1
|
Kharouf N, Flanagan TW, Hassan SY, Shalaby H, Khabaz M, Hassan SL, Megahed M, Haikel Y, Santourlidis S, Hassan M. Tumor Microenvironment as a Therapeutic Target in Melanoma Treatment. Cancers (Basel) 2023; 15:3147. [PMID: 37370757 DOI: 10.3390/cancers15123147] [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: 05/07/2023] [Revised: 06/02/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023] Open
Abstract
The role of the tumor microenvironment in tumor growth and therapy has recently attracted more attention in research and drug development. The ability of the microenvironment to trigger tumor maintenance, progression, and resistance is the main cause for treatment failure and tumor relapse. Accumulated evidence indicates that the maintenance and progression of tumor cells is determined by components of the microenvironment, which include stromal cells (endothelial cells, fibroblasts, mesenchymal stem cells, and immune cells), extracellular matrix (ECM), and soluble molecules (chemokines, cytokines, growth factors, and extracellular vesicles). As a solid tumor, melanoma is not only a tumor mass of monolithic tumor cells, but it also contains supporting stroma, ECM, and soluble molecules. Melanoma cells are continuously in interaction with the components of the microenvironment. In the present review, we focus on the role of the tumor microenvironment components in the modulation of tumor progression and treatment resistance as well as the impact of the tumor microenvironment as a therapeutic target in melanoma.
Collapse
Affiliation(s)
- Naji Kharouf
- Biomaterials and Bioengineering, Institut National de la Santé et de la Recherche Médicale, Université de Strasbourg, Unité Mixte de Recherche 1121, 67000 Strasbourg, France
- Department of Endodontics and Conservative Dentistry, Faculty of Dental Medicine, University of Strasbourg, 67000 Strasbourg, France
| | - Thomas W Flanagan
- Department of Pharmacology and Experimental Therapeutics, LSU Health Sciences Center, New Orleans, LA 70112, USA
| | - Sofie-Yasmin Hassan
- Department of Chemistry, Faculty of Science, Heinrich-Heine University Duesseldorf, 40225 Dusseldorf, Germany
| | - Hosam Shalaby
- Department of Urology, School of Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Marla Khabaz
- Department of Production, Beta Factory for Veterinary Pharmaceutical Industries, Damascus 0100, Syria
| | - Sarah-Lilly Hassan
- Department of Chemistry, Faculty of Science, Heinrich-Heine University Duesseldorf, 40225 Dusseldorf, Germany
| | - Mosaad Megahed
- Clinic of Dermatology, University Hospital of Aachen, 52074 Aachen, Germany
| | - Youssef Haikel
- Biomaterials and Bioengineering, Institut National de la Santé et de la Recherche Médicale, Université de Strasbourg, Unité Mixte de Recherche 1121, 67000 Strasbourg, France
- Department of Endodontics and Conservative Dentistry, Faculty of Dental Medicine, University of Strasbourg, 67000 Strasbourg, France
- Pôle de Médecine et Chirurgie Bucco-Dentaire, Hôpital Civil, Hôpitaux Universitaire de Strasbourg, 67000 Strasbourg, France
| | - Simeon Santourlidis
- Epigenetics Core Laboratory, Institute of Transplantation Diagnostics and Cell Therapeutics, Medical Faculty, Heinrich-Heine University Duesseldorf, 40225 Duesseldorf, Germany
| | - Mohamed Hassan
- Biomaterials and Bioengineering, Institut National de la Santé et de la Recherche Médicale, Université de Strasbourg, Unité Mixte de Recherche 1121, 67000 Strasbourg, France
- Department of Endodontics and Conservative Dentistry, Faculty of Dental Medicine, University of Strasbourg, 67000 Strasbourg, France
- Research Laboratory of Surgery-Oncology, Department of Surgery, School of Medicine, Tulane University, New Orleans, LA 70112, USA
| |
Collapse
|
2
|
The Role and Regulation of Thromboxane A2 Signaling in Cancer-Trojan Horses and Misdirection. Molecules 2022; 27:molecules27196234. [PMID: 36234768 PMCID: PMC9573598 DOI: 10.3390/molecules27196234] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/09/2022] [Accepted: 09/09/2022] [Indexed: 11/24/2022] Open
Abstract
Over the last two decades, there has been an increasing awareness of the role of eicosanoids in the development and progression of several types of cancer, including breast, prostate, lung, and colorectal cancers. Several processes involved in cancer development, such as cell growth, migration, and angiogenesis, are regulated by the arachidonic acid derivative thromboxane A2 (TXA2). Higher levels of circulating TXA2 are observed in patients with multiple cancers, and this is accompanied by overexpression of TXA2 synthase (TBXAS1, TXA2S) and/or TXA2 receptors (TBXA2R, TP). Overexpression of TXA2S or TP in tumor cells is generally associated with poor prognosis, reduced survival, and metastatic disease. However, the role of TXA2 signaling in the stroma during oncogenesis has been underappreciated. TXA2 signaling regulates the tumor microenvironment by modulating angiogenic potential, tumor ECM stiffness, and host immune response. Moreover, the by-products of TXA2S are highly mutagenic and oncogenic, adding to the overall phenotype where TXA2 synthesis promotes tumor formation at various levels. The stability of synthetic enzymes and receptors in this pathway in most cancers (with few mutations reported) suggests that TXA2 signaling is a viable target for adjunct therapy in various tumors to reduce immune evasion, primary tumor growth, and metastasis.
Collapse
|
3
|
Hurwitz LM, Shadyab AH, Tabung FK, Anderson GL, Saquib N, Wallace RB, Wild RA, Pfeiffer RM, Xu X, Trabert B. Analgesic Use and Circulating Estrogens, Androgens, and Their Metabolites in the Women's Health Initiative Observational Study. Cancer Prev Res (Phila) 2022; 15:173-183. [PMID: 34893532 PMCID: PMC8898279 DOI: 10.1158/1940-6207.capr-21-0264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 09/27/2021] [Accepted: 11/29/2021] [Indexed: 11/16/2022]
Abstract
Though studies have observed inverse associations between use of analgesics (aspirin, NSAIDs, and acetaminophen) and the risk of several cancers, the potential biological mechanisms underlying these associations are unclear. We investigated the relationship between analgesic use and serum concentrations of estrogens, androgens, and their metabolites among postmenopausal women to provide insights on whether analgesic use might influence endogenous hormone levels, which could in turn influence hormone-related cancer risk. The study included 1,860 postmenopausal women from two case-control studies nested within the Women's Health Initiative Observational Study. Analgesic use was reported at study baseline. Fifteen estrogens and estrogen metabolites and 12 androgens and androgen metabolites were quantified in baseline serum by LC/MS-MS. Linear regression with inverse probability weighting, stratified by menopausal hormone therapy (MHT) use, was used to estimate adjusted geometric mean concentrations of each hormone by analgesic use. Among women not currently using MHT (n = 951), low-dose aspirin (<100 mg) use was associated with a higher serum concentration of estrone, estradiol, and 2, 4, and 16 hydroxylated metabolites. Use of regular-dose aspirin (≥100 mg), non-aspirin NSAIDs, and acetaminophen was not associated with serum concentrations of estrogens, androgens, or their metabolites. This study highlights the importance of examining aspirin use by dose and suggests that low-dose aspirin may influence endogenous estrogen concentrations. PREVENTION RELEVANCE This study explores a potential pathway by which analgesic medications such as aspirin may prevent hormone-related cancers. The findings support a positive association between low-dose aspirin use and endogenous estrogens, indicating that further elucidation of the interplay between low-dose aspirin, estrogen concentrations, and cancer risk is needed.
Collapse
Affiliation(s)
- Lauren M. Hurwitz
- Division of Cancer Epidemiology and Genetics, National Cancer Institute
| | - Aladdin H. Shadyab
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA
| | - Fred K. Tabung
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University College of Medicine and Comprehensive Cancer Center
| | | | - Nazmus Saquib
- Research Unit, College of Medicine, Sulaiman AlRajhi University
| | - Robert B. Wallace
- Department of Epidemiology, University of Iowa College of Public Health
| | - Robert A. Wild
- Department of Obstetrics and Gynecology, University of Oklahoma College of Medicine
| | - Ruth M. Pfeiffer
- Division of Cancer Epidemiology and Genetics, National Cancer Institute
| | - Xia Xu
- Cancer Research Technology Program, Leidos Biomedical Research, Inc., Frederick National Laboratory for Cancer Research
| | - Britton Trabert
- Division of Cancer Epidemiology and Genetics, National Cancer Institute
| |
Collapse
|
4
|
Polo-Cuadrado E, Acosta-Quiroga K, Rojas-Peña C, Rodriguez-Nuñez YA, Duarte Y, Brito I, Cisterna J, Gutiérrez M. Molecular modeling and structural analysis of some tetrahydroindazole and cyclopentanepyrazole derivatives as COX-2 inhibitors. ARAB J CHEM 2022. [DOI: 10.1016/j.arabjc.2021.103540] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
5
|
Gao Y, Zhai P, Jiang F, Zhou F, Wang X. Association between coffee drinking and endometrial cancer risk: A meta‐analysis. J Obstet Gynaecol Res 2022; 48:774-795. [PMID: 35048465 DOI: 10.1111/jog.15139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 11/15/2021] [Accepted: 12/16/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Yu Gao
- Department of Obstetrics and Gynecology Liangxiang Hospital of Beijing Fangshan District Beijing China
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Peiling Zhai
- Department of Obstetrics and Gynecology The Affiliated Hospital of Weifang Medical University Weifang China
| | - Fang Jiang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Fushun Zhou
- Department of Obstetrics and Gynecology Liangxiang Hospital of Beijing Fangshan District Beijing China
| | - Xinbo Wang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
- Department of Obstetrics and Gynecology The Affiliated Hospital of Weifang Medical University Weifang China
| |
Collapse
|
6
|
Lu YC, Chen PT, Lin MC, Lin CC, Wang SH, Pan YJ. Nonsteroidal Anti-Inflammatory Drugs Reduce Second Cancer Risk in Patients With Breast Cancer: A Nationwide Population-Based Propensity Score-Matched Cohort Study in Taiwan. Front Oncol 2021; 11:756143. [PMID: 34900705 PMCID: PMC8651993 DOI: 10.3389/fonc.2021.756143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 11/04/2021] [Indexed: 11/16/2022] Open
Abstract
Nonsteroidal anti-inflammatory drugs (NSAIDs) reduce mortality in patients with cancer, especially breast cancer, but their influence on second cancer risk is uncertain. This study aimed to examine whether NSAID use is associated with second cancer risk in patients with breast cancer. This population-based propensity score-matched cohort study using Taiwan’s National Health Insurance Research Database enrolled patients with newly diagnosed breast cancer (n = 7356) with and without (n = 1839) NSAID therapy from 2000 to 2009. They were followed up until the diagnosis of second cancer, death, or end of 2011. Cox proportional hazard models were used to estimate adjusted hazard ratios (aHR). The NSAID cohort had a lower incidence rate of second cancer than the non-NSAID cohort (5.57 vs. 9.19 per 1,000 person-years), with an aHR of 0.63 (95% confidence interval (CI) 0.46–0.87). When compared with the non-NSAID cohort, the second cancer incidence was lower in patients taking non-cyclooxygenase 2 inhibitors (aHR 0.67, 95% CI 0.47–0.94) and in those receiving multiple NSAIDs during follow-up (aHR 0.55, 95% CI 0.37–0.84). A dose–response relationship existed in NSAID cumulative days. The findings demonstrate that NSAID use reduces second cancer risk in a dose-dependent manner in patients with primary breast cancer.
Collapse
Affiliation(s)
- Yin-Che Lu
- Division of Hematology-Oncology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan.,Department of Nursing, Min-Hwei Junior College of Health Care Management, Tainan, Taiwan
| | - Pin-Tzu Chen
- Division of Hematology-Oncology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan
| | - Mei-Chen Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.,School of Medicine, China Medical University, Taichung, Taiwan
| | - Che-Chen Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.,School of Medicine, China Medical University, Taichung, Taiwan
| | - Shi-Heng Wang
- Department of Occupational Safety and Health, China Medical University, Taichung, Taiwan.,Department of Public Health, China Medical University, Taichung, Taiwan
| | - Yi-Jiun Pan
- School of Medicine, China Medical University, Taichung, Taiwan
| |
Collapse
|
7
|
Yasin HK, Taylor AH, Ayakannu T. A Narrative Review of the Role of Diet and Lifestyle Factors in the Development and Prevention of Endometrial Cancer. Cancers (Basel) 2021; 13:cancers13092149. [PMID: 33946913 PMCID: PMC8125712 DOI: 10.3390/cancers13092149] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 04/12/2021] [Accepted: 04/16/2021] [Indexed: 12/19/2022] Open
Abstract
Simple Summary The incidence and prevalence of endometrial cancer is increasing globally. The main factors involved in this increase have been the way women live today and what they eat and drink. In fact, the obesity pandemic that is sweeping across the planet is considered to be the main contributory feature. This review aims to introduce to a new audience, those that are not experts in the field, what is known about the different types of endometrial cancer and the mechanisms for their induction and protection. We also seek to summarise the existing knowledge on dietary and lifestyle factors that prevent endometrial development in susceptible populations and identify the main problem in this arena; the paucity of research studies and clinical trials that investigate the interaction(s) between diet, lifestyle and endometrial cancer risk whilst highlighting those areas of promise that should be further investigated. Abstract Endometrial cancer is the most common cancer affecting the reproductive organs of women living in higher-income countries. Apart from hormonal influences and genetic predisposition, obesity and metabolic syndrome are increasingly recognised as major factors in endometrial cancer risk, due to changes in lifestyle and diet, whereby high glycaemic index and lipid deposition are prevalent. This is especially true in countries where micronutrients, such as vitamins and minerals are exchanged for high calorific diets and a sedentary lifestyle. In this review, we will survey the currently known lifestyle factors, dietary requirements and hormonal changes that increase an individual’s risk for endometrial cancer and discuss their relevance for clinical management. We also examine the evidence that everyday factors and clinical interventions have on reducing that risk, such that informed healthy choices can be made. In this narrative review, we thus summarise the dietary and lifestyle factors that promote and prevent the incidence of endometrial cancer.
Collapse
Affiliation(s)
- Hajar Ku Yasin
- Department of Obstetrics & Gynaecology, Cumberland Infirmary, Carlisle CA2 7HY, UK;
| | - Anthony H. Taylor
- Department of Molecular and Cell Biology, University of Leicester, Leicester LE1 7RH, UK;
| | - Thangesweran Ayakannu
- Gynaecology Oncology Cancer Centre, Liverpool Women’s NHS Foundation Trust, Liverpool Women’s Hospital, Liverpool L8 7SS, UK
- Correspondence: ; Tel.: +44-(0)-151-708-9988 (ext. 4531)
| |
Collapse
|
8
|
Baxter E, Brennan DJ, McAlpine JN, Mueller JJ, Amant F, van Gent MDJM, Huntsman DG, Coleman RL, Westin SN, Yates MS, Krakstad C, Quinn MA, Janda M, Obermair A. Improving response to progestin treatment of low-grade endometrial cancer. Int J Gynecol Cancer 2020; 30:1811-1823. [PMID: 32381512 DOI: 10.1136/ijgc-2020-001309] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 04/11/2020] [Accepted: 04/20/2020] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES This review examines how response rates to progestin treatment of low-grade endometrial cancer can be improved. In addition to providing a brief overview of the pathogenesis of low-grade endometrial cancer, we discuss limitations in the current classification of endometrial cancer and how stratification may be refined using molecular markers to reproducibly identify 'low-risk' cancers which may represent the best candidates for progestin therapy. We also discuss constraints in current approaches to progestin treatment of low-grade endometrial cancer and perform a systematic review of predictive biomarkers. METHODS PubMed, ClinicalTrials.gov, and Cochrane Library were searched for studies reporting pre-treatment biomarkers associated with outcome in women with low-grade endometrial cancer or endometrial hyperplasia with an intact uterus who received progestin treatment. Studies of fewer than 50 women were excluded. The study protocol was registered in PROSPERO (ID 152374). A descriptive synthesis of pre-treatment predictive biomarkers reported in the included studies was conducted. RESULTS Of 1908 records reviewed, 19 studies were included. Clinical features such as age or body mass index cannot predict progestin response. Lesions defined as 'low-risk' by FIGO criteria (stage 1A, grade 1) can respond well; however, the reproducibility and prognostic ability of the current histopathological classification system is suboptimal. Molecular markers can be reproducibly assessed, have been validated as prognostic biomarkers, and may inform patient selection for progestin treatment. DNA polymerase epsilon (POLE)-ultramutated tumors and a subset of p53 wild-type or DNA mismatch repair (MMR)-deficient tumors with 'low-risk' features (eg, progesterone and estrogen receptor-positive) may have improved response rates, though this needs to be validated. DISCUSSION Molecular markers can identify cases which may be candidates for progestin treatment. More work is needed to validate these biomarkers and potentially identify new ones. Predictive biomarkers are anticipated to inform future research into progestin treatment of low-grade endometrial cancer and ultimately improve patient outcomes.
Collapse
Affiliation(s)
- Eva Baxter
- Queensland Centre for Gynaecological Cancer Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Donal J Brennan
- Department of Gynaecological Oncology, UCD School of Medicine, Mater Misericordiae University Hospital, Dublin, Ireland.,Systems Biology Ireland, University College Dublin, Dublin, Ireland
| | - Jessica N McAlpine
- Department of Gynecology and Obstetrics, Division of Gynecologic Oncology, The University of British Columbia, Vancouver, British Columbia, Canada.,BC Cancer Agency, Vancouver, British Columbia, Canada
| | - Jennifer J Mueller
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA.,Department of Obstetrics & Gynecology, Weill Cornell Medical College, New York, New York, USA
| | - Frédéric Amant
- Department of Oncology, KU Leuven, Leuven, Flanders, Belgium.,Centre for Gynaecologic Oncology Amsterdam, Antoni van Leeuwenhoek Netherlands Cancer Institute and Amsterdam University Medical Centres, Amsterdam, Noord-Holland, The Netherlands
| | - Mignon D J M van Gent
- Centre for Gynaecologic Oncology Amsterdam, Antoni van Leeuwenhoek Netherlands Cancer Institute and Amsterdam University Medical Centres, Amsterdam, Noord-Holland, The Netherlands
| | - David G Huntsman
- BC Cancer Agency, Vancouver, British Columbia, Canada.,Departments of Pathology and Laboratory Medicine and Gynecology and Obstetrics, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Robert L Coleman
- Department of Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Shannon N Westin
- Department of Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Melinda S Yates
- Department of Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Camilla Krakstad
- Centre for Cancer Biomarkers CCBIO, Department of Clinical Science, University of Bergen, Bergen, Vestland, Norway.,Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Vestland, Norway
| | | | - Monika Janda
- Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Andreas Obermair
- Queensland Centre for Gynaecological Cancer Research, The University of Queensland, Brisbane, Queensland, Australia
| |
Collapse
|
9
|
Current and future approaches to screening for endometrial cancer. Best Pract Res Clin Obstet Gynaecol 2020; 65:79-97. [DOI: 10.1016/j.bpobgyn.2019.12.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 12/18/2019] [Accepted: 12/19/2019] [Indexed: 02/07/2023]
|
10
|
McCarthy AM, Kumar NP, He W, Regan S, Welch M, Moy B, Iafrate AJ, Chan AT, Bardia A, Armstrong K. Different associations of tumor PIK3CA mutations and clinical outcomes according to aspirin use among women with metastatic hormone receptor positive breast cancer. BMC Cancer 2020; 20:347. [PMID: 32326897 PMCID: PMC7181475 DOI: 10.1186/s12885-020-06810-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 03/31/2020] [Indexed: 01/05/2023] Open
Abstract
Introduction The relationships among PIK3CA mutations, medication use and tumor progression remains poorly understood. Aspirin use post-diagnosis may modify components of the PI3K pathway, including AKT and mTOR, and has been associated with lower risk of breast cancer recurrence and mortality. We assessed time to metastasis (TTM) and survival with respect to aspirin use and tumor PIK3CA mutations among women with metastatic breast cancer. Methods Patients with hormone receptor positive, HER2 negative (HR+/HER2-) metastatic breast cancer treated in 2009–2016 who received tumor genotyping were included. Aspirin use between primary and metastatic diagnosis was extracted from electronic medical records. TTM and survival were estimated using Cox proportional hazards regression. Results Among 267 women with metastatic breast cancer, women with PIK3CA mutated tumors had longer TTM than women with PIK3CA wildtype tumors (7.1 vs. 4.7 years, p = 0.008). There was a significant interaction between PIK3CA mutations and aspirin use on TTM (p = 0.006) and survival (p = 0.026). PIK3CA mutations were associated with longer TTM among aspirin non-users (HR = 0.60 95% CI:0.44–0.82 p = 0.001) but not among aspirin users (HR = 1.57 0.86–2.84 p = 0.139). Similarly, PIK3CA mutations were associated with reduced mortality among aspirin non-users (HR = 0.70 95% CI:0.48–1.02 p = 0.066) but not among aspirin users (HR = 1.75 95% CI:0.88–3.49 p = 0.110). Conclusions Among women who develop metastatic breast cancer, tumor PIK3CA mutations are associated with slower time to progression and mortality only among aspirin non-users. Larger studies are needed to confirm this finding and examine the relationship among aspirin use, tumor mutation profile, and the overall risk of breast cancer progression.
Collapse
Affiliation(s)
- Anne Marie McCarthy
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, USA. .,Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, 833 Blockley Hall, 423 Guardian Drive, Philadelphia, PA, 19104, USA.
| | | | - Wei He
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, USA
| | - Susan Regan
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, USA
| | - Michaela Welch
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, USA
| | - Beverly Moy
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, USA
| | - A John Iafrate
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, USA
| | - Andrew T Chan
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, USA
| | - Aditya Bardia
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, USA
| | - Katrina Armstrong
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, USA
| |
Collapse
|
11
|
Wang Y, Zhao J, Chen X, Zhang F, Li X. Aspirin use and endometrial cancer risk: a meta-analysis and systematic review. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:461. [PMID: 32395505 PMCID: PMC7210134 DOI: 10.21037/atm.2020.03.125] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background The use of aspirin has been linked to a reduced risk of cancer at several sites, such as the breast, prostate, and colorectum. However, the evidence for this chemopreventive effect from aspirin use on endometrial cancer is conflicting, and whether an association exists is an open question. Methods After carrying out a database search of articles published up to December 2019, we identified 7 case-control studies and 11 cohort studies, including a total of 14,766 endometrial cancer cases. We pooled the odds ratios (ORs) in case-control studies and risk ratios (RRs) in cohort studies, and then conducted subgroup analysis based on factors such as the frequency and duration of aspirin use, and obesity. Results In the overall meta-analysis, we found a significant inverse association between any aspirin use and the risk of endometrial cancer both in case-control studied [pooled ORs =0.88, 95% confidence interval (CI): 0.78–0.98] and cohort studies (pooled RRs =0.86, 95% CI: 0.86–0.99). In the subgroup analysis, a negative association was observed between the maximal frequency of aspirin use and the endometrial cancer risk (pooled ORs/RRs: 0.82; 95% CI: 0.71–0.95), but no correlations were observed based on the longest duration of aspirin use or obesity. Conclusions Our results suggest that the use of aspirin was associated with a reduced risk of endometrial cancer, and the reduced risk was closely related to the high-frequency of use. Further randomized controlled trials (RCTs) are needed to confirm these findings.
Collapse
Affiliation(s)
- Yang Wang
- Department of Gynecology, Obstetrics & Gynecology Hospital of Fudan University, Shanghai 200011, China
| | - Junda Zhao
- The Outpatient Department of Gynecology, First Teaching Hospital of Xinjiang Medical University, Urumqi 830054, China
| | - Xing Chen
- Department of Gynecology, Obstetrics & Gynecology Hospital of Fudan University, Shanghai 200011, China
| | - Feifei Zhang
- Department of Gynecology, Obstetrics & Gynecology Hospital of Fudan University, Shanghai 200011, China
| | - Xin Li
- Department of Gynecology, Obstetrics & Gynecology Hospital of Fudan University, Shanghai 200011, China
| |
Collapse
|
12
|
Donohoe F, Wilkinson M, Baxter E, Brennan DJ. Mitogen-Activated Protein Kinase (MAPK) and Obesity-Related Cancer. Int J Mol Sci 2020; 21:ijms21041241. [PMID: 32069845 PMCID: PMC7072904 DOI: 10.3390/ijms21041241] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 02/06/2020] [Accepted: 02/12/2020] [Indexed: 12/13/2022] Open
Abstract
Obesity is a major public health concern worldwide. The increased risk of certain types of cancer is now an established deleterious consequence of obesity, although the molecular mechanisms of this are not completely understood. In this review, we aim to explore the links between MAPK signalling and obesity-related cancer. We focus mostly on p38 and JNK MAPK, as the role of ERK remains unclear. These links are seen through the implication of MAPK in obesity-related immune paralysis as well as through effects on the endoplasmic reticulum stress response and activation of aromatase. By way of example, we highlight areas of interest and possibilities for future research in endometrioid endometrial cancer and hepatocellular carcinoma associated with non-alcoholic fatty liver disease (NAFLD), non-alcoholic steatohepatitis (NASH) and MAPK.
Collapse
Affiliation(s)
- Fionán Donohoe
- Ireland East Hospital Gynaeoncology Group, UCD School of Medicine, Mater Misericordiae University, D07R2WY Dublin 7, Ireland; (F.D.); (M.W.)
| | - Michael Wilkinson
- Ireland East Hospital Gynaeoncology Group, UCD School of Medicine, Mater Misericordiae University, D07R2WY Dublin 7, Ireland; (F.D.); (M.W.)
| | - Eva Baxter
- Queensland Centre for Gynaecological Cancer Research, The University of Queensland, Brisbane QLD 4029, Australia;
| | - Donal J. Brennan
- Ireland East Hospital Gynaeoncology Group, UCD School of Medicine, Mater Misericordiae University, D07R2WY Dublin 7, Ireland; (F.D.); (M.W.)
- Systems Biology Ireland, UCD School of Medicine, Belfield, D04V1W8 Dublin 4, Ireland
- Correspondence: ; Tel.: +353-1-7164567
| |
Collapse
|
13
|
Wu Y, Yan B, Xu W, Guo L, Wang Z, Li G, Hou N, Zhang J, Ling R. Compound C enhances the anticancer effect of aspirin in HER-2-positive breast cancer by regulating lipid metabolism in an AMPK-independent pathway. Int J Biol Sci 2020; 16:583-597. [PMID: 32025207 PMCID: PMC6990926 DOI: 10.7150/ijbs.39936] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 11/05/2019] [Indexed: 12/21/2022] Open
Abstract
Various clinical studies have determined that aspirin shows anticancer effects in many human malignant cancers, including human epidermal growth factor receptor-2 (HER-2)-positive breast cancer. However, the anti-tumor mechanism of aspirin has not been fully defined. The aim of this study was to determine the role of Compound C in enhancing the anticancer effect of aspirin. HER-2-positive breast cancer cell lines were treated with aspirin with or without Compound C pre-treatment; their phenotypes and mechanisms were then analyzed in vitro and in vivo. Aspirin exhibited anticancer effects in HER-2-positive breast cancer by inhibiting cell growth and inducing apoptosis through the activation of AMP-activated protein kinase (AMPK). Unexpectedly, pre-treatment with Compound C, a widely used AMPK inhibitor, induced robust anticancer effects in cells compared to aspirin monotherapy. This anticancer effect was not distinct in HER-2 negative breast cancer MDA-MB-231 cells and may be due to the inhibition of lipid metabolism mediated by c-myc. Besides, c-myc re-expression or palmitic acid supply could partially restored cell proliferation. Aspirin exhibits anticancer effects in HER-2-positive breast cancer by regulating lipid metabolism mediated by c-myc, and Compound C strengthens these effects in an AMPK-independent manner. Our results potentially provide a novel therapeutic strategy exploiting combined aspirin and Compound C therapy for HER-2-positive breast cancer, which acts by reducing de novo lipid synthesis.
Collapse
Affiliation(s)
- Ying Wu
- Department of Thyroid, Breast and Vascular Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China.,Key Laboratory of Cancer Biology, Department of Biochemistry and Molecular Biology, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Bohua Yan
- Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Wenqin Xu
- Department of Ophthalmology, Eye Institute of China PLA, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Lili Guo
- Department of Thyroid, Breast and Vascular Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Zhe Wang
- Department of Thyroid, Breast and Vascular Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Guoyin Li
- College of Life Science and Agronomy, Zhoukou Normal University, Zhoukou, Henan, China
| | - Niuniu Hou
- Department of Thyroid, Breast and Vascular Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Jian Zhang
- Key Laboratory of Cancer Biology, Department of Biochemistry and Molecular Biology, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Rui Ling
- Department of Thyroid, Breast and Vascular Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| |
Collapse
|
14
|
Joharatnam-Hogan N, Cafferty FH, Macnair A, Ring A, Langley RE. The role of aspirin in the prevention of ovarian, endometrial and cervical cancers. WOMEN'S HEALTH (LONDON, ENGLAND) 2020; 16:1745506520961710. [PMID: 33019903 PMCID: PMC7543116 DOI: 10.1177/1745506520961710] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 07/30/2020] [Accepted: 09/07/2020] [Indexed: 12/12/2022]
Abstract
Drug repurposing is the application of an existing licenced drug for a new indication and potentially provides a faster and cheaper approach to developing new anti-cancer agents. Gynaecological cancers contribute significantly to the global cancer burden, highlighting the need for low cost, widely accessible therapies. A large body of evidence supports the role of aspirin as an anti-cancer agent, and a number of randomized trials are currently underway aiming to assess the potential benefit of aspirin in the treatment of cancer. This review summarizes the evidence underpinning aspirin use for the prevention of the development and recurrence of gynaecological cancers (ovarian, endometrial and cervical) and potential mechanisms of action.
Collapse
Affiliation(s)
- Nalinie Joharatnam-Hogan
- MRC Clinical Trials Unit, University College London, Institute of Clinical Trials & Methodology, London, UK
| | - Fay H Cafferty
- MRC Clinical Trials Unit, University College London, Institute of Clinical Trials & Methodology, London, UK
| | - Archie Macnair
- MRC Clinical Trials Unit, University College London, Institute of Clinical Trials & Methodology, London, UK
| | - Alistair Ring
- Royal Marsden Hospital, NHS Foundation Trust, London, UK
| | - Ruth E Langley
- MRC Clinical Trials Unit, University College London, Institute of Clinical Trials & Methodology, London, UK
| |
Collapse
|
15
|
Hamy AS, Derosa L, Valdelièvre C, Yonekura S, Opolon P, Priour M, Guerin J, Pierga JY, Asselain B, De Croze D, Pinheiro A, Lae M, Talagrand LS, Laas E, Darrigues L, Grandal B, Marangoni E, Montaudon E, Kroemer G, Zitvogel L, Reyal F. Comedications influence immune infiltration and pathological response to neoadjuvant chemotherapy in breast cancer. Oncoimmunology 2019; 9:1677427. [PMID: 32002287 PMCID: PMC6959439 DOI: 10.1080/2162402x.2019.1677427] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 09/18/2019] [Accepted: 10/04/2019] [Indexed: 12/22/2022] Open
Abstract
Immunosurveillance plays an important role in breast cancer (BC) prognosis and progression, and can be geared by immunogenic chemotherapy. In a cohort of 1023 BC patients treated with neoadjuvant chemotherapy (NAC), 40% of the individuals took comedications mostly linked to aging and comorbidities. We systematically analyzed the off-target effects of 1178 concurrent comedications (classified according to the Anatomical Therapeutic Chemical (ATC) Classification System) on the density of tumor-infiltrating lymphocytes (TILs) and pathological complete responses (pCR). At level 1 of the ATC system, the main anatomical classes of drugs were those targeting the nervous system (class N, 39.1%), cardiovascular disorders (class C, 26.6%), alimentary and metabolism (class A, 16.9%), or hormonal preparations (class H, 6.5%). At level 2, the most frequent therapeutic classes were psycholeptics (N05), analgesics (N02), and psychoanaleptics (N06). Pre-NAC TIL density in triple-negative BC (TNBC) was influenced by medications from class H, N, and A, while TIL density in HER2+ BC was associated with the use of class C. Psycholeptics (N05) and agents acting on the renin-angiotensin system (C09) were independently associated with pCR in the whole population of BC or TNBC, and in HER2-positive BC, respectively. Importantly, level 3 hypnotics (N05C) alone were able to reduce tumor growth in BC bearing mice and increased the anti-cancer activity of cyclophosphamide in a T cell-dependent manner. These findings prompt for further exploration of drugs interactions in cancer, and for prospective drug-repositioning strategies to improve the efficacy of NAC in BC.
Collapse
Affiliation(s)
- Anne-Sophie Hamy
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, U932, Immunity and Cancer, Institut Curie, PSL Research University, Paris, France.,Department of Medical Oncology, Institut Curie, Saint-Cloud, France
| | - Lisa Derosa
- Gustave Roussy Cancer Campus (GRCC), Villejuif, France.,Institut National de la Santé Et de la Recherche Medicale (INSERM), Equipe Labellisée-Ligue Nationale contre le Cancer, Villejuif, France.,Univ. Paris-Sud, Université Paris-Saclay, Gustave Roussy, Villejuif, France
| | | | - Satoru Yonekura
- Gustave Roussy Cancer Campus (GRCC), Villejuif, France.,Institut National de la Santé Et de la Recherche Medicale (INSERM), Equipe Labellisée-Ligue Nationale contre le Cancer, Villejuif, France.,Univ. Paris-Sud, Université Paris-Saclay, Gustave Roussy, Villejuif, France
| | - Paule Opolon
- Gustave Roussy Cancer Campus (GRCC), Villejuif, France.,Institut National de la Santé Et de la Recherche Medicale (INSERM), Equipe Labellisée-Ligue Nationale contre le Cancer, Villejuif, France.,Univ. Paris-Sud, Université Paris-Saclay, Gustave Roussy, Villejuif, France
| | - Maël Priour
- Informatics Department, Institut Curie, Paris, France
| | - Julien Guerin
- Informatics Department, Institut Curie, Paris, France
| | - Jean-Yves Pierga
- Department of Medical Oncology, Institut Curie, Saint-Cloud, France
| | | | | | - Alice Pinheiro
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, U932, Immunity and Cancer, Institut Curie, PSL Research University, Paris, France
| | - Marick Lae
- Tumor Biology, Institut Curie, Paris, France
| | | | - Enora Laas
- Department of Surgery, Institut Curie, Paris, France
| | | | | | - Elisabetta Marangoni
- Preclinical investigation laboratory, Translational Research Department, Institut Curie, PSL Research University, Paris
| | - Elodie Montaudon
- Preclinical investigation laboratory, Translational Research Department, Institut Curie, PSL Research University, Paris
| | - Guido Kroemer
- Equipe 11 labellisée par la Ligue contre le Cancer, Centre de Recherche des Cordeliers, Paris, France.,Cell Biology and Metabolomics platforms, Villejuif, France.,INSERM, Paris, France.,Sorbonne Paris Cité, Université Paris Descartes, Paris, France.,Université Pierre et Marie Curie, Paris, France.,Pôle de Biologie, Hôpital Européen Georges Pompidou, AP-HP, Paris, France.,Karolinska Institute, Department of Women's and Children's Health, Karolinska University Hospital, Stockholm, Sweden
| | - Laurence Zitvogel
- Gustave Roussy Cancer Campus (GRCC), Villejuif, France.,Institut National de la Santé Et de la Recherche Medicale (INSERM), Equipe Labellisée-Ligue Nationale contre le Cancer, Villejuif, France.,Univ. Paris-Sud, Université Paris-Saclay, Gustave Roussy, Villejuif, France.,Center of Clinical Investigations in Biotherapies of Cancer (CICBT), Gustave Roussy and Institut Curie, France
| | - Fabien Reyal
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, U932, Immunity and Cancer, Institut Curie, PSL Research University, Paris, France.,Department of Surgery, Institut Curie, Paris, France.,Sorbonne Paris Cité, Université Paris Descartes, Paris, France
| |
Collapse
|
16
|
Raglan O, Kalliala I, Markozannes G, Cividini S, Gunter MJ, Nautiyal J, Gabra H, Paraskevaidis E, Martin-Hirsch P, Tsilidis KK, Kyrgiou M. Risk factors for endometrial cancer: An umbrella review of the literature. Int J Cancer 2019; 145:1719-1730. [PMID: 30387875 DOI: 10.1002/ijc.31961] [Citation(s) in RCA: 262] [Impact Index Per Article: 52.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 10/19/2018] [Indexed: 03/25/2024]
Abstract
Although many risk factors could have causal association with endometrial cancer, they are also prone to residual confounding or other biases which could lead to over- or underestimation. This umbrella review evaluates the strength and validity of evidence pertaining risk factors for endometrial cancer. Systematic reviews or meta-analyses of observational studies evaluating the association between non-genetic risk factors and risk of developing or dying from endometrial cancer were identified from inception to April 2018 using PubMed, the Cochrane database and manual reference screening. Evidence was graded strong, highly suggestive, suggestive or weak based on statistical significance of random-effects summary estimate, largest study included, number of cases, between-study heterogeneity, 95% prediction intervals, small study effects, excess significance bias and sensitivity analysis with credibility ceilings. We identified 171 meta-analyses investigating associations between 53 risk factors and endometrial cancer incidence and mortality. Risk factors were categorised: anthropometric indices, dietary intake, physical activity, medical conditions, hormonal therapy use, biochemical markers, gynaecological history and smoking. Of 127 meta-analyses including cohort studies, three associations were graded with strong evidence. Body mass index and waist-to-hip ratio were associated with increased cancer risk in premenopausal women (RR per 5 kg/m2 1.49; CI 1.39-1.61) and for total endometrial cancer (RR per 0.1unit 1.21; CI 1.13-1.29), respectively. Parity reduced risk of disease (RR 0.66, CI 0.60-0.74). Of many proposed risk factors, only three had strong association without hints of bias. Identification of genuine risk factors associated with endometrial cancer may assist in developing targeted prevention strategies for women at high risk.
Collapse
Affiliation(s)
- Olivia Raglan
- Department of Surgery and Cancer, Institute of Reproductive and Developmental Biology, Faculty of Medicine, Imperial College London, London, United Kingdom
- Queen Charlotte's and Chelsea - Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Ilkka Kalliala
- Department of Surgery and Cancer, Institute of Reproductive and Developmental Biology, Faculty of Medicine, Imperial College London, London, United Kingdom
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Georgios Markozannes
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
| | | | - Marc J Gunter
- Section of Nutrition and Metabolism, International Agency for Research on Cancer (IARC), Lyon, France
| | - Jaya Nautiyal
- Department of Surgery and Cancer, Institute of Reproductive and Developmental Biology, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Hani Gabra
- Department of Surgery and Cancer, Institute of Reproductive and Developmental Biology, Faculty of Medicine, Imperial College London, London, United Kingdom
- Early Clinical Development, IMED Biotech Unit, Cambridge, United Kingdom
| | | | - Pierre Martin-Hirsch
- Department of Gynaecologic Oncology, Lancashire Teaching Hospitals, Preston, United Kingdom
- Department of Biophysics, University of Lancaster, Lancaster, United Kingdom
| | - Kostas K Tsilidis
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
| | - Maria Kyrgiou
- Department of Surgery and Cancer, Institute of Reproductive and Developmental Biology, Faculty of Medicine, Imperial College London, London, United Kingdom
- Queen Charlotte's and Chelsea - Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| |
Collapse
|
17
|
Ajrouche A, De Rycke Y, Dalichampt M, Messika Zeitoun D, Hulot J, Estellat C, Tubach F. Reduced risk of cancer among low‐dose aspirin users: Data from French health care databases. Pharmacoepidemiol Drug Saf 2019; 28:1258-1266. [DOI: 10.1002/pds.4870] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 06/16/2019] [Accepted: 07/05/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Aya Ajrouche
- Faculté de médecine Sorbonne Université, AP‐HP, Hôpital Pitié‐Salpêtrière, Département Biostatistique Santé Publique et Information Médicale, Centre de Pharmacoépidémiologie (Cephepi)Sorbonne Université INSERM, UMR 1123, ECEVE, CIC‐P 1421 Paris France
| | - Yann De Rycke
- Faculté de médecine Sorbonne Université, AP‐HP, Hôpital Pitié‐Salpêtrière, Département Biostatistique Santé Publique et Information Médicale, Centre de Pharmacoépidémiologie (Cephepi)Sorbonne Université INSERM, UMR 1123, ECEVE, CIC‐P 1421 Paris France
| | - Marie Dalichampt
- Caisse nationale d'assurance maladie des travailleurs salariés cnamts Paris France
| | | | - Jean‐Sebastien Hulot
- Faculté de médecine Sorbonne UniversitéSorbonne Université, INSERM, CIC‐1421 Paris France
| | - Candice Estellat
- Faculté de médecine Sorbonne Université, AP‐HP, Hôpital Pitié‐Salpêtrière, Département Biostatistique Santé Publique et Information Médicale, Centre de Pharmacoépidémiologie (Cephepi)Sorbonne Université INSERM, UMR 1123, ECEVE, CIC‐P 1421 Paris France
| | - Florence Tubach
- Faculté de médecine Sorbonne Université, AP‐HP, Hôpital Pitié‐Salpêtrière, Département Biostatistique Santé Publique et Information Médicale, Centre de Pharmacoépidémiologie (Cephepi)Sorbonne Université INSERM, UMR 1123, ECEVE, CIC‐P 1421 Paris France
| |
Collapse
|
18
|
McDonald ME, Bender DP. Endometrial Cancer: Obesity, Genetics, and Targeted Agents. Obstet Gynecol Clin North Am 2019; 46:89-105. [PMID: 30683268 DOI: 10.1016/j.ogc.2018.09.006] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
It is imperative to understand the underlying mechanisms of both endometrial carcinogenesis and recurrence in order to develop more effective prevention and treatment. This article reviews available molecular data, the interplay between endometrial cancer carcinogenesis with obesity and genetics, as well as current targeted therapies.
Collapse
Affiliation(s)
- Megan E McDonald
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Iowa, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242, USA
| | - David P Bender
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Iowa, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242, USA.
| |
Collapse
|
19
|
Webb PM, Na R, Weiderpass E, Adami HO, Anderson KE, Bertrand KA, Botteri E, Brasky TM, Brinton LA, Chen C, Doherty JA, Lu L, McCann SE, Moysich KB, Olson S, Petruzella S, Palmer JR, Prizment AE, Schairer C, Setiawan VW, Spurdle AB, Trabert B, Wentzensen N, Wilkens L, Yang HP, Yu H, Risch HA, Jordan SJ. Use of aspirin, other nonsteroidal anti-inflammatory drugs and acetaminophen and risk of endometrial cancer: the Epidemiology of Endometrial Cancer Consortium. Ann Oncol 2019; 30:310-316. [PMID: 30566587 PMCID: PMC6386026 DOI: 10.1093/annonc/mdy541] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Regular use of aspirin has been associated with a reduced risk of cancer at several sites but the data for endometrial cancer are conflicting. Evidence regarding use of other analgesics is limited. PATIENTS AND METHODS We pooled individual-level data from seven cohort and five case-control studies participating in the Epidemiology of Endometrial Cancer Consortium including 7120 women with endometrial cancer and 16 069 controls. For overall analyses, study-specific odds ratios (ORs) and 95% confidence intervals (CI) were estimated using logistic regression and combined using random-effects meta-analysis; for stratified analyses, we used mixed-effects logistic regression with study as a random effect. RESULTS At least weekly use of aspirin and non-aspirin nonsteroidal anti-inflammatory drugs (NSAIDs) was associated with an approximately 15% reduced risk of endometrial cancer among both overweight and obese women (OR = 0.86 [95% CI 0.76-0.98] and 0.86 [95% CI 0.76-0.97], respectively, for aspirin; 0.87 [95% CI 0.76-1.00] and 0.84 [0.74-0.96], respectively, for non-aspirin NSAIDs). There was no association among women of normal weight (body mass index < 25 kg/m2, Pheterogeneity = 0.04 for aspirin, Pheterogeneity = 0.003 for NSAIDs). Among overweight and obese women, the inverse association with aspirin was stronger for use 2-6 times/week (OR = 0.81, 95% CI 0.68-0.96) than for daily use (0.91, 0.80-1.03), possibly because a high proportion of daily users use low-dose formulations. There was no clear association with use of acetaminophen. CONCLUSION Our pooled analysis provides further evidence that use of standard-dose aspirin or other NSAIDs may reduce risk of endometrial cancer among overweight and obese women.
Collapse
Affiliation(s)
- P M Webb
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia; School of Public Health, University of Queensland, Brisbane, Australia.
| | - R Na
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - E Weiderpass
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Research, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway; Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway; Genetic Epidemiology Group, Folkhälsan Research Center, Helsinki, Finland; Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - H O Adami
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Clinical Effectiveness Research Group, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - K E Anderson
- School of Public Health, University of Minnesota, Minneapolis, USA
| | - K A Bertrand
- Slone Epidemiology Center, Boston University, Boston, USA
| | - E Botteri
- Women and Children's Division, Norwegian National Advisory Unit on Women's Health, Oslo University Hospital, Oslo, Norway; Department of Bowel Cancer Screening, Cancer Registry of Norway, Oslo, Norway
| | - T M Brasky
- Ohio State University Comprehensive Cancer Center, Columbus, USA
| | - L A Brinton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, USA
| | - C Chen
- Fred Hutchinson Cancer Research Center, Seattle, USA
| | - J A Doherty
- Fred Hutchinson Cancer Research Center, Seattle, USA; Huntsman Cancer Institute, University of Utah, Salt Lake City, USA; Huntsman Cancer Institute, University of Utah, Salt Lake City, USA; Department of Population Health Sciences, University of Utah, Salt Lake City, USA
| | - L Lu
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, USA
| | - S E McCann
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, USA
| | - K B Moysich
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, USA
| | - S Olson
- Memorial Sloan Kettering Cancer Center, New York, USA
| | - S Petruzella
- Memorial Sloan Kettering Cancer Center, New York, USA
| | - J R Palmer
- Slone Epidemiology Center, Boston University, Boston, USA
| | - A E Prizment
- School of Public Health, University of Minnesota, Minneapolis, USA
| | - C Schairer
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, USA
| | - V W Setiawan
- University of Southern California, Los Angeles, USA
| | - A B Spurdle
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - B Trabert
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, USA
| | - N Wentzensen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, USA
| | - L Wilkens
- Epidemiology Program, University of Hawaii Cancer Center, Honolulu, USA
| | - H P Yang
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, USA
| | - H Yu
- Epidemiology Program, University of Hawaii Cancer Center, Honolulu, USA
| | - H A Risch
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, USA
| | - S J Jordan
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia; School of Public Health, University of Queensland, Brisbane, Australia
| |
Collapse
|
20
|
Role of Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) in Cancer Prevention and Cancer Promotion. Adv Pharmacol Sci 2019; 2019:3418975. [PMID: 30838040 PMCID: PMC6374867 DOI: 10.1155/2019/3418975] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 12/01/2018] [Accepted: 01/08/2019] [Indexed: 12/21/2022] Open
Abstract
The nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly prescribed by medical practitioners in many clinical conditions for the symptomatic treatment of pain and fever. Due to their anti-inflammatory properties, these drugs have been investigated for their anticancer effects in numerous studies. This is because chronic inflammation has long been linked to carcinogenesis. As such, anti-inflammatory drugs are believed to play a role in cancer treatment and prevention. In the past few decades, research has shown that NSAIDs may decrease the risk of certain types of cancer. However, there is also a growing body of research that proves the contrary. Furthermore, NSAIDs are well known for many side effects, including some life-threatening ones. This review will discuss the relationship between chronic inflammation and cancer, the role of NSAIDs in cancer prevention and cancer promotion, and some of the potentially lethal side effects of these drugs.
Collapse
|
21
|
Cermisoni GC, Alteri A, Corti L, Rabellotti E, Papaleo E, Viganò P, Sanchez AM. Vitamin D and Endometrium: A Systematic Review of a Neglected Area of Research. Int J Mol Sci 2018; 19:E2320. [PMID: 30096760 PMCID: PMC6122064 DOI: 10.3390/ijms19082320] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 08/02/2018] [Accepted: 08/04/2018] [Indexed: 01/27/2023] Open
Abstract
Growing evidence supports a role of vitamin D (VD) in reproductive health. Vitamin D receptor (VDR) is expressed in the ovary, endometrium, and myometrium. The biological actions of VD in fertility and reproductive tissues have been investigated but mainly using animal models. Conversely, the molecular data addressing the mechanisms underlying VD action in the physiologic endometrium and in endometrial pathologies are still scant. Levels of VDR expression according to the menstrual cycle are yet to be definitively clarified, possibly being lower in the proliferative compared to the secretory phase and in mid-secretory compared to early secretory phase. Endometrial tissue also expresses the enzymes involved in the metabolism of VD. The potential anti-proliferative and anti-inflammatory effects of VD for the treatment of endometriosis have been investigated in recent years. Treatment of ectopic endometrial cells with 1,25(OH)₂D₃ could significantly reduce cytokine-mediated inflammatory responses. An alteration of VD metabolism in terms of increased 24-hydroxylase mRNA and protein expression has been demonstrated in endometrial cancer, albeit not consistently. The effect of the active form of the vitamin as an anti-proliferative, pro-apoptotic, anti-inflammatory, and differentiation-inducing agent has been demonstrated in various endometrial cancer cell lines.
Collapse
Affiliation(s)
- Greta Chiara Cermisoni
- Reproductive Sciences Laboratory, Division of Genetics and Cell Biology, IRCCS San Raffaele Scientific Institute, 20132 Milano, Italy.
| | - Alessandra Alteri
- Obstetrics and Gynaecology Department, IRCCS San Raffaele Scientific Institute, 20132 Milano, Italy.
| | - Laura Corti
- Obstetrics and Gynaecology Department, IRCCS San Raffaele Scientific Institute, 20132 Milano, Italy.
| | - Elisa Rabellotti
- Obstetrics and Gynaecology Department, IRCCS San Raffaele Scientific Institute, 20132 Milano, Italy.
| | - Enrico Papaleo
- Obstetrics and Gynaecology Department, IRCCS San Raffaele Scientific Institute, 20132 Milano, Italy.
| | - Paola Viganò
- Reproductive Sciences Laboratory, Division of Genetics and Cell Biology, IRCCS San Raffaele Scientific Institute, 20132 Milano, Italy.
| | - Ana Maria Sanchez
- Reproductive Sciences Laboratory, Division of Genetics and Cell Biology, IRCCS San Raffaele Scientific Institute, 20132 Milano, Italy.
| |
Collapse
|
22
|
Qiao Y, Yang T, Gan Y, Li W, Wang C, Gong Y, Lu Z. Associations between aspirin use and the risk of cancers: a meta-analysis of observational studies. BMC Cancer 2018. [PMID: 29534696 PMCID: PMC5851082 DOI: 10.1186/s12885-018-4156-5] [Citation(s) in RCA: 99] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background Epidemiological studies have clarified the potential associations between regular aspirin use and cancers. However, it remains controversial on whether aspirin use decreases the risk of cancers risks. Therefore, we conducted an updated meta-analysis to assess the associations between aspirin use and cancers. Methods The PubMed, Embase, and Web of Science databases were systematically searched up to March 2017 to identify relevant studies. Relative risks (RRs) with 95% confidence intervals (CIs) were used to assess the strength of associations. Results A total of 218 studies with 309 reports were eligible for this meta-analysis. Aspirin use was associated with a significant decrease in the risk of overall cancer (RR = 0.89, 95% CI: 0.87–0.91), and gastric (RR = 0.75, 95% CI: 0.65–0.86), esophageal (RR = 0.75, 95% CI: 0.62–0.89), colorectal (RR = 0.79, 95% CI: 0.74–0.85), pancreatic (RR = 0.80, 95% CI: 0.68–0.93), ovarian (RR = 0.89, 95% CI: 0.83–0.95), endometrial (RR = 0.92, 95% CI: 0.85–0.99), breast (RR = 0.92, 95% CI: 0.88–0.96), and prostate (RR = 0.94, 95% CI: 0.90–0.99) cancers, as well as small intestine neuroendocrine tumors (RR = 0.17, 95% CI: 0.05–0.58). Conclusions These findings suggest that aspirin use is associated with a reduced risk of gastric, esophageal, colorectal, pancreatic, ovarian, endometrial, breast, and prostate cancers, and small intestine neuroendocrine tumors. Electronic supplementary material The online version of this article (10.1186/s12885-018-4156-5) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Yan Qiao
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Tingting Yang
- Department of Nutriology, The People's Hospital of Henan Province, Zhengzhou, Henan, 450003, People's Republic of China
| | - Yong Gan
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Wenzhen Li
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Chao Wang
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Yanhong Gong
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China.
| | - Zuxun Lu
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China.
| |
Collapse
|
23
|
Effects of a Small Interfering RNA Targeting YKL-40 Gene on the Proliferation and Invasion of Endometrial Cancer HEC-1A Cells. Int J Gynecol Cancer 2018; 26:1190-5. [PMID: 27465891 DOI: 10.1097/igc.0000000000000774] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE The purpose of this study was to explore the effects of a small interfering RNA (siRNA) targeting YKL-40 on the proliferation and invasion of endometrial cancer (EC) HEC-1A cells. METHODS We used an siRNA targeting a sequence in YKL-40 (si-YKL-40) to transfect HEC-1A cells. Quantitative real-time polymerase chain reaction assay was performed to investigate the mRNA levels of YKL-40. MTT, migration, and invasion assays were performed to identify the effects of si-YKL-40 on the proliferation, migration, and invasive abilities of the HEC-1A cells. RESULTS mRNA expression of YKL-40 was down-regulated in HEC-1A cells after transfection with si-YKL-40 (P < 0.05). The proliferation, migration, and invasive abilities of HEC-1A cells were inhibited by siRNA (P < 0.05). CONCLUSIONS YKL-40 targeting siRNA specifically blocks the activity of YKL-40 in human EC HEC-1A cells, resulting in tumor suppression. This indicates that YKL-40 might serve as a potential small molecule target in the treatment of EC.
Collapse
|
24
|
Aspirin use and endometrial cancer risk and survival. Gynecol Oncol 2017; 148:222-232. [PMID: 29132875 DOI: 10.1016/j.ygyno.2017.10.026] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 10/20/2017] [Accepted: 10/23/2017] [Indexed: 02/06/2023]
Abstract
The role of acetylsalicylic acid (aspirin) as a chemo-preventive and adjuvant therapeutic agent for cancers is generating attention. Mounting evidence indicates that aspirin reduces the incidence and mortality of certain obesity-related cancers, particularly colorectal cancer. In endometrial cancer, previous studies examining the effect of aspirin remain inconsistent as to the reduction in the risk of endometrial cancer. While some evidence indicates protective effects in obese women, other studies have showed a potential deleterious effect of these medications on endometrial cancer outcomes. However, exposure measurement across studies has been inconsistent in recording dose, duration, and frequency of use; thus making comparisons difficult. In this article, we review the evidence for the association between endometrial cancer and obesity, the pharmacological differences between regular- and low-dose aspirin, as well as the potential anti-tumor mechanism of aspirin, supporting a possible therapeutic effect on endometrial cancer. A proposed mechanism behind decreased cancer mortality in endometrial cancer may be a result of inhibition of metastasis via platelet inactivation and possible prostaglandin E2 suppression by aspirin. Additionally, aspirin use in particular may have a secondary benefit for obesity-related comorbidities including cardiovascular disease in women with endometrial cancer. Although aspirin-related bleeding needs to be considered as a possible adverse effect, the benefits of aspirin therapy may exceed the potential risk in women with endometrial cancer. The current evidence reviewed herein has resulted in conflicting findings regarding the potential effect on endometrial cancer outcomes, thus indicating that future studies in this area are needed to resolve the effects of aspirin on endometrial cancer survival, particularly to identify specific populations that might benefit from aspirin use.
Collapse
|
25
|
Can Aspirin Reduce the Risk of Endometrial Cancer?: A Systematic Review and Meta-analysis of Observational Studies. Int J Gynecol Cancer 2017; 26:1111-20. [PMID: 27177285 DOI: 10.1097/igc.0000000000000731] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Current evidences suggest that nonsteroidal anti-inflammatory drugs can reduce the risk of several types of cancer, including breast, prostate, and colorectal cancer. However, evidences regarding the chemopreventive effect of aspirin to endometrial cancer are inconsistent. Therefore, we aimed to further explore the association. We searched PubMed, EMBASE, Web of Science, and Scopus to identify potentially eligible studies. After title/abstract screening and full-text review, we identified 7 cohort studies and 6 case-control studies. Data extraction and quality assessment were performed independently, and a random-effects model was used for data synthesis. Subgroup analysis was conducted based on obesity, hormone replacement therapy use, and cancer subtype; sensitivity analysis was conducted by pooling risk ratios of the highest dosage or longest duration of use. Dose-response relationship was assessed by a 2-stage linear dose-response model. Statistical heterogeneity was assessed by the I value and a χ test for the Cochrane Q statistic. In overall meta-analysis, the pooled risk ratio was 0.93 (95% confidence interval, 0.88-0.99), and no substantial statistical heterogeneity was observed (I = 0.0%, P = 0.550). In subgroup analysis, a negative association was observed for obese women and type I endometrial cancer. Higher dosage or frequency of aspirin use was significantly associated with a reduced risk, and long-term aspirin use was protective only for obese women. In conclusion, our study suggests that the use of aspirin can reduce the risk of endometrial cancer, particularly for obese women. However, the generalizability of our conclusion should be further studied for premenopausal women and type II endometrial cancer.
Collapse
|
26
|
Sanni OB, Mc Menamin ÚC, Cardwell CR, Sharp L, Murray LJ, Coleman HG. Commonly used medications and endometrial cancer survival: a population-based cohort study. Br J Cancer 2017; 117:432-438. [PMID: 28683466 PMCID: PMC5537503 DOI: 10.1038/bjc.2017.207] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 05/22/2017] [Accepted: 06/09/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Increasing incidence and new indications for existing drugs make it important to identify new adjuvant therapies for endometrial cancer (EC). METHODS This is a prospective cohort study of 3058 newly diagnosed EC cases from 1998 to 2010, identified through record linkages between the UK Clinical Practice Research Datalink, the National Cancer Research Datalink and death registrations from the Office of National Statistics. Using Cox regression models, unadjusted and adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated for EC-specific survival. RESULTS Over a mean 6.1 (range 1-16) years of follow-up, there were 394 EC-specific deaths. There was no evidence of a significant association between post-diagnostic use of statins (adjusted HR 0.83, 95% CI 0.64, 1.08), β-blockers (adjusted HR 0.86, 95% CI 0.65, 1.13) or low-dose aspirin (adjusted HR 0.91, 95% CI 0.69, 1.20) and EC survival before or after adjustment for confounders. There were also no evidence of a dose-response association between these drug groups and EC survival. CONCLUSIONS In this large UK population-based study, no significant associations were observed for post-diagnostic use of statins, β-blockers or low-dose aspirin and EC survival.
Collapse
Affiliation(s)
- Omolara B Sanni
- Cancer Epidemiology and Health Services Research Group, Centre for Public Health, Royal Victoria Hospital, Queen’s University Belfast, Block B, Grosvenor Road, Belfast, Northern Ireland
| | - Úna C Mc Menamin
- Cancer Epidemiology and Health Services Research Group, Centre for Public Health, Royal Victoria Hospital, Queen’s University Belfast, Block B, Grosvenor Road, Belfast, Northern Ireland
| | - Chris R Cardwell
- Cancer Epidemiology and Health Services Research Group, Centre for Public Health, Royal Victoria Hospital, Queen’s University Belfast, Block B, Grosvenor Road, Belfast, Northern Ireland
| | - Linda Sharp
- Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne NE2 4AX, UK
| | - Liam J Murray
- Cancer Epidemiology and Health Services Research Group, Centre for Public Health, Royal Victoria Hospital, Queen’s University Belfast, Block B, Grosvenor Road, Belfast, Northern Ireland
| | - Helen G Coleman
- Cancer Epidemiology and Health Services Research Group, Centre for Public Health, Royal Victoria Hospital, Queen’s University Belfast, Block B, Grosvenor Road, Belfast, Northern Ireland
| |
Collapse
|
27
|
Breastfeeding and Endometrial Cancer Risk: An Analysis From the Epidemiology of Endometrial Cancer Consortium. Obstet Gynecol 2017; 129:1059-1067. [PMID: 28486362 DOI: 10.1097/aog.0000000000002057] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the association between breastfeeding and endometrial cancer risk using pooled data from 17 studies participating in the Epidemiology of Endometrial Cancer Consortium. METHODS We conducted a meta-analysis with individual-level data from three cohort and 14 case-control studies. Study-specific odds ratios (ORs) and 95% confidence intervals (CIs) were estimated for the association between breastfeeding and risk of endometrial cancer using multivariable logistic regression and pooled using random-effects meta-analysis. We investigated between-study heterogeneity with I and Q statistics and metaregression. RESULTS After excluding nulliparous women, the analyses included 8,981 women with endometrial cancer and 17,241 women in a control group. Ever breastfeeding was associated with an 11% reduction in risk of endometrial cancer (pooled OR 0.89, 95% CI 0.81-0.98). Longer average duration of breastfeeding per child was associated with lower risk of endometrial cancer, although there appeared to be some leveling of this effect beyond 6-9 months. The association with ever breastfeeding was not explained by greater parity and did not vary notably by body mass index or histologic subtype (grouped as endometrioid and mucinous compared with serous and clear cell). CONCLUSION Our findings suggest that reducing endometrial cancer risk can be added to the list of maternal benefits associated with breastfeeding. Ongoing promotion, support, and facilitation of this safe and beneficial behavior might therefore contribute to the prevention of this increasingly common cancer.
Collapse
|
28
|
Brasky TM, Felix AS, Cohn DE, McMeekin DS, Mutch DG, Creasman WT, Thaker PH, Walker JL, Moore RG, Lele SB, Guntupalli SR, Downs LS, Nagel CI, Boggess JF, Pearl ML, Ioffe OB, Park KJ, Ali S, Brinton LA. Nonsteroidal Anti-inflammatory Drugs and Endometrial Carcinoma Mortality and Recurrence. J Natl Cancer Inst 2017; 109:1-10. [PMID: 28376204 DOI: 10.1093/jnci/djw251] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 09/26/2016] [Indexed: 12/21/2022] Open
Abstract
Background Recent data suggest that the use of nonsteroidal anti-inflammatory drugs (NSAIDs) may be associated with reductions in endometrial cancer risk, yet very few have examined whether their use is related to prognosis among endometrial cancer patients. Methods Study subjects comprised 4374 participants of the NRG Oncology/Gynecology Oncology Group 210 Study with endometrial carcinoma who completed a presurgical questionnaire that assessed history of regular prediagnostic NSAID use and endometrial cancer risk factors. Recurrences, vital status, and causes of death were obtained from medical records and cancer registries. Fine-Gray semiproportional hazards regression estimated adjusted subhazard ratios (HRs) and 95% confidence intervals (CIs) for associations of NSAID use with endometrial carcinoma-specific mortality and recurrence. Models were stratified by endometrial carcinoma type (ie, type I [endometrioid] vs type II [serous, clear cell, or carcinosarcoma]) and histology. Results Five hundred fifty endometrial carcinoma-specific deaths and 737 recurrences occurred during a median of five years of follow-up. NSAID use was associated with 66% (HR = 1.66, 95% CI = 1.21 to 2.30) increased endometrial carcinoma-specific mortality among women with type I cancers. Associations were statistically significant for former and current users, and strongest among former users who used NSAIDs for 10 years or longer (HR = 2.23, 95% CI = 1.19 to 4.18, two-sided P trend = .01). NSAID use was not associated with recurrence or endometrial carcinoma-specific mortality among women with type II tumors. Conclusions In this study, use of NSAIDs was associated with increased endometrial carcinoma-specific mortality, especially in patients with type I tumors. Barring a clear biologic mechanism by which NSAIDs would increase the risk of cause-specific mortality, cautious interpretation is warranted.
Collapse
Affiliation(s)
- Theodore M Brasky
- Division of Cancer Prevention and Control, Ohio State University, Columbus, OH, USA
| | - Ashley S Felix
- College of Medicine, and Division of Epidemiology, College of Public Health, Ohio State University, Columbus, OH, USA.,Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.,Cancer Prevention Fellowship Program, Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - David E Cohn
- Division of Gynecologic Oncology, Ohio State University, Columbus, OH, USA
| | - D Scott McMeekin
- Stephenson Oklahoma Cancer Center, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Oklahoma, USA
| | - David G Mutch
- Washington University School of Medicine, St. Louis, MO, USA
| | - William T Creasman
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC, USA
| | - Premal H Thaker
- Washington University School of Medicine, St. Louis, MO, USA
| | - Joan L Walker
- Department of Obstetrics and Gynecology, University of Oklahoma, Oklahoma City, OK, USA
| | - Richard G Moore
- Program in Women's Oncology, Department of Obstetrics and Gynecology, Women and Infants Hospital/Brown University, Providence, RI, USA
| | - Shashikant B Lele
- Gynecologic Oncology, Roswell Park Cancer Institute, Buffalo, NY, USA
| | | | - Levi S Downs
- Gynecologic Oncology, University of Minnesota, Minneapolis, MN, USA
| | - Christa I Nagel
- Division of Gynecologic Oncology, Case Western Reserve University, Cleveland, OH, USA
| | - John F Boggess
- Gynecologic Oncology Program, University of North Carolina, Chapel Hill, NC, USA
| | - Michael L Pearl
- Gynecologic Oncology, State University of New York at Stonybrook, Stonybrook, NY , USA
| | - Olga B Ioffe
- Anatomical Pathology, University of Maryland, College Park, MD, USA
| | - Kay J Park
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Shamshad Ali
- NRG Statistics and Data Management Center, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Louise A Brinton
- Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| |
Collapse
|
29
|
Abstract
OBJECTIVE To examine the survival outcomes in women with endometrial cancer who were taking low-dose aspirin (81-100 mg/d). METHODS A multicenter retrospective study was conducted examining patients with stage I-IV endometrial cancer who underwent hysterectomy-based surgical staging between January 2000 and December 2013 (N=1,687). Patient demographics, medical comorbidities, medication types, tumor characteristics, and treatment patterns were correlated to survival outcomes. A Cox proportional hazard regression model was used to estimate adjusted hazard ratio for disease-free and disease-specific overall survival. RESULTS One hundred fifty-eight patients (9.4%, 95% confidence interval [CI] 8.8-11.9) were taking low-dose aspirin. Median follow-up time for the study cohort was 31.5 months. One hundred twenty-seven patients (7.5%) died of endometrial cancer. Low-dose aspirin use was significantly correlated with concurrent obesity, hypertension, diabetes mellitus, and hypercholesterolemia (all P<.001). Low-dose aspirin users were more likely to take other antihypertensive, antiglycemic, and anticholesterol agents (all P<.05). Low-dose aspirin use was not associated with histologic subtype, tumor grade, nodal metastasis, or cancer stage (all P>.05). On multivariable analysis, low-dose aspirin use remained an independent prognostic factor associated with an improved 5-year disease-free survival rate (90.6% compared with 80.9%, adjusted hazard ratio 0.46, 95% CI 0.25-0.86, P=.014) and disease-specific overall survival rate (96.4% compared with 87.3%, adjusted hazard ratio 0.23, 95% CI 0.08-0.64, P=.005). The increased survival effect noted with low-dose aspirin use was greatest in patients whose age was younger than 60 years (5-year disease-free survival rates, 93.9% compared with 84.0%, P=.013), body mass index was 30 or greater (92.2% compared with 81.4%, P=.027), who had type I cancer (96.5% compared with 88.6%, P=.029), and who received postoperative whole pelvic radiotherapy (88.2% compared with 61.5%, P=.014). These four factors remained significant for disease-specific overall survival (all P<.05). CONCLUSION Our results suggest that low-dose aspirin use is associated with improved survival outcomes in women with endometrial cancer, especially in those who are young, obese, with low-grade disease, and who receive postoperative radiotherapy.
Collapse
|
30
|
Verdoodt F, Kjaer S, Friis S. Influence of aspirin and non-aspirin NSAID use on ovarian and endometrial cancer: Summary of epidemiologic evidence of cancer risk and prognosis. Maturitas 2017; 100:1-7. [DOI: 10.1016/j.maturitas.2017.03.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 03/06/2017] [Indexed: 12/26/2022]
|
31
|
Ding YY, Yao P, Verma S, Han ZK, Hong T, Zhu YQ, Li HX. Use of acetaminophen and risk of endometrial cancer: evidence from observational studies. Oncotarget 2017; 8:34643-34651. [PMID: 28410226 PMCID: PMC5470998 DOI: 10.18632/oncotarget.16663] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 03/21/2017] [Indexed: 12/11/2022] Open
Abstract
Previous meta-analyses suggested that aspirin was associated with reduced risk of endometrial cancer. However, there has been no study comprehensively summarize the evidence of acetaminophen use and risk of endometrial cancer from observational studies. We systematically searched electronic databases (PubMed , EMBASE, Web of Science, and Cochrane Library) for relevant cohort or case-control studies up to February 28, 2017. Two independent authors performed the eligibility evaluation and data extraction. All differences were resolved by discussion. A random-effects model was applied to estimate summary relative risks (RRs) with 95% CIs. All statistical tests were two-sided. Seven observational studies including four prospective cohort studies and three case-control studies with 3874 endometrial cancer cases were included for final analysis. Compared with never use acetaminophen, ever use this drug was not associated with risk of endometrial cancer (summarized RR = 1.02; 95% CI: 0.93-1.13, I2 = 0%). Similar null association was also observed when compared the highest category of frequency/duration with never use acetaminophen (summarized RR = 0.88; 95% CI: 0.70-1.11, I2 = 15.2%). Additionally, the finding was robust in the subgroup analyses stratified by study characteristics and adjustment for potential confounders and risk factors. There was no evidence of publication bias by a visual inspection of a funnel plot and formal statistical tests. In summary, the present meta-analysis reveals no association between acetaminophen use and risk of endometrial cancer. More large scale prospective cohort studies are warranted to confirm our findings and carry out the dose-response analysis of aforementioned association.
Collapse
Affiliation(s)
- Yuan-Yuan Ding
- Department of Pain Management, Shengjing Hospital of China Medical University, Shenyang, China
| | - Peng Yao
- Department of Pain Management, Shengjing Hospital of China Medical University, Shenyang, China
| | - Surya Verma
- School of Undergraduate, China Medical University, Shenyang, China
| | - Zhen-Kai Han
- Department of Pain Management, Shengjing Hospital of China Medical University, Shenyang, China
| | - Tao Hong
- Department of Pain Management, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yong-Qiang Zhu
- Department of Pain Management, Shengjing Hospital of China Medical University, Shenyang, China
| | - Hong-Xi Li
- Department of Pain Management, Shengjing Hospital of China Medical University, Shenyang, China
| |
Collapse
|
32
|
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.
Collapse
|
33
|
Use of acetaminophen in relation to the occurrence of cancer: a review of epidemiologic studies. Cancer Causes Control 2016; 27:1411-1418. [PMID: 27832383 PMCID: PMC5108822 DOI: 10.1007/s10552-016-0818-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 10/20/2016] [Indexed: 11/24/2022]
Abstract
Acetaminophen has several pharmacologic properties that suggest it could be carcinogenic in human beings. A number of epidemiologic studies have been conducted to examine whether use of acetaminophen actually predisposes to the occurrence of one or more forms of cancer. There are inherent limitations to many of these studies, including the inaccurate identification of users and nonusers of acetaminophen, relatively short follow-up for cancer incidence, and the potential for confounding by indication. The present manuscript reviews the results of epidemiologic studies of acetaminophen use in relation to cancer incidence published through the end of 2015. The limitations of the underlying studies notwithstanding, some interim conclusions can be reached. For all but several forms of cancer, there is no suggestion that persons who have taken acetaminophen are at altered risk, even persons who have consumed a large quantity of the drug or those who have taken it for an extended duration. While in some studies the incidence of renal cell carcinoma has been observed to be increased among acetaminophen users, several other studies have failed to observe any such association; the reason for the discrepant findings is unclear. Some of the small number of studies that have presented data on the incidence of lymphoma, leukemia, and plasma cell disorders have found the risk to be modestly higher in users than nonusers of acetaminophen, but the results of other studies of these malignancies will be needed to gauge the possible role of publication bias as the basis for the positive results.
Collapse
|
34
|
Beavis AL, Smith AJB, Fader AN. Lifestyle changes and the risk of developing endometrial and ovarian cancers: opportunities for prevention and management. Int J Womens Health 2016; 8:151-67. [PMID: 27284267 PMCID: PMC4883806 DOI: 10.2147/ijwh.s88367] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Modifiable lifestyle factors, such as obesity, lack of physical activity, and smoking, contribute greatly to cancer and chronic disease morbidity and mortality worldwide. This review appraises recent evidence on modifiable lifestyle factors in the prevention of endometrial cancer (EC) and ovarian cancer (OC) as well as new evidence for lifestyle management of EC and OC survivors. For EC, obesity continues to be the strongest risk factor, while new evidence suggests that physical activity, oral contraceptive pills, and bariatric surgery may be protective against EC. Other medications, such as metformin and nonsteroidal anti-inflammatory drugs, may be protective, and interventional research is ongoing. For OC, we find increasing evidence to support the hypothesis that obesity and hormone replacement therapy increase the risk of developing OC. Oral contraceptive pills are protective against OC but are underutilized. Dietary factors such as the Mediterranean diet and alcohol consumption do not seem to affect the risk of either OC or EC. For EC and OC survivors, physical activity and weight loss are associated with improved quality of life. Small interventional trials show promise in increasing physical activity and weight maintenance for EC and OC survivors, although the impact on long-term health, including cancer recurrence and overall mortality, is unknown. Women's health providers should integrate counseling about these modifiable lifestyle factors into both the discussion of prevention for all women and the management of survivors of gynecologic cancers.
Collapse
Affiliation(s)
- Anna L Beavis
- Department of Gynecology and Obstetrics, The Kelly Gynecologic Oncology Service, Johns Hopkins Medicine, Baltimore, MD, USA
| | | | - Amanda Nickles Fader
- Department of Gynecology and Obstetrics, The Kelly Gynecologic Oncology Service, Johns Hopkins Medicine, Baltimore, MD, USA
| |
Collapse
|
35
|
Merritt MA, Strickler HD, Einstein MH, Yang HP, Sherman ME, Wentzensen N, Brouwer-Visser J, Cossio MJ, Whitney KD, Yu H, Gunter MJ, Huang GS. Insulin/IGF and sex hormone axes in human endometrium and associations with endometrial cancer risk factors. Cancer Causes Control 2016; 27:737-48. [PMID: 27125830 PMCID: PMC4870288 DOI: 10.1007/s10552-016-0751-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 04/16/2016] [Indexed: 12/22/2022]
Abstract
PURPOSE Experimental and observational data link insulin, insulin-like growth factor (IGF), and estrogens to endometrial tumorigenesis. However, there are limited data regarding insulin/IGF and sex hormone axes protein and gene expression in normal endometrial tissues, and very few studies have examined the impact of endometrial cancer risk factors on endometrial tissue biology. METHODS We evaluated endometrial tissues from 77 premenopausal and 30 postmenopausal women who underwent hysterectomy for benign indications and had provided epidemiological data. Endometrial tissue mRNA and protein levels were measured using quantitative real-time PCR and immunohistochemistry, respectively. RESULTS In postmenopausal women, we observed higher levels of phosphorylated IGF-I/insulin receptor (pIGF1R/pIR) in diabetic versus non-diabetic women (p value =0.02), while women who reported regular nonsteroidal anti-inflammatory drug use versus no use had higher levels of insulin and progesterone receptors (both p values ≤0.03). We also noted differences in pIGF1R/pIR staining with OC use (postmenopausal women only), and the proportion of estrogen receptor-positive tissues varied by the number of live births and PTEN status (premenopausal only) (p values ≤0.04). Compared to premenopausal proliferative phase women, postmenopausal women exhibited lower mRNA levels of IGF1, but higher IGFBP1 and IGFBP3 expression (all p values ≤0.004), and higher protein levels of the receptors for estrogen, insulin, and IGF-I (all p values ≤0.02). Conversely, pIGF1R/pIR levels were higher in premenopausal proliferative phase versus postmenopausal endometrium (p value =0.01). CONCLUSIONS These results highlight links between endometrial cancer risk factors and mechanistic factors that may contribute to early events in the multistage process of endometrial carcinogenesis.
Collapse
Affiliation(s)
- Melissa A Merritt
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St Mary's Campus, Norfolk Place, London, W2 1PG, UK.
| | - Howard D Strickler
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Jack and Pearl Resnick Campus, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
| | - Mark H Einstein
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Jack and Pearl Resnick Campus, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine and Montefiore Medical Center, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
| | - Hannah P Yang
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, Bethesda, MD, 20892, USA
| | - Mark E Sherman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, Bethesda, MD, 20892, USA
- Division of Cancer Prevention, National Cancer Institute, 9609 Medical Center Drive, Bethesda, MD, 20892, USA
| | - Nicolas Wentzensen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, Bethesda, MD, 20892, USA
| | - Jurriaan Brouwer-Visser
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine and Montefiore Medical Center, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
| | - Maria Jose Cossio
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine and Montefiore Medical Center, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
| | - Kathleen D Whitney
- Department of Pathology, Jack D. Weiler Hospital, The University Hospital for Albert Einstein College of Medicine, Montefiore Medical Center, 1825 Eastchester Road, Room 338, Bronx, NY, 10461, USA
| | - Herbert Yu
- Cancer Epidemiology Program, University of Hawaii Cancer Center, 701 Ilalo Street, Honolulu, HI, 96813, USA
| | - Marc J Gunter
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St Mary's Campus, Norfolk Place, London, W2 1PG, UK
| | - Gloria S Huang
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine and Montefiore Medical Center, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
| |
Collapse
|
36
|
Peres LC, Camacho F, Abbott SE, Alberg AJ, Bandera EV, Barnholtz-Sloan J, Bondy M, Cote ML, Crankshaw S, Funkhouser E, Moorman PG, Peters ES, Schwartz AG, Terry P, Wang F, Schildkraut JM. Analgesic medication use and risk of epithelial ovarian cancer in African American women. Br J Cancer 2016; 114:819-25. [PMID: 26908324 PMCID: PMC4984862 DOI: 10.1038/bjc.2016.39] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 01/21/2016] [Accepted: 01/28/2016] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Existing literature examining analgesic medication use and epithelial ovarian cancer (EOC) risk has been inconsistent, with the majority of studies reporting an inverse association. Race-specific effects of this relationship have not been adequately addressed. METHODS Utilising data from the largest population-based case-control study of EOC in African Americans, the African American Cancer Epidemiology Study, the relationship between analgesic use (aspirin, non-aspirin nonsteroidal anti-inflammatory drugs (NSAIDs), and acetaminophen) and risk of EOC was estimated by multivariate logistic regression. The association of frequency, duration, and indication of analgesic use on EOC risk was also assessed. RESULTS Aspirin use, overall, was associated with a 44% lower EOC risk (OR=0.56; 95% CI=0.35-0.92) and a 26% lower EOC risk was observed for non-aspirin NSAID use (OR=0.74; 95% CI=0.52-1.05). The inverse association was strongest for women taking aspirin to prevent cardiovascular disease and women taking non-aspirin NSAIDs for arthritis. Significantly decreased EOC risks were observed for low-dose aspirin use, daily aspirin use, aspirin use for <5 years, and occasional non-aspirin NSAID use for a duration of ⩾5 years. No association was observed for acetaminophen use. CONCLUSIONS Collectively, these findings support previous evidence that any NSAID use is inversely associated with EOC risk.
Collapse
Affiliation(s)
- Lauren C Peres
- Department of Public Health Sciences, University of Virginia, PO Box 800765, Charlottesville, VA 22903, USA
| | - Fabian Camacho
- Department of Public Health Sciences, University of Virginia, PO Box 800765, Charlottesville, VA 22903, USA
| | - Sarah E Abbott
- Department of Public Health Sciences, University of Virginia, PO Box 800765, Charlottesville, VA 22903, USA
| | - Anthony J Alberg
- Hollings Cancer Center and Department of Public Health Sciences, Medical University of South Carolina, 68 President Street, Bioengineering Building 103, Charleston, SC 29425, USA
| | - Elisa V Bandera
- Department of Population Science, Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, NJ 08903, USA
| | - Jill Barnholtz-Sloan
- Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, 2-526 Wolstein Research Building, 2103 Cornell Road, Cleveland, OH 44106, USA
| | - Melissa Bondy
- Cancer Prevention and Population Sciences Program, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | - Michele L Cote
- Department of Oncology and the Karmanos Cancer Institute Population Studies and Disparities Research Program, Wayne State University School of Medicine, 4100 John R Street, Detroit, MI 48201, USA
| | - Sydnee Crankshaw
- Department of Community and Family Medicine, Duke University Medical Center, 2424 Erwin Road, Suite 602, Durham, NC 27705, USA
| | - Ellen Funkhouser
- Division of Preventive Medicine, University of Alabama at Birmingham, Medical Towers 611, 1717 11th Avenue South, Birmingham, AL 35205, USA
| | - Patricia G Moorman
- Department of Community and Family Medicine, Duke University Medical Center, 2424 Erwin Road, Suite 602, Durham, NC 27705, USA
| | - Edward S Peters
- Department of Epidemiology, Louisiana State University Health Sciences Center School of Public Health, 2020 Gravier Street, 3rd Floor, New Orleans, LA 70112, USA
| | - Ann G Schwartz
- Department of Oncology and the Karmanos Cancer Institute Population Studies and Disparities Research Program, Wayne State University School of Medicine, 4100 John R Street, Detroit, MI 48201, USA
| | - Paul Terry
- Department of Medicine, University of Tennessee Medical Center-Knoxville, 1914 Andy Holt Avenue, HPER 390, Knoxville, TN 37996, USA
| | - Frances Wang
- Department of Community and Family Medicine, Duke University Medical Center, 2424 Erwin Road, Suite 602, Durham, NC 27705, USA
| | - Joellen M Schildkraut
- Department of Public Health Sciences, University of Virginia, PO Box 800765, Charlottesville, VA 22903, USA
| |
Collapse
|
37
|
Verdoodt F, Friis S, Dehlendorff C, Albieri V, Kjaer SK. Non-steroidal anti-inflammatory drug use and risk of endometrial cancer: A systematic review and meta-analysis of observational studies. Gynecol Oncol 2016; 140:352-8. [DOI: 10.1016/j.ygyno.2015.12.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 12/09/2015] [Accepted: 12/12/2015] [Indexed: 01/06/2023]
|
38
|
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.
Collapse
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.
| |
Collapse
|
39
|
Henry CJ, Casás-Selves M, Kim J, Zaberezhnyy V, Aghili L, Daniel AE, Jimenez L, Azam T, McNamee EN, Clambey ET, Klawitter J, Serkova NJ, Tan AC, Dinarello CA, DeGregori J. Aging-associated inflammation promotes selection for adaptive oncogenic events in B cell progenitors. J Clin Invest 2015; 125:4666-80. [PMID: 26551682 DOI: 10.1172/jci83024] [Citation(s) in RCA: 104] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 10/01/2015] [Indexed: 12/21/2022] Open
Abstract
The incidence of cancer is higher in the elderly; however, many of the underlying mechanisms for this association remain unexplored. Here, we have shown that B cell progenitors in old mice exhibit marked signaling, gene expression, and metabolic defects. Moreover, B cell progenitors that developed from hematopoietic stem cells (HSCs) transferred from young mice into aged animals exhibited similar fitness defects. We further demonstrated that ectopic expression of the oncogenes BCR-ABL, NRAS(V12), or Myc restored B cell progenitor fitness, leading to selection for oncogenically initiated cells and leukemogenesis specifically in the context of an aged hematopoietic system. Aging was associated with increased inflammation in the BM microenvironment, and induction of inflammation in young mice phenocopied aging-associated B lymphopoiesis. Conversely, a reduction of inflammation in aged mice via transgenic expression of α-1-antitrypsin or IL-37 preserved the function of B cell progenitors and prevented NRAS(V12)-mediated oncogenesis. We conclude that chronic inflammatory microenvironments in old age lead to reductions in the fitness of B cell progenitor populations. This reduced progenitor pool fitness engenders selection for cells harboring oncogenic mutations, in part due to their ability to correct aging-associated functional defects. Thus, modulation of inflammation--a common feature of aging--has the potential to limit aging-associated oncogenesis.
Collapse
|
40
|
Movahedi M, Bishop DT, Macrae F, Mecklin JP, Moeslein G, Olschwang S, Eccles D, Evans DG, Maher ER, Bertario L, Bisgaard ML, Dunlop MG, Ho JWC, Hodgson SV, Lindblom A, Lubinski J, Morrison PJ, Murday V, Ramesar RS, Side L, Scott RJ, Thomas HJW, Vasen HF, Burn J, Mathers JC. Obesity, Aspirin, and Risk of Colorectal Cancer in Carriers of Hereditary Colorectal Cancer: A Prospective Investigation in the CAPP2 Study. J Clin Oncol 2015; 33:3591-7. [PMID: 26282643 DOI: 10.1200/jco.2014.58.9952] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
PURPOSE In the general population, increased adiposity is a significant risk factor for colorectal cancer (CRC), but whether obesity has similar effects in those with hereditary CRC is uncertain. This prospective study investigated the association between body mass index and cancer risk in patients with Lynch syndrome (LS). PATIENTS AND METHODS Participants with LS were recruited to the CAPP2 study, in which they were randomly assigned to receive aspirin 600 mg per day or aspirin placebo, plus resistant starch 30 g per day or starch placebo (2 × 2 factorial design). Mean intervention period was 25.0 months, and mean follow-up was 55.7 months. RESULTS During follow-up, 55 of 937 participants developed CRC. For obese participants, CRC risk was 2.41× (95% CI, 1.22 to 4.85) greater than for underweight and normal-weight participants (reference group), and CRC risk increased by 7% for each 1-kg/m(2) increase in body mass index. The risk of all LS-related cancers in obese people was 1.77× (95% CI, 1.06 to 2.96; P = .03) greater than for the reference group. In subgroup analysis, obesity was associated with 3.72× (95% CI, 1.41 to 9.81) greater CRC risk in patients with LS with MLH1 mutation, but no excess risk was observed in those with MSH2 or MSH6 mutation (P = .5). The obesity-related excess CRC risk was confined to those randomly assigned to the aspirin placebo group (adjusted hazard ratio, 2.75; 95% CI, 1.12 to 6.79; P = .03). CONCLUSION Obesity is associated with substantially increased CRC risk in patients with LS, but this risk is abrogated in those taking aspirin. Such patients are likely to benefit from obesity prevention and/or regular aspirin.
Collapse
Affiliation(s)
- Mohammad Movahedi
- Mohammad Movahedi, Beheshti University of Medical Sciences, Tehran, Iran; Mohammad Movahedi and D. Timothy Bishop, University of Leeds, Leeds; Diana Eccles, University of Southampton, Southampton; D. Gareth Evans, St Mary's Hospital, Manchester; Eamonn R. Maher, University of Birmingham, Birmingham; Malcolm G. Dunlop, Western General Hospital, Edinburgh; Shirley V. Hodgson, St George's Hospital; Lucy Side, University College London; Huw J.W. Thomas, St Mark's Hospital, Imperial College, London; Patrick J. Morrison, Queens University Belfast, Belfast City Hospital Health and Social Care Trust, Belfast; Victoria Murday, Yorkhill Hospital, Glasgow; John Burn and John C. Mathers, Newcastle University, Newcastle upon Tyne, United Kingdom; Finlay Macrae, Royal Melbourne Hospital, Melbourne, Victoria; Rodney J. Scott, John Hunter Hospital, New Lambton, New South Wales, Australia; Jukka-Pekka Mecklin, Jyväskylä Central Hospital, Jyväskylä, Finland; Gabriela Moeslein, HELIOS St Josefs Hospital, Bochum-Linden, Germany; Sylviane Olschwang, Institut Paoli Calmettes, Marseille, France; Lucio Bertario, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy; Marie-Luise Bisgaard, University of Copenhagen, Hvidovre, Denmark; Judy W.C. Ho, Queen Mary Hospital, Hong Kong, Special Administrative Region, People's Republic of China; Annika Lindblom, Karolinska Institutet, Stockholm, Sweden; Jan Lubinski, International Hereditary Cancer Centre, Szczecin, Poland; Raj S. Ramesar, University of Cape Town, South Africa; and Hans F. Vasen, Netherlands Foundation of the Detection of Hereditary Tumours and Leiden University, Leiden, the Netherlands
| | - D Timothy Bishop
- Mohammad Movahedi, Beheshti University of Medical Sciences, Tehran, Iran; Mohammad Movahedi and D. Timothy Bishop, University of Leeds, Leeds; Diana Eccles, University of Southampton, Southampton; D. Gareth Evans, St Mary's Hospital, Manchester; Eamonn R. Maher, University of Birmingham, Birmingham; Malcolm G. Dunlop, Western General Hospital, Edinburgh; Shirley V. Hodgson, St George's Hospital; Lucy Side, University College London; Huw J.W. Thomas, St Mark's Hospital, Imperial College, London; Patrick J. Morrison, Queens University Belfast, Belfast City Hospital Health and Social Care Trust, Belfast; Victoria Murday, Yorkhill Hospital, Glasgow; John Burn and John C. Mathers, Newcastle University, Newcastle upon Tyne, United Kingdom; Finlay Macrae, Royal Melbourne Hospital, Melbourne, Victoria; Rodney J. Scott, John Hunter Hospital, New Lambton, New South Wales, Australia; Jukka-Pekka Mecklin, Jyväskylä Central Hospital, Jyväskylä, Finland; Gabriela Moeslein, HELIOS St Josefs Hospital, Bochum-Linden, Germany; Sylviane Olschwang, Institut Paoli Calmettes, Marseille, France; Lucio Bertario, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy; Marie-Luise Bisgaard, University of Copenhagen, Hvidovre, Denmark; Judy W.C. Ho, Queen Mary Hospital, Hong Kong, Special Administrative Region, People's Republic of China; Annika Lindblom, Karolinska Institutet, Stockholm, Sweden; Jan Lubinski, International Hereditary Cancer Centre, Szczecin, Poland; Raj S. Ramesar, University of Cape Town, South Africa; and Hans F. Vasen, Netherlands Foundation of the Detection of Hereditary Tumours and Leiden University, Leiden, the Netherlands
| | - Finlay Macrae
- Mohammad Movahedi, Beheshti University of Medical Sciences, Tehran, Iran; Mohammad Movahedi and D. Timothy Bishop, University of Leeds, Leeds; Diana Eccles, University of Southampton, Southampton; D. Gareth Evans, St Mary's Hospital, Manchester; Eamonn R. Maher, University of Birmingham, Birmingham; Malcolm G. Dunlop, Western General Hospital, Edinburgh; Shirley V. Hodgson, St George's Hospital; Lucy Side, University College London; Huw J.W. Thomas, St Mark's Hospital, Imperial College, London; Patrick J. Morrison, Queens University Belfast, Belfast City Hospital Health and Social Care Trust, Belfast; Victoria Murday, Yorkhill Hospital, Glasgow; John Burn and John C. Mathers, Newcastle University, Newcastle upon Tyne, United Kingdom; Finlay Macrae, Royal Melbourne Hospital, Melbourne, Victoria; Rodney J. Scott, John Hunter Hospital, New Lambton, New South Wales, Australia; Jukka-Pekka Mecklin, Jyväskylä Central Hospital, Jyväskylä, Finland; Gabriela Moeslein, HELIOS St Josefs Hospital, Bochum-Linden, Germany; Sylviane Olschwang, Institut Paoli Calmettes, Marseille, France; Lucio Bertario, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy; Marie-Luise Bisgaard, University of Copenhagen, Hvidovre, Denmark; Judy W.C. Ho, Queen Mary Hospital, Hong Kong, Special Administrative Region, People's Republic of China; Annika Lindblom, Karolinska Institutet, Stockholm, Sweden; Jan Lubinski, International Hereditary Cancer Centre, Szczecin, Poland; Raj S. Ramesar, University of Cape Town, South Africa; and Hans F. Vasen, Netherlands Foundation of the Detection of Hereditary Tumours and Leiden University, Leiden, the Netherlands
| | - Jukka-Pekka Mecklin
- Mohammad Movahedi, Beheshti University of Medical Sciences, Tehran, Iran; Mohammad Movahedi and D. Timothy Bishop, University of Leeds, Leeds; Diana Eccles, University of Southampton, Southampton; D. Gareth Evans, St Mary's Hospital, Manchester; Eamonn R. Maher, University of Birmingham, Birmingham; Malcolm G. Dunlop, Western General Hospital, Edinburgh; Shirley V. Hodgson, St George's Hospital; Lucy Side, University College London; Huw J.W. Thomas, St Mark's Hospital, Imperial College, London; Patrick J. Morrison, Queens University Belfast, Belfast City Hospital Health and Social Care Trust, Belfast; Victoria Murday, Yorkhill Hospital, Glasgow; John Burn and John C. Mathers, Newcastle University, Newcastle upon Tyne, United Kingdom; Finlay Macrae, Royal Melbourne Hospital, Melbourne, Victoria; Rodney J. Scott, John Hunter Hospital, New Lambton, New South Wales, Australia; Jukka-Pekka Mecklin, Jyväskylä Central Hospital, Jyväskylä, Finland; Gabriela Moeslein, HELIOS St Josefs Hospital, Bochum-Linden, Germany; Sylviane Olschwang, Institut Paoli Calmettes, Marseille, France; Lucio Bertario, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy; Marie-Luise Bisgaard, University of Copenhagen, Hvidovre, Denmark; Judy W.C. Ho, Queen Mary Hospital, Hong Kong, Special Administrative Region, People's Republic of China; Annika Lindblom, Karolinska Institutet, Stockholm, Sweden; Jan Lubinski, International Hereditary Cancer Centre, Szczecin, Poland; Raj S. Ramesar, University of Cape Town, South Africa; and Hans F. Vasen, Netherlands Foundation of the Detection of Hereditary Tumours and Leiden University, Leiden, the Netherlands
| | - Gabriela Moeslein
- Mohammad Movahedi, Beheshti University of Medical Sciences, Tehran, Iran; Mohammad Movahedi and D. Timothy Bishop, University of Leeds, Leeds; Diana Eccles, University of Southampton, Southampton; D. Gareth Evans, St Mary's Hospital, Manchester; Eamonn R. Maher, University of Birmingham, Birmingham; Malcolm G. Dunlop, Western General Hospital, Edinburgh; Shirley V. Hodgson, St George's Hospital; Lucy Side, University College London; Huw J.W. Thomas, St Mark's Hospital, Imperial College, London; Patrick J. Morrison, Queens University Belfast, Belfast City Hospital Health and Social Care Trust, Belfast; Victoria Murday, Yorkhill Hospital, Glasgow; John Burn and John C. Mathers, Newcastle University, Newcastle upon Tyne, United Kingdom; Finlay Macrae, Royal Melbourne Hospital, Melbourne, Victoria; Rodney J. Scott, John Hunter Hospital, New Lambton, New South Wales, Australia; Jukka-Pekka Mecklin, Jyväskylä Central Hospital, Jyväskylä, Finland; Gabriela Moeslein, HELIOS St Josefs Hospital, Bochum-Linden, Germany; Sylviane Olschwang, Institut Paoli Calmettes, Marseille, France; Lucio Bertario, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy; Marie-Luise Bisgaard, University of Copenhagen, Hvidovre, Denmark; Judy W.C. Ho, Queen Mary Hospital, Hong Kong, Special Administrative Region, People's Republic of China; Annika Lindblom, Karolinska Institutet, Stockholm, Sweden; Jan Lubinski, International Hereditary Cancer Centre, Szczecin, Poland; Raj S. Ramesar, University of Cape Town, South Africa; and Hans F. Vasen, Netherlands Foundation of the Detection of Hereditary Tumours and Leiden University, Leiden, the Netherlands
| | - Sylviane Olschwang
- Mohammad Movahedi, Beheshti University of Medical Sciences, Tehran, Iran; Mohammad Movahedi and D. Timothy Bishop, University of Leeds, Leeds; Diana Eccles, University of Southampton, Southampton; D. Gareth Evans, St Mary's Hospital, Manchester; Eamonn R. Maher, University of Birmingham, Birmingham; Malcolm G. Dunlop, Western General Hospital, Edinburgh; Shirley V. Hodgson, St George's Hospital; Lucy Side, University College London; Huw J.W. Thomas, St Mark's Hospital, Imperial College, London; Patrick J. Morrison, Queens University Belfast, Belfast City Hospital Health and Social Care Trust, Belfast; Victoria Murday, Yorkhill Hospital, Glasgow; John Burn and John C. Mathers, Newcastle University, Newcastle upon Tyne, United Kingdom; Finlay Macrae, Royal Melbourne Hospital, Melbourne, Victoria; Rodney J. Scott, John Hunter Hospital, New Lambton, New South Wales, Australia; Jukka-Pekka Mecklin, Jyväskylä Central Hospital, Jyväskylä, Finland; Gabriela Moeslein, HELIOS St Josefs Hospital, Bochum-Linden, Germany; Sylviane Olschwang, Institut Paoli Calmettes, Marseille, France; Lucio Bertario, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy; Marie-Luise Bisgaard, University of Copenhagen, Hvidovre, Denmark; Judy W.C. Ho, Queen Mary Hospital, Hong Kong, Special Administrative Region, People's Republic of China; Annika Lindblom, Karolinska Institutet, Stockholm, Sweden; Jan Lubinski, International Hereditary Cancer Centre, Szczecin, Poland; Raj S. Ramesar, University of Cape Town, South Africa; and Hans F. Vasen, Netherlands Foundation of the Detection of Hereditary Tumours and Leiden University, Leiden, the Netherlands
| | - Diana Eccles
- Mohammad Movahedi, Beheshti University of Medical Sciences, Tehran, Iran; Mohammad Movahedi and D. Timothy Bishop, University of Leeds, Leeds; Diana Eccles, University of Southampton, Southampton; D. Gareth Evans, St Mary's Hospital, Manchester; Eamonn R. Maher, University of Birmingham, Birmingham; Malcolm G. Dunlop, Western General Hospital, Edinburgh; Shirley V. Hodgson, St George's Hospital; Lucy Side, University College London; Huw J.W. Thomas, St Mark's Hospital, Imperial College, London; Patrick J. Morrison, Queens University Belfast, Belfast City Hospital Health and Social Care Trust, Belfast; Victoria Murday, Yorkhill Hospital, Glasgow; John Burn and John C. Mathers, Newcastle University, Newcastle upon Tyne, United Kingdom; Finlay Macrae, Royal Melbourne Hospital, Melbourne, Victoria; Rodney J. Scott, John Hunter Hospital, New Lambton, New South Wales, Australia; Jukka-Pekka Mecklin, Jyväskylä Central Hospital, Jyväskylä, Finland; Gabriela Moeslein, HELIOS St Josefs Hospital, Bochum-Linden, Germany; Sylviane Olschwang, Institut Paoli Calmettes, Marseille, France; Lucio Bertario, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy; Marie-Luise Bisgaard, University of Copenhagen, Hvidovre, Denmark; Judy W.C. Ho, Queen Mary Hospital, Hong Kong, Special Administrative Region, People's Republic of China; Annika Lindblom, Karolinska Institutet, Stockholm, Sweden; Jan Lubinski, International Hereditary Cancer Centre, Szczecin, Poland; Raj S. Ramesar, University of Cape Town, South Africa; and Hans F. Vasen, Netherlands Foundation of the Detection of Hereditary Tumours and Leiden University, Leiden, the Netherlands
| | - D Gareth Evans
- Mohammad Movahedi, Beheshti University of Medical Sciences, Tehran, Iran; Mohammad Movahedi and D. Timothy Bishop, University of Leeds, Leeds; Diana Eccles, University of Southampton, Southampton; D. Gareth Evans, St Mary's Hospital, Manchester; Eamonn R. Maher, University of Birmingham, Birmingham; Malcolm G. Dunlop, Western General Hospital, Edinburgh; Shirley V. Hodgson, St George's Hospital; Lucy Side, University College London; Huw J.W. Thomas, St Mark's Hospital, Imperial College, London; Patrick J. Morrison, Queens University Belfast, Belfast City Hospital Health and Social Care Trust, Belfast; Victoria Murday, Yorkhill Hospital, Glasgow; John Burn and John C. Mathers, Newcastle University, Newcastle upon Tyne, United Kingdom; Finlay Macrae, Royal Melbourne Hospital, Melbourne, Victoria; Rodney J. Scott, John Hunter Hospital, New Lambton, New South Wales, Australia; Jukka-Pekka Mecklin, Jyväskylä Central Hospital, Jyväskylä, Finland; Gabriela Moeslein, HELIOS St Josefs Hospital, Bochum-Linden, Germany; Sylviane Olschwang, Institut Paoli Calmettes, Marseille, France; Lucio Bertario, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy; Marie-Luise Bisgaard, University of Copenhagen, Hvidovre, Denmark; Judy W.C. Ho, Queen Mary Hospital, Hong Kong, Special Administrative Region, People's Republic of China; Annika Lindblom, Karolinska Institutet, Stockholm, Sweden; Jan Lubinski, International Hereditary Cancer Centre, Szczecin, Poland; Raj S. Ramesar, University of Cape Town, South Africa; and Hans F. Vasen, Netherlands Foundation of the Detection of Hereditary Tumours and Leiden University, Leiden, the Netherlands
| | - Eamonn R Maher
- Mohammad Movahedi, Beheshti University of Medical Sciences, Tehran, Iran; Mohammad Movahedi and D. Timothy Bishop, University of Leeds, Leeds; Diana Eccles, University of Southampton, Southampton; D. Gareth Evans, St Mary's Hospital, Manchester; Eamonn R. Maher, University of Birmingham, Birmingham; Malcolm G. Dunlop, Western General Hospital, Edinburgh; Shirley V. Hodgson, St George's Hospital; Lucy Side, University College London; Huw J.W. Thomas, St Mark's Hospital, Imperial College, London; Patrick J. Morrison, Queens University Belfast, Belfast City Hospital Health and Social Care Trust, Belfast; Victoria Murday, Yorkhill Hospital, Glasgow; John Burn and John C. Mathers, Newcastle University, Newcastle upon Tyne, United Kingdom; Finlay Macrae, Royal Melbourne Hospital, Melbourne, Victoria; Rodney J. Scott, John Hunter Hospital, New Lambton, New South Wales, Australia; Jukka-Pekka Mecklin, Jyväskylä Central Hospital, Jyväskylä, Finland; Gabriela Moeslein, HELIOS St Josefs Hospital, Bochum-Linden, Germany; Sylviane Olschwang, Institut Paoli Calmettes, Marseille, France; Lucio Bertario, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy; Marie-Luise Bisgaard, University of Copenhagen, Hvidovre, Denmark; Judy W.C. Ho, Queen Mary Hospital, Hong Kong, Special Administrative Region, People's Republic of China; Annika Lindblom, Karolinska Institutet, Stockholm, Sweden; Jan Lubinski, International Hereditary Cancer Centre, Szczecin, Poland; Raj S. Ramesar, University of Cape Town, South Africa; and Hans F. Vasen, Netherlands Foundation of the Detection of Hereditary Tumours and Leiden University, Leiden, the Netherlands
| | - Lucio Bertario
- Mohammad Movahedi, Beheshti University of Medical Sciences, Tehran, Iran; Mohammad Movahedi and D. Timothy Bishop, University of Leeds, Leeds; Diana Eccles, University of Southampton, Southampton; D. Gareth Evans, St Mary's Hospital, Manchester; Eamonn R. Maher, University of Birmingham, Birmingham; Malcolm G. Dunlop, Western General Hospital, Edinburgh; Shirley V. Hodgson, St George's Hospital; Lucy Side, University College London; Huw J.W. Thomas, St Mark's Hospital, Imperial College, London; Patrick J. Morrison, Queens University Belfast, Belfast City Hospital Health and Social Care Trust, Belfast; Victoria Murday, Yorkhill Hospital, Glasgow; John Burn and John C. Mathers, Newcastle University, Newcastle upon Tyne, United Kingdom; Finlay Macrae, Royal Melbourne Hospital, Melbourne, Victoria; Rodney J. Scott, John Hunter Hospital, New Lambton, New South Wales, Australia; Jukka-Pekka Mecklin, Jyväskylä Central Hospital, Jyväskylä, Finland; Gabriela Moeslein, HELIOS St Josefs Hospital, Bochum-Linden, Germany; Sylviane Olschwang, Institut Paoli Calmettes, Marseille, France; Lucio Bertario, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy; Marie-Luise Bisgaard, University of Copenhagen, Hvidovre, Denmark; Judy W.C. Ho, Queen Mary Hospital, Hong Kong, Special Administrative Region, People's Republic of China; Annika Lindblom, Karolinska Institutet, Stockholm, Sweden; Jan Lubinski, International Hereditary Cancer Centre, Szczecin, Poland; Raj S. Ramesar, University of Cape Town, South Africa; and Hans F. Vasen, Netherlands Foundation of the Detection of Hereditary Tumours and Leiden University, Leiden, the Netherlands
| | - Marie-Luise Bisgaard
- Mohammad Movahedi, Beheshti University of Medical Sciences, Tehran, Iran; Mohammad Movahedi and D. Timothy Bishop, University of Leeds, Leeds; