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Verrilli L. Primary Ovarian Insufficiency and Ovarian Aging. Obstet Gynecol Clin North Am 2023; 50:653-661. [PMID: 37914485 DOI: 10.1016/j.ogc.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
Primary ovarian insufficiency (POI) is a complex condition of aberrant ovarian aging. POI etiologies are varied, and most cases have no identifiable underlying cause. Caring for women with POI requires an approach that understands the importance of ovarian function in a variety of target organs and tissues.
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Affiliation(s)
- Lauren Verrilli
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, 50 North Medical Drive, Salt Lake City, UT, USA.
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2
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Sayedali E, Abdel-Rhman R, Yalin S. Combined Hormonal Replacement Therapy and The Risk of Endometrial Cancer in Postmenopausal Women: A Meta-analysis. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2022. [DOI: 10.1007/s40944-022-00640-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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3
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Matsuo K, Mandelbaum R, Deshpande RR, Nusbaum DJ, Yoshihara K, Machida H, Bainvoll L, Matsuzaki S, Klar M, Roman LD, Wright JD. Population incidence and characteristics of secondary breast cancer after uterine cancer: a competing risk analysis. Arch Gynecol Obstet 2022; 306:865-874. [PMID: 35235021 DOI: 10.1007/s00404-022-06440-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 02/09/2022] [Indexed: 01/17/2023]
Abstract
PURPOSE To examine incidence and characteristics of women who developed secondary breast cancer after uterine cancer. METHODS This is a population-based retrospective cohort study utilizing the National Cancer Institute's Surveillance, Epidemiology, and End Result Program from 1973 to 2013. Women with uterine cancer who did not have synchronous or a history of breast cancer were followed after their uterine cancer diagnosis (N = 236,561). A time-dependent competing risk analysis was performed to examine cumulative incidences and clinico-pathological characteristics of those who subsequently developed breast cancer. RESULTS There were 7110 (3.0%) women who developed secondary breast cancers after uterine cancer with 5-, 10-, and 20-year cumulative incidence rates of 1.5, 2.8, and 4.7%, respectively. The increase in the rate of secondary breast cancer was particularly high in the first 3 years after a uterine cancer diagnosis (annual percent change [APC] 4.9), followed by 3-7 years (APC 1.6) after diagnosis (P < 0.001). The median time to develop secondary breast cancer was 6.4 years. Older women had significantly shorter time intervals between uterine and breast cancer diagnoses (3.7 years for aged > 71, 5.9 for aged 64-71, 7.6 for aged 56-63, and 9.4 for aged < 56, P < 0.001). In a multivariable analysis, older age, White race, married status, endometrioid, serous, and mixed histology types, and early-stage tumors remained as independent factors of developing secondary breast cancer (all, P < 0.05). CONCLUSION Tumor factors with endometrioid and serous histology types and early-stage disease were the factors associated with secondary breast cancer after uterine cancer diagnosis. Older women had shorter time to develop secondary breast cancer.
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Affiliation(s)
- Koji Matsuo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, 2020 Zonal Avenue, IRD 520, Los Angeles, CA, 90033, USA.
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA.
| | - Rachel Mandelbaum
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, 2020 Zonal Avenue, IRD 520, Los Angeles, CA, 90033, USA
| | - Rasika R Deshpande
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, 2020 Zonal Avenue, IRD 520, Los Angeles, CA, 90033, USA
| | - David J Nusbaum
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, 2020 Zonal Avenue, IRD 520, Los Angeles, CA, 90033, USA
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Kosuke Yoshihara
- Department of Obstetrics and Gynecology, Niigata University, Niigata, Japan
| | - Hiroko Machida
- Department of Obstetrics and Gynecology, Tokai University, Kanagawa, Japan
| | - Liat Bainvoll
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, 2020 Zonal Avenue, IRD 520, Los Angeles, CA, 90033, USA
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Shinya Matsuzaki
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, 2020 Zonal Avenue, IRD 520, Los Angeles, CA, 90033, USA
| | - Maximilian Klar
- Department of Obstetrics and Gynecology, University of Freiburg Faculty of Medicine, Freiburg, Germany
| | - Lynda D Roman
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, 2020 Zonal Avenue, IRD 520, Los Angeles, CA, 90033, USA
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Jason D Wright
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY, USA
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Iuele H, Bucciarelli A, Ling N. Novel hyphenation of DGT in-situ passive sampling with YES assay to ascertain the potency of emerging endocrine disruptors in water systems in New Zealand. WATER RESEARCH 2022; 219:118567. [PMID: 35580392 DOI: 10.1016/j.watres.2022.118567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 02/27/2022] [Accepted: 05/05/2022] [Indexed: 06/15/2023]
Abstract
This study represents the first attempt to investigate selected estrogenic compounds that include 17α-ethynylestradiol (EE2), 17β-estradiol (E2) bisphenol A (BPA), and bisphenol AF (BPAF) along the drinkable water, from river-to-tap, and wastewater, from effluent-to-treated wastewater, treatment processes of the Hamilton City Council and the monitoring of the freshwater, from source-to-outfall, of the Waikato River in New Zealand. This was accomplished by the adoption of a novel combination of diffusive gradients in thin films (DGTs) in-situ passive sampling coupled with high-performance liquid chromatography/mass spectrometry analysis (HPLC/MS) and the Yeast Estrogen Screen (YES). Estradiol equivalency quantities, integrated in time, were evaluated theoretically (cEEQ) by DGT-HPLC/MS and experimentally (EEQ) by DGT-YES assay. cEEQ and EEQ highlighted that primary treatments are not suitable for estrogens and bisphenolic plastics removal both at drinkable and wastewater treatment plants in Hamilton where they worsen the water quality in terms of estrogenicity making these pollutants more available in the water phase. All downstream sites monitored along the Waikato River showed higher cEEQ and EEQ, moreover the Waikato River water quality showed a moderate worsening moving from Taupo (source) to Tuakau (outfall). The most polluted sites were downstream of Hamilton city and Huntly township wastewater treatment plants that serve the main conurbations in the area. cEEQ and EEQ generally showed good agreement at low concentrations but differed substantially at more polluted sites where cEEQ consistently underestimated estrogenic potency, possibly due to DGT accumulation of estrogenic compounds not quantified by HPLC/MS.
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Affiliation(s)
- Helena Iuele
- Institute of Nanotechnology, National Research Council (CNR-NANOTEC), Lecce 73100, Italy; School of Science, Science and Engineering, University of Waikato, Hamilton 3240, New Zealand.
| | - Alessio Bucciarelli
- Institute of Nanotechnology, National Research Council (CNR-NANOTEC), Lecce 73100, Italy
| | - Nicholas Ling
- School of Science, Science and Engineering, University of Waikato, Hamilton 3240, New Zealand
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Hutt S, Mihaies D, Karteris E, Michael A, Payne AM, Chatterjee J. Statistical Meta-Analysis of Risk Factors for Endometrial Cancer and Development of a Risk Prediction Model Using an Artificial Neural Network Algorithm. Cancers (Basel) 2021; 13:cancers13153689. [PMID: 34359595 PMCID: PMC8345114 DOI: 10.3390/cancers13153689] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 07/05/2021] [Accepted: 07/09/2021] [Indexed: 11/16/2022] Open
Abstract
Simple Summary A robust and comprehensive meta-analysis, for the first time, identified definitely that BMI is by far the most influential risk factor in endometrial cancer. Risk factors were previously only studied individually and or in smaller meta-analysis studies which grouped some factors together. BMI was shown to be an important risk factor with other factors less so, but no rank order was established. This work also offers, for the first time, a neural network computer model to predict the overall increase or decreased risk of cancer for individual patients, which is 98.6% accurate. This prediction can be used as a tool to determine if a patient should be considered for testing and to predict diagnosis, as well as to suggest prevention measures to patients. Abstract Objectives: In this study we wished to determine the rank order of risk factors for endometrial cancer and calculate a pooled risk and percentage risk for each factor using a statistical meta-analysis approach. The next step was to design a neural network computer model to predict the overall increase or decreased risk of cancer for individual patients. This would help to determine whether this prediction could be used as a tool to decide if a patient should be considered for testing and to predict diagnosis, as well as to suggest prevention measures to patients. Design: A meta-analysis of existing data was carried out to calculate relative risk, followed by design and implementation of a risk prediction computational model based on a neural network algorithm. Setting: Meta-analysis data were collated from various settings from around the world. Primary data to test the model were collected from a hospital clinic setting. Participants: Data from 40 patients notes currently suspected of having endometrial cancer and undergoing investigations and treatment were collected to test the software with their cancer diagnosis not revealed to the software developers. Main outcome measures: The forest plots allowed an overall relative risk and percentage risk to be calculated from all the risk data gathered from the studies. A neural network computational model to determine percentage risk for individual patients was developed, implemented, and evaluated. Results: The results show that the greatest percentage increased risk was due to BMI being above 25, with the risk increasing as BMI increases. A BMI of 25 or over gave an increased risk of 2.01%, a BMI of 30 or over gave an increase of 5.24%, and a BMI of 40 or over led to an increase of 6.9%. PCOS was the second highest increased risk at 4.2%. Diabetes, which is incidentally also linked to an increased BMI, gave a significant increased risk along with null parity and noncontinuous HRT of 1.54%, 1.2%, and 0.56% respectively. Decreased risk due to contraception was greatest with IUD (intrauterine device) and IUPD (intrauterine progesterone device) at −1.34% compared to −0.9% with oral. Continuous HRT at −0.75% and parity at −0.9% also decreased the risk. Using open-source patient data to test our computational model to determine risk, our results showed that the model is 98.6% accurate with an algorithm sensitivity 75% on average. Conclusions: In this study, we successfully determined the rank order of risk factors for endometrial cancer and calculated a pooled risk and risk percentage for each factor using a statistical meta-analysis approach. Then, using a computer neural network model system, we were able to model the overall increase or decreased risk of cancer and predict the cancer diagnosis for particular patients to an accuracy of over 98%. The neural network model developed in this study was shown to be a potentially useful tool in determining the percentage risk and predicting the possibility of a given patient developing endometrial cancer. As such, it could be a useful tool for clinicians to use in conjunction with other biomarkers in determining which patients warrant further preventative interventions to avert progressing to endometrial cancer. This result would allow for a reduction in the number of unnecessary invasive tests on patients. The model may also be used to suggest interventions to decrease the risk for a particular patient. The sensitivity of the model limits it at this stage due to the small percentage of positive cases in the datasets; however, since this model utilizes a neural network machine learning algorithm, it can be further improved by providing the system with more and larger datasets to allow further refinement of the neural network.
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Affiliation(s)
- Suzanna Hutt
- Academic Department of Gynaecological Oncology, Royal Surrey NHS Foundation Trust Hospital, Guildford GU2 7XX, UK; (S.H.); (A.M.); (J.C.)
- Department of Clinical and Experimental Medicine, Faculty of Health and Medical Sciences, School of Biosciences and Medicine, University of Surrey, Guildford GU2 7XH, UK
| | - Denis Mihaies
- Department of Computer Science, College of Engineering, Design and Physical Sciences, Brunel University, London UB8 3PN, UK;
| | - Emmanouil Karteris
- Department of Life Sciences, Division of Biosciences, College of Health, Medicine and Life Sciences, Brunel University, London UB8 3PN, UK;
| | - Agnieszka Michael
- Academic Department of Gynaecological Oncology, Royal Surrey NHS Foundation Trust Hospital, Guildford GU2 7XX, UK; (S.H.); (A.M.); (J.C.)
| | - Annette M. Payne
- Department of Computer Science, College of Engineering, Design and Physical Sciences, Brunel University, London UB8 3PN, UK;
- Correspondence:
| | - Jayanta Chatterjee
- Academic Department of Gynaecological Oncology, Royal Surrey NHS Foundation Trust Hospital, Guildford GU2 7XX, UK; (S.H.); (A.M.); (J.C.)
- Department of Clinical and Experimental Medicine, Faculty of Health and Medical Sciences, School of Biosciences and Medicine, University of Surrey, Guildford GU2 7XH, UK
- Department of Cancer and Surgery, Imperial College London, London SW7 2BX, UK
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Menopausal Hormone Therapy and Risk of Endometrial Cancer: A Systematic Review. Cancers (Basel) 2020; 12:cancers12082195. [PMID: 32781573 PMCID: PMC7465414 DOI: 10.3390/cancers12082195] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 08/04/2020] [Accepted: 08/05/2020] [Indexed: 01/03/2023] Open
Abstract
Background: Menopausal hormone therapy (MHT) is an appropriate treatment for women with the climacteric syndrome. The estrogen component of MHT effectively alleviates climacteric symptoms but also stimulates the endometrium and thus may increase the risk of endometrial cancer (EC). Materials and Methods: We performed a systematic literature search of the databases PubMed and Cochrane Central Register of Controlled Trials to identify controlled and uncontrolled clinical trials reporting on the prevalence and/or incidence of EC among women using MHT. Results: 31 publications reporting on 21,306 women with EC diagnosed during or after MHT were identified. A significantly reduced risk of EC among continuous-combined (cc)MHT users with synthetic progestins (SPs) was demonstrated in 10/19 studies with odds ratios (ORs)/hazard ratios (HRs) between 0.24 and 0.71. Only one study documented an increased risk of EC among long-term users (≥10 years), not confirmed in three other sub-group analyses of women with ≥6, ≥5, and >10 years of ccMHT use. A significantly increased risk of EC among users of sequential-combined (sc)MHT with SPs was demonstrated in 6/12 studies with ORs/HRs between 1.38 and 4.35. Number of days of progestin per month was a significant modulator of EC risk. A decreased risk of EC was seen in obese women. Two studies documented an increased risk of EC among users of cc/scMHT with micronized progesterone. A significantly increased risk of EC among estrogen-only MHT users was demonstrated in 9/12 studies with ORs/HRs between 1.45 and 4.46. The adverse effect of estrogen-only MHT was greatest among obese women. Conclusion: ccMHT with SPs reduces the risk of EC, whereas estrogen-only MHT increases the risk. scMHT with SPs and cc/scMHT with micronized progesterone increase the risk of EC depending on type of progestin, progestin dosage, and duration of MHT use.
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Cagnacci A, Venier M. The Controversial History of Hormone Replacement Therapy. MEDICINA (KAUNAS, LITHUANIA) 2019; 55:E602. [PMID: 31540401 PMCID: PMC6780820 DOI: 10.3390/medicina55090602] [Citation(s) in RCA: 88] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 09/12/2019] [Accepted: 09/13/2019] [Indexed: 11/30/2022]
Abstract
The history of hormone replacement therapy (HRT) started in the 1960s, with very high popularity in the 1990s. The first clinical trials on HRT and chronic postmenopausal conditions were started in the USA in the late 1990s. After the announcement of the first results of the Women's Health Initiative (WHI) in 2002, which showed that HRT had more detrimental than beneficial effects, HRT use dropped. The negative results of the study received wide publicity, creating panic among some users and new guidance for doctors on prescribing HRT. The clear message from the media was that HRT had more risks than benefits for all women. In the following years, a reanalysis of the WHI trial was performed, and new studies showed that the use of HRT in younger women or in early postmenopausal women had a beneficial effect on the cardiovascular system, reducing coronary disease and all-cause mortality. Notwithstanding this, the public opinion on HRT has not changed yet, leading to important negative consequences for women's health and quality of life.
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Affiliation(s)
- Angelo Cagnacci
- Obstetrics and Gynecology Unit, Azienda Sanitaria Universitaria Integrata di, 33100 Udine, Italy.
| | - Martina Venier
- Obstetrics and Gynecology Unit, Azienda Sanitaria Universitaria Integrata di, 33100 Udine, Italy.
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Palumbo Júnior A, de Sousa VPL, Esposito F, De Martino M, Forzati F, Moreira FCDB, Simão TDA, Nasciutti LE, Fusco A, Ribeiro Pinto LF, Bessa Pereira Chaves C, Meireles Da Costa N. Overexpression of HMGA1 Figures as a Potential Prognostic Factor in Endometrioid Endometrial Carcinoma (EEC). Genes (Basel) 2019; 10:genes10050372. [PMID: 31096664 PMCID: PMC6562754 DOI: 10.3390/genes10050372] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 05/06/2019] [Accepted: 05/06/2019] [Indexed: 12/18/2022] Open
Abstract
Endometrioid endometrial carcinomas (EEC) are the most common malignant gynecologic tumors. Despite the increase in EEC molecular knowledge, the identification of new biomarkers involved in disease's development and/or progression would represent an improvement in its course. High-mobility group A protein (HMGA) family members are frequently overexpressed in a wide range of malignancies, correlating with a poor prognosis. Thus, the aim of this study was to analyze HMGA1 and HMGA2 expression pattern and their potential role as EEC biomarkers. HMGA1 and HMGA2 expression was initially evaluated in a series of 46 EEC tumors (stages IA to IV), and the findings were then validated in The Cancer Genome Atlas (TCGA) EEC cohort, comprising 381 EEC tumors (stages IA to IV). Our results reveal that HMGA1 and HMGA2 mRNA and protein are overexpressed in ECC, but only HMGA1 expression is associated with increased histological grade and tumor size. Moreover, HMGA1 but not HMGA2 overexpression was identified as a negative prognostic factor to EEC patients. Finally, a positive correlation between expression of HMGA1 pseudogenes-HMGA1-P6 and HMGA1-P7-and HMGA1 itself was detected, suggesting HMGA1 pseudogenes may play a role in HMGA1 expression regulation in EEC. Thus, these results indicate that HMGA1 overexpression possesses a potential role as a prognostic biomarker for EEC.
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Affiliation(s)
- Antonio Palumbo Júnior
- Programa de Carcinogênese Molecular, Instituto Nacional de Câncer-INCA, Rua André Cavalcanti, 37 - Centro, Rio de Janeiro, RJ 20231-050, Brazil.
- Laboratório de Interações Celulares, Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro Prédio de Ciências da Saúde-Cidade Universitária, Ilha do Fundão, A. Carlos Chagas, 373-bloco F, sala 26, Rio de Janeiro, RJ 21941-902, Brasil.
| | - Vanessa Paiva Leite de Sousa
- Programa de Carcinogênese Molecular, Instituto Nacional de Câncer-INCA, Rua André Cavalcanti, 37 - Centro, Rio de Janeiro, RJ 20231-050, Brazil.
| | - Francesco Esposito
- Istituto di Endocrinologia e Oncologia Sperimentale-CNR c/o Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli Studi di Napoli "Federico II", via Pansini 5, 80131 Naples, Italy.
| | - Marco De Martino
- Istituto di Endocrinologia e Oncologia Sperimentale-CNR c/o Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli Studi di Napoli "Federico II", via Pansini 5, 80131 Naples, Italy.
| | - Floriana Forzati
- Istituto di Endocrinologia e Oncologia Sperimentale-CNR c/o Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli Studi di Napoli "Federico II", via Pansini 5, 80131 Naples, Italy.
| | - Fábio Carvalho de Barros Moreira
- Divisão de Patologia, Instituto Nacional de Câncer-INCA, Rua Cordeiro da Graça, 156-Santo Cristo, Rio de Janeiro, RJ 20220-040, Brazil.
| | - Tatiana de Almeida Simão
- Programa de Carcinogênese Molecular, Instituto Nacional de Câncer-INCA, Rua André Cavalcanti, 37 - Centro, Rio de Janeiro, RJ 20231-050, Brazil.
- Laboratório de Toxicologia e Biologia Molecular, Departamento de Bioquímica, Instituto de Biologia Roberto Alcântara Gomes, Universidade do Estado do Rio de Janeiro, Av. 28 de setembro, 87-fundos-4º andar, Rio de Janeiro, RJ 20551-030, Brazil.
| | - Luiz Eurico Nasciutti
- Laboratório de Interações Celulares, Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro Prédio de Ciências da Saúde-Cidade Universitária, Ilha do Fundão, A. Carlos Chagas, 373-bloco F, sala 26, Rio de Janeiro, RJ 21941-902, Brasil.
| | - Alfredo Fusco
- Programa de Carcinogênese Molecular, Instituto Nacional de Câncer-INCA, Rua André Cavalcanti, 37 - Centro, Rio de Janeiro, RJ 20231-050, Brazil.
- Istituto di Endocrinologia e Oncologia Sperimentale-CNR c/o Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli Studi di Napoli "Federico II", via Pansini 5, 80131 Naples, Italy.
| | - Luis Felipe Ribeiro Pinto
- Programa de Carcinogênese Molecular, Instituto Nacional de Câncer-INCA, Rua André Cavalcanti, 37 - Centro, Rio de Janeiro, RJ 20231-050, Brazil.
| | - Cláudia Bessa Pereira Chaves
- Programa de Carcinogênese Molecular, Instituto Nacional de Câncer-INCA, Rua André Cavalcanti, 37 - Centro, Rio de Janeiro, RJ 20231-050, Brazil.
- Seção de Ginecologia Oncológica, Hospital de Câncer II, Instituto Nacional de Câncer-INCA, Rua Equador, 835. Santo Cristo, Rio de Janeiro, RJ 20220-410, Brazil.
| | - Nathalia Meireles Da Costa
- Programa de Carcinogênese Molecular, Instituto Nacional de Câncer-INCA, Rua André Cavalcanti, 37 - Centro, Rio de Janeiro, RJ 20231-050, Brazil.
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Sponholtz TR, Palmer JR, Rosenberg LA, Hatch EE, Adams-Campbell LL, Wise LA. Exogenous Hormone Use and Endometrial Cancer in U.S. Black Women. Cancer Epidemiol Biomarkers Prev 2018; 27:558-565. [PMID: 29475971 DOI: 10.1158/1055-9965.epi-17-0722] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Revised: 10/31/2017] [Accepted: 02/02/2018] [Indexed: 11/16/2022] Open
Abstract
Background: Although endometrial cancer risk differs among white and black women, few data on its associations with exogenous hormone use in the latter group are available. Studies have reported lower endometrial cancer risk among users of oral contraceptives (OCs), but higher risk among users of estrogen-only female menopausal hormones (FMHs). Evidence for the risk among estrogen plus progestin FMHs users is equivocal.Methods: We followed 47,555 Black Women's Health Study participants with an intact uterus from 1995 through 2013. Data on exogenous hormone use, covariates, and endometrial cancer were obtained biennially. Self-reported incident cases of endometrial cancer were confirmed by medical records or cancer registries whenever possible. We estimated incidence rate ratios (IRRs) and 95% confidence intervals (CIs) using Cox proportional hazards regression.Results: We observed 300 endometrial cancer cases during 689,546 person-years of follow-up. Compared with never use, ≥10 years' duration of OC use was associated with lower risk (multivariable IRR = 0.45, 95% CI, 0.27-0.74), but risk was higher among current users of estrogen-only (IRR = 3.78, 95% CI, 1.69-8.43) and estrogen plus progestin FMH (IRR = 1.55, 95% CI, 0.78-3.11). Risk was not increased among former users of estrogen-only (IRR = 0.87, 95% CI, 0.44-1.72) or estrogen plus progestin FMH (IRR = 0.63, 95% CI, 0.36-1.09).Conclusions: Current use of estrogen-only and estrogen plus progestin FMH was associated with increased risk of endometrial cancer. Risk appeared lower among former users of estrogen plus progestin FMH. Long-term OC use was associated with reduced risk.Impact: Our results are generally consistent with those among white women. Cancer Epidemiol Biomarkers Prev; 27(5); 558-65. ©2018 AACR.
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Affiliation(s)
- Todd R Sponholtz
- Section of Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, Massachusetts.
| | - Julie R Palmer
- Slone Epidemiology Center, Boston University, Boston, Massachusetts.,Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Lynn A Rosenberg
- Slone Epidemiology Center, Boston University, Boston, Massachusetts.,Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Elizabeth E Hatch
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Lucile L Adams-Campbell
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia
| | - Lauren A Wise
- Slone Epidemiology Center, Boston University, Boston, Massachusetts.,Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
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Abstract
Primary ovarian insufficiency describes a spectrum of declining ovarian function and reduced fecundity due to a premature decrease in initial follicle number, an increase in follicle destruction, or poor follicular response to gonadotropins. The sequelae of primary ovarian insufficiency include vasomotor symptoms, urogenital atrophy, osteoporosis and fracture, cardiovascular disease, and increased all-cause mortality. In women with primary ovarian insufficiency, systemic hormone therapy (HT) is an effective approach to treat the symptoms of hypoestrogenism and mitigate long-term health risks if there are no contraindications to treatment. Hormone therapy is indicated to reduce the risk of osteoporosis, cardiovascular disease, and urogenital atrophy and to improve the quality of life of women with primary ovarian insufficiency. Although exogenous estrogen replacement is recommended for women with primary ovarian insufficiency, data comparing various hormonal regimens for disease prevention, symptom amelioration, and safety are lacking in this population. As a first-line approach, HT (either orally or transdermally) that achieves replacement levels of estrogen is recommended. Combined hormonal contraceptives prevent ovulation and pregnancy more reliably than HT; despite only modest odds of spontaneous pregnancy in women with primary ovarian insufficiency, this is a critical consideration for those who deem pregnancy prevention a priority. Treatment for all women with primary ovarian insufficiency should continue until the average age of natural menopause is reached (age 50-51 years). Finally, considering the challenges that adolescents and young women may face in coping with the physical, reproductive, and social effects of primary ovarian insufficiency, comprehensive longitudinal management of this condition is essential.
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Brant AR, Ye PP, Teng SJ, Lotke PS. Non-Contraceptive Benefits of Hormonal Contraception: Established Benefits and New Findings. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2017. [DOI: 10.1007/s13669-017-0205-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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L’Hermite M. Custom-compounded bioidentical hormone therapy: why so popular despite potential harm? The case against routine use. Climacteric 2017; 20:205-211. [DOI: 10.1080/13697137.2017.1285277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- M. L’Hermite
- Service de Gynécologie-Obstétrique, CHU Brugmann, Université Libre de Bruxelles, Bruxelles, Belgium
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Wu QJ, Li YY, Tu C, Zhu J, Qian KQ, Feng TB, Li C, Wu L, Ma XX. Parity and endometrial cancer risk: a meta-analysis of epidemiological studies. Sci Rep 2015; 5:14243. [PMID: 26373341 PMCID: PMC4642705 DOI: 10.1038/srep14243] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 08/20/2015] [Indexed: 11/11/2022] Open
Abstract
The association between parity and endometrial cancer risk is inconsistent from observational studies. We aimed to quantitatively assess the relationship by summarizing all relevant epidemiological studies. PubMed (MEDLINE), Embase and Scopus were searched up to February 2015 for eligible case–control studies and prospective studies. Random-effects model was used to pool risk estimations. Ten prospective studies, 35 case-control studies and 1 pooled analysis of 10 cohort and 14 case-control studies including 69681 patients were identified. Pooled analysis revealed that there was a significant inverse association between parity and risk of endometrial cancer (relative risk (RR) for parous versus nulliparous: 0.69, 95% confidence interval (CI) 0.65–0.74; I2 = 76.9%). By evaluating the number of parity, we identified that parity number of 1, 2 or 3 versus nulliparous demonstrated significant negative association (RR = 0.73, 95% CI 0.64–0.84, I2 = 88.3%; RR = 0.62, 95% CI 0.53–0.74, I2 = 92.1%; and RR = 0.68, 95% CI 0.65–0.70, I2 = 20.0% respectively). The dose-response analysis suggested a nonlinear relationship between the number of parity and endometrial cancer risk. The RR decreased when the number of parity increased. This meta-analysis suggests that parity may be associated with a decreased risk of endometrial cancer. Further studies are warranted to replicate our findings.
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Affiliation(s)
- Qi-Jun Wu
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning, China
| | - Yuan-Yuan Li
- Department of Hematology, the Affiliated Hospital of Xuzhou Medical College, Xuzhou, Jiangsu, 221000, China
| | - Chao Tu
- Oncology Institute, the Affiliated Hospital of Nanjing Medical University, Changzhou No.2 People's Hospital, Changzhou, Jiangsu, 213003, China
| | - Jingjing Zhu
- Program of Quantitative Methods in Education, University of Minnesota, Minneapolis, Minnesota, 55455, USA.,Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt University School of Medicine, Nashville, TN 37203, USA
| | - Ke-Qing Qian
- Oncology Institute, the Affiliated Hospital of Nanjing Medical University, Changzhou No.2 People's Hospital, Changzhou, Jiangsu, 213003, China
| | - Tong-Bao Feng
- Oncology Institute, the Affiliated Hospital of Nanjing Medical University, Changzhou No.2 People's Hospital, Changzhou, Jiangsu, 213003, China
| | - Changwei Li
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, 70112, USA
| | - Lang Wu
- Center for Clinical and Translational Science, Mayo Clinic, Rochester, Minnesota, 55905, USA.,Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt University School of Medicine, Nashville, TN 37203, USA
| | - Xiao-Xin Ma
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning, China
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Depypere H, Inki P. The levonorgestrel-releasing intrauterine system for endometrial protection during estrogen replacement therapy: a clinical review. Climacteric 2015; 18:470-82. [DOI: 10.3109/13697137.2014.991302] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Abstract
OBJECTIVE To examine the association between premenopausal use of the levonorgestrel-releasing intrauterine system and cancer incidence in Finland with a special focus on endometrial adenocarcinoma. METHODS All Finnish women aged 30-49 years using a levonorgestrel-releasing intrauterine system for treatment of menorrhagia in 1994-2007 (n=93,843) were identified from the National Reimbursement Registry and linked to the Finnish Cancer Registry data. The incidence of cancers in levonorgestrel-releasing intrauterine system users was compared with that in the general population. RESULTS A total of 2,781 cancer cases were detected in levonorgestrel-releasing intrauterine system users during the follow-up of 855,324 women-years. The standardized incidence ratio (observed-to-expected ratio) for endometrial adenocarcinoma was 0.50 (95% confidence interval [CI] 0.35-0.70; 34 observed compared with 68 expected cases) after the first levonorgestrel-releasing intrauterine system purchase and 0.25 (95% CI 0.05-0.73; three observed compared with 12 expected cases) after two purchases. The standardized incidence ratio for ovarian cancer was 0.60 (95% CI 0.45-0.76; 59 observed compared with 99 expected cases), for pancreatic cancer 0.50 (95% CI 0.28-0.81; 15 observed compared with 30 expected cases), and for lung cancer 0.68 (95% CI 0.49-0.91; 43 observed compared with 63 expected cases). The standardized incidence ratio for breast cancer among all levonorgestrel-releasing intrauterine system users was 1.19 (95% CI 1.13-1.25; 1,542 observed compared with 1,292 expected cases). CONCLUSION The levonorgestrel-releasing intrauterine system may have a protective effect against endometrial malignant transformation. Using the levonorgestrel-releasing intrauterine system for treatment of menorrhagia during reproductive years was associated with a lower incidence of endometrial, ovarian, pancreatic, and lung cancers than expected. Levonorgestrel-releasing intrauterine system use was associated with a higher than expected incidence of breast cancer. LEVEL OF EVIDENCE II.
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Fournier A, Dossus L, Mesrine S, Vilier A, Boutron-Ruault MC, Clavel-Chapelon F, Chabbert-Buffet N. Risks of endometrial cancer associated with different hormone replacement therapies in the E3N cohort, 1992-2008. Am J Epidemiol 2014; 180:508-17. [PMID: 25008104 DOI: 10.1093/aje/kwu146] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
We assessed whether different oral progestogens in hormone replacement therapy may differentially affect the risk of endometrial cancer, using data from the Etude Epidémiologique auprès de femmes de l'Education Nationale (E3N), a French cohort study (1992-2008). Hazard ratios and their confidence intervals were derived from Cox models. Among 65,630 postmenopausal women (mean follow-up: 10.8 years), 301 endometrial cancers occurred. Compared with never use, ever use of estrogen + micronized progesterone was associated with an increased risk of endometrial cancer (hazard ratio (HR) = 1.80, 95% confidence interval (CI): 1.38, 2.34) that was significantly more marked with longer duration of use (for ≤5 years, HR = 1.39 (95% CI: 0.99, 1.97); for >5 years, HR = 2.66 (95% CI: 1.87, 3.77)). Although use of estrogen + dydrogesterone was not associated overall with endometrial cancer risk (HR = 1.05, 95% CI: 0.76, 1.45), there was a significantly increased risk with long-term use compared with never use (for >5 years, HR = 1.69, 95% CI: 1.06, 2.70). Users of preparations containing other progesterone derivatives or a norsteroid derivative were not at significantly increased risk (HR = 0.79 (95% CI: 0.60, 1.05) and HR = 1.30 (95% CI: 0.85, 1.99), respectively). In conclusion, micronized progesterone and, to a lesser extent, dydrogesterone at the doses used in France may not be sufficient to prevent estrogen-induced endometrial cancers.
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Burke WM, Orr J, Leitao M, Salom E, Gehrig P, Olawaiye AB, Brewer M, Boruta D, Herzog TJ, Shahin FA. Endometrial cancer: A review and current management strategies: Part II. Gynecol Oncol 2014; 134:393-402. [DOI: 10.1016/j.ygyno.2014.06.003] [Citation(s) in RCA: 138] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 05/25/2014] [Accepted: 06/03/2014] [Indexed: 10/25/2022]
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Brinton LA, Felix AS. Menopausal hormone therapy and risk of endometrial cancer. J Steroid Biochem Mol Biol 2014; 142:83-9. [PMID: 23680641 PMCID: PMC3775978 DOI: 10.1016/j.jsbmb.2013.05.001] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Revised: 04/09/2013] [Accepted: 05/06/2013] [Indexed: 11/29/2022]
Abstract
Endometrial cancer is clearly a hormonally responsive tumor, with a critical role played by estrogens unopposed by progestins. Numerous epidemiologic studies have shown substantial risk increases associated with use of unopposed estrogens, especially among thin women. This risk, however, can be reduced if progestins are added to the therapy. The manner in which progestins are prescribed is a critical determinant of risk. Most studies show that women who have ever used progestins continuously (>25 days/months) are at somewhat reduced risk relative to non-users (meta-analysis relative risk, RR, based on observational studies=0.78, 95 confidence intervals, CI, 0.72-0.86). The reduced risk in greatest among heavy women. In contrast, women who have ever used progestins sequentially for <10 days each month are at increased risk, with meta-analysis results showing on overall RR of 1.76 (1.51-2.05); in contrast, progestins given for 10-24 days/month appear unrelated to risk (RR=1.07, 0.92-1.24). These risks were based on varying patterns of usage, with little information available regarding how endometrial cancer risk is affected by duration of use, type and/or dose of estrogen or progestin, or mode of administration. Effects may also vary by clinical characteristics (e.g., differences for Type I vs. II tumors). Further resolution of many of these relationships may be dependent on pooling data from multiple studies to derive sufficient power for subgroups of users. With changing clinical practices, it will be important for future studies to monitor a wide range of exposures and to account for divergent effects of different usage patterns. This article is part of a Special Issue entitled 'Menopause'.
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Affiliation(s)
- Louise A Brinton
- Hormonal and Reproductive Epidemiology Branch, National Cancer Institute, Rockville, MD 20852-7234, United States.
| | - Ashley S Felix
- Hormonal and Reproductive Epidemiology Branch, National Cancer Institute, Rockville, MD 20852-7234, United States
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Abstract
OBJECTIVE To determine cancer incidence among Finnish women with 10 or more deliveries. METHODS Finnish women with at least 10 childbirths before December 31, 2010 (n=4,967) were identified from the Finnish Population Register and followed for cancer incidence through the Finnish Cancer Registry to the end of 2010. Cancer risks in this cohort were expressed as ratios between observed and expected numbers of cases (standardized incidence ratios), both drawn from the Finnish Cancer Registry, with 95% confidence intervals (CIs). RESULTS Total cancer incidence was markedly lower than in the reference population (656 cases, standardized incidence ratio 0.76, 95% CI 0.73-0.79). There was clearly less breast (0.44, 0.35-0.53), ovarian (0.49, 0.28-0.80), endometrial (0.31, 0.17-0.44), and basal cell skin cancer (0.72, 0.60-0.85) than in the reference population. The incidence of thyroid cancer (2.33, 1.59-3.29), lip cancer (2.87, 1.05-6.24), and uterine sarcoma (3.41, 1.47-6.72) was markedly increased. CONCLUSION Women with 10 or more deliveries show a decreased overall cancer incidence as a result of decreased risks of cancers of the ovary, endometrium, and breast and basal cell carcinoma of the skin. The increased risks were observed in thyroid cancer and some rare cancer types.
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de Sousa VPL, Chaves CBP, Huguenin JFL, Moreira FCDB, de Reis BSB, Chimelli L, Bergmann A, Simão TDA, Pinto LFR. ERM/ETV5 and RUNX1/AML1 expression in endometrioid adenocarcinomas of endometrium and association with neoplastic progression. Cancer Biol Ther 2014; 15:888-94. [PMID: 24756106 DOI: 10.4161/cbt.28879] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
The majority of endometrioid endometrial carcinomas (EEC) is diagnosed at stage I. Among these, 30% present myometrial invasion (stage IB), which is associated with tumor spread and relapse after primary treatment. Although an increased expression of RUNX1/AML1 and ERM/ETV5 in EEC have been suggested to be associated with early events of myometrial infiltration, there is no data regarding its expression along the evolution of EEC and possible associations with other clinicopathological parameters. Therefore, ERM/ETV5 and RUNX1/AML1 protein and gene expression profiles were assessed in different EEC stages to evaluate their role in endometrial carcinogenesis. RUNX1/AML1 and ERM/ETV5 proteins were analyzed by immunohistochemistry in 219 formalin fixed paraffin embedded endometrioid tumors and in 12 normal atrophic and proliferative endometrium samples. RUNX1/AML1 and ERM/ETV5 genes expression were analyzed by RT-qPCR. RUNX1/AML1 and ERM/ETV5 expression were decreased with increasing EEC stage, with a positive correlation between protein and gene expression for ERM/ETV5, but not for RUNX1/AML1. Both proteins were present in the nucleus of the tumor cells, whereas RUNX1/AML1, but not ERM/ETV5, was expressed in 7 out of 12 normal endometrial samples, with its expression being restricted to the cytoplasm of the positive cells. We concluded that there is a higher expression of ERM/ETV5 in early stages of EEC, whereas there seems to be a RUNX1/AML1 translocation from cytoplasm to nucleus in EEC neoplastic transformation.
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Affiliation(s)
- Vanessa Paiva Leite de Sousa
- Programa de Carcinogênese Molecular; Centro de Pesquisa (CPQ); Instituto Nacional de Câncer (INCA); Rio de Janeiro, Brazil
| | - Claudia Bessa Pereira Chaves
- Programa de Carcinogênese Molecular; Centro de Pesquisa (CPQ); Instituto Nacional de Câncer (INCA); Rio de Janeiro, Brazil; Departamento de Ginecologia Oncológica; Instituto Nacional de Câncer (INCA); Rio de Janeiro, Brazil
| | | | | | | | - Leila Chimelli
- Divisão de Patologia (DIPAT); Instituto Nacional de Câncer (INCA); Rio de Janeiro, Brazil
| | - Anke Bergmann
- Epidemiologia Clínica Aplicada à Oncologia; Instituto Nacional de Câncer (INCA); Rio de Janeiro, Brazil
| | - Tatiana de Almeida Simão
- Programa de Carcinogênese Molecular; Centro de Pesquisa (CPQ); Instituto Nacional de Câncer (INCA); Rio de Janeiro, Brazil; Laboratório de Toxicologia e Biologia Molecular; Departamento de Bioquímica; Instituto de Biologia Roberto Alcantara Gomes (IBRAG); Universidade do Estado do Rio de Janeiro (UERJ); Rio de Janeiro, Brazil
| | - Luis Felipe Ribeiro Pinto
- Programa de Carcinogênese Molecular; Centro de Pesquisa (CPQ); Instituto Nacional de Câncer (INCA); Rio de Janeiro, Brazil; Laboratório de Toxicologia e Biologia Molecular; Departamento de Bioquímica; Instituto de Biologia Roberto Alcantara Gomes (IBRAG); Universidade do Estado do Rio de Janeiro (UERJ); Rio de Janeiro, Brazil
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Munro MG. Investigation of women with postmenopausal uterine bleeding: clinical practice recommendations. Perm J 2013; 18:55-70. [PMID: 24377427 DOI: 10.7812/tpp/13-072] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Postmenopausal uterine bleeding is defined as uterine bleeding after permanent cessation of menstruation resulting from loss of ovarian follicular activity. Bleeding can be spontaneous or related to ovarian hormone replacement therapy or to use of selective estrogen receptor modulators (eg, tamoxifen adjuvant therapy for breast carcinoma). Because anovulatory "cycles" with episodes of multimonth amenorrhea frequently precede menopause, no consensus exists regarding the appropriate interval of amenorrhea before an episode of bleeding that allows for the definition of postmenopausal bleeding. The clinician faces the possibility that an underlying malignancy exists, knowing that most often the bleeding comes from a benign source. Formerly, the gold-standard clinical investigation of postmenopausal uterine bleeding was institution-based dilation and curettage, but there now exist office-based methods for the evaluation of women with this complaint. Strategies designed to implement these diagnostic methods must be applied in a balanced way considering the resource utilization issues of overinvestigation and the risk of missing a malignancy with underinvestigation. Consequently, guidelines and recommendations were developed to consider these issues and the diverse spectrum of practitioners who evaluate women with postmenopausal bleeding. The guideline development group determined that, for initial management of spontaneous postmenopausal bleeding, primary assessment may be with either endometrial sampling or transvaginal ultrasonography, allowing patients with an endometrial echo complex thickness of 4 mm or less to be managed expectantly. Guidelines are also provided for patients receiving selective estrogen receptor modulators or hormone replacement therapy, and for an endometrial echo complex with findings consistent with fluid in the endometrial cavity.�
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Affiliation(s)
- Malcolm G Munro
- Chair of the Southern California Permanente Medical Group's Abnormal Uterine Bleeding Working Group, Director of Gynecological Services for the Los Angeles Medical Center in California, and a Professor in the Department of Obstetrics and Gynecology at the David Geffen School of Medicine at the University of California Los Angeles.
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22
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Endometriumhyperplasie und -karzinom. GYNAKOLOGISCHE ENDOKRINOLOGIE 2013. [DOI: 10.1007/s10304-013-0588-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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23
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L’Hermite M. HRT optimization, using transdermal estradiol plus micronized progesterone, a safer HRT. Climacteric 2013; 16 Suppl 1:44-53. [DOI: 10.3109/13697137.2013.808563] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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24
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Koskela-Niska V, Pukkala E, Lyytinen H, Ylikorkala O, Dyba T. Effect of various forms of postmenopausal hormone therapy on the risk of ovarian cancer-A population-based case control study from Finland. Int J Cancer 2013; 133:1680-8. [DOI: 10.1002/ijc.28167] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Accepted: 02/27/2013] [Indexed: 12/12/2022]
Affiliation(s)
- Virpi Koskela-Niska
- Department of Obstetrics and Gynecology; Helsinki University Central Hospital; HUS; Finland
| | - Eero Pukkala
- Institute for Statistical and Epidemiological Cancer Research; Finnish Cancer Registry; Pieni Roobertinkatu 9; FI-00130; Helsinki; Finland
| | - Heli Lyytinen
- Department of Obstetrics and Gynecology; Helsinki University Central Hospital; HUS; Finland
| | - Olavi Ylikorkala
- Department of Obstetrics and Gynecology; Helsinki University Central Hospital; HUS; Finland
| | - Tadeusz Dyba
- Institute for Statistical and Epidemiological Cancer Research; Finnish Cancer Registry; Pieni Roobertinkatu 9; FI-00130; Helsinki; Finland
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Schonfeld SJ, Hartge P, Pfeiffer RM, Freedman DM, Greenlee RT, Linet MS, Park Y, Schairer C, Visvanathan K, Lacey JV. An aggregated analysis of hormonal factors and endometrial cancer risk by parity. Cancer 2013; 119:1393-401. [PMID: 23280123 PMCID: PMC3744666 DOI: 10.1002/cncr.27909] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Revised: 10/16/2012] [Accepted: 10/23/2012] [Indexed: 01/07/2023]
Abstract
BACKGROUND Nulliparity is associated with an increased risk of endometrial cancer. It is less clear whether nulliparity modifies the association between other established hormone-related risk factors. The proportion of nulliparous women has increased since the mid-1970s, but most individual studies to date have been too small to test the hypothesis that endometrial cancer risk factors may be associated more strongly with risk among nulliparous women compared with parous women. METHODS Data were aggregated on 26,936 postmenopausal, Caucasian, nulliparous women (360 endometrial cancers) and 146,583 postmenopausal, Caucasian, parous women (1378 endometrial cancers) from 4 US prospective studies (1979-2006). Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated in stratified analyses. RESULTS The risk of endometrial cancer was higher among nulliparous women than among parous women, as expected (nulliparous vs parous: HR, 1.42; 95% CI, 1.26-1.60). Stratified associations between endometrial cancer and hormone-related risk factors did not differ between nulliparous versus parous women: For both groups, oral contraceptives and earlier menopause were associated with reduced risk. The highest HRs were for obesity: A body mass index ≥30 kg/m(2) (vs <25 kg/m(2) ) increased the risk of endometrial cancer 3-fold among nulliparous women (HR, 3.04; 95% CI, 2.34-3.94) and parous women (HR, 2.88; 95% CI, 2.52-3.29). CONCLUSIONS The results from this large, pooled analysis of data from 4 large prospective studies suggested that nulliparity does not modify the risks of endometrial cancer associated with established hormone-related risk factors.
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Affiliation(s)
- Sara J Schonfeld
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
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Sonigo C, Dray G, Chabbert-Buffet N. Le traitement hormonal de la ménopause : aspects pratiques. ACTA ACUST UNITED AC 2012; 41:F3-12. [DOI: 10.1016/j.jgyn.2012.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Use of Levonorgestrel-Releasing Intrauterine System in the Prevention and Treatment of Endometrial Hyperplasia. Obstet Gynecol Surv 2012; 67:726-33. [DOI: 10.1097/ogx.0b013e318273570b] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Terzic M, Micic J, Dotlic J, Maricic S, Mihailovic T, Knezevic N. Impact of Phytoestrogens on Serum Lipids in Postmenopausal Women. Geburtshilfe Frauenheilkd 2012; 72:527-531. [PMID: 25284841 DOI: 10.1055/s-0031-1298624] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2012] [Revised: 04/23/2012] [Accepted: 04/23/2012] [Indexed: 10/28/2022] Open
Abstract
Objectives: The aim of the study was to assess the impact of soy- and red clover-derived isoflavones on serum lipid levels in postmenopausal women and to compare the effects to the lipid levels of healthy postmenopausal women without phytoestrogen supplementation. Materials and Methods: Blood levels of triglycerides, total cholesterol and cholesterol fractions were assessed. Measurements were performed before treatment and at 6-month intervals over a period of 18 months. The investigation included 74 healthy postmenopausal women randomized into three groups according to treatment. The first group of 23 patients received soy-derived isoflavones, the second group (26 patients) was given red clover-derived phytoestrogens, while the third control group (25 patients) received no supplements. Results: Mean triglyceride, cholesterol and LDL levels of patients in the control group were significantly higher than in both the soy and the red clover groups (p < 0.001) at all three time points, while mean values did not differ significantly between the soy and the red clover groups. The mean HDL levels of patients in the control group was significantly lower than in both the soy and the red clover groups (p < 0.001). Conclusions: Phytoestrogen supplementation had a positive metabolic effect on serum lipid levels in postmenopausal women. The impact on serum lipids levels was similar for soy and red clover.
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Affiliation(s)
- M Terzic
- Obstetrics and Gynecology, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - J Micic
- Clinical Center of Serbia, Institute of Obstetrics and Gynecology, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - J Dotlic
- Clinical Center of Serbia, Institute of Obstetrics and Gynecology, Belgrade, Serbia
| | - S Maricic
- General Health Center "Savski Venac", Belgrade, Serbia
| | - T Mihailovic
- Ultramedica Clinic, American Medical Academy, Belgrade, Serbia
| | - N Knezevic
- Department of Anesthesiology, University of Illinois; Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, United States
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Effects of the levonorgestrel-releasing intrauterine system plus estrogen therapy in perimenopausal and postmenopausal women: systematic review and meta-analysis. Menopause 2012; 18:1060-6. [PMID: 21720280 DOI: 10.1097/gme.0b013e31821606c5] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The objective of this study was to compare the effects of the levonorgestrel-releasing intrauterine system (LNG-IUS) with those of systemic progestogen in perimenopausal and postmenopausal women taking systemic estrogen therapy (ET). METHODS We searched Medline (August 8, 2009), Embase (August 8, 2009), the Cochrane Central Register of Controlled Trials on the Cochrane Library Issue 3 (2009), the MetaRegister of Controlled Trials, and the reference lists of articles for relevant trials. Randomized controlled studies of LNG-IUS versus systemic progestogen in perimenopausal and postmenopausal women taking ET were included in the review. Two reviewers abstracted the trials independently. Any disagreement was resolved through discussion with the third reviewer. For dichotomous outcomes, a Peto odds ratio was calculated. For continuous outcomes, nonskewed data from valid scales were synthesized using a weighted mean difference or a standardized mean difference. RESULTS Six trials with a total of 518 participants were included. The methodological limitation was an attrition bias. In perimenopausal and postmenopausal women taking ET, the incidence of a proliferative endometrium was comparable between the use of systemic progestogen and LNG-IUS, except for sequential medroxyprogesterone acetate, which had a higher incidence of proliferative endometrium. Descriptive data synthesis showed that ET combined with either LNG-IUS or systemic progestogen effectively relieved climacteric symptoms. Vaginal bleeding and spotting were common in the LNG-IUS group for the first 3 to 6 months of use. The discontinuation rate was not different. There was insufficient evidence to draw any conclusions about the other outcomes. CONCLUSIONS The LNG-IUS was more effective than sequential medroxyprogesterone acetate but was comparable with other systemic progestogen regimens for endometrial protection in perimenopausal and postmenopausal women taking ET.
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Cochrane RA, Gebbie AE, Loudon JC. Contraception in obese older women. Maturitas 2012; 71:240-7. [PMID: 22240491 DOI: 10.1016/j.maturitas.2011.12.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Accepted: 12/09/2011] [Indexed: 11/26/2022]
Abstract
Obesity is increasing in most western countries and rises significantly with age. Obese women are as sexually active as women of normal weight, and new sexual relationships in the older reproductive years are becoming more commonplace and still require effective contraception. Continuation of pregnancy in a woman over 40 carries health risks which are exacerbated by the presence of obesity. A high proportion of pregnancies in women over 40 are unplanned and end in therapeutic abortion. The prevalence of obesity and the high rates of contraceptive use amongst older women mean that any increase in associated risk is likely to be of public health concern. There are very few data on the specific risks of contraceptive use in obese older women. As fertility declines with age, all methods become increasingly effective. No single method is contraindicated by age alone but particular caution is required where the use of estrogen containing preparations is considered as the risks associated with estrogen are all also independently associated with increasing age and body mass index. Non-estrogen containing methods are available, whether hormonal, barrier or surgical, which are effective, acceptable and safer in the obese older woman. Some methods of contraception may indeed have particular non-contraceptive benefits for this population.
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Affiliation(s)
- Rosemary A Cochrane
- NHS Lothian Sexual and Reproductive Health Service, Chalmers Centre for Sexual Health, Edinburgh, UK.
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Jaakkola S, Pukkala E, K.Lyytinen H, Ylikorkala O. Postmenopausal estradiol-progestagen therapy and risk for uterine cervical cancer. Int J Cancer 2011; 131:E537-43. [DOI: 10.1002/ijc.27321] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Accepted: 10/10/2011] [Indexed: 11/08/2022]
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GEMZELL-DANIELSSON KRISTINA, INKI PIRJO, HEIKINHEIMO OSKARI. Recent developments in the clinical use of the levonorgestrel-releasing intrauterine system. Acta Obstet Gynecol Scand 2011; 90:1177-88. [DOI: 10.1111/j.1600-0412.2011.01256.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Phipps AI, Doherty JA, Voigt LF, Hill DA, Beresford SAA, Rossing MA, Chen C, Weiss NS. Long-term use of continuous-combined estrogen-progestin hormone therapy and risk of endometrial cancer. Cancer Causes Control 2011; 22:1639-46. [PMID: 21909949 DOI: 10.1007/s10552-011-9840-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Accepted: 08/30/2011] [Indexed: 10/17/2022]
Abstract
The daily administered dose of progestin in continuous-combined estrogen-progestin therapy is provided to counteract the proliferative effect of estrogen on the postmenopausal endometrium. However, there remains some uncertainty as to whether use of such a combined regimen, over the long term, is associated with an altered risk of endometrial cancer. We pooled data from four population-based case-control studies of endometrial cancer in western Washington State. Cases, ages 45-74, were diagnosed between 1985 and 2005. Using logistic regression with the adjustment for confounding factors, women who had exclusively used continuous-combined estrogen-progestin therapy (90 endometrial cancer cases, 227 controls) were compared with women who had never used any type of hormone therapy (774 cases, 1,116 controls). Associations with duration and recency of use were evaluated overall and within strata defined by body mass index. Long-term use of continuous-combined estrogen-progestin therapy (≥10 years) was associated with a reduced risk of endometrial cancer (OR = 0.37, 95% CI: 0.21-0.66). This association was most pronounced in women with a body mass index ≥30 kg/m(2) (OR = 0.19, 95% CI: 0.05-0.68). Associations did not differ according to recency of use. These results suggest that long duration of use of continuous-combined estrogen-progestin therapy is associated with a reduced risk of endometrial cancer.
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Affiliation(s)
- Amanda I Phipps
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., Seattle, WA 98109, USA.
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