', Milan; Department of Occupational Medicine, Sezione di Statistica Medica e Biometria 'Giulio A. Maccacaro', Università degli Studi di Milano, Milan, Italy.
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Largent JA, Bernstein L, Horn-Ross PL, Marshall SF, Neuhausen S, Reynolds P, Ursin G, Zell JA, Ziogas A, Anton-Culver H. Hypertension, antihypertensive medication use, and breast cancer risk in the California Teachers Study cohort. Cancer Causes Control 2010; 21:1615-24. [PMID: 20526803 PMCID: PMC2941047 DOI: 10.1007/s10552-010-9590-x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2009] [Accepted: 05/18/2010] [Indexed: 12/24/2022]
Abstract
BACKGROUND We investigated the association between hypertension, antihypertensive (AH) medication use, and breast cancer in a large prospective study, the California Teachers Study (CTS). METHODS Information on history of hypertension and lifetime regular use of AH medications was collected from 114,549 women in 1995-1996. Among them, 4,151 invasive breast cancers were diagnosed between 1995 and 2006. Additional information on AH use was collected from 73,742 women in 2000-2001, and 1,714 of these women were subsequently diagnosed with breast cancer. Cox proportional hazards regression was used to estimate relative risks (RR) and 95% confidence intervals (CI) for breast cancer. RESULTS Use of AH medication for ≥5 years, when compared with no use, was associated with a modest increased risk of invasive breast cancer (RR = 1.18, 95%CI 1.02-1.36). This increased risk appeared to be confined to estrogen receptor (ER)-positive tumors (RR = 1.21, 95%CI 1.03-1.43) and pre-/peri-menopausal women (RR = 1.58, 95%CI 1.11-2.25). CONCLUSIONS Increased risk of invasive breast cancer was observed for long-term (≥5 years) AH use, and this appeared to be confined to ER + breast cancer and younger women.
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Affiliation(s)
- Joan A Largent
- Department of Epidemiology, College of Health Sciences, University of California Irvine, Irvine, CA 92697-7555, USA.
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Bjørge T, Stocks T, Lukanova A, Tretli S, Selmer R, Manjer J, Rapp K, Ulmer H, Almquist M, Concin H, Hallmans G, Jonsson H, Stattin P, Engeland A. Metabolic syndrome and endometrial carcinoma. Am J Epidemiol 2010; 171:892-902. [PMID: 20219764 DOI: 10.1093/aje/kwq006] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The authors examined the association between the metabolic syndrome and risk of incident endometrial and fatal uterine corpus cancer within a large prospective cohort study. Approximately 290,000 women from Austria, Norway, and Sweden were enrolled during 1974-2005, with measurements of height, weight, systolic and diastolic blood pressure, and circulating levels of glucose, total cholesterol, and triglycerides. Relative risks were estimated using Cox proportional hazards regression. The metabolic syndrome was assessed as a composite z score, as the standardized sum of z scores for body mass index, blood pressure, glucose, cholesterol, and triglycerides. A total of 917 endometrial carcinomas and 129 fatal cancers were identified. Increased risks of incident endometrial carcinoma and fatal uterine corpus cancer were seen for the metabolic syndrome factors combined, as well as for individual factors (except for cholesterol). The relative risk of endometrial carcinoma for the metabolic syndrome was 1.37 (95% confidence interval: 1.28, 1.46) per 1-unit increment of z score. The positive associations between metabolic syndrome factors (both individually and combined) and endometrial carcinoma were confined to the heaviest women. The association between the metabolic syndrome and endometrial carcinoma risk seems to go beyond the risk conferred by obesity alone, particularly in women with a high body mass index.
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Affiliation(s)
- Tone Bjørge
- Department of Public Health and Primary Health Care, University of Bergen, N-5018 Bergen, Norway.
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Burbos N, Musonda P, Giarenis I, Shiner AM, Giamougiannis P, Morris EP, Nieto JJ. Predicting the risk of endometrial cancer in postmenopausal women presenting with vaginal bleeding: the Norwich DEFAB risk assessment tool. Br J Cancer 2010; 102:1201-6. [PMID: 20354525 PMCID: PMC2856001 DOI: 10.1038/sj.bjc.6605620] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: This study aimed to show the longitudinal use of routinely collected clinical data from history and ultrasound evaluation of the endometrium in developing an algorithm to predict the risk of endometrial carcinoma for postmenopausal women presenting with vaginal bleeding. Methods: This prospective study collected data from 3047 women presenting with postmenopausal bleeding. Data regarding the presence of risk factors for endometrial cancer was collected and univariate and multivariate analyses were performed. Results: Age distribution ranged from 35 to 97 years with a median of 59 years. A total of 149 women (5% of total) were diagnosed with endometrial carcinoma. Women in the endometrial cancer group were significantly more likely to be older, have higher BMI, recurrent episodes of bleeding, diabetes, hypertension, or a previous history of breast cancer. An investigator best model selection approach was used to select the best predictors of cancer, and using logistic regression analysis we created a model, ‘Norwich DEFAB’, which is a clinical prediction rule for endometrial cancer. The calculated Norwich DEFAB score can vary from a value of 0 to 9. A Norwich DEFAB value equal to or greater than 3 has a positive predictive value (PPV) of 7.78% and negative predictive value (NPV) of 98.2%, whereas a score equal to or greater than 5 has a PPV of 11.9% and NPV of 97.8%. Conclusion: The combination of clinical information with our investigation tool for women with postmenopausal vaginal bleeding allows the clinician to calculate a predicted risk of endometrial malignancy and prioritise subsequent clinical investigations.
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Affiliation(s)
- N Burbos
- Department of Obstetrics and Gynaecology, Norfolk and Norwich University Hospital NHS Foundation Trust, UK.
