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Ji M, Weng S, Li X, Xiao Q, Tong Y, Zhou Y, Luo T, Liu Z. Revitalizing premature ovarian failure: quercetin counteracts imatinib-induced apoptosis via the PI3K/AKT signaling pathway based on network pharmacology. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2024:10.1007/s00210-024-03293-3. [PMID: 39073414 DOI: 10.1007/s00210-024-03293-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Accepted: 07/08/2024] [Indexed: 07/30/2024]
Abstract
As a commonly used first-line targeted drug, imatinib (Ima) is widely used first-line treatment for cancer patients. Patient survival is significantly prolonged, but Ima can cause premature ovarian failure (POF) and affect fertility. However, the underlying mechanism is unknown, and no effective method can be employed to improve this process. To investigate the effect of quercetin (Que) on Ima-induced POF and the underlying mechanism. The therapeutic impact of Que on Ima-induced POF in mice was clarified via molecular biology experiments and in vivo experiments in animals. To verify the underlying mechanism, network pharmacology was employed to construct a signaling network of Que-Ima-POF-related genes, followed by molecular biology and docking analysis. Network pharmacology analysis identified 38 therapeutic targets of Que in Ima-induced POF. The KEGG pathways of these genes were enriched for the phosphatidylinositol-3-kinase/protein kinase B (PI3K/Akt) signaling pathway. Molecular docking analysis revealed that the epidermal growth factor receptor (EGFR) is a shared target of Que, Ima, and POF and has strong binding affinity. Hematoxylin-eosin (HE) staining and ELISA confirmed that Que can partially restore the ovarian index and function of mice with Ima-induced POF. Western blot, TUNEL, and immunohistochemical staining confirmed that Que promoted the PI3K/Akt signaling pathway and reduced apoptosis in Ima-induced POF mice. Thus, Que could inhibit apoptosis in Ima-induced POF by activating the PI3K/Akt pathway.
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Affiliation(s)
- Min Ji
- Reproductive Medicine Center, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, China
| | - Shiqi Weng
- Reproductive Medicine Center, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, China
| | - Xia Li
- Department of Assisted Reproduction, Maternity and Child Health Hospital of Jiujiang, Jiujiang, Jiangxi, 332000, China
| | - Qin Xiao
- Reproductive Medicine Center, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, China
| | - Yan Tong
- Reproductive Medicine Center, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, China
| | - Yan Zhou
- Reproductive Medicine Center, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, China
| | - Tao Luo
- School of Basic Medical Sciences, Jiangxi Medical College, Nanchang University; Institute of Biomedical Innovation, Jiangxi Medical College, Nanchang University, Nanchang, 330031, China.
| | - Zhaoxia Liu
- Reproductive Medicine Center, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, China.
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Lee HJ, Lee B, Choi H, Lee M, Lee K, Lee TK, Hwang SO, Kim YB. Hormone Replacement Therapy and Risks of Various Cancers in Postmenopausal Women with De Novo or a History of Endometriosis. Cancers (Basel) 2024; 16:809. [PMID: 38398200 PMCID: PMC10886569 DOI: 10.3390/cancers16040809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 02/08/2024] [Accepted: 02/14/2024] [Indexed: 02/25/2024] Open
Abstract
This study examined the impact of hormone replacement therapy (HRT) on the occurrence of various cancers in postmenopausal women with de novo or a history of endometriosis. In the datasets for ten cancers (cervical, uterine, ovarian, breast, colon, gastric, liver, lung, pancreatic, and thyroid), women who received HRT (the HRT group) and those who did not (the control group) were selected by a 1:1 matching with those who met the study criteria. In the dataset for each cancer, the incidence of each cancer was very low (0.2% to 1.5% in the HRT group and 0.2% to 1.3% in the control group). The duration of HRT was 1.3 ± 2.1 years. After adjusting for co-variables, HRT was a significant risk factor for uterine cancer (p < 0.05). However, the risk of liver cancer decreased significantly with duration of HRT (p < 0.05). Moreover, combined estrogen and progesterone decreased the risks of liver and thyroid cancers significantly (p < 0.05), and estrogen alone decreased the risks of breast and lung cancers significantly (p < 0.05). Tibolone was not associated with the risk of any of the cancers assessed. These results can help guide the use of HRT in women with de novo or a history of endometriosis.
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Affiliation(s)
- Hee Joong Lee
- Department of Obstetrics & Gynecology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 11765, Republic of Korea
| | - Banghyun Lee
- Department of Obstetrics and Gynecology, Inha University Hospital, Inha University College of Medicine, Incheon 22332, Republic of Korea
| | - Hangseok Choi
- Medical Science Research Center, Korea University College of Medicine, Seoul 02841, Republic of Korea
| | - Minkyung Lee
- Department of Obstetrics and Gynecology, Inha University Hospital, Inha University College of Medicine, Incheon 22332, Republic of Korea
| | - Kyungjin Lee
- Department of Obstetrics and Gynecology, Inha University Hospital, Inha University College of Medicine, Incheon 22332, Republic of Korea
| | - Tae Kyoung Lee
- Department of Obstetrics and Gynecology, Inha University Hospital, Inha University College of Medicine, Incheon 22332, Republic of Korea
| | - Sung Ook Hwang
- Department of Obstetrics and Gynecology, Inha University Hospital, Inha University College of Medicine, Incheon 22332, Republic of Korea
| | - Yong Beom Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam-si 13620, Republic of Korea
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Liu J, Yang Y, He Y, Feng C, Ou H, Yang J, Chen Y, You F, Shao B, Bao J, Guan X, Chen F, Zhao P. Erxian decoction alleviates cisplatin-induced premature ovarian failure in rats by reducing oxidation levels in ovarian granulosa cells. JOURNAL OF ETHNOPHARMACOLOGY 2023; 304:116046. [PMID: 36567042 DOI: 10.1016/j.jep.2022.116046] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/26/2022] [Accepted: 12/08/2022] [Indexed: 06/17/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANT Erxian Decoction (EXD) has been used empirically for more than 70 years to treat premature ovarian failure (POF), but more research is needed to understand how it works. AIM OF THE RESEARCH The study aims to ascertain both in vivo and in vitro rewards of EXD. MATERIALS AND METHODS EXD is composed of Curculiginis Rhizoma, Epimedii Folium, Morindae Officinalis, Angelicae Sinensis, Anemarrhenae Rhizoma, and Phellodendri Chinensis Cortex. UPLC/MS analysis was used to investigate the components of EXD. Using a POF model created by administering cisplatin to rats intraperitoneally, the pharmacodynamic effects of EXD were investigated. Three dose groups of EXD were garaged into rats: high (15.6 g/kg), medium (7.8 g/kg), and low (3.9 g/kg). By using a vaginal smear, the impact of EXD on the rat estrous cycle was evaluated. An ELISA test was used to measure the anti-Mullerian hormone (AMH), estradiol (E2), follicle-stimulating hormone (FSH), and luteinizing hormone (LH) levels in the serum of rats. By using HE stains, pathological alterations in the ovaries may be seen. MDA and SOD levels in ovarian samples were used to measure the degree of ovarian oxidation. TUNEL labeling of ovarian sections was used to find apoptosis levels. By using ATP, energy production was evaluated. The relative expression of proteins connected to aging and the RAGE pathway was assessed using Western blot. Then, using H2O2, a model of senescent human ovarian granulosa cells (KGN) was created in vitro. The impact of EXD and H2O2 on cellular senescence was discovered using-galactosidase staining. Cell apoptosis levels were found using PI/Hoechest33342. By using DCFH-DA, intracellular ROS was examined. MDA and SOD concentrations were used to measure the degree of cellular oxidation. RAGE-related mRNA and protein expression were evaluated using RT-qPCR and western blotting. RESULTS Using UPLC/MS analysis, 39 chemicals in EXD were found. Rats' estrous cycles were enhanced by EXD, which increased ovarian index and follicle count and reduced the proportion of atretic follicles in the rats. EXD reduced LH and FSH output while restoring AMH and E2 secretion. In ovarian tissues, EXD reduced the amount of apoptosis and MDA while raising SOD activity and ATP levels. The protein levels of p16, p21, p53, and Lamin A/C were among the senescence-related proteins that EXD lowered, along with the levels of RAGE, PI3K, BAX, and CASPASE 3. Anti-apoptotic protein BCL-2 was also raised in the RAGE pathway. Senescence, apoptosis, ROS, and MDA levels in the KGN cells were lowered in vitro by EXD. Additionally, EXD increased the anti-apoptotic potential by changing the expression of CAT, SOD2, and SIRT1. RAGE, BAX, BCL-2, CASPASE 3, and p38 expression levels were altered by EXD, enhancing its anti-apoptotic capability. CONCLUSION EXD boosted the ovary's antioxidant and anti-apoptotic capabilities while enhancing the estrous cycle and hormone output. These findings strongly suggested that EXD may contribute to the alleviation of POF and ovarian granulosa cells senescence.
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Affiliation(s)
- Jiao Liu
- School of Life Sciences, Beijing University of Chinese Medicine, No.11 East Road, North 3rd Ring Road, Beijing, 100029, China
| | - Yang Yang
- School of Life Sciences, Beijing University of Chinese Medicine, No.11 East Road, North 3rd Ring Road, Beijing, 100029, China
| | - Yueshuang He
- School of Life Sciences, Beijing University of Chinese Medicine, No.11 East Road, North 3rd Ring Road, Beijing, 100029, China
| | - Chenran Feng
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, No.11 East Road, North 3rd Ring Road, Beijing, 100029, China
| | - Haosong Ou
- School of Life Sciences, Beijing University of Chinese Medicine, No.11 East Road, North 3rd Ring Road, Beijing, 100029, China
| | - Jiadi Yang
- School of Life Sciences, Beijing University of Chinese Medicine, No.11 East Road, North 3rd Ring Road, Beijing, 100029, China
| | - Yao Chen
- School of Life Sciences, Beijing University of Chinese Medicine, No.11 East Road, North 3rd Ring Road, Beijing, 100029, China
| | - Fengming You
- School of Life Sciences, Beijing University of Chinese Medicine, No.11 East Road, North 3rd Ring Road, Beijing, 100029, China
| | - Binghao Shao
- School of Life Sciences, Beijing University of Chinese Medicine, No.11 East Road, North 3rd Ring Road, Beijing, 100029, China
| | - Jirong Bao
- School of Life Sciences, Beijing University of Chinese Medicine, No.11 East Road, North 3rd Ring Road, Beijing, 100029, China
| | - Xingyu Guan
- School of Life Sciences, Beijing University of Chinese Medicine, No.11 East Road, North 3rd Ring Road, Beijing, 100029, China
| | - Fangfang Chen
- School of Life Sciences, Beijing University of Chinese Medicine, No.11 East Road, North 3rd Ring Road, Beijing, 100029, China
| | - Piwen Zhao
- School of Life Sciences, Beijing University of Chinese Medicine, No.11 East Road, North 3rd Ring Road, Beijing, 100029, China.
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Medgyesi DN, Trabert B, Fisher JA, Xiao Q, James P, White AJ, Madrigal JM, Jones RR. Outdoor light at night and risk of endometrial cancer in the NIH-AARP diet and health study. Cancer Causes Control 2023; 34:181-187. [PMID: 36222982 DOI: 10.1007/s10552-022-01632-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 09/15/2022] [Indexed: 01/28/2023]
Abstract
PURPOSE Outdoor light at night (LAN) can result in circadian disruption and hormone dysregulation and is a suspected risk factor for some cancers. Our study is the first to evaluate the association between LAN and risk of endometrial cancer, a malignancy with known relationship to circulating estrogen levels. METHODS We linked enrollment addresses (1996) for 97,677 postmenopausal women in the prospective NIH-AARP cohort to satellite imagery of nighttime radiance to estimate LAN exposure. Multivariable Cox models estimated hazard ratios (HR) and 95% confidence intervals (95% CI) for LAN quintiles and incident endometrial cancer overall (1,669 cases) and endometrioid adenocarcinomas (991 cases) through follow-up (2011). We tested for interaction with established endometrial cancer risk factors. RESULTS We observed no association for endometrial cancer overall (HRQ1vsQ5 0.92; 95% CI 0.78-1.08; p trend = 0.67) or endometrioid adenocarcinoma (HRQ1vsQ5 1.01; 95% CI 0.82-1.24; p trend = 0.36). Although body mass index and menopause hormone therapy were both associated with risk, there was no evidence of interaction with LAN (p interactions = 0.52 and 0.50, respectively). CONCLUSION Our study did not find an association between outdoor LAN and endometrial cancer risk, but was limited by the inability to account for individual-level exposure determinants. Future studies should consider approaches to improve characterization of personal exposures to light.
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Affiliation(s)
- Danielle N Medgyesi
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Britton Trabert
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Jared A Fisher
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Qian Xiao
- Department of Epidemiology, Human Genetics, and Environmental Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Peter James
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA.,Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Alexandra J White
- Epidemiology Branch, National Institute of Environmental Health Sciences, Durham, NC, USA
| | - Jessica M Madrigal
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Rena R Jones
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA. .,Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, Room 6E606, Rockville, MD, 20850, USA.
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Zorrilla Veloz RI, McKenzie T, Palacios BE, Hu J. Nuclear hormone receptors in demyelinating diseases. J Neuroendocrinol 2022; 34:e13171. [PMID: 35734821 PMCID: PMC9339486 DOI: 10.1111/jne.13171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 04/20/2022] [Accepted: 05/27/2022] [Indexed: 11/28/2022]
Abstract
Demyelination results from the pathological loss of myelin and is a hallmark of many neurodegenerative diseases. Despite the prevalence of demyelinating diseases, there are no disease modifying therapies that prevent the loss of myelin or promote remyelination. This review aims to summarize studies in the field that highlight the importance of nuclear hormone receptors in the promotion and maintenance of myelination and the relevance of nuclear hormone receptors as potential therapeutic targets for demyelinating diseases. These nuclear hormone receptors include the estrogen receptor, progesterone receptor, androgen receptor, vitamin D receptor, thyroid hormone receptor, peroxisome proliferator-activated receptor, liver X receptor, and retinoid X receptor. Pre-clinical studies in well-established animal models of demyelination have shown a prominent role of these nuclear hormone receptors in myelination through their promotion of oligodendrocyte maturation and development. The activation of the nuclear hormone receptors by their ligands also promotes the synthesis of myelin proteins and lipids in mouse models of demyelination. There are limited clinical studies that focus on how the activation of these nuclear hormone receptors could alleviate demyelination in patients with diseases such as multiple sclerosis (MS). However, the completed clinical trials have reported improved clinical outcome in MS patients treated with the ligands of some of these nuclear hormone receptors. Together, the positive results from both clinical and pre-clinical studies point to nuclear hormone receptors as promising therapeutic targets to counter demyelination.
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Affiliation(s)
- Rocío I Zorrilla Veloz
- Department of Cancer Biology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Cancer Biology Program, The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA
| | - Takese McKenzie
- Department of Cancer Biology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Neuroscience Program, The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA
| | - Bridgitte E Palacios
- Department of Cancer Biology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Cancer Biology Program, The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA
- Neuroscience Program, The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA
| | - Jian Hu
- Department of Cancer Biology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Cancer Biology Program, The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA
- Neuroscience Program, The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA
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7
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Trémollieres FA, Chabbert-Buffet N, Plu-Bureau G, Rousset-Jablonski C, Lecerf JM, Duclos M, Pouilles JM, Gosset A, Boutet G, Hocke C, Maris E, Hugon-Rodin J, Maitrot-Mantelet L, Robin G, André G, Hamdaoui N, Mathelin C, Lopes P, Graesslin O, Fritel X. Management of postmenopausal women: Collège National des Gynécologues et Obstétriciens Français (CNGOF) and Groupe d'Etude sur la Ménopause et le Vieillissement (GEMVi) Clinical Practice Guidelines. Maturitas 2022; 163:62-81. [PMID: 35717745 DOI: 10.1016/j.maturitas.2022.05.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 03/23/2022] [Accepted: 05/17/2022] [Indexed: 12/26/2022]
Abstract
AIM The aim of these recommendations is to set forth an individualized approach to the management of early postmenopausal women (i.e., within the first 10 years after natural menopause) covering all aspects of lifestyle and therapeutic management, with or without menopause hormone therapy (MHT). MATERIALS AND METHODS Literature review and consensus of French expert opinion. Recommendations were graded according to the HAS methodology and levels of evidence derived from the international literature, except when there was no good-quality evidence. SUMMARY RECOMMENDATIONS The beginning of menopause is an ideal time for each woman to evaluate her health status by assessing her bone, cardiovascular, and cancer-related risk factors that may be amplified by postmenopausal estrogen deficiency and by reviewing her lifestyle habits. Improving lifestyle, including nutrition and physical activity, and avoiding risk factors (notably smoking), should be recommended to all women. MHT remains the most effective treatment for vasomotor symptoms but it could be also recommended as first-line treatment for the prevention of osteoporosis in early postmenopausal women at low to moderate risk for fracture. The risks of MHT differ depending on its type, dose, duration of use, route of administration, timing of initiation, and whether a progestogen is used. There is reasonable evidence that using transdermal estradiol in association with micronized progesterone or dydrogesterone may limit both the venous thromboembolic risk associated with oral estrogens and the risk of breast cancer associated with synthetic progestins. Treatment should be individualized to each woman, by using the best available evidence to maximize benefits and minimize risks, with periodic reevaluation of its benefit-risk balance. For bothersome genitourinary syndrome of menopause (GSM) symptoms, vaginal treatment with lubricants and moisturizers is recommended as first-line treatment together with low-dose vaginal estrogen therapy, depending on the clinical course. No recommendation of an optimal duration of MHT can be made, but it must take into consideration the initial indication for MHT as well as each woman's benefit-risk balance. Management of gynecological side-effects of MHT is also examined. These recommendations are endorsed by the Groupe d'Etude sur la Ménopause et le Vieillissement hormonal (GEMVI) and the Collège National des Gynécologues-Obstétriciens Français (CNGOF).
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Affiliation(s)
- F A Trémollieres
- Centre de Ménopause et Maladies Osseuses Métaboliques, Hôpital Paule-de-Viguier, CHU Toulouse, 330, avenue de Grande-Bretagne, TSA 70034, 31059 Toulouse, France; Inserm U1048-I2MC-Equipe 9, Université Toulouse III Paul-Sabatier, 1, avenue du Professeur-Jean-Poulhes, BP 84225, 31432 Toulouse cedex 4, France.
| | - N Chabbert-Buffet
- Service de gynécologie obstétrique, médecine de la reproduction, APHP Sorbonne Universitaire, Site Tenon, 4, rue de la Chine, 75020 Paris, France
| | - G Plu-Bureau
- Unité de gynécologie médicale, Hôpital Port-Royal, 123 boulevard de Port-Royal, 75014 Paris, France; Université de Paris, Paris, France; Inserm U1153 Equipe EPOPEE, Paris, France
| | - C Rousset-Jablonski
- Département de chirurgie oncologique, Centre Léon Bérard, 28, Promenade Léa-et-Napoléon-Bullukian, 69008 Lyon, France; Département d'obstétrique et gynécologie, Hospices Civils de Lyon, CHU Lyon Sud, 165, Chemin du Grand-Revoyet, 69310 Pierre-Bénite, France; Université Lyon, EA 7425 HESPER-Health Services and Performance Research, 8, avenue Rockefeller, 69003 Lyon, France
| | - J M Lecerf
- Service de nutrition et activité physique, Institut Pasteur de Lille, 1, rue du Professeur-Calmette, 59019 Lille cedex, France; Service de médecine interne, CHRU Lille, 2, avenue Oscar-Lambret, 59000 Lille, France
| | - M Duclos
- Service de médecine du sport et des explorations fonctionnelles, CHU Clermont-Ferrand, 63003 Clermont-Ferrand, France; Clermont Université, Université d'Auvergne, UFR Médecine, BP 10448, 63000 Clermont-Ferrand, France; INRAE, UMR 1019, UNH, CRNH Auvergne, 63000 Clermont-Ferrand, France
| | - J M Pouilles
- Centre de Ménopause et Maladies Osseuses Métaboliques, Hôpital Paule-de-Viguier, CHU Toulouse, 330, avenue de Grande-Bretagne, TSA 70034, 31059 Toulouse, France
| | - A Gosset
- Centre de Ménopause et Maladies Osseuses Métaboliques, Hôpital Paule-de-Viguier, CHU Toulouse, 330, avenue de Grande-Bretagne, TSA 70034, 31059 Toulouse, France
| | - G Boutet
- AGREGA, Service de chirurgie gynécologique et médecine de la reproduction, Centre Aliénor d'Aquitaine, Hôpital Pellegrin, 33000 Bordeaux, France
| | - C Hocke
- Service de chirurgie gynécologique et médecine de la reproduction, Centre Aliénor d'Aquitaine, CHU de Bordeaux, Place Amélie-Raba-Léon, 33076 Bordeaux cedex, France
| | - E Maris
- Département d'obstétrique et gynécologie, CHU Montpellier, Université Montpellier, Montpellier, France
| | - J Hugon-Rodin
- Unité de gynécologie médicale, Hôpital Port-Royal, 123 boulevard de Port-Royal, 75014 Paris, France
| | - L Maitrot-Mantelet
- Unité de gynécologie médicale, Hôpital Port-Royal, 123 boulevard de Port-Royal, 75014 Paris, France
| | - G Robin
- Service de gynécologie médicale, orthogénie et sexologie, UF de gynécologie endocrinienne, Hôpital Jeanne-de-Flandre, CHU de Lille, avenue Eugène-Avinée, 59037 Lille cedex, France
| | - G André
- 15, boulevard Ohmacht, 67000 Strasbourg, France
| | - N Hamdaoui
- Centre Hospitalier Universitaire Nord, Assistance publique-Hôpitaux de Marseille, Chemin des Bourrely, 13015 Marseille, France
| | - C Mathelin
- Institut de cancérologie Strasbourg Europe, 17, rue Albert-Calmette, 67200 Strasbourg, France; Hôpitaux Universitaires de Strasbourg, 1 avenue Molière, 67200 Strasbourg, France; Institut de génétique et de biologie moléculaire et cellulaire (IGBMC), CNRS UMR7104 Inserm U964, 1, rue Laurent-Fries, 67400 Illkirch-Graffenstaden, France
| | - P Lopes
- Nantes, France Polyclinique de l'Atlantique Saint Herblain, 44819 St Herblain, France; Université ́de Nantes, 44093 Nantes cedex, France
| | - O Graesslin
- Département de gynécologie-obstétrique, Institut Mère-Enfant Alix de Champagne, Centre Hospitalier Universitaire, 45, rue Cognacq-Jay, 51092 Reims cedex, France
| | - X Fritel
- Service de gynécologie-obstétrique et médecine de la reproduction, CHU de Poitiers, 2, rue de la Milétrie, 86000 Poitiers, France
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Xue W, Xue F, Jia T, Hao A. Research and experimental verification of the molecular mechanism of berberine in improving premature ovarian failure based on network pharmacology. Bioengineered 2022; 13:9885-9900. [PMID: 35420511 PMCID: PMC9161839 DOI: 10.1080/21655979.2022.2062104] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Based on the research methods of network pharmacology, this study analyzed the improvement effect of berberine (BBR) on premature ovarian failure (POF) and its molecular mechanism. Carry out GO and KEGG enrichment analysis by R language to obtain the potential targets and pathways of BBR in the improvement of POF. Use SD rats and ovarian granulosa cells (GCs) for experimental verification. ELISA was used to measure the content of related hormones in the serum, CCK-8 was used to measure cell viability, western blot was used to measure the content of the target protein in the ovaries and GCs, and q-RT-PCR was used to detect the expression of the target genes in the ovaries and GCs. Predicted by network pharmacology: PTEN, AKT1, FoxO1, FasL, and Bim are the targets with the highest relative correlation between BBR and POF. The results of experiments show that the treatment of low and medium doses of BBR can increase the ovarian index of rats; BBR can increase the levels of Estradiol (E2) and Anti-Mullerian hormone (AMH) in the serum of rats and reduce the levels of Follicle stimulating hormone (FSH) and Luteinizing hormone (LH). BBR can increase the cell viability of GCs; BBR can inhibit the PTEN/AKT1/FoxO1 signaling pathway and its phosphorylation level and reduce the expression of Fas/FasL and Bim mRNA. Overall, BBR can promote the ovarian to maintain normal hormone levels, protect GCs, and enhance the function of POF.
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Affiliation(s)
- Wu Xue
- Graduate School, Jinzhou Medical University, Jinzhou, Liaoning, China.,Key Laboratory of Follicular Development and Reproductive Health of Liaoning Province, Jinzhou Medical University, Jinzhou, Liaoning Province, China
| | - Fan Xue
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning, China
| | - Tao Jia
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning, China
| | - Ai Hao
- Graduate School, Jinzhou Medical University, Jinzhou, Liaoning, China.,Key Laboratory of Follicular Development and Reproductive Health of Liaoning Province, Jinzhou Medical University, Jinzhou, Liaoning Province, China.,Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning, China
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Li S, Chen H, Zhang T, Li R, Yin X, Man J, He Q, Yang X, Lu M. Spatiotemporal trends in burden of uterine cancer and its attribution to body mass index in 204 countries and territories from 1990 to 2019. Cancer Med 2022; 11:2467-2481. [PMID: 35156336 PMCID: PMC9189473 DOI: 10.1002/cam4.4608] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 01/08/2022] [Accepted: 01/16/2022] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Uterine cancer is one of the most common female cancers worldwide, with huge heterogeneity in morbidity and mortality. Although a high body-mass index (BMI) has been linked to uterine cancer, systematic reports about the influence of high BMI and its temporal trends are scarce. METHODS The annual morbidity, mortality, and disability-adjusted life years (DALYs) of uterine cancer in 204 countries or territories were retrieved from the GBD 2019 study. To reflect trends in disease burden, we also calculated the estimated annual percentage change (EAPC) based on the age-standardized rates of uterine cancer from 1990 to 2019. RESULTS The global incident cases of uterine cancer increased 2.3 times from 187,190 in 1990 to 435,040 in 2019. Although the age-standardized incidence rate (ASIR) of uterine cancer increased worldwide from 8.67/100,000 in 1990 to 9.99/100,000 in 2019, the age-standardized death rate (ASDR) and DALY rate decreased during the same period. High socio-demographic index (SDI) countries tended to have a higher ASIR than developing regions, and their increasing trend in ASIR was also more pronounced. The disease was rare before 40 years old, but its risk rose sharply among women aged 50-70. A high BMI was linked to more than one-third of deaths from uterine cancer in 2019. CONCLUSIONS The incidence in developed areas was significantly higher than in developing areas and also increased much more rapidly. Elderly females, especially those with a high BMI, have a higher risk of uterine cancer. Therefore, more health resources may be needed to curb the rising burden in specific populations.
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Affiliation(s)
- Songbo Li
- Clinical Epidemiology Unit, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Hui Chen
- Clinical Epidemiology Unit, Qilu Hospital of Shandong University, Jinan, Shandong, China.,Clinical Research Center of Shandong University, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Tongchao Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Rongrong Li
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Xiaolin Yin
- Department of Epidemiology and Health Statistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Jinyu Man
- Department of Epidemiology and Health Statistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Qiufeng He
- Department of Epidemiology and Health Statistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Xiaorong Yang
- Clinical Epidemiology Unit, Qilu Hospital of Shandong University, Jinan, Shandong, China.,Clinical Research Center of Shandong University, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Ming Lu
- Clinical Epidemiology Unit, Qilu Hospital of Shandong University, Jinan, Shandong, China.,Clinical Research Center of Shandong University, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.,Department of Epidemiology and Health Statistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
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10
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Liang Y, Jiao H, Qu L, Liu H. Association Between Hormone Replacement Therapy and Development of Endometrial Cancer: Results From a Prospective US Cohort Study. Front Med (Lausanne) 2022; 8:802959. [PMID: 35111783 PMCID: PMC8801732 DOI: 10.3389/fmed.2021.802959] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 12/09/2021] [Indexed: 12/04/2022] Open
Abstract
Although hormone replacement therapy (HRT) use is associated with elevated endometrial cancer(EC) risk, little evidence assesses potential effect-modifiers on HRT-related EC in a long-term follow-up. In this large-scale longitudinal cohort study, we tried to evaluate the association between different HRT types/methods use and risk of EC, and reveal this risk within different body mass index (BMI) groups. In whole cohort, 677 EC occurred during mean 11.6 years follow-up. Cox proportional hazards regression was used to estimate multivariable-adjusted hazards ratios (HRs) and 95% confidence intervals (CIs) with HRT status (never, former, or current) for risk of EC incidence. Current HRT use was not significantly associated with EC risk (HR for current vs. never HRT use: 1.13; 95% CI: 0.92, 1.38) in the whole cohort, but presented a dose-response effect on increased EC risk (HR for >10-year use vs. never HRT use: 1.73; 95% CI: 1.35, 2.21). Moreover, EC risk differed in distinct regimens or subsets (all Pinteraction < 0.05). Estrogen-only use was associated with elevated EC risk (HR for current vs. never HRT use: 1.51; 95% CI: 1.12, 2.04), but women with high BMI (> 30 kg/m2) who currently use estrogen-only harbored decreased EC risk (HR: 0.56; 95% CI: 0.38, 0.82) compared to counterparts without HRT use. Estrogen-only use is associated with increased EC risk, and precise monitoring of EC development for postmenopausal women with long-term HRT use are urgently needed. BMI could serve as an important surrogate to assess this risk.
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Affiliation(s)
- Ying Liang
- Department of Pharmacy, Guangdong Food and Drug Vocational College, Guangzhou, China
| | - Haoyan Jiao
- Department of Pharmacy, Guangdong Food and Drug Vocational College, Guangzhou, China
| | - Lingbo Qu
- Department of Chemistry, Zhengzhou University, Zhengzhou, China
| | - Hao Liu
- Department of Pharmacy, Guangdong Food and Drug Vocational College, Guangzhou, China
- *Correspondence: Hao Liu
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11
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Trabert B, Geczik AM, Bauer DC, Buist DSM, Cauley JA, Falk RT, Gierach GL, Hue TF, Lacey JV, LaCroix AZ, Michels KA, Tice JA, Xu X, Brinton LA, Dallal CM. Association of Endogenous Pregnenolone, Progesterone, and Related Metabolites with Risk of Endometrial and Ovarian Cancers in Postmenopausal Women: The B ∼FIT Cohort. Cancer Epidemiol Biomarkers Prev 2021; 30:2030-2037. [PMID: 34465588 DOI: 10.1158/1055-9965.epi-21-0669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 07/19/2021] [Accepted: 08/24/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Postmenopausal pregnenolone and/or progesterone levels in relation to endometrial and ovarian cancer risks have been infrequently evaluated. To address this, we utilized a sensitive and reliable assay to quantify prediagnostic levels of seven markers related to endogenous hormone metabolism. METHODS Hormones were quantified in baseline serum collected from postmenopausal women in a cohort study nested within the Breast and Bone Follow-up to the Fracture Intervention Trial (B∼FIT). Women using exogenous hormones at baseline (1992-1993) were excluded. Incident endometrial (n = 65) and ovarian (n = 67) cancers were diagnosed during 12 follow-up years and compared with a subcohort of 345 women (no hysterectomy) and 413 women (no oophorectomy), respectively. Cox models with robust variance were used to estimate cancer risk. RESULTS Circulating progesterone levels were not associated with endometrial [tertile (T)3 vs. T1 HR (95% confidence interval): 1.87 (0.85-4.11); P trend = 0.17] or ovarian cancer risk [1.16 (0.58-2.33); 0.73]. Increasing levels of the progesterone-to-estradiol ratio were inversely associated with endometrial cancer risk [T3 vs. T1: 0.29 (0.09-0.95); 0.03]. Increasing levels of 17-hydroxypregnenolone were inversely associated with endometrial cancer risk [0.40 (0.18-0.91); 0.03] and positively associated with ovarian cancer risk [3.11 (1.39-6.93); 0.01]. CONCLUSIONS Using sensitive and reliable assays, this study provides novel data that endogenous progesterone levels are not strongly associated with incident endometrial or ovarian cancer risks. 17-hydroxypregnenolone was positively associated with ovarian cancer and inversely associated with endometrial cancer. IMPACT While our results require replication in large studies, they provide further support of the hormonal etiology of endometrial and ovarian cancers.
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Affiliation(s)
- Britton Trabert
- Division of Cancer Epidemiology and Genetics, NCI, Bethesda, Maryland. .,Department of Obstetrics and Gynecology, University of Utah, and Cancer Control and Population Sciences Research Program, Huntsman Cancer Institute, Salt Lake City, Utah
| | - Ashley M Geczik
- Division of Cancer Epidemiology and Genetics, NCI, Bethesda, Maryland
| | - Doug C Bauer
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California.,Department of Medicine, University of California San Francisco, San Francisco, California
| | - Diana S M Buist
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Jane A Cauley
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Roni T Falk
- Division of Cancer Epidemiology and Genetics, NCI, Bethesda, Maryland
| | | | - Trisha F Hue
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - James V Lacey
- Division of Health Analytics, Department of Computational and Quantitative Medicine, City of Hope, Duarte, California
| | - Andrea Z LaCroix
- Division of Epidemiology, Department of Family and Preventive Medicine, University of California San Diego, San Diego, California
| | - Kara A Michels
- Division of Cancer Epidemiology and Genetics, NCI, Bethesda, Maryland
| | - Jeffrey A Tice
- Department of Medicine, University of California San Francisco, San Francisco, California
| | - Xia Xu
- Leidos Biomedical Research, Inc., Frederick, Maryland
| | - Louise A Brinton
- Division of Cancer Epidemiology and Genetics, NCI, Bethesda, Maryland
| | - Cher M Dallal
- School of Public Health, University of Maryland, College Park, Maryland
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12
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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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13
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Stinton C, Jordan M, Fraser H, Auguste P, Court R, Al-Khudairy L, Madan J, Grammatopoulos D, Taylor-Phillips S. Testing strategies for Lynch syndrome in people with endometrial cancer: systematic reviews and economic evaluation. Health Technol Assess 2021; 25:1-216. [PMID: 34169821 PMCID: PMC8273681 DOI: 10.3310/hta25420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Lynch syndrome is an inherited genetic condition that is associated with an increased risk of certain cancers. The National Institute for Health and Care Excellence has recommended that people with colorectal cancer are tested for Lynch syndrome. Routine testing for Lynch syndrome among people with endometrial cancer is not currently conducted. OBJECTIVES To systematically review the evidence on the test accuracy of immunohistochemistry- and microsatellite instability-based strategies to detect Lynch syndrome among people who have endometrial cancer, and the clinical effectiveness and the cost-effectiveness of testing for Lynch syndrome among people who have been diagnosed with endometrial cancer. DATA SOURCES Searches were conducted in the following databases, from inception to August 2019 - MEDLINE ALL, EMBASE (both via Ovid), Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials (both via Wiley Online Library), Database of Abstracts of Reviews of Effects, Health Technology Assessment Database (both via the Centre for Reviews and Dissemination), Science Citation Index, Conference Proceedings Citation Index - Science (both via Web of Science), PROSPERO international prospective register of systematic reviews (via the Centre for Reviews and Dissemination), NHS Economic Evaluation Database, Cost-Effectiveness Analysis Registry, EconPapers (Research Papers in Economics) and School of Health and Related Research Health Utilities Database. The references of included studies and relevant systematic reviews were also checked and experts on the team were consulted. REVIEW METHODS Eligible studies included people with endometrial cancer who were tested for Lynch syndrome using immunohistochemistry- and/or microsatellite instability-based testing [with or without mutL homologue 1 (MLH1) promoter hypermethylation testing], with Lynch syndrome diagnosis being established though germline testing of normal (non-tumour) tissue for constitutional mutations in mismatch repair. The risk of bias in studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool, the Consolidated Health Economic Reporting Standards and the Philips' checklist. Two reviewers independently conducted each stage of the review. A meta-analysis of test accuracy was not possible because of the number and heterogeneity of studies. A narrative summary of test accuracy results was provided, reporting test accuracy estimates and presenting forest plots. The economic model constituted a decision tree followed by Markov models for the impact of colorectal and endometrial surveillance, and aspirin prophylaxis with a lifetime time horizon. RESULTS The clinical effectiveness search identified 3308 studies; 38 studies of test accuracy were included. (No studies of clinical effectiveness of endometrial cancer surveillance met the inclusion criteria.) Four test accuracy studies compared microsatellite instability with immunohistochemistry. No clear difference in accuracy between immunohistochemistry and microsatellite instability was observed. There was some evidence that specificity of immunohistochemistry could be improved with the addition of methylation testing. There was high concordance between immunohistochemistry and microsatellite instability. The economic model indicated that all testing strategies, compared with no testing, were cost-effective at a willingness-to-pay threshold of £20,000 per quality-adjusted life-year. Immunohistochemistry with MLH1 promoter hypermethylation testing was the most cost-effective strategy, with an incremental cost-effectiveness ratio of £9420 per quality-adjusted life-year. The second most cost-effective strategy was immunohistochemistry testing alone, but incremental analysis produced an incremental cost-effectiveness ratio exceeding £130,000. Results were robust across all scenario analyses. Incremental cost-effectiveness ratios ranged from £5690 to £20,740; only removing the benefits of colorectal cancer surveillance produced an incremental cost-effectiveness ratio in excess of the £20,000 willingness-to-pay threshold. A sensitivity analysis identified the main cost drivers of the incremental cost-effectiveness ratio as percentage of relatives accepting counselling and prevalence of Lynch syndrome in the population. A probabilistic sensitivity analysis showed, at a willingness-to-pay threshold of £20,000 per quality-adjusted life-year, a 0.93 probability that immunohistochemistry with MLH1 promoter hypermethylation testing is cost-effective, compared with no testing. LIMITATIONS The systematic review excluded grey literature, studies written in non-English languages and studies for which the reference standard could not be established. Studies were included when Lynch syndrome was diagnosed by genetic confirmation of constitutional variants in the four mismatch repair genes (i.e. MLH1, mutS homologue 2, mutS homologue 6 and postmeiotic segregation increased 2). Variants of uncertain significance were reported as per the studies. There were limitations in the economic model around uncertainty in the model parameters and a lack of modelling of the potential harms of gynaecological surveillance and specific pathway modelling of genetic testing for somatic mismatch repair mutations. CONCLUSION The economic model suggests that testing women with endometrial cancer for Lynch syndrome is cost-effective, but that results should be treated with caution because of uncertain model inputs. FUTURE WORK Randomised controlled trials could provide evidence on the effect of earlier intervention on outcomes and the balance of benefits and harms of gynaecological cancer surveillance. Follow-up of negative cases through disease registers could be used to determine false negative cases. STUDY REGISTRATION This study is registered as PROSPERO CRD42019147185. FUNDING This project was funded by the National Institute for Health Research (NIHR) Evidence Synthesis programme and will be published in full in Health Technology Assessment; Vol. 25, No. 42. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Chris Stinton
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Mary Jordan
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Hannah Fraser
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Peter Auguste
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Rachel Court
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Jason Madan
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Dimitris Grammatopoulos
- Institute of Precision Diagnostics and Translational Medicine, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
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14
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Yang M, Ma F, Guan M. Role of Steroid Hormones in the Pathogenesis of Nonalcoholic Fatty Liver Disease. Metabolites 2021; 11:metabo11050320. [PMID: 34067649 PMCID: PMC8156407 DOI: 10.3390/metabo11050320] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/10/2021] [Accepted: 05/12/2021] [Indexed: 01/10/2023] Open
Abstract
Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease and may progress to cirrhosis or even hepatocellular carcinoma. A number of steroid hormones are important regulators of lipid homeostasis through fine tuning the expression of genes related to lipid synthesis, export, and metabolism. Dysregulation of such pathways has been implicated in the pathogenesis of NAFLD. The aim of this review is to clarify the potential impact of steroid hormones on NAFLD. We also highlight potential interventions through modulating steroid hormone levels or the activities of their cognate receptors as therapeutic strategies for preventing NAFLD.
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Affiliation(s)
- Meng Yang
- Guangdong Provincial Key Laboratory of Medical Molecular Diagnostics, Institute of Biochemistry and Molecular Biology, Institute of Aging Research, Guangdong Medical University, Dongguan 523808, China;
- Center for Human Tissues and Organs Degeneration, Institute of Biomedicine and Biotechnology, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China;
| | - Feng Ma
- Center for Human Tissues and Organs Degeneration, Institute of Biomedicine and Biotechnology, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China;
| | - Min Guan
- Center for Human Tissues and Organs Degeneration, Institute of Biomedicine and Biotechnology, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China;
- Correspondence: ; Tel.: +86-755-86585232
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15
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Gosset A, Robin G, Letombe B, Pouillès JM, Trémollieres F. [Menopause hormone treatment in practice. Postmenopausal women management: CNGOF and GEMVi clinical practice guidelines]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2021; 49:358-372. [PMID: 33757922 DOI: 10.1016/j.gofs.2021.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Menopause Hormonal Treatment (MHT) was initially developed to correct the climacteric symptoms induced by postmenopausal estrogen deficiency. In non-hysterectomized women, MHT combines estrogens and a progestogen, the latter opposing the negative impact of estrogen on endometrial proliferation. In France, and contrary to the USA and Northern European countries, MHT mainly combines 17β-estradiol, which is the physiological estrogen produced by the ovary, and progesterone or its derivative, dihydrogesterone. France has been a pioneer in the development of cutaneous administration routes (gel or transdermal patch) for estradiol, allowing better metabolic tolerance and a reduction of the risk of venous thromboembolism compared to the oral route. The choice of the doses as well as the treatment regimen is underpinned by tolerance as well as acceptance and compliance. The risk of breast cancer, which is one of the main risks of MHT, is higher with estro-progestogen combinations than with estrogens alone ; the preferential use of progesterone or dihydrogesterone being likely to limit the excess risk of breast cancer associated with MHT at least for duration of treatment of less than 5 to 7 years. The question of the optimal duration of MHT remains an issue and must take into account the initial indication of treatment as well as the benefit-risk balance, which is specific to each woman. Continuation of MHT is conditioned by the benefit-risk balance, which must be evaluated regularly, but also by the evolution of symptoms when MHT is stopped as well as menopause-related health risks or induced by MHT. After stopping MHT, it is necessary to maintain a medical follow-up to be adapted to the clinical situation of each woman and in particular, her cardiovascular and gynecological risk factors.
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Affiliation(s)
- A Gosset
- Centre de ménopause et maladies osseuses métaboliques, hôpital Paule-de-Viguier, CHU de Toulouse, 330, avenue de Grande-Bretagne, TSA 70034, 31059 Toulouse cedex 9, France
| | - G Robin
- Service de gynécologie médicale, orthogénie et sexologie-UF de gynécologie endocrinienne, CHU Jeanne-de-Flandres, Lille, France
| | - B Letombe
- Service de gynécologie médicale, orthogénie et sexologie-UF de gynécologie endocrinienne, CHU Jeanne-de-Flandres, Lille, France
| | - J-M Pouillès
- Centre de ménopause et maladies osseuses métaboliques, hôpital Paule-de-Viguier, CHU de Toulouse, 330, avenue de Grande-Bretagne, TSA 70034, 31059 Toulouse cedex 9, France
| | - F Trémollieres
- Centre de ménopause et maladies osseuses métaboliques, hôpital Paule-de-Viguier, CHU de Toulouse, 330, avenue de Grande-Bretagne, TSA 70034, 31059 Toulouse cedex 9, France; Inserm U1048-I2MC-équipe 9, université Toulouse III Paul-Sabatier, Toulouse, France.
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16
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Poudou C, Baffet H, Nadeau C, Rolland AL, Catteau-Jonard S, Robin G. [Benefit-risk balance of hormone replacement therapy: Cancers and mortality. Postmenopausal women management - CNGOF and GEMVi clinical practice guidelines]. ACTA ACUST UNITED AC 2021; 49:462-473. [PMID: 33771739 DOI: 10.1016/j.gofs.2021.03.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The use of hormone replacement therapy (HRT) for menopausal women has been the subject of much controversy in recent years, particularly concerning the carcinologic risks. The purpose of this review is to evaluate the impact of the use of HRT on the risk of gynecological but also extra-gynecological cancers. The effect of the type and the duration of use of HRT in menopausal women will also be discussed. The beneficial impact of HRT on overall mortality is also an element that will be discussed and must be taken into account when evaluating the benefit-risk balance of HRT for menopausal women.
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Affiliation(s)
- C Poudou
- Service gynécologie obstétrique et médecine de la reproduction, CHU de Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France
| | - H Baffet
- Service de gynécologie médicale, orthogénie et sexologie, hôpital Jeanne-de-Flandre, CHU de Lille, avenue Eugène-Avinée, 59073 Lille cedex, France; Service d'assistance médicale à la procréation et préservation de la fertilité, CHU de Lille, avenue Eugène-Avinée, 59037 Lille cedex, France
| | - C Nadeau
- Service gynécologie obstétrique et médecine de la reproduction, CHU de Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France
| | - A-L Rolland
- Service de gynécologie médicale, orthogénie et sexologie, hôpital Jeanne-de-Flandre, CHU de Lille, avenue Eugène-Avinée, 59073 Lille cedex, France; Service d'assistance médicale à la procréation et préservation de la fertilité, CHU de Lille, avenue Eugène-Avinée, 59037 Lille cedex, France
| | - S Catteau-Jonard
- Service de gynécologie médicale, orthogénie et sexologie, hôpital Jeanne-de-Flandre, CHU de Lille, avenue Eugène-Avinée, 59073 Lille cedex, France; Faculté de médecine, université de Lille, 2, avenue Eugène-Avinée, 59120 Loos, France
| | - G Robin
- Service de gynécologie médicale, orthogénie et sexologie, hôpital Jeanne-de-Flandre, CHU de Lille, avenue Eugène-Avinée, 59073 Lille cedex, France; Faculté de médecine, université de Lille, 2, avenue Eugène-Avinée, 59120 Loos, France.
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Testing for lynch syndrome in people with endometrial cancer using immunohistochemistry and microsatellite instability-based testing strategies - A systematic review of test accuracy. Gynecol Oncol 2020; 160:148-160. [PMID: 33190932 DOI: 10.1016/j.ygyno.2020.10.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 10/05/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Lynch syndrome is an inherited genetic condition that is associated with an increased risk of cancer, including endometrial and colorectal cancer. We assessed the test accuracy of immunohistochemistry and microsatellite instability-based testing (with or without MLH1 promoter methylation testing) for Lynch syndrome in women with endometrial cancer. METHODS We conducted a systematic review of literature published up to August 2019. We searched bibliographic databases, contacted experts and checked reference lists of relevant studies. Two reviewers conducted each stage of the review. RESULTS Thirteen studies were identified that included approximately 3500 participants. None of the studies was at low risk of bias in all domains. Data could not be pooled due to the small number of heterogeneous studies. Sensitivity ranged from 60.7-100% for immunohistochemistry, 41.7-100% for microsatellite instability-based testing, and 90.5-100% for studies combining immunohistochemistry, microsatellite instability-based testing, and MLH1 promoter methylation testing. Specificity ranged from 60.9-83.3% (excluding 1 study with highly selective inclusion criteria) for immunohistochemistry, 69.2-89.9% for microsatellite instability-based testing, and 72.4-92.3% (excluding 1 study with highly selective inclusion criteria) for testing strategies that included immunohistochemistry, microsatellite instability-based testing, and MLH1 promoter methylation. We found no statistically significant differences in test accuracy estimates (sensitivity, specificity) in head-to-head studies of immunohistochemistry versus microsatellite instability-based testing. Reported test failures were rare. CONCLUSIONS Sensitivity of the index tests were generally high, though most studies had much lower specificity. We found no evidence that test accuracy differed between IHC and MSI based strategies. The evidence base is currently small and at high risk of bias.
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Negative correlation of high serum bilirubin with cancer development in adults without hepatobiliary disease. Eur J Cancer Prev 2020; 30:69-75. [DOI: 10.1097/cej.0000000000000643] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Clarke MA, Long BJ, Sherman ME, Lemens MA, Podratz KC, Hopkins MR, Ahlberg LJ, Mc Guire LJ, Laughlin-Tommaso SK, Bakkum-Gamez JN, Wentzensen N. Risk assessment of endometrial cancer and endometrial intraepithelial neoplasia in women with abnormal bleeding and implications for clinical management algorithms. Am J Obstet Gynecol 2020; 223:549.e1-549.e13. [PMID: 32268124 DOI: 10.1016/j.ajog.2020.03.032] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 03/23/2020] [Accepted: 03/26/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Most endometrial cancer cases are preceded by abnormal uterine bleeding, offering a potential opportunity for early detection and cure of endometrial cancer. Although clinical guidelines exist for diagnostic workup of abnormal uterine bleeding, consensus is lacking regarding optimal management for women with abnormal bleeding to diagnose endometrial cancer. OBJECTIVE We report the baseline data from a prospective clinical cohort study of women referred for endometrial evaluation at the Mayo Clinic, designed to evaluate risk stratification in women at increased risk for endometrial cancer. Here, we introduce a risk-based approach to evaluate diagnostic tests and clinical management algorithms in a population of women with abnormal bleeding undergoing endometrial evaluation at the Mayo Clinic. STUDY DESIGN A total of 1163 women aged ≥45 years were enrolled from February 2013 to May 2019. We evaluated baseline absolute risks and 95% confidence intervals of endometrial cancer and endometrial intraepithelial neoplasia according to clinical algorithms for diagnostic workup of women with postmenopausal bleeding (assessment of initial vs recurrent bleeding episode and endometrial thickness measured through transvaginal ultrasound). We also evaluated risks among women with postmenopausal bleeding according to baseline age (<60 vs 60+ years) as an alternative example. For this approach, biopsy would be conducted for all women aged 60+ years and those aged <60 years with an endometrial thickness of >4 mm. We assessed the clinical efficiency of each strategy by estimating the percentage of women who would be referred for endometrial biopsy, the percentage of cases detected and missed, and the ratio of biopsies per case detected. RESULTS Among the 593 women with postmenopausal bleeding, 18 (3.0%) had endometrial intraepithelial neoplasia, and 47 (7.9%) had endometrial cancer, and among the 570 premenopausal women with abnormal bleeding, 8 (1.4%) had endometrial intraepithelial neoplasia, and 7 (1.2%) had endometrial cancer. Maximum risk was noted in women aged 60+ years (17.7%; 13.0%-22.3%), followed by those with recurrent bleeding (14.7%; 11.0%-18.3%). Among women with an initial bleeding episode for whom transvaginal ultrasound was recommended, endometrial thickness did not provide meaningful risk stratification: risks of endometrial cancer and endometrial intraepithelial neoplasia were nearly identical in women with an endometrial thickness of >4 mm (5.8%; 1.3%-10.3%) and ≤4 mm (3.6%; 0.9%-8.6%). In contrast, among those aged <60 years with an endometrial thickness of >4 mm, the risk of endometrial cancer and endometrial intraepithelial neoplasia was 8.4% (4.3%-12.5%), and in those with an endometrial thickness of ≤4 mm, the risk was 0% (0.0%-3.0%; P=.01). The most efficient strategy was to perform biopsy in all women aged 60+ years and among those aged <60 years with an endometrial thickness of >4 mm, with the lowest percentage referred to biopsy while still detecting all cases. CONCLUSION Existing clinical recommendations for endometrial cancer detection in women with abnormal bleeding are not consistent with the underlying risk. Endometrial cancer risk factors such as age can provide important risk stratification compared with the assessment of recurrent bleeding. Future research will include a formal assessment of clinical and epidemiologic risk prediction models in our study population as well as validation of our findings in other populations.
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Sidorkiewicz I, Jóźwik M, Niemira M, Krętowski A. Insulin Resistance and Endometrial Cancer: Emerging Role for microRNA. Cancers (Basel) 2020; 12:E2559. [PMID: 32911852 PMCID: PMC7563767 DOI: 10.3390/cancers12092559] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 09/03/2020] [Accepted: 09/07/2020] [Indexed: 12/21/2022] Open
Abstract
Endometrial cancer (EC) remains one of the most common cancers of the female reproductive system. Epidemiological and clinical data implicate insulin resistance (IR) and its accompanying hyperinsulinemia as key factors in the development of EC. MicroRNAs (miRNAs) are short molecules of non-coding endogenous RNA that function as post-transcriptional regulators. Accumulating evidence has shown that the miRNA expression pattern is also likely to be associated with EC risk factors. The aim of this work was the verification of the relationships between IR, EC, and miRNA, and, as based on the literature data, elucidation of miRNA's potential utility for EC prevention in IR patients. The pathways affected in IR relate to the insulin receptors, insulin-like growth factors and their receptors, insulin-like growth factor binding proteins, sex hormone-binding globulin, and estrogens. Herein, we present and discuss arguments for miRNAs as a plausible molecular link between IR and EC development. Specifically, our careful literature search indicated that dysregulation of at least 13 miRNAs has been ascribed to both conditions. We conclude that there is a reasonable possibility for miRNAs to become a predictive factor of future EC in IR patients.
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Affiliation(s)
- Iwona Sidorkiewicz
- Clinical Research Centre, Medical University of Białystok, M. Skłodowskiej-Curie 24a, 15-276 Białystok, Poland; (M.N.); (A.K.)
| | - Maciej Jóźwik
- Department of Gynecology and Gynecologic Oncology, Medical University of Białystok, M. Skłodowskiej-Curie 24a, 15-276 Białystok, Poland;
| | - Magdalena Niemira
- Clinical Research Centre, Medical University of Białystok, M. Skłodowskiej-Curie 24a, 15-276 Białystok, Poland; (M.N.); (A.K.)
| | - Adam Krętowski
- Clinical Research Centre, Medical University of Białystok, M. Skłodowskiej-Curie 24a, 15-276 Białystok, Poland; (M.N.); (A.K.)
- Department of Endocrinology, Diabetology and Internal Medicine, Medical University of Białystok, M. Skłodowskiej-Curie 24a, 15-276 Białystok, Poland
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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: 30] [Impact Index Per Article: 7.5] [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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Piperigkou Z, Karamanos NK. Estrogen receptor-mediated targeting of the extracellular matrix network in cancer. Semin Cancer Biol 2020; 62:116-124. [DOI: 10.1016/j.semcancer.2019.07.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 06/21/2019] [Accepted: 07/08/2019] [Indexed: 01/04/2023]
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Abstract
OBJECTIVE The aim of the study was to systematically review studies that evaluated endometrial hyperplasia or cancer incidence with unopposed vaginal estrogens. METHODS PubMed and EMBASE were searched from inception to August 2017 for relevant articles and abstracts. Bibliographies of review articles and abstracts of major women's health medical meetings were examined. Eligible studies (independently reviewed by 4 authors) had to report menopausal vaginal estrogen use and endometrial histology, or incidence of endometrial hyperplasia or cancer. RESULTS Of 5,593 abstracts from the literature search and 47 articles from other sources, 36 articles and 2 abstracts were eligible, describing 20 randomized controlled studies, 8 interventional studies, and 10 observational studies. Collectively, the studies did not support an increased risk of endometrial hyperplasia or cancer with low-dose vaginal estrogens. Rates of endometrial cancer and hyperplasia were 0.03% and 0.4%, respectively, from 20 randomized controlled trials (2,983 women) of vaginal estrogens. Overall, reports of endometrial hyperplasia were observed with various doses and durations and appeared sporadic (except 1.25 mg conjugated equine estrogens), consistent with endometrial hyperplasia rates in the general population. A Denmark registry study was an exception and may be of limited applicability to the United States. The Women's Health Initiative Observational Study showed no association (1.3 cases/1,000 women-years with vaginal estrogens versus 1.0/1,000 women-years for nonuse). CONCLUSION This systematic review supports the use of low-dose vaginal estrogens for treating vulvar and vaginal atrophy in menopausal women without a concomitant progestogen. This review does not support increased endometrial hyperplasia or cancer risk with low-dose, unopposed vaginal estrogens; however, longer-term, real-world data are needed.
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A prospective clinical cohort study of women at increased risk for endometrial cancer. Gynecol Oncol 2019; 156:169-177. [PMID: 31718832 DOI: 10.1016/j.ygyno.2019.09.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 09/07/2019] [Accepted: 09/11/2019] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To evaluate endometrial cancer (EC) risk assessment and early detection strategies in high-risk populations, we designed a large, prospective cohort study of women undergoing endometrial evaluation to assess risk factors and collect novel biospecimens for future testing of emerging EC biomarkers. Here we report on the baseline findings of this study. METHODS Women aged ≥45 years were enrolled at the Mayo Clinic from February 2013-June 2018. Risk factors included age, body mass index (BMI), smoking, oral contraceptive and hormone therapy use, and parity. We collected vaginal tampons, endometrial biopsies, and Tao brush samples. We estimated mutually-adjusted odds ratios (OR) and 95% confidence intervals (CI) using multinomial logistic regression; outcomes included EC, atypical hyperplasia, hyperplasia without atypia, disordered proliferative endometrium, and polyps, versus normal endometrium. RESULTS Subjects included 1205 women with a mean age of 55 years; 55% were postmenopausal, and 90% had abnormal uterine bleeding. The prevalence of EC was 4.1% (n = 49), predominantly diagnosed in postmenopausal women (85.7%). Tampons and Tao brushings were obtained from 99% and 68% of women, respectively. Age (OR 1.14, 95% CI 1.1-1.2) and BMI (OR 1.39, 95% CI 1.1-1.7) were positively associated with EC; atypical hyperplasia (OR 1.07, 95% CI 1.0-1.1; OR 2.00, 95% CI 1.5-2.6, respectively), and polyps (OR 1.06, 95% CI 1.0-1.1; OR 1.17, 95% CI 1.0-1.3, respectively); hormone therapy use and smoking were inversely associated with EC (OR 0.42, 95%, 0.2-0.9; OR 0.43, 95% CI, 0.2-0.9, respectively). Parity and past oral contraception use were not associated with EC. CONCLUSIONS Well-established EC risk factors may have less discriminatory accuracy in high-risk populations. Future analyses will integrate risk factor assessment with biomarker testing for EC detection.
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Trabert B, Coburn SB, Falk RT, Manson JE, Brinton LA, Gass ML, Kuller LH, Rohan TE, Pfeiffer RM, Qi L, Stefanick ML, Wentzensen N, Anderson GL, Xu X. Circulating estrogens and postmenopausal ovarian and endometrial cancer risk among current hormone users in the Women's Health Initiative Observational Study. Cancer Causes Control 2019; 30:1201-1211. [PMID: 31542834 PMCID: PMC6785392 DOI: 10.1007/s10552-019-01233-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 09/11/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE Menopausal hormone therapy (MHT) use induces alterations in circulating estrogens/estrogen metabolites, which may contribute to the altered risk of reproductive tract cancers among current users. Thus, the current study assessed associations between circulating estrogens/estrogen metabolites and ovarian and endometrial cancer risk among MHT users. METHODS We conducted a nested case-control study among postmenopausal women using MHT at baseline in the Women's Health Initiative Observational Study (179 ovarian cancers, 396 controls; 230 endometrial cancers, 253 controls). Multivariable logistic regression was utilized to estimate odds ratios and 95% confidence intervals overall and by subtype. RESULTS Estrogen/estrogen metabolite levels were not associated with overall or serous ovarian cancer risk, examined separately. However, unconjugated estradiol was positively associated with non-serous ovarian cancer risk [quintile 5 vs. quintile 1: 3.01 (1.17-7.73); p-trend = 0.03; p-het < 0.01]. Endometrial cancer risk was unrelated to estrogen/estrogen metabolite levels among women who took combined estrogen/progestin therapy (EPT). CONCLUSIONS These findings provide novel evidence that may support a heterogeneous hormonal etiology across ovarian cancer subtypes. Circulating estrogens did not influence endometrial cancer risk among women with EPT-induced high-estrogen levels. Larger studies are needed to delineate the relationship between ovarian/endometrial cancer subtypes and estrogen levels in the context of MHT use.
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Affiliation(s)
- Britton Trabert
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, Bethesda, MD, 20892-9768, USA.
| | - Sally B Coburn
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, Bethesda, MD, 20892-9768, USA
| | - Roni T Falk
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, Bethesda, MD, 20892-9768, USA
| | - JoAnn E Manson
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Louise A Brinton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, Bethesda, MD, 20892-9768, USA
| | - Margery L Gass
- Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Lewis H Kuller
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Thomas E Rohan
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Ruth M Pfeiffer
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, Bethesda, MD, 20892-9768, USA
| | - Lihong Qi
- Public Health Sciences, School of Medicine, UC Davis, Sacramento, CA, USA
| | - Marcia L Stefanick
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Nicolas Wentzensen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, Bethesda, MD, 20892-9768, USA
| | - Garnet L Anderson
- Division of Public Health Sciences, Cancer Prevention Program, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Xia Xu
- Frederick National Laboratory for Cancer Research, Cancer Research Technology Program, Leidos Biomedical Research, Inc., Frederick, MD, USA
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Keshavarzi Z, Janghorban R, Alipour S, Tahmasebi S, Jokar A. The effect of vitamin D and E vaginal suppositories on tamoxifen-induced vaginal atrophy in women with breast cancer. Support Care Cancer 2019; 27:1325-1334. [PMID: 30729333 DOI: 10.1007/s00520-019-04684-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 01/29/2019] [Indexed: 12/31/2022]
Abstract
PURPOSE Vaginal atrophy is one of the most common side effects of using tamoxifen in women with breast cancer. Hormone therapy for vaginal atrophy is prohibited in these women. The present study was conducted to investigate the effect of vitamin D and E vaginal suppositories on vaginal atrophy in women with breast cancer receiving tamoxifen. METHODS Women under breast cancer management receiving tamoxifen and showing symptoms of vaginal atrophy were randomized triple-blind to an 8-week trial on vaginal suppository vitamin E or vitamin D or placebo administered every night before bedtime. The genitourinary atrophy self-assessment tool was administered, and pH was measured in all three groups before the intervention and at the end of weeks 2, 4, and 8 of the intervention. The Vaginal Maturation Index (VMI) was also measured before the intervention and at the end of the eighth week. Data were analyzed with paired t tests, repeated measures analysis of variance, and chi-square test. RESULTS Thirty-two patients were randomized in each group. The results obtained showed an increase in the VMI by the end of the eighth week of the intervention in the groups receiving the vitamin D and E vaginal suppositories compared with the placebo group (P < 0.001). The vaginal pH also reduced in both groups compared with that in the placebo group (P < 0.001). The symptoms of self-reported genitourinary atrophy also improved in the two intervention groups compared with those in the placebo group by the end of the eighth week (P < 0.001). CONCLUSION These data support that vitamin D and E vaginal suppositories were beneficial in improving vaginal atrophy in women with breast cancer receiving tamoxifen. Given the prohibition on hormone therapy in these women, the suppositories can be used as an alternative therapy to improve these symptoms.
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Affiliation(s)
- Zahra Keshavarzi
- Department of Midwifery, School of Nursing and Midwifery, Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Roksana Janghorban
- Department of Midwifery, School of Nursing and Midwifery, Community Based Psychiatric Care Research Center, Shiraz University of Medical Sciences, Nemazee Square, Zand Blv., Shiraz, 7193613119, Iran.
| | - Shohreh Alipour
- Department of Pharmaceutical Quality Control, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sedigheh Tahmasebi
- Department of Surgery, School of Medicine, Breast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Azam Jokar
- Department of Midwifery, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
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Clarke MA, Long BJ, Del Mar Morillo A, Arbyn M, Bakkum-Gamez JN, Wentzensen N. Association of Endometrial Cancer Risk With Postmenopausal Bleeding in Women: A Systematic Review and Meta-analysis. JAMA Intern Med 2018; 178:1210-1222. [PMID: 30083701 PMCID: PMC6142981 DOI: 10.1001/jamainternmed.2018.2820] [Citation(s) in RCA: 214] [Impact Index Per Article: 35.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
IMPORTANCE As the worldwide burden of endometrial cancer continues to rise, interest is growing in the evaluation of early detection and prevention strategies among women at increased risk. Focusing efforts on women with postmenopausal bleeding (PMB), a common symptom of endometrial cancer, may be a useful strategy; however, PMB is not specific for endometrial cancer and is often caused by benign conditions. OBJECTIVE To provide a reference of the prevalence of PMB in endometrial cancers and the risk of endometrial cancer in women with PMB. DATA SOURCES For this systematic review and meta-analysis, PubMed and Embase were searched for English-language studies published January 1, 1977, through January 31, 2017. STUDY SELECTION Observational studies reporting the prevalence of PMB in women with endometrial cancer and the risk of endometrial cancer in women with PMB in unselected populations were selected. DATA EXTRACTION AND SYNTHESIS Two independent reviewers evaluated study quality and risk of bias using items from the Newcastle-Ottawa Quality Assessment Scale and the Quality Assessment of Diagnostic Accuracy Studies tool. Studies that included highly selected populations, lacked detailed inclusion criteria, and/or included 25 or fewer women were excluded. MAIN OUTCOMES AND MEASURES The pooled prevalence of PMB in women with endometrial cancer and the risk of endometrial cancer in women with PMB. RESULTS A total of 129 unique studies, including 34 432 unique patients with PMB and 6358 with endometrial cancer (40 790 women), were analyzed. The pooled prevalence of PMB among women with endometrial cancer was 91% (95% CI, 87%-93%), irrespective of tumor stage. The pooled risk of endometrial cancer among women with PMB was 9% (95% CI, 8%-11%), with estimates varying by use of hormone therapy (range, 7% [95% CI, 6%-9%] to 12% [95% CI, 9%-15%]; P < .001 for heterogeneity) and geographic region (range, 5% [95% CI, 3%-11%] in North America to 13% [95% CI, 9%-19%] in Western Europe; P = .09 for heterogeneity). CONCLUSIONS AND RELEVANCE Early detection strategies focused on women with PMB have the potential to capture as many as 90% of endometrial cancers; however, most women with PMB will not be diagnosed with endometrial cancer. These results can aid in the assessment of the potential clinical value of new early detection markers and clinical management strategies for endometrial cancer and will help to inform clinical and epidemiologic risk prediction models to support decision making.
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Affiliation(s)
- Megan A Clarke
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Beverly J Long
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota
| | - Arena Del Mar Morillo
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Marc Arbyn
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Sciensano, Brussels, Belgium
| | | | - Nicolas Wentzensen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
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Felix AS, Brinton LA. Cancer Progress and Priorities: Uterine Cancer. Cancer Epidemiol Biomarkers Prev 2018; 27:985-994. [PMID: 30181320 PMCID: PMC6504985 DOI: 10.1158/1055-9965.epi-18-0264] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 04/07/2018] [Accepted: 05/15/2018] [Indexed: 12/27/2022] Open
Affiliation(s)
- Ashley S Felix
- Division of Epidemiology, The Ohio State University College of Public Health, Columbus, Ohio.
| | - Louise A Brinton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
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Changes in Uterine Cancer Incidence Rates in Egypt. Obstet Gynecol Int 2018; 2018:3632067. [PMID: 30013598 PMCID: PMC6022259 DOI: 10.1155/2018/3632067] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 04/11/2018] [Indexed: 01/23/2023] Open
Abstract
Background Uterine cancer is one of the top-ranking cancers in women with wide international variations in incidence rates. Developed countries have higher incidence rates than the developing countries. Egypt has significantly lower incidence of uterine cancer than other countries in the Middle East. This study aimed at verifying the incidence rate of uterine cancer and characterizing the demographic and clinical profiles of patients residing in the Gharbiah province in the Nile delta region of Egypt. Methods Data from 660 uterine cancer patients diagnosed during the period of 1999 to 2010 were abstracted from the Gharbiah Cancer Registry, the only population-based registry in Egypt. The data included age, marital status, number of children, residence, smoking, occupation, date and basis of diagnosis, tumor topography, morphology, stage and grade, and treatment. Crude rate, age-standardized rate (ASR), and age-specific rate were calculated and associated with demographic and clinical characteristics of patients. Results The study confirmed the low ASR of uterine cancer in Egypt, (4.1 per 100,000 (95% CI: 3.8-4.4)). The incidence rate increased significantly over the 12-year period. The crude rate (CR) was 1.95, 95% CI (1.64-2.25) in 1999-2002; 2.9, 95% CI (2.5-3.2) in 2003-2006; and 3.5, 95% CI (3.1-3.9) in 2007-2010. The rate ratio was 1.5, 95% CI (1.2-1.8) in 2003-2006 and 1.8, 95% CI (1.5-2.2) in 2007-2010 compared to 1999-2002. The majority of patients (83%) were postmenopausal with the highest age-specific rate in the 60-69-year age group (22.07 per 100,000 (95% CI: 19.3-25.2). The majority of patients were diagnosed at early stages (60% localized and 5% regional), had adenocarcinoma (68%), and resided in urban areas (54%). Conclusions The study confirmed the low incidence rate of uterine cancer in the Gharbiah province of Egypt and significant increase in incidence in recent years. Future studies should focus on verifying the possible effect of hysterectomy on lowering the incidence, the factors related to the changes in rates between rural and urban areas, and the possible impact of nutritional and epidemiologic transitions on the increasing rates.
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Troisi R, Bjørge T, Gissler M, Grotmol T, Kitahara CM, Sæther SMM, Ording AG, Sköld C, Sørensen HT, Trabert B, Glimelius I. The role of pregnancy, perinatal factors and hormones in maternal cancer risk: a review of the evidence. J Intern Med 2018; 283:430-445. [PMID: 29476569 PMCID: PMC6688839 DOI: 10.1111/joim.12747] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
An understanding of the origin of cancer is critical for cancer prevention and treatment. Complex biological mechanisms promote carcinogenesis, and there is increasing evidence that pregnancy-related exposures influence foetal growth cell division and organ functioning and may have a long-lasting impact on health and disease susceptibility in the mothers and offspring. Nulliparity is an established risk factor for breast, ovarian, endometrial and possibly pancreatic cancer, whilst the risk of kidney cancer is elevated in parous compared with nulliparous women. For breast, endometrial and ovarian cancer, each pregnancy provides an additional risk reduction. The associations of parity with thyroid and colorectal cancers are uncertain. The timing of reproductive events is also recognized to be important. Older age at first birth is associated with an increased risk of breast cancer, and older age at last birth is associated with a reduced risk of endometrial cancer. The risks of breast and endometrial cancers increase with younger age at menarche and older age at menopause. The mechanisms, and hormone profiles, that underlie alterations in maternal cancer risk are not fully understood and may differ by malignancy. Linking health registries and pooling of data in the Nordic countries have provided opportunities to conduct epidemiologic research of pregnancy exposures and subsequent cancer. We review the maternal risk of several malignancies, including those with a well-known hormonal aetiology and those with less established relationships. The tendency for women to have fewer pregnancies and at later ages, together with the age-dependent increase in the incidence of most malignancies, is expected to affect the incidence of pregnancy-associated cancer.
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Affiliation(s)
- Rebecca Troisi
- Division of Cancer Epidemiology and Biostatistics, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA
| | - Tone Bjørge
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Cancer Registry of Norway, Oslo, Norway
| | - Mika Gissler
- Information Services Department, National Institute for Health and Welfare (THL), Helsinki, Finland
- Department of Neurobiology, Care Sciences and Society, Division of Family Medicine, Karolinska Institute, Stockholm, Sweden
| | | | - Cari M. Kitahara
- Division of Cancer Epidemiology and Biostatistics, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA
| | | | - Anne Gulbech Ording
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Camilla Sköld
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Britton Trabert
- Division of Cancer Epidemiology and Biostatistics, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA
| | - Ingrid Glimelius
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
- Department of Medicine, Clinical Epidemiology Unit, Karolinska Institutet Stockholm, Sweden
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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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Chang YS, Huang HD, Yeh KT, Chang JG. Identification of novel mutations in endometrial cancer patients by whole-exome sequencing. Int J Oncol 2017; 50:1778-1784. [PMID: 28339086 DOI: 10.3892/ijo.2017.3919] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 03/07/2017] [Indexed: 11/05/2022] Open
Abstract
The aim of the present study was to identify genomic alterations in Taiwanese endometrial cancer patients. This information is vitally important in Taiwan, where endometrial cancer is the second most common gynecological cancer. We performed whole-exome sequencing on DNA from 14 tumor tissue samples from Taiwanese endometrial cancer patients. We used the Genome Analysis Tool kit software package for data analysis, and the dbSNP, Catalogue of Somatic Mutations in Cancer (COSMIC) and The Cancer Genome Atlas (TCGA) databases for comparisons. Variants were validated via Sanger sequencing. We identified 143 non-synonymous mutations in 756 canonical cancer-related genes and 1,271 non-synonymous mutations in non-canonical cancer-related genes in 14 endometrial samples. PTEN, KRAS and PIK3R1 were the most frequently mutated canonical cancer-related genes. Our results revealed nine potential driver genes (MAPT, IL24, MCM6, TSC1, BIRC2, CIITA, DST, CASP8 and NOTCH2) and 21 potential passenger genes (ARMCX4, IGSF10, VPS13C, DCT, DNAH14, TLN1, ZNF605, ZSCAN29, MOCOS, CMYA5, PCDH17, UGT1A8, CYFIP2, MACF1, NUDT5, JAKMIP1, PCDHGB4, FAM178A, SNX6, IMP4 and PCMTD1). The detected molecular aberrations led to putative activation of the mTOR, Wnt, MAPK, VEGF and ErbB pathways, as well as aberrant DNA repair, cell cycle control and apoptosis pathways. We characterized the mutational landscape and genetic alterations in multiple cellular pathways of endometrial cancer in the Taiwanese population.
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Affiliation(s)
- Ya-Sian Chang
- Epigenome Research Center, China Medical University Hospital, Taichung 404, Taiwan, R.O.C
| | - Hsien-Da Huang
- Department of Biological Science and Technology, National Chiao Tung University, Hsinchu 300, Taiwan, R.O.C
| | - Kun-Tu Yeh
- Department of Pathology, Changhua Christian Hospital, Changhua 500, Taiwan, R.O.C
| | - Jan-Gowth Chang
- Epigenome Research Center, China Medical University Hospital, Taichung 404, Taiwan, R.O.C
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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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Epidemiology of Endometrial Carcinoma: Etiologic Importance of Hormonal and Metabolic Influences. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 943:3-46. [PMID: 27910063 DOI: 10.1007/978-3-319-43139-0_1] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Endometrial carcinoma is the most common gynecologic cancer in developed nations, and the annual incidence is projected to increase, secondary to the high prevalence of obesity, a strong endometrial carcinoma risk factor. Although endometrial carcinomas are etiologically, biologically, and clinically diverse, hormonal and metabolic mechanisms are particularly strongly implicated in the pathogenesis of endometrioid carcinoma, the numerically predominant subtype. The centrality of hormonal and metabolic disturbances in the pathogenesis of endometrial carcinoma, combined with its slow development from well-characterized precursors in most cases, offers a substantial opportunity to reduce endometrial carcinoma mortality through early detection, lifestyle modification, and chemoprevention. In this chapter, we review the epidemiology of endometrial carcinoma, emphasizing theories that link risk factors for these tumors to hormonal and metabolic mechanisms. Future translational research opportunities related to prevention are discussed.
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Sjögren LL, Mørch LS, Løkkegaard E. Hormone replacement therapy and the risk of endometrial cancer: A systematic review. Maturitas 2016; 91:25-35. [DOI: 10.1016/j.maturitas.2016.05.013] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 05/31/2016] [Indexed: 01/11/2023]
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Staff S, Aaltonen M, Huhtala H, Pylvänäinen K, Mecklin JP, Mäenpää J. Endometrial cancer risk factors among Lynch syndrome women: a retrospective cohort study. Br J Cancer 2016; 115:375-81. [PMID: 27336600 PMCID: PMC4973157 DOI: 10.1038/bjc.2016.193] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 05/18/2016] [Accepted: 05/24/2016] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Lynch syndrome (LS) is associated with a significant lifetime risk of endometrial cancer (EC). There are limited data on factors modifying the EC risk in LS patients. METHODS The study cohort included 136 LS mutation-positive women. Exposure data were collected by postal questionnaires. Cox regression model was used to estimate the associations between lifestyle, hormonal, reproductive and medical factors and the risk of EC. RESULTS Increased EC risk was associated with type II diabetes and hypercholesterolaemia in univariable (HR 3.21, (95% CI 1.34-7.78), P=0.009 and HR 2.08, (95% CI 1.11-3.90), P=0.02; respectively) and with diabetes and duration of hormone replacement therapy (HRT) in multivariable analysis (HR 4.18 (95% CI 1.52-11.52), P=0.006 and HR 1.07 (95% CI 1.02-1.13), P=0.010; respectively). CONCLUSIONS Prevention of diabetes and avoiding long-duration HRT are potential targets for reduction of EC risk in women with LS.
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Affiliation(s)
- Synnöve Staff
- Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland
- Laboratory of Cancer Biology, BioMediTech, University of Tampere, Tampere, Finland
| | - Mari Aaltonen
- Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland
| | - Heini Huhtala
- School of Health Sciences, University of Tampere, Tampere, Finland
| | - Kirsi Pylvänäinen
- Department of Education and Research, Jyväskylä Central Hospital, Jyväskylä, Finland
| | - Jukka-Pekka Mecklin
- Department of Surgery, Jyväskylä Central Hospital and University of Eastern Finland, Jyväskylä, Finland
| | - Johanna Mäenpää
- Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland
- School of Medicine, University of Tampere, Tampere, Finland
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Brinton LA, Trabert B, Anderson GL, Falk RT, Felix AS, Fuhrman BJ, Gass ML, Kuller LH, Pfeiffer RM, Rohan TE, Strickler HD, Xu X, Wentzensen N. Serum Estrogens and Estrogen Metabolites and Endometrial Cancer Risk among Postmenopausal Women. Cancer Epidemiol Biomarkers Prev 2016; 25:1081-9. [PMID: 27197275 PMCID: PMC4930692 DOI: 10.1158/1055-9965.epi-16-0225] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 04/05/2016] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Although endometrial cancer is clearly influenced by hormonal factors, few epidemiologic studies have investigated the role of endogenous estrogens or especially estrogen metabolites. METHODS We conducted a nested case-control study within the Women's Health Initiative Observational Study (WHI-OS), a cohort of 93,676 postmenopausal women recruited between 1993 and 1998. Using baseline serum samples from women who were non-current hormone users with intact uteri, we measured 15 estrogens/estrogen metabolites via HPLC/MS-MS among 313 incident endometrial cancer cases (271 type I, 42 type II) and 354 matched controls, deriving adjusted ORs and 95% confidence intervals (CI) for overall and subtype-specific endometrial cancer risk. RESULTS Parent estrogens (estrone and estradiol) were positively related to endometrial cancer risk, with the highest risk observed for unconjugated estradiol (OR 5th vs. 1st quintile = 6.19; 95% CI, 2.95-13.03, Ptrend = 0.0001). Nearly all metabolites were significantly associated with elevated risks, with some attenuation after adjustment for unconjugated estradiol (residual risks of 2- to 3-fold). Body mass index (kg/m(2), BMI) relations were somewhat reduced after adjustment for estrogen levels. The association with unconjugated estradiol was stronger for type I than type II tumors (Phet = 0.01). CONCLUSIONS Parent estrogens as well as individual metabolites appeared to exert generalized uterotropic activity, particularly for type I tumors. The effects of obesity on risk were only partially explained by estrogens. IMPACT These findings enhance our understanding of estrogen mechanisms involved in endometrial carcinogenesis but also highlight the need for studying additional markers that may underlie the effects on risk of certain risk factors, for example, obesity. Cancer Epidemiol Biomarkers Prev; 25(7); 1081-9. ©2016 AACR.
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Affiliation(s)
- Louise A Brinton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland.
| | - Britton Trabert
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Garnet L Anderson
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Roni T Falk
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Ashley S Felix
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland. Division of Epidemiology, The Ohio State University College of Public Health, Columbus, Ohio
| | - Barbara J Fuhrman
- Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | | | - Lewis H Kuller
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Ruth M Pfeiffer
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Thomas E Rohan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Howard D Strickler
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Xia Xu
- Cancer Research Technology Program, Leidos Biomedical Research, Inc., Frederick National Laboratory for Cancer Research, Frederick, Maryland
| | - Nicolas Wentzensen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
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Trabert B, Falk RT, Stanczyk FZ, McGlynn KA, Brinton LA, Xu X. Reproducibility of an assay to measure serum progesterone metabolites that may be related to breast cancer risk using liquid chromatography-tandem mass spectrometry. Horm Mol Biol Clin Investig 2016; 23:79-84. [PMID: 26353176 DOI: 10.1515/hmbci-2015-0026] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 07/17/2015] [Indexed: 12/26/2022]
Abstract
Recent data suggest a novel role of progesterone in breast cancer etiology involving the progesterone metabolites 3α-dihydroprogesterone (3αHP), 5α-dihydroprogesterone (5αP), and 20α-dihydroprogesterone (20αHP). Accurate and precise measures of progesterone metabolites are needed for etiologic studies of hormonally related cancers. We have developed a high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS) method to measure five hormones, including progesterone, its precursor pregnenolone, and three progesterone metabolites, 5αP, 3αHP, and 20αHP. Hormone levels were measured in serum from 20 healthy volunteers (7 men, 5 premenopausal women, and 8 postmenopausal women). Two blinded, randomized aliquots per individual were assayed in each of four batches. The coefficients of variation (CV) and intraclass correlation coefficients (ICC) were calculated from the individual components of variance. The overall laboratory CVs were <3% and ICCs were uniformly high (>98%) for all hormones measured across sex/menopausal status groups. Our HPLC-MS/MS assay of progesterone metabolites demonstrated excellent sensitivity, laboratory reproducibility, and interindividual variation, suggesting that this serum assay is suitable for epidemiologic research. The high sensitivity of the assay, and thus the ability to quantify concentrations among postmenopausal women and men, further supports that this novel assay is suitable for studies of serum progesterone metabolite concentrations and risk of breast cancer or other hormonally related cancer.
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Chlebowski RT, Anderson GL, Sarto GE, Haque R, Runowicz CD, Aragaki AK, Thomson CA, Howard BV, Wactawski-Wende J, Chen C, Rohan TE, Simon MS, Reed SD, Manson JE. Continuous Combined Estrogen Plus Progestin and Endometrial Cancer: The Women's Health Initiative Randomized Trial. J Natl Cancer Inst 2015; 108:djv350. [PMID: 26668177 DOI: 10.1093/jnci/djv350] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Accepted: 10/21/2015] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND While progestin addition to estrogen mitigates endometrial cancer risk, the magnitude of the effect on incidence, specific endometrial cancer histologies, and endometrial cancer mortality remains unsettled. These issues were assessed by analyses after extended follow-up of the Women's Health Initiative (WHI) randomized clinical trial evaluating continuous combined estrogen plus progestin use. METHODS The WHI enrolled 16 608 postmenopausal women into a randomly assigned, double-blind, placebo-controlled trial. Women age 50 to 79 years with intact uteri with normal endometrial biopsy at entry were randomly assigned to once-daily 0.625 mg conjugated equine estrogen plus 2.5mg medroxyprogesterone acetate (n = 8506) as a single pill or matching placebo (n = 8102). Follow-up beyond the original trial completion date required reconsent, obtained from 12 788 (83%) of surviving participants. Analyses were by intent-to-treat. All statistical tests were two-sided. RESULTS After 5.6 years' median intervention and 13 years' median cumulative follow-up, there were fewer endometrial cancers in the combined hormone therapy compared with the placebo group (66 vs 95 case patients, yearly incidence, 0.06% vs 0.10%; hazard ratio [HR] = 0.65, 95% confidence interval [CI] = 0.48 to 0.89, P = .007). While there were somewhat fewer endometrial cancers during intervention (25 vs 30, respectively; HR = 0.77, 95% CI = 0.45 to 1.31), the difference became statistically significant postintervention (41 vs 65, respectively; HR = 0.59, 95% CI = 0.40 to 0.88, P = .008), but hazard ratios did not differ between phases (P difference = .46). There was a statistically nonsignificant reduction in deaths from endometrial cancer in the estrogen plus progestin group (5 vs 11 deaths, HR = 0.42, 95% CI = 0.15 to 1.22). CONCLUSION In postmenopausal women, continuous combined estrogen plus progestin decreases endometrial cancer incidence.
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Affiliation(s)
- R T Chlebowski
- Affiliations of authors: Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA (RTC); Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, Seattle, WA (GLA, AKA, CC ); Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, WA (GES, SDR); Department of Research and Evaluation, Southern California Permanente Medical Group, Pasadena, CA (RH); Herbert Wertheim College of Medicine Florida International University, Miami, FL (CDR); Department of Nutritional Sciences and Arizona Cancer Center, University of Arizona, Tucson, AZ (CAT); Star Research Institute / Howard University, Washington, DC (BVH); Department of Social and Preventive Medicine, State University of New York, Memphis, TN (JWW); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (TER); Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI (MSS); Brigham and Women's Health Hospital, Harvard Medical School, Boston, MA (JEM)
| | - G L Anderson
- Affiliations of authors: Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA (RTC); Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, Seattle, WA (GLA, AKA, CC ); Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, WA (GES, SDR); Department of Research and Evaluation, Southern California Permanente Medical Group, Pasadena, CA (RH); Herbert Wertheim College of Medicine Florida International University, Miami, FL (CDR); Department of Nutritional Sciences and Arizona Cancer Center, University of Arizona, Tucson, AZ (CAT); Star Research Institute / Howard University, Washington, DC (BVH); Department of Social and Preventive Medicine, State University of New York, Memphis, TN (JWW); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (TER); Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI (MSS); Brigham and Women's Health Hospital, Harvard Medical School, Boston, MA (JEM)
| | - G E Sarto
- Affiliations of authors: Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA (RTC); Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, Seattle, WA (GLA, AKA, CC ); Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, WA (GES, SDR); Department of Research and Evaluation, Southern California Permanente Medical Group, Pasadena, CA (RH); Herbert Wertheim College of Medicine Florida International University, Miami, FL (CDR); Department of Nutritional Sciences and Arizona Cancer Center, University of Arizona, Tucson, AZ (CAT); Star Research Institute / Howard University, Washington, DC (BVH); Department of Social and Preventive Medicine, State University of New York, Memphis, TN (JWW); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (TER); Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI (MSS); Brigham and Women's Health Hospital, Harvard Medical School, Boston, MA (JEM)
| | - R Haque
- Affiliations of authors: Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA (RTC); Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, Seattle, WA (GLA, AKA, CC ); Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, WA (GES, SDR); Department of Research and Evaluation, Southern California Permanente Medical Group, Pasadena, CA (RH); Herbert Wertheim College of Medicine Florida International University, Miami, FL (CDR); Department of Nutritional Sciences and Arizona Cancer Center, University of Arizona, Tucson, AZ (CAT); Star Research Institute / Howard University, Washington, DC (BVH); Department of Social and Preventive Medicine, State University of New York, Memphis, TN (JWW); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (TER); Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI (MSS); Brigham and Women's Health Hospital, Harvard Medical School, Boston, MA (JEM)
| | - C D Runowicz
- Affiliations of authors: Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA (RTC); Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, Seattle, WA (GLA, AKA, CC ); Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, WA (GES, SDR); Department of Research and Evaluation, Southern California Permanente Medical Group, Pasadena, CA (RH); Herbert Wertheim College of Medicine Florida International University, Miami, FL (CDR); Department of Nutritional Sciences and Arizona Cancer Center, University of Arizona, Tucson, AZ (CAT); Star Research Institute / Howard University, Washington, DC (BVH); Department of Social and Preventive Medicine, State University of New York, Memphis, TN (JWW); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (TER); Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI (MSS); Brigham and Women's Health Hospital, Harvard Medical School, Boston, MA (JEM)
| | - A K Aragaki
- Affiliations of authors: Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA (RTC); Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, Seattle, WA (GLA, AKA, CC ); Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, WA (GES, SDR); Department of Research and Evaluation, Southern California Permanente Medical Group, Pasadena, CA (RH); Herbert Wertheim College of Medicine Florida International University, Miami, FL (CDR); Department of Nutritional Sciences and Arizona Cancer Center, University of Arizona, Tucson, AZ (CAT); Star Research Institute / Howard University, Washington, DC (BVH); Department of Social and Preventive Medicine, State University of New York, Memphis, TN (JWW); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (TER); Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI (MSS); Brigham and Women's Health Hospital, Harvard Medical School, Boston, MA (JEM)
| | - C A Thomson
- Affiliations of authors: Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA (RTC); Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, Seattle, WA (GLA, AKA, CC ); Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, WA (GES, SDR); Department of Research and Evaluation, Southern California Permanente Medical Group, Pasadena, CA (RH); Herbert Wertheim College of Medicine Florida International University, Miami, FL (CDR); Department of Nutritional Sciences and Arizona Cancer Center, University of Arizona, Tucson, AZ (CAT); Star Research Institute / Howard University, Washington, DC (BVH); Department of Social and Preventive Medicine, State University of New York, Memphis, TN (JWW); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (TER); Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI (MSS); Brigham and Women's Health Hospital, Harvard Medical School, Boston, MA (JEM)
| | - B V Howard
- Affiliations of authors: Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA (RTC); Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, Seattle, WA (GLA, AKA, CC ); Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, WA (GES, SDR); Department of Research and Evaluation, Southern California Permanente Medical Group, Pasadena, CA (RH); Herbert Wertheim College of Medicine Florida International University, Miami, FL (CDR); Department of Nutritional Sciences and Arizona Cancer Center, University of Arizona, Tucson, AZ (CAT); Star Research Institute / Howard University, Washington, DC (BVH); Department of Social and Preventive Medicine, State University of New York, Memphis, TN (JWW); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (TER); Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI (MSS); Brigham and Women's Health Hospital, Harvard Medical School, Boston, MA (JEM)
| | - J Wactawski-Wende
- Affiliations of authors: Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA (RTC); Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, Seattle, WA (GLA, AKA, CC ); Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, WA (GES, SDR); Department of Research and Evaluation, Southern California Permanente Medical Group, Pasadena, CA (RH); Herbert Wertheim College of Medicine Florida International University, Miami, FL (CDR); Department of Nutritional Sciences and Arizona Cancer Center, University of Arizona, Tucson, AZ (CAT); Star Research Institute / Howard University, Washington, DC (BVH); Department of Social and Preventive Medicine, State University of New York, Memphis, TN (JWW); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (TER); Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI (MSS); Brigham and Women's Health Hospital, Harvard Medical School, Boston, MA (JEM)
| | - C Chen
- Affiliations of authors: Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA (RTC); Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, Seattle, WA (GLA, AKA, CC ); Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, WA (GES, SDR); Department of Research and Evaluation, Southern California Permanente Medical Group, Pasadena, CA (RH); Herbert Wertheim College of Medicine Florida International University, Miami, FL (CDR); Department of Nutritional Sciences and Arizona Cancer Center, University of Arizona, Tucson, AZ (CAT); Star Research Institute / Howard University, Washington, DC (BVH); Department of Social and Preventive Medicine, State University of New York, Memphis, TN (JWW); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (TER); Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI (MSS); Brigham and Women's Health Hospital, Harvard Medical School, Boston, MA (JEM)
| | - T E Rohan
- Affiliations of authors: Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA (RTC); Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, Seattle, WA (GLA, AKA, CC ); Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, WA (GES, SDR); Department of Research and Evaluation, Southern California Permanente Medical Group, Pasadena, CA (RH); Herbert Wertheim College of Medicine Florida International University, Miami, FL (CDR); Department of Nutritional Sciences and Arizona Cancer Center, University of Arizona, Tucson, AZ (CAT); Star Research Institute / Howard University, Washington, DC (BVH); Department of Social and Preventive Medicine, State University of New York, Memphis, TN (JWW); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (TER); Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI (MSS); Brigham and Women's Health Hospital, Harvard Medical School, Boston, MA (JEM)
| | - M S Simon
- Affiliations of authors: Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA (RTC); Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, Seattle, WA (GLA, AKA, CC ); Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, WA (GES, SDR); Department of Research and Evaluation, Southern California Permanente Medical Group, Pasadena, CA (RH); Herbert Wertheim College of Medicine Florida International University, Miami, FL (CDR); Department of Nutritional Sciences and Arizona Cancer Center, University of Arizona, Tucson, AZ (CAT); Star Research Institute / Howard University, Washington, DC (BVH); Department of Social and Preventive Medicine, State University of New York, Memphis, TN (JWW); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (TER); Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI (MSS); Brigham and Women's Health Hospital, Harvard Medical School, Boston, MA (JEM)
| | - S D Reed
- Affiliations of authors: Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA (RTC); Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, Seattle, WA (GLA, AKA, CC ); Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, WA (GES, SDR); Department of Research and Evaluation, Southern California Permanente Medical Group, Pasadena, CA (RH); Herbert Wertheim College of Medicine Florida International University, Miami, FL (CDR); Department of Nutritional Sciences and Arizona Cancer Center, University of Arizona, Tucson, AZ (CAT); Star Research Institute / Howard University, Washington, DC (BVH); Department of Social and Preventive Medicine, State University of New York, Memphis, TN (JWW); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (TER); Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI (MSS); Brigham and Women's Health Hospital, Harvard Medical School, Boston, MA (JEM)
| | - J E Manson
- Affiliations of authors: Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA (RTC); Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, Seattle, WA (GLA, AKA, CC ); Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, WA (GES, SDR); Department of Research and Evaluation, Southern California Permanente Medical Group, Pasadena, CA (RH); Herbert Wertheim College of Medicine Florida International University, Miami, FL (CDR); Department of Nutritional Sciences and Arizona Cancer Center, University of Arizona, Tucson, AZ (CAT); Star Research Institute / Howard University, Washington, DC (BVH); Department of Social and Preventive Medicine, State University of New York, Memphis, TN (JWW); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (TER); Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI (MSS); Brigham and Women's Health Hospital, Harvard Medical School, Boston, MA (JEM)
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Friis S, Kesminiene A, Espina C, Auvinen A, Straif K, Schüz J. European Code against Cancer 4th Edition: Medical exposures, including hormone therapy, and cancer. Cancer Epidemiol 2015; 39 Suppl 1:S107-19. [PMID: 26390952 DOI: 10.1016/j.canep.2015.08.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 07/27/2015] [Accepted: 08/06/2015] [Indexed: 12/13/2022]
Abstract
The 4th edition of the European Code against Cancer recommends limiting - or avoiding when possible - the use of hormone replacement therapy (HRT) because of the increased risk of cancer, nevertheless acknowledging that prescription of HRT may be indicated under certain medical conditions. Current evidence shows that HRT, generally prescribed as menopausal hormone therapy, is associated with an increased risk of cancers of the breast, endometrium, and ovary, with the risk pattern depending on factors such as the type of therapy (oestrogen-only or combined oestrogen-progestogen), duration of treatment, and initiation according to the time of menopause. Carcinogenicity has also been established for anti-neoplastic agents used in cancer therapy, immunosuppressants, oestrogen-progestogen contraceptives, and tamoxifen. Medical use of ionising radiation, an established carcinogen, can provide major health benefits; however, prudent practices need to be in place, with procedures and techniques providing the needed diagnostic information or therapeutic gain with the lowest possible radiation exposure. For pharmaceutical drugs and medical radiation exposure with convincing evidence on their carcinogenicity, health benefits have to be balanced against the risks; potential increases in long-term cancer risk should be considered in the context of the often substantial and immediate health benefits from diagnosis and/or treatment. Thus, apart from HRT, no general recommendations on reducing cancer risk were given for carcinogenic drugs and medical radiation in the 4th edition of European Code against Cancer. It is crucial that the application of these measures relies on medical expertise and thorough benefit-risk evaluation. This also pertains to cancer-preventive drugs, and self-medication with aspirin or other potential chemopreventive drugs is strongly discouraged because of the possibility of serious, potentially lethal, adverse events.
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Affiliation(s)
- Søren Friis
- Danish Cancer Society Research Center, Danish Cancer Society, Strandboulevarden 49, 2100 Copenhagen, Denmark; Department of Public Health, University of Copenhagen, 2100 Copenhagen, and Department of Clinical Epidemiology, Faculty of Health, Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - Ausrele Kesminiene
- International Agency for Research on Cancer (IARC), 150 Cours Albert Thomas, 69372 Lyon, France
| | - Carolina Espina
- International Agency for Research on Cancer (IARC), 150 Cours Albert Thomas, 69372 Lyon, France
| | - Anssi Auvinen
- School of Health Sciences, University of Tampere, FI-33014 Tampere, Finland; STUK-Radiation and Nuclear Safety Authority, Research and Environmental Surveillance, FI-00881 Helsinki, Finland
| | - Kurt Straif
- International Agency for Research on Cancer (IARC), 150 Cours Albert Thomas, 69372 Lyon, France
| | - Joachim Schüz
- International Agency for Research on Cancer (IARC), 150 Cours Albert Thomas, 69372 Lyon, France.
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Hernandez AV, Pasupuleti V, Benites-Zapata VA, Thota P, Deshpande A, Perez-Lopez FR. Insulin resistance and endometrial cancer risk: A systematic review and meta-analysis. Eur J Cancer 2015; 51:2747-58. [PMID: 26597445 DOI: 10.1016/j.ejca.2015.08.031] [Citation(s) in RCA: 106] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 08/24/2015] [Accepted: 08/30/2015] [Indexed: 02/06/2023]
Abstract
AIM It has been suggested that chronic hyperinsulinemia from insulin resistance is involved in the etiology of endometrial cancer (EC). We performed a systematic review and meta-analysis to assess whether insulin resistance is associated with the risk of EC. METHODS We searched PubMed-Medline, Embase, Scopus, and Web of Science for articles published from database inception through 30th September 2014. We included all observational studies evaluating components defining insulin resistance in women with and without EC. Quality of the included studies was assessed by Newcastle-Ottawa scale. Random-effects models and inverse variance method were used to meta-analyze the association between insulin resistance components and EC. RESULTS Twenty-five studies satisfied our inclusion criteria. Fasting insulin levels (13 studies, n = 4088) were higher in women with EC (mean difference [MD] 33.94 pmol/L, 95% confidence interval [CI] 15.04-52.85, p = 0.0004). No differences were seen in postmenopausal versus pre- and postmenopausal subgroup analysis. Similarly, non-fasting/fasting C-peptide levels (five studies, n = 1938) were also higher in women with EC (MD 0.14 nmol/L, 95% CI 0.08-0.21, p < 0.00001). Homeostatic model assessment - insulin resistance (HOMA-IR) values (six studies, n = 1859) in EC patients were significantly higher than in women without EC (MD 1.13, 95% CI 0.20-2.06, p = 0.02). There was moderate-to-high heterogeneity among the included studies. CONCLUSION Currently available epidemiologic evidence is suggestive of significantly higher risk of EC in women with high fasting insulin, non-fasting/fasting C-peptide and HOMA-IR values.
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Affiliation(s)
- Adrian V Hernandez
- School of Medicine, Universidad Peruana de Ciencias Aplicadas (UPC), Lima 9, Peru; Health Outcomes and Clinical Epidemiology Section, Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, 44195 USA.
| | - Vinay Pasupuleti
- Department of Medicine, Case Western Reserve University, Cleveland, OH, 44106 USA.
| | - Vicente A Benites-Zapata
- Faculty of Human Medicine, Postgraduate Section, Universidad de San Martin de Porres, Lima 12, Peru.
| | - Priyaleela Thota
- Department of Medicine, Case Western Reserve University, Cleveland, OH, 44106 USA.
| | - Abhishek Deshpande
- Medicine Institute Center for Value Based Care Research, Cleveland Clinic, Cleveland, OH, 44195 USA.
| | - Faustino R Perez-Lopez
- Department of Obstetrics and Gynecology, University of Zaragoza Faculty of Medicine and Lozano Blesa University Hospital, Domingo Miral s/n, Zaragoza 50009, Spain.
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Mørch LS, Kjaer SK, Keiding N, Løkkegaard E, Lidegaard Ø. The influence of hormone therapies on type I and II endometrial cancer: A nationwide cohort study. Int J Cancer 2015; 138:1506-15. [DOI: 10.1002/ijc.29878] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 09/14/2015] [Accepted: 09/21/2015] [Indexed: 12/28/2022]
Affiliation(s)
- Lina S. Mørch
- The Juliane Marie Centre, Gynecological Clinic, Copenhagen University Hospital; Copenhagen Denmark
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Centre; Copenhagen Denmark
| | - Susanne K. Kjaer
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Centre; Copenhagen Denmark
| | - Niels Keiding
- Department of Public Health; Section of Biostatistics, University of Copenhagen; Copenhagen Denmark
| | - Ellen Løkkegaard
- Gynecological-Obstetrical Department; North Zealand Hospital, University of Copenhagen; Hillerød Denmark
| | - Øjvind Lidegaard
- The Juliane Marie Centre, Gynecological Clinic, Copenhagen University Hospital; Copenhagen Denmark
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Menopausal hormone therapy and mortality among endometrial cancer patients in the NIH-AARP Diet and Health Study. Cancer Causes Control 2015; 26:1055-63. [PMID: 25962764 DOI: 10.1007/s10552-015-0598-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 05/03/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND While menopausal hormone therapy (MHT) is an established endometrial cancer risk factor, its relationship with mortality among endometrial cancer patients is understudied. METHODS Within the NIH-AARP Diet and Health Study, we examined the associations of pre-diagnosis MHT use with 10-year all-cause and endometrial cancer-specific mortality among 890 endometrial cancer patients. We used Cox proportional hazards regression models to estimate hazard ratios (HRs) and 95 % confidence intervals (CIs) adjusted for tumor characteristics, treatment, and other risk factors. RESULTS Endometrial cancer cases were diagnosed a median of 4.6 years (range 0.0-10.1 years) after the second risk factor questionnaire was completed. We identified a total of 241 deaths, of which 104 were due to endometrial cancer. Compared with non-MHT use, pre-diagnosis use of estrogen plus progestin therapy (EPT)-only was associated with lower 10-year all-cause (HR 0.65, 95 % CI 0.43-0.99, based on 29 deaths) and endometrial cancer-specific mortality (HR 0.51, 95 % CI 0.26-0.98, based on 11 deaths). Recency of MHT use, assessed approximately 5 years prior to the endometrial cancer diagnosis, was associated with mortality. Compared with non-MHT users, former ET users had higher all-cause (HR 1.71, 95 % CI 1.02-2.88, based on 18 deaths) and endometrial cancer-specific mortality (HR 2.17, 95 % CI 0.96-4.90, based on 8 deaths), whereas current EPT users had nonsignificant lower risks of death. CONCLUSION Based on small numbers, we observed that pre-diagnosis use of EPT was related to lower mortality among endometrial cancer patients. Future studies examining the biological mechanisms underlying this association are warranted.
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Affiliation(s)
- Nicolas Wentzensen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892-9774, USA.
| | - Britton Trabert
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892-9774, USA
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Ceccarelli S, D'Amici S, Vescarelli E, Coluccio P, Matricardi P, di Gioia C, Benedetti Panici P, Romano F, Frati L, Angeloni A, Marchese C. Topical KGF treatment as a therapeutic strategy for vaginal atrophy in a model of ovariectomized mice. J Cell Mol Med 2014; 18:1895-907. [PMID: 25088572 PMCID: PMC4196664 DOI: 10.1111/jcmm.12334] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 05/07/2014] [Indexed: 12/01/2022] Open
Abstract
One of the most frequent complaints for post-menopausal women is vaginal atrophy, because of reduction in circulating oestrogens. Treatments based on local oestrogen administration have been questioned as topic oestrogens can reach the bloodstream, thus leading to consider their safety as controversial, especially for patients with a history of breast or endometrial cancers. Recently, growth factors have been shown to interact with the oestrogen pathway, but the mechanisms still need to be fully clarified. In this study, we investigated the effect of keratinocyte growth factor (KGF), a known mitogen for epithelial cells, on human vaginal mucosa cells, and its potential crosstalk with oestrogen pathways. We also tested the in vivo efficacy of KGF local administration on vaginal atrophy in a murine model. We demonstrated that KGF is able to induce proliferation of vaginal mucosa, and we gained insight on its mechanism of action by highlighting its contribution to switch ERα signalling towards non-genomic pathway. Moreover, we demonstrated that KGF restores vaginal trophism in vivo similarly to intravaginal oestrogenic preparations, without systemic effects. Therefore, we suggest a possible alternative therapy for vaginal atrophy devoid of the risks related to oestrogen-based treatments, and a patent (no. RM2012A000404) has been applied for this study.
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Affiliation(s)
- Simona Ceccarelli
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
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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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Cigarette smoking and endometrial carcinoma risk: the role of effect modification and tumor heterogeneity. Cancer Causes Control 2014; 25:479-89. [PMID: 24487725 DOI: 10.1007/s10552-014-0350-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Accepted: 01/18/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE The inverse relationship between cigarette smoking and endometrial carcinoma risk is well established. We examined effect modification of this relationship and associations with tumor characteristics in the National Institutes of Health-AARP Diet and Health Study. METHODS We examined the association between cigarette smoking and endometrial carcinoma risk among 110,304 women. During 1,029,041 person years of follow-up, we identified 1,476 incident endometrial carcinoma cases. Multivariable Cox proportional hazards regression models were used to estimate relative risks (RRs) and 95 % confidence intervals (CIs) for the association between smoking status, years since smoking cessation, and endometrial carcinoma risk overall and within strata of endometrial carcinoma risk factors. Effect modification was assessed using likelihood ratio test statistics. Smoking associations by histologic subtype/grade and stage at diagnosis were also evaluated. RESULTS Reduced endometrial carcinoma risk was evident among former (RR 0.89, 95 % CI 0.80, 1.00) and current (RR 0.65, 95 % CI 0.55, 0.78) smokers compared with never smokers. Smoking cessation 1-4 years prior to baseline was significantly associated with endometrial carcinoma risk (RR 0.65, 95 % CI 0.48, 0.89), while cessation ≥ 10 years before baseline was not. The association between smoking and endometrial carcinoma risk was not significantly modified by any endometrial carcinoma risk factor, nor did we observe major differences in risk associations by tumor characteristics. CONCLUSION The cigarette smoking-endometrial carcinoma risk relationship was consistent within strata of important endometrial carcinoma risk factors and by clinically relevant tumor characteristics.
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Brinton LA, Westhoff CL, Scoccia B, Lamb EJ, Trabert B, Niwa S, Moghissi KS. Fertility drugs and endometrial cancer risk: results from an extended follow-up of a large infertility cohort. Hum Reprod 2013; 28:2813-21. [PMID: 23943795 DOI: 10.1093/humrep/det323] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
STUDY QUESTION Do fertility drugs influence the subsequent risk of endometrial cancer in a manner that is independent of other risk predictors, such as parity? SUMMARY ANSWER In this follow-up of a large cohort of women evaluated for infertility and for whom information was captured on fertility drugs, indications for usage and other risk factors that might influence cancer risk, we found no evidence for a substantial relationship between fertility drug use and endometrial cancer risk. WHAT IS ALREADY KNOWN Although the hormonal etiology of endometrial cancer has been well established, it remains unclear whether the use of fertility drugs has an influence on risk. Results regarding the effects of fertility drugs on endometrial cancer risk have been inconsistent, although several studies have shown some evidence for possible increases in risk. The relationship is of particular interest given that clomiphene, a commonly prescribed drug, is a selective estrogen receptor modulator, with chemical properties similar to tamoxifen, another drug linked to an increase in endometrial cancer risk. STUDY DESIGN, SIZE, DURATION In a retrospective cohort of 12 193 women evaluated for infertility between 1965 and 1988 at five US sites, follow-up was pursued through 2010 via both passive as well as active (questionnaire) means. PARTICIPANTS, SETTING, METHODS Among the 9832 subjects for whom follow-up was allowed and achieved, 259 346 at-risk person-years (i.e. prior to hysterectomy) were accrued, and 118 invasive endometrial cancers identified. Cox regression determined hazard ratios (HRs) and 95% confidence intervals (CIs) for fertility treatments adjusted for endometrial cancer risk factors and causes of infertility. MAIN RESULTS AND THE ROLE OF CHANCE Although we observed slight increases in endometrial cancer risk associated with clomiphene (HR = 1.39, 95% CI: 0.96-2.01) and the less commonly prescribed gonadotrophins (1.34, 0.76-2.37), there were no convincing relationships of risk with either cycles of use or cumulative exposures for either drug. A statistically significant risk associated with the use of clomiphene among women who began use at younger ages (<30) (1.93, 1.24-3.00) may have reflected indications for drug usage rather than the effect of the drug itself. Women who received clomiphene followed by gonadotrophins were at a non-significantly elevated risk (1.77, 0.98-3.19). LIMITATIONS, REASONS FOR CAUTION Like most studies of endometrial cancer, we were limited by sample sizes, particularly for evaluating subgroup associations. We were also unable to follow all women and were not able to obtain complete risk factor information (including hysterectomy status) for the entire cohort. WIDER IMPLICATIONS OF THE FINDINGS Although we found no support for a relationship between fertility drugs and endometrial cancer risk, the association should continue to be monitored given that our study population was still young and had not yet reached the age of peak endometrial cancer incidence. STUDY FUNDING/COMPETING INTEREST(S) This project was supported in part by funds from the intramural research program of the National Cancer Institute, National Institutes of Health. None of the authors has any conflicting interests to declare.
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Affiliation(s)
- Louise A Brinton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
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Wartko P, Sherman ME, Yang HP, Felix AS, Brinton LA, Trabert B. Recent changes in endometrial cancer trends among menopausal-age U.S. women. Cancer Epidemiol 2013; 37:374-7. [PMID: 23591011 PMCID: PMC3679300 DOI: 10.1016/j.canep.2013.03.008] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Revised: 03/01/2013] [Accepted: 03/15/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Changes in endometrial cancer incidence rates after the precipitous decline in menopausal hormone therapy (MHT) use in 2002 have not been evaluated. METHODS Using data from the Surveillance, Epidemiology, and End Results Program from 1992 to 2009 (SEER 13), we identified 63428 incident endometrial cancer cases among women ages 20-74. We compared annual percent change (APC) in endometrial cancer incidence rates from 1992 to 2002 to rates from 2003 to 2009. RESULTS In contrast to the constant endometrial cancer rate pattern observed from 1992 to 2002 (APC 0.0%), rates increased after 2002 in women 50-74 years old (2.5%; PAPC comparison<0.01). Endometrial cancer incidence increased over the entire time period among women ages 20-49 (1992-2002: 1.1%; 2003-2009: 2.1%; PAPC comparison=0.21). Post-2002 increases in incidence among women ages 50-74 were specific to Type I endometrial tumors (1992-2002: -0.6%; 2003-2009: 1.6%; PAPC comparison<0.01). DISCUSSION The increase in endometrial cancer incidence rates after 2002 may be related to the widespread decrease in estrogen plus progestin MHT use, which has been reported to lower endometrial cancer risk in overweight and obese women.
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Affiliation(s)
- Paige Wartko
- Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD
| | - Mark E Sherman
- Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD
| | - Hannah P Yang
- Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD
| | - Ashley S Felix
- Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD
| | - Louise A Brinton
- Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD
| | - Britton Trabert
- Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD
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