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Agnoli C, Berrino F, Abagnato CA, Muti P, Panico S, Crosignani P, Krogh V. Metabolic syndrome and postmenopausal breast cancer in the ORDET cohort: a nested case-control study. Nutr Metab Cardiovasc Dis 2010; 20:41-48. [PMID: 19361966 PMCID: PMC2819536 DOI: 10.1016/j.numecd.2009.02.006] [Citation(s) in RCA: 137] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2008] [Revised: 01/20/2009] [Accepted: 02/13/2009] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND AIMS The increase in breast cancer incidence over recent decades has been accompanied by an increase in the frequency of metabolic syndrome. Several studies suggest that breast cancer risk is associated with the components of metabolic syndrome (high serum glucose and triglycerides, low HDL-cholesterol, high blood pressure, and abdominal obesity), but no prospective study has investigated risk in relation to the presence of explicitly defined metabolic syndrome. We investigated associations between metabolic syndrome, its components, and breast cancer risk in a nested case-control study on postmenopausal women of the ORDET cohort. METHODS AND RESULTS After a median follow-up of 13.5 years, 163 women developed breast cancer; metabolic syndrome was present in 29.8%. Four matched controls per case were selected by incidence density sampling, and rate ratios were estimated by conditional logistic regression. Metabolic syndrome (i.e. presence of three or more metabolic syndrome components) was significantly associated with breast cancer risk (rate ratio 1.58 [95% confidence interval 1.07-2.33]), with a significant risk increase for increasing number of components (P for trend 0.004). Among individual metabolic syndrome components, only low serum HDL-cholesterol and high triglycerides were significantly associated with increased risk. CONCLUSIONS This prospective study indicates that metabolic syndrome is an important risk factor for breast cancer in postmenopausal women. Although serum HDL-cholesterol and triglycerides had the strongest association with breast cancer, all components may contribute to increased risk by multiple interacting mechanisms. Prevention or reversal of metabolic syndrome by life-style changes may be effective in preventing breast cancer in postmenopausal women.
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Affiliation(s)
- Claudia Agnoli
- Nutritional Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Franco Berrino
- Etiological and Preventive Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Paola Muti
- Epidemiology and Prevention Unit, Istituto Regina Elena, Rome, Italy
| | - Salvatore Panico
- Department of Clinical and Experimental Medicine, Federico II University, Naples, Italy
| | - Paolo Crosignani
- Cancer Registry Division, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Vittorio Krogh
- Nutritional Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Montejo M, Werner TL, Gaffney D. Current challenges in clinical management of endometrial cancer. Adv Drug Deliv Rev 2009; 61:883-9. [PMID: 19422864 DOI: 10.1016/j.addr.2009.04.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2008] [Accepted: 04/28/2009] [Indexed: 12/25/2022]
Abstract
Endometrial cancer remains a management challenge. Improved understanding of the mechanisms of carcinogenesis may enable better understanding of biologic behavior and guide therapy. Improvements in diagnostic imaging, radiation delivery systems, and systemic therapies potentially can improve outcomes while minimizing morbidity. Novel strategies for screening and prevention also hold promise for reducing incidence and mortality of this disease.
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Pasanisi P, Villarini A, Bruno E, Raimondi M, Gargano G, Berrino F. Nutritional advice to breast cancer survivors. Support Care Cancer 2009; 18 Suppl 2:S29-33. [DOI: 10.1007/s00520-009-0701-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2009] [Accepted: 07/07/2009] [Indexed: 02/05/2023]
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Kabat GC, Kim M, Chlebowski RT, Khandekar J, Ko MG, McTiernan A, Neuhouser ML, Parker DR, Shikany JM, Stefanick ML, Thomson CA, Rohan TE. A longitudinal study of the metabolic syndrome and risk of postmenopausal breast cancer. Cancer Epidemiol Biomarkers Prev 2009; 18:2046-53. [PMID: 19567502 PMCID: PMC6204126 DOI: 10.1158/1055-9965.epi-09-0235] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The metabolic syndrome, characterized by abdominal obesity, high blood glucose levels, impaired glucose tolerance, dyslipidemia, and hypertension, is associated with increased risk of type 2 diabetes and coronary heart disease. Several studies have examined the association of the individual components of the metabolic syndrome with breast cancer; to date, however, no study has assessed the metabolic syndrome per se in relation to breast cancer risk. Furthermore, previous studies have relied only on baseline assessment of components of the syndrome. Therefore, we assessed the association of the metabolic syndrome with the risk of postmenopausal breast cancer among women in the 6% sample of subjects in the Women's Health Initiative clinical trial and the 1% sample of women in the observational study who had repeated measurements of the components of the syndrome during follow-up. We used Cox proportional hazards models to estimate hazard ratios and 95% confidence intervals for the association of breast cancer risk with the presence of the metabolic syndrome, as well as its components, at baseline and in time-dependent analyses. After exclusion of women with diabetes, among 4,888 women with baseline measurements, 165 incident cases of breast cancer were ascertained over a median of 8 years of follow-up. The presence of the metabolic syndrome at baseline was not associated with altered risk. Of the individual components measured at baseline, diastolic blood pressure showed a borderline positive association with breast cancer. In time-dependent covariate analyses, however, certain scenarios indicated a positive association between the metabolic syndrome and breast cancer, due primarily to positive associations with serum glucose, serum triglycerides, and diastolic blood pressure.
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Affiliation(s)
- Geoffrey C Kabat
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA.
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Alokail MS, Al-Daghri NM, Al-Attas OS, Hussain T. Combined effects of obesity and type 2 diabetes contribute to increased breast cancer risk in premenopausal women. Cardiovasc Diabetol 2009; 8:33. [PMID: 19545451 PMCID: PMC2706231 DOI: 10.1186/1475-2840-8-33] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2009] [Accepted: 06/23/2009] [Indexed: 12/12/2022] Open
Abstract
Background Both obesity and type 2 diabetes are among the risk factors for breast cancer development. Combined effect of these metabolic abnormalities on breast cancer risk however, has not been examined in premenopausal women. We tested this association in type 2 diabetic women, categorized as obese, overweight and normal body weight groups based on BMI. Design and methods A total of 101 subjects were included in this study. Serum levels of IL-6, TNF-α, C reactive protein, leptin, TGF-α, adiponectin and insulin were measured by ELISA. Data were logarithmically transformed for variables not normally distributed. Analysis of variance with post-hoc Bonferroni was applied to compare the data between the groups. Simple and partial correlation coefficients between the variables were determined and a stepwise multiple linear regression analysis was performed to determine the relationships between the variables of interest. Results Significantly increased levels of IL-6, C reactive protein, leptin and significantly decreased levels of adiponectin were found in obese group, while the levels of TNF-α and TGF-α were unaltered. A positive correlation between waist circumference and IL-6 was found in obese group. Similarly, C reactive protein, waist and hip circumferences were linearly correlated with BMI in obese group. Stepwise multiple linear regression analysis revealed several significant predictors for breast cancer risk. Conclusion Obesity and type 2 diabetes, owing to their effects on adipocytokines and inflammatory mediators, contribute to increased breast cancer risk in premenopausal women. This study emphasizes healthy life style and better management of these metabolic disorders to avoid the pathogenesis of breast cancer and of other chronic diseases.
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Affiliation(s)
- Majed S Alokail
- Department of Biochemistry, College of Science, King Saud University, Riyadh, Kingdom of Saudi Arabia.
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Fortuny J, Sima C, Bayuga S, Wilcox H, Pulick K, Faulkner S, Zauber AG, Olson SH. Risk of endometrial cancer in relation to medical conditions and medication use. Cancer Epidemiol Biomarkers Prev 2009; 18:1448-56. [PMID: 19383893 DOI: 10.1158/1055-9965.epi-08-0936] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We studied the relation of medical conditions related to obesity and medications used for these conditions with endometrial cancer. We also investigated the association of other medical conditions and medications with risk. This U.S. population-based case-control study included 469 endometrial cancer cases and 467 controls. Information on putative risk factors for endometrial cancer was collected through personal interviews. We asked women about their medical history and medications used for six months or longer and the number of years each medication was taken. Risk was strongly associated with increasing obesity (P for trend < 0.001). Among the conditions related to obesity, and after adjustment for age, body mass index, and other risk factors and conditions, uterine fibroids were independently related to an increased cancer risk [adjusted odds ratio (OR), 1.8; 95% confidence interval (95% CI), 1.2-2.5]. Although hypertension was not significantly related to endometrial cancer after adjustment for age and body mass index, the use of thiazide diuretics was independently associated with increased risk (OR, 1.8; 95% CI, 1.1-3.0). Anemia was associated with decreased risk (OR, 0.6; 95% CI, 0.5-0.9). Use of nonsteroidal anti-inflammatory drugs was related to a decreased risk (OR, 0.7; 95% CI, 0.5-0.97). To our knowledge, the observation about thiazide diuretics is novel and requires confirmation in other studies and populations.
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Affiliation(s)
- Joan Fortuny
- Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA
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68
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Sun YF, Leu JD, Chen SM, Lin IF, Lee YJ. Results based on 124 cases of breast cancer and 97 controls from Taiwan suggest that the single nucleotide polymorphism (SNP309) in the MDM2 gene promoter is associated with earlier onset and increased risk of breast cancer. BMC Cancer 2009; 9:13. [PMID: 19144119 PMCID: PMC2649157 DOI: 10.1186/1471-2407-9-13] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2008] [Accepted: 01/13/2009] [Indexed: 12/24/2022] Open
Abstract
Background It has been suggested that the single nucleotide polymorphism 309 (SNP309, T -> G) in the promoter region of the MDM2 gene is important for tumor development; however, with regards to breast cancer, inconsistent associations have been reported worldwide. It is speculated that these conflicting results may have arisen due to different patient subgroups and ethnicities studied. For the first time, this study explores the effect of the MDM2 SNP309 genotype on Taiwanese breast cancer patients. Methods Genomic DNA was obtained from the whole blood of 124 breast cancer patients and 97 cancer-free healthy women living in Taiwan. MDM2 SNP309 genotyping was carried out by restriction fragment length polymorphism (RFLP) assay. The multivariate logistic regression and the Kaplan-Meier method were used for analyzing the risk association and significance of age at diagnosis among different MDM2 SNP309 genotypes, respectively. Results Compared to the TT genotype, an increased risk association with breast cancer was apparent for the GG genotype (OR = 3.05, 95% CI = 1.04 to 8.95), and for the TG genotype (OR = 2.12, 95% CI = 0.90 to 5.00) after adjusting for age, cardiovascular disease/diabetes, oral contraceptive usage, and body mass index, which exhibits significant difference between cases and controls. Furthermore, the average ages at diagnosis for breast cancer patients were 53.6, 52 and 47 years for those harboring TT, TG and GG genotypes, respectively. A significant difference in median age of onset for breast cancer between GG and TT+TG genotypes was obtained by the log-rank test (p = 0.0067). Conclusion Findings based on the current sample size suggest that the MDM2 SNP309 GG genotype may be associated with both the risk of breast cancer and an earlier age of onset in Taiwanese women.
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Affiliation(s)
- Ying-Fang Sun
- Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan
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69
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Abstract
OBJECTIVE The potential role of allium vegetables on endometrial cancer risk has been scarcely investigated and the results of previous Chinese studies are not easily applicable to Western populations. Therefore, we evaluated the relationship between onion and garlic intake and endometrial cancer, using data from an Italian case-control study. SETTING We analysed data from a multi-centre case-control study of 454 endometrial cancer cases and 908 controls, admitted to the same hospitals for a wide spectrum of acute, non-neoplastic conditions. Information was collected by trained interviewers using a validated and reproducible FFQ. Multivariate odds ratios and 95% confidence intervals were obtained after allowance for recognized confounding factors. RESULTS Compared with non-users, the OR of endometrial cancer for successive categories of onion intake were 0.94 (95% CI 0.72, 1.21) for <2 portions/week and 0.40 (95% CI 0.22, 0.72) for > or =2 portions/week, with a significant inverse trend in risk (P = 0.01). The OR for an increment of one portion (i.e. 80 g) of onions per week was 0.81 (95% CI 0.70, 0.95). For garlic, the OR for successive categories of intake were 0.89 (95% CI 0.68, 1.15) for intermediate use and 0.62 (95% CI 0.42, 0.92) for high use, with a significant inverse trend in risk (P = 0.02). CONCLUSIONS Our study found a moderate protective role of allium vegetables on the risk of endometrial cancer.
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70
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Metabolic syndrome and cancer risk. Eur J Cancer 2007; 44:293-7. [PMID: 18055193 DOI: 10.1016/j.ejca.2007.11.005] [Citation(s) in RCA: 159] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2007] [Revised: 11/01/2007] [Accepted: 11/07/2007] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The purpose of this population-based study is to explore for the first time the link between metabolic syndrome and cancer risk using information from the health information system of the Cancer Registry. METHODS Referring to all pharmaceutical prescriptions between 1 January 1999 and 31 December 2005, coded with the Anatomical Therapeutic Chemical classification, all subjects aged 40 and over resident in Milan, which were simultaneously prescribed with antihypertensive, hypolypemic and hypoglycaemic drugs, were considered affected by metabolic syndrome. New cancer cases among cohort subjects were identified trough the local Cancer Registry and standardised incidence ratios (and corresponding 95% exact confidence intervals) were computed. RESULTS Overall 16,677 subjects were identified corresponding to 45,828 person-years; among them 823 incidents cancers occurred. Significantly increased risks for pancreatic cancer in males--SIR 178 (114-266)--and colorectal cancer in females--SIR 133 (101-170)--were observed. Non-significantly increased risks were also observed in women for liver, gallbladder and biliary tract, breast and endometrial cancers. CONCLUSIONS Our study suggests that the risk for several cancers increases in subjects affected by metabolic syndrome. The pharmacological control of the syndrome seems to be inadequate for reducing cancer risk, even though both a high competitive mortality effect and short duration of follow up have to be considered.
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71
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Rose DP, Haffner SM, Baillargeon J. Adiposity, the metabolic syndrome, and breast cancer in African-American and white American women. Endocr Rev 2007; 28:763-77. [PMID: 17981890 DOI: 10.1210/er.2006-0019] [Citation(s) in RCA: 126] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Breast cancer, the second most common cause of cancer-related deaths in American women, varies substantially in incidence and mortality according to race and ethnicity in the United States. Although the overall incidence of breast cancer among African-American (AA) women is lower than in white American women, this cancer is more common in young premenopausal AA women, and AA breast cancer patients of all ages are more likely to have advanced disease at diagnosis, higher risk of recurrence, and poorer overall prognosis. Epidemiological studies indicate that these differences may be attributable in part to variation in obesity and body fat distribution. Additionally, AA women more frequently exhibit breast cancer with an aggressive and metastatic phenotype that may also be attributable to the endocrine and metabolic changes associated with upper body obesity. These changes include both elevated estrogen and androgen bioactivity, hyperinsulinemia, and perturbations of the adipokines. Type 2 diabetes and the metabolic syndrome, which are more common in AA women, have also been associated with breast cancer risk. Moreover, each of the individual components of the syndrome has been associated with increased breast cancer risk, including low levels of the adipocytokine, adiponectin. This review explores the specific roles of obesity, body fat distribution (particularly visceral and sc adipose tissue), type 2 diabetes, metabolic syndrome, and adipocytokines in explaining the differential patterns of breast cancer risk and prognosis between AA and white American women.
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Affiliation(s)
- David P Rose
- Center for Epidemiology and Biostatistics, University of Texas Health Sciences Center at San Antonio, Texas 78284-7802, USA
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72
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Brinton LA, Sakoda LC, Frederiksen K, Sherman ME, Kjaer SK, Graubard BI, Olsen JH, Mellemkjaer L. Relationships of uterine and ovarian tumors to pre-existing chronic conditions. Gynecol Oncol 2007; 107:487-94. [PMID: 17825884 PMCID: PMC2199881 DOI: 10.1016/j.ygyno.2007.08.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2007] [Revised: 07/24/2007] [Accepted: 08/03/2007] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Several chronic diseases have been hypothesized to affect the risk of subsequent gynecologic malignancies, possibly through shared hormonal mechanisms. METHODS Using record linkage techniques, we assessed the relationships between hospital and outpatient admissions for gallbladder disease, diabetes, hypertension, thyroid diseases and obesity and the subsequent development of uterine and ovarian cancers in Denmark between 1978 and 1998. Based on a subsample of more than 99,000 women, including 1398 uterine and 2491 ovarian cancers, we derived relative risks (RRs) and 95% confidence intervals (CIs) associated with overall and histology-specific cancer risks after adjustment for age, calendar time and reproductive characteristics. RESULTS Uterine cancers were related to previous diagnoses of thyroid diseases (RR=1.52, 95% CI 1.17-1.98) and obesity (2.05, 1.40-3.00). Associations with diabetes were confounded by obesity, but there were some elevations in risk for subjects diagnosed with obesity prior to age 45 (RRs 1.66-1.79). Although the "usual types" of endometrial cancer largely accounted for the observed associations, there was some evidence that uterine sarcomas (n=137) were related to prior diagnoses of thyroid diseases (2.78, 1.41-5.50). In contrast, ovarian cancers were not strongly related to most documented chronic diseases. Serous carcinomas were associated with gallbladder diseases of short durations, but detection bias or misdiagnosis probably accounts for this association. An association of obesity and endometrioid ovarian cancer was not identified. CONCLUSIONS Uterine cancers, including sarcomas, appear to be influenced by selected chronic diseases. Further attention should focus on possible biologic mechanisms underlying observed associations with thyroid diseases and obesity.
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Affiliation(s)
- Louise A Brinton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA.
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73
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Abstract
Upper body obesity and the related metabolic disorder type 2 diabetes have been identified as risk factors for breast cancer, and associated with late-stage disease and a poor prognosis. Components of the metabolic syndrome, including visceral adiposity, insulin resistance, hyperglycemia and hyperinsulinemia, with or without clinically manifest diabetes mellitus, low serum high-density lipoprotein cholesterol and hypertension have all been related to increased breast cancer risk. The biochemical mechanisms include extraglandular oestrogen production, reduced sex hormone-binding globulin with consequent elevation of the bioactive plasma free oestradiol and increased insulin biosynthesis, all of which exert mitogenic effects on both untransformed and neoplastic breast epithelial cells. Obesity, type 2 diabetes and the metabolic syndrome also have in common an increased production of leptin and a decreased production of adiponectin by adipose tissue, with consequent elevations and reductions, respectively, in the circulating levels of these two adipokines. These changes in plasma leptin and adiponectin, acting through endocrine and paracrine mechanisms, have been associated in several studies with an increase in breast cancer risk and, perhaps, to more aggressive tumours; studies in vitro showed that leptin stimulates, and adiponectin inhibits, tumour cell proliferation and the microvessel angiogenesis which is essential for breast cancer development and progression.
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Affiliation(s)
- L Vona-Davis
- Department of Surgery and Mary Babb Randolph Cancer Center, West Virginia University, Morgantown, WV 26506-9238, USA.
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74
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Xue F, Michels KB. Diabetes, metabolic syndrome, and breast cancer: a review of the current evidence. Am J Clin Nutr 2007; 86:s823-35. [PMID: 18265476 DOI: 10.1093/ajcn/86.3.823s] [Citation(s) in RCA: 250] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Incidences of breast cancer, type 2 diabetes, and metabolic syndrome have increased over the past decades with the obesity epidemic, especially in industrialized countries. Insulin resistance, hyperinsulinemia, and changes in the signaling of growth hormones and steroid hormones associated with diabetes may affect the risk of breast cancer. We reviewed epidemiologic studies of the association between type 2 diabetes and risk of breast cancer and the available evidence on the role of hormonal mediators of an association between diabetes and breast cancer. The combined evidence supports a modest association between type 2 diabetes and the risk of breast cancer, which appears to be more consistent among postmenopausal than among premenopausal women. Despite many proposed potential pathways, the mechanisms underlying an association between diabetes and breast cancer risk remain unclear, particularly because the 2 diseases share several risk factors, including obesity, a sedentary lifestyle, and possibly intake of saturated fat and refined carbohydrates, that may confound this association. Although the metabolic syndrome is closely related to diabetes and embraces additional components that might influence breast cancer risk, the role of the metabolic syndrome in breast carcinogenesis has not been studied and thus remains unknown.
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Affiliation(s)
- Fei Xue
- Obstetrics and Gynecology Epidemiology Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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75
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Beji NK, Reis N. Risk factors for breast cancer in Turkish women: a hospital-based case-control study. Eur J Cancer Care (Engl) 2007; 16:178-84. [PMID: 17371428 DOI: 10.1111/j.1365-2354.2006.00711.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The aim of this study was to investigate the association between risk factors and breast cancer in Turkish women. In a hospital-based case-control study in Istanbul, 405 patients with histologically confirmed breast cancer were compared with 1050 controls, who were admitted to different departments of the same hospital. Unadjusted odds ratios (ORs) and 95% confidence intervals (CIs) for each risk factor were obtained from logistic regression analyses. Risk factors for breast cancer were found to be early menarche age (OR 3.87, 95% CI 2.46-6.08), use of alcohol (OR 3.87, 95% CI 1.79-8.37), history of diabetes (OR 3.31, 95% CI 2.36-4.64) or hypertension (OR 3.44, 95% CI 2.07-5.71), oral contraceptive use (OR 1.98, 95% CI 1.38-2.85) and hormone replacement therapy (HRT) use (OR 1.94, 95% CI 1.15-3.29). The findings of the present study indicated that history of diabetes or hypertension, use of alcohol, oral contraceptive and HRT, never having breastfed and delayed age at first birth associated with changing of lifestyle led to an increased risk of breast cancer in Turkish women.
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Affiliation(s)
- N K Beji
- Department of Obstetric and Gynecological Nursing, Florence Nightingale College of Nursing, Istanbul University, Istanbul, Turkey
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76
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77
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Lindgren A, Pukkala E, Tuomilehto J, Nissinen A. Incidence of breast cancer among postmenopausal, hypertensive women. Int J Cancer 2007; 121:641-4. [PMID: 17372911 DOI: 10.1002/ijc.22689] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Elevated blood pressure has been proposed to be a risk factor for breast cancer but the results remain controversial. In this study, the incidence of breast cancer among 9,112 postmenopausal, hypertensive women included in the community-based hypertension register of the North Karelia project was assessed through the Finnish Cancer Registry. The mean follow-up time was 27 years. The incidence of breast cancer in hypertensive women in our cohort was similar to the age and period specific population-based rates for Eastern Finland [the standardised incidence ratio 0.96 (95% confidence interval 0.86-1.05)]. In the Cox regression analysis, there was no association between blood pressure levels, or use of antihypertensive (AH) drugs, and breast cancer incidence, when all women were considered. There was a statistically significant interaction of the use of AH drugs at baseline and the diastolic blood pressure (DBP). Among women who were not using AH drugs at baseline, the DBP level was positively associated with the subsequent risk of breast cancer (hazard ratio 1.26/10 mm Hg, 95% confidence interval 1.06-1.46). In women with AH drugs at baseline, the DBP had an opposite effect of borderline significance (hazard ratio 0.90/10 mm Hg, 95% confidence interval 0.78-1.01). In conclusion, breast cancer incidence among postmenopausal hypertensive patients in general does not differ from that of general population. Elevated DBP levels may be associated with an increased breast cancer risk among nonpharmacologically treated women.
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Affiliation(s)
- Annamarja Lindgren
- Department of child psychiatry, Kuopio University Hospital, Kuopio, Finland.
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78
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Berrino F, Villarini A, De Petris M, Raimondi M, Pasanisi P. Adjuvant Diet to Improve Hormonal and Metabolic Factors Affecting Breast Cancer Prognosis. Ann N Y Acad Sci 2006; 1089:110-8. [PMID: 17261760 DOI: 10.1196/annals.1386.023] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Western lifestyle, characterized by reduced physical activity and a diet rich in fat, refined carbohydrates, and animal protein is associated with high prevalence of overweight, metabolic syndrome, insulin resistance, and high plasma levels of several growth factors and sex hormones. Most of these factors are associated with breast cancer risk and, in breast cancer patients, with increased risk of recurrences. Recent trials have proven that such a metabolic and endocrine imbalance can be favorably modified through comprehensive dietary modification, shifting from Western to Mediterranean and macrobiotic diet.
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Affiliation(s)
- Franco Berrino
- Department of Preventive and Predictive Medicine, Istituto Nazionale Tumori, Via Venezian, 1, 20133, Milan, Italy.
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79
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Goon PKY, Messerli FH, Lip GYH. Hypertension and breast cancer: an association revisited? J Hum Hypertens 2006; 20:722-4. [PMID: 16885997 DOI: 10.1038/sj.jhh.1002053] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- P K Y Goon
- Haemostasis, Thrombosis and Vascular Biology Unit, University Department of Medicine, City Hospital, Birmingham, UK
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80
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Largent JA, McEligot AJ, Ziogas A, Reid C, Hess J, Leighton N, Peel D, Anton-Culver H. Hypertension, diuretics and breast cancer risk. J Hum Hypertens 2006; 20:727-32. [PMID: 16885996 DOI: 10.1038/sj.jhh.1002075] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
It is unclear whether hypertension and antihypertensive medication use are associated with breast cancer. In order to examine these associations, we conducted a case-control study among women aged 50-75 years. Breast cancer cases were ascertained via a population-based cancer registry (n=523) and controls were ascertained via random-digit-dialing (n=131). Participants completed a self-administered questionnaire which queried history of hypertension, antihypertensive medication use and risk factors. Unconditional logistic regression was used to estimate the odds ratio (OR) and 95% confidence intervals (CI), adjusted for age, body mass index (BMI), diabetes, smoking, alcohol use, menopausal status, family history of breast or ovarian cancer, age at first full-term pregnancy and education. History of treated hypertension was associated with significant increased risk of breast cancer (OR, 1.77; 95% CI, 1.04-3.03) and this association appeared only in women with BMI > or =25 kg/m(2) (OR, 2.30; 95% CI, 1.12-4.71). Diuretic use was also associated with elevated breast cancer risk (OR, 1.79; 95% CI, 1.07-3.01). The risk associated with diuretic use increased with duration of use (P for trend, <0.01). Use of other blood pressure medications was not found to be associated with breast cancer risk. These results support a positive association between treated hypertension, diuretic use and breast cancer risk among women aged 50-75 years.
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Affiliation(s)
- J A Largent
- Department of Medicine, Epidemiology Division, University of California, Irvine, Irvine, CA 92697-7555, USA.
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81
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Pasanisi P, Berrino F, De Petris M, Venturelli E, Mastroianni A, Panico S. Metabolic syndrome as a prognostic factor for breast cancer recurrences. Int J Cancer 2006; 119:236-8. [PMID: 16450399 DOI: 10.1002/ijc.21812] [Citation(s) in RCA: 179] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Several studies have shown that hormonal, metabolic and inflammatory mechanisms may affect breast cancer progression. We tested the prognostic value of metabolic syndrome in 110 postmenopausal breast cancer patients, who participated in a 1-year dietary intervention study. The risk of adverse events after 5.5 years of follow-up was examined by Cox' proportional hazard modelling, adjusting for hormone receptor status, stage at diagnosis and serum testosterone level, which were shown to significantly affect prognosis. The adjusted hazard ratio of recurrence for the presence of metabolic syndrome at baseline was 3.0 (95% CI 1.2-7.1). Combining metabolic syndrome and serum testosterone, the adjusted hazard ratio of recurrence among women with metabolic syndrome and testosterone levels higher than 0.40 ng/ml (median value) was 6.7 (95% CI 2.3-19.8) compared with that among women without metabolic syndrome and testosterone levels < or =0.40 ng/ml. The results suggest that metabolic syndrome may be an important prognostic factor for breast cancer.
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Affiliation(s)
- Patrizia Pasanisi
- Department of Preventive and Predictive Medicine, Istituto Nazionale Tumori, Milano, Italy.
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82
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Kuijpens JLP, Janssen-Heijnen MLG, Lemmens VEPP, Haak HR, Heijckmann AC, Coebergh JWW. Comorbidity in newly diagnosed thyroid cancer patients: a population-based study on prevalence and the impact on treatment and survival. Clin Endocrinol (Oxf) 2006; 64:450-5. [PMID: 16584519 DOI: 10.1111/j.1365-2265.2006.02492.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Comorbidity may be an important contributory factor to differences in the treatment and outcome of cancer, especially in older patients. It might also provide information on the aetiology of the cancer in cases of high or low frequency. The aim of this study was to describe the spectrum of comorbidity and the possible impact on treatment and survival in newly diagnosed thyroid cancer (TC). DESIGN A population-based observational study. SETTING The Eindhoven Cancer Registry, Comprehensive Cancer Centre South (IKZ), the Netherlands. METHODS Demographic, histological and treatment data on all 417 TC patients diagnosed between 1 January 1993 and 31 December 2002 were collected and followed up till 2004. An adapted version of the list of Charlson was used for registration of clinically relevant concomitant disorders. The prevalence of comorbidity at diagnosis was analysed according to gender, age, histological type and therapy. Crude 6-month and 1- and 5-year survival rates were determined. A regression analysis was performed to identify independent variables related to survival. RESULTS Information on comorbidity was available for 378 patients (91%). Comorbidity was present in 32% of the patients; 23% had one and 12% had two or more concomitant diseases. The prevalence of comorbidity increased with age. Hypertension was the most frequent comorbidity (18%), followed by 'other cancers' (7%), cardiovascular diseases (6%) and diabetes mellitus (6%). The prevalence of hypertension was twice as high as expected at all age groups. Six patients > 60 years had had tuberculosis. Initial surgical treatment was negatively related to the presence of concomitant diseases in patients < 70 years (P = 0.02), but not in patients > or = 70 years. Comorbidity was not independently associated with crude survival up to 5 years. CONCLUSIONS A previous diagnosis of hypertension was associated with TC. The use of external radiation for diagnostic and therapeutic procedures for tuberculosis probably explains the high prevalence of former tuberculosis in elderly TC patients. Treatment choices appeared to be influenced by the presence of comorbidity. Comorbidity did not affect survival up to 5 years; a study with a longer period of follow-up is needed.
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83
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Sonoda Y, Barakat RR. Screening and the prevention of gynecologic cancer: Endometrial cancer. Best Pract Res Clin Obstet Gynaecol 2006; 20:363-77. [PMID: 16364689 DOI: 10.1016/j.bpobgyn.2005.10.015] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Over the years, endometrial cancer has remained the most common gynecologic malignancy in the United States. Two categories of endometrial cancer exist: type I and type II. Type I cancers constitute the majority of cases of endometrial cancer, and the risk factors for this type have been studied in greatest detail. These cancers are driven by estrogen, and many of the risk factors are directly or indirectly linked to a state of excessive estrogen. Protective factors seem to be related to conditions that may result in decreased estrogen exposure. Cure rates for endometrial cancer remain high, mainly because of the early stage at which the majority of cases present. Warning signs of abnormal vaginal bleeding or discharge allow detection of these cancers in their early stages. Screening for these cancers is not effective and often leads to additional unnecessary tests; thus, it is not currently recommended in the general population.
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Affiliation(s)
- Yukio Sonoda
- Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA.
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84
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Nilsson G, Holmberg L, Garmo H, Terent A, Blomqvist C. Increased incidence of stroke in women with breast cancer. Eur J Cancer 2005; 41:423-9. [PMID: 15691643 DOI: 10.1016/j.ejca.2004.11.013] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2004] [Revised: 10/18/2004] [Accepted: 11/16/2004] [Indexed: 12/22/2022]
Abstract
Meta-analyses have shown an excess of vascular deaths in women with breast cancer given radiotherapy (RT). In women with breast cancer, RT to the supraclavicular lymph nodes gives a substantial radiation dose to the proximal carotid artery. RT is known to increase the risk of carotid stenosis and ischaemic stroke in head and neck cancer. A study base of 25,171 women with breast cancer was defined. A linkage between the study base and the Hospital Discharge Register yielded 1766 women who were diagnosed with a stroke after a breast cancer. The observed number of strokes was compared with the expected number in the background population. The Relative Risk (RR) of stroke in the study group with breast cancer was 1.12 (95% Confidence Interval (CI)=1.07-1.17). The increased risk was confined to the subtype cerebral infarction, RR=1.12 (95% CI=1.05-1.19). A statistically significant increase in the risk of stroke was seen among women with a history of breast cancer. Whether this risk is associated with the breast cancer disease per se or related to any treatment requires further study.
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Affiliation(s)
- Greger Nilsson
- Section of Oncology, Department of Oncology, Radiology and Clinical Immunology, University Hospital, SE-751 85 Uppsala, Sweden.
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85
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Lindgren AM, Nissinen AM, Tuomilehto JO, Pukkala E. Cancer pattern among hypertensive patients in North Karelia, Finland. J Hum Hypertens 2005; 19:373-9. [PMID: 15703772 DOI: 10.1038/sj.jhh.1001834] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The objective of this study was to determine the site-specific cancer incidence of hypertensive patients and examine the effect of blood pressure-related variables on the risk of cancers with elevated incidence among the hypertensive patients. A record linkage study of Hypertension Register of the North Karelia Project and the Finnish Cancer Registry was conducted. The mean follow-up time was 16 years. A total of 20 529 hypertensive patients were studied. Main outcome measures were standardised incidence ratios and hazard ratios. The overall cancer incidence was close to that of the general population for both men and women. The incidence rate for the kidney cancer was significantly increased in hypertensive patients (standardised incidence ratio 1.34, 95% confidence interval (CI) 1.11-1.60), as well as incidence rates for cancers of pancreas (1.26, 1.02-1.54), and endometrium (1.22, 1.01-1.44) in hypertensive women. The incidence of lung cancer was significantly decreased (0.86, 0.77-0.95). The incidence of liver cancer was elevated with borderline significance (1.36, 0.99-1.82). In Cox regression models, the use of antihypertensive drugs at baseline was a significant predictor of kidney (hazard ratio for use of antihypertensive drugs 1.89, 95% CI 0.96-3.75) and pancreatic cancer (1.78, 0.99-3.22) in women but not in men. The incidence of endometrial cancer or liver cancer was not related to blood pressure levels or the use of antihypertensive drugs. In women, obesity was a significant predictor of cancers of the endometrium, kidney and liver. In conclusion, increased occurrence of some cancer types among hypertensive patients seem to be partly explained by obesity and the use of antihypertensive drugs.
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Affiliation(s)
- A M Lindgren
- Department of Public Health and General Practice, University of Kuopio, Finland.
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86
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Wang JL, Wang ZQ, Wei LH. Primary clinical analysis of medical disorders in Chinese women with endometrial carcinoma. Int J Gynecol Cancer 2004; 14:502-7. [PMID: 15228424 DOI: 10.1111/j.1048-891x.2004.014311.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
The objectives of this study were to survey the prevalence of medical disorders in Chinese women with endometrial carcinoma and evaluate their potential impact on the clinical treatment and prognosis. Three hundred and seven women with endometrial carcinoma, from July 1, 1971 to October 31, 2001, were analyzed retrospectively. One hundred and forty-six of them (47.6%) were found to have associated medical disorders. The most common medical disorders were hypertension (33.9%), diabetes mellitus (9.8%), and coronary heart disease (9.4%). As many as 38.4% of the women had two or more medical disorders. The patients with medical disorders were on average elder than those without any medical disorders (P < 0.01). Radiotherapy and chemotherapy were administered more commonly in the group with medical disorders than in the one without (P < 0.01). The rate of surgical procedures was significantly lower in the group with medical disorders than in the group without (P < 0.01). However, the extent of surgical interventions was similar in both groups (P > 0.05). The occurrence of medical disorders was independent of the tumor stage, grade, and histological types (P > 0.05). In addition, follow-up data showed that the 3-year and 5-year survivals were not influenced by the medical disorders (P > 0.05). The results thus suggest that Chinese women with endometrial carcinoma have frequently concurrent medical disorders. Selection of treatment strategies can be influenced by these associated medical disorders, but the overall survival is little changed.
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Affiliation(s)
- J-L Wang
- Center of Gynecological Oncology, Peking University People's Hospital, Beijing, China.
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87
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Savelli L, De Iaco P, Santini D, Rosati F, Ghi T, Pignotti E, Bovicelli L. Histopathologic features and risk factors for benignity, hyperplasia, and cancer in endometrial polyps. Am J Obstet Gynecol 2003; 188:927-31. [PMID: 12712087 DOI: 10.1067/mob.2003.247] [Citation(s) in RCA: 155] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the rate of benign, hyperplastic, and malignant endometrial polyps and whether clinical data can predict histopathologic outcome. STUDY DESIGN Five hundred nine patients with endometrial polyps who consecutively underwent hysteroscopic removal of endometrial polyps over 48 months were identified from our gynecologic oncology surgical database. Medical reports provided clinical data. Statistical analysis was performed. RESULTS Histologically, 358 polyps (70.3%) were benign; 131 polyps (25.7%) had simple or complex endometrial hyperplasia, 16 polyps (3.1%) had hyperplasia with atypia, and 4 polyps (0.8%) were cancerous. Polyps were divided into group A and group B, according to the risk of malignancy (group A, benign; group B, atypical hyperplastic and cancerous). Age, menopause status, and hypertension were associated significantly with group B. CONCLUSION Endometrial polyps rarely become malignant, but hyperplastic changes are more common. Age, menopause status, and hypertension may increase the risk of premalignant and malignant polyps. To achieve complete removal of the polyp and a reliable histologic analysis, operative hysteroscopy should be offered to symptomatic patients or to patients with risk factors.
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Affiliation(s)
- Luca Savelli
- Department of Obstetrics and Gynecology, University of Bologna, Italy.
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88
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Lindholm LH, Anderson H, Ekbom T, Hansson L, Lanke J, Dahlöf B, de Faire U, Forsén K, Hedner T, Linjer E, Scherstén B, Wester P, Möller T. Relation between drug treatment and cancer in hypertensives in the Swedish Trial in Old Patients with Hypertension 2: a 5-year, prospective, randomised, controlled trial. Lancet 2001; 358:539-44. [PMID: 11520524 DOI: 10.1016/s0140-6736(01)05704-x] [Citation(s) in RCA: 85] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Is cancer related to hypertension and blood pressure? Do antihypertensive drugs promote cancer? Do antihypertensive drugs protect against cancer? We previously analysed the frequency of cardiovascular mortality and morbidity in elderly people who participated in the Swedish Trial in Old Patients with Hypertension 2 (STOP-Hypertension-2). We have also looked at the frequency of cancer in these patients. METHODS We randomly assigned 6614 elderly patients with hypertension (mean age 76 years, median time of follow-up 5.3 years) to one of three treatment strategies: conventional drugs (diuretics or b-blockers), calcium antagonists, or ACE inhibitors. We matched the patients to the Swedish Cancer Registry and compared our findings with expected values based on age, sex, and calendar-year-specific reference frequencies for the general Swedish population. We also compared the number of cancers between the three treatment groups. FINDINGS At baseline, 607 (9%) patients had previous malignant disease. Diagnoses were closely similar to the distribution of cancer types that might be seen in elderly patients. During follow-up, there were 625 new cases of cancer in 590 patients. The frequency of cancer did not differ significantly between the treatment strategies, including all cancers and those at individual sites. The standardised incidence ratios (SIRs) for all cancers were also close to unity: 0.92 (95% CI 0.80-1.06) for conventional drugs, 0.96 (0.83-1.10) for calcium antagonists, and 0.99 (0.86-1.13) for ACE inhibitors. INTERPRETATIONS No difference in cancer risk was seen between patients randomly assigned to conventional drugs, calcium antagonists, or ACE inhibitors. Thus, the general message to the practising physician is that more attention should be given to getting the blood pressure down than to the risk of cancer.
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Affiliation(s)
- L H Lindholm
- Department of Public Health and Clinical Medicine, Umeå University, SE 901 85, Umeå, Sweden.
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Abstract
Endometrial cancer is the commonest gynaecological cancer mostly affecting women in the post-menopausal age group. Rates vary worldwide and are highest in white women in Western populations. Some risk factors are related to reproduction, such as early age at menarche, late age at menopause and nulliparity, while others are more directly oestrogen-related, for example, conditions such as the polycystic ovarian syndrome. Use of unopposed oestrogen replacement therapy is associated with an increased risk, and use of the combined oral contraceptive pill is associated with a decreased risk. The relationship between tamoxifen and endometrial cancer is not established. Obesity, diabetes and hypertension increase the risk of endometrial cancer while smoking, low-fat diets and physical exercise appear to decrease the risk; all of these possibly exert their effects by various indirect influences on oestrogen levels, thus influencing the level of stimulation of the target endometrial epithelium.
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Affiliation(s)
- D M Purdie
- Population and Clinical Sciences Division, Queensland Institute of Medical Research, Queensland, 4029, Australia
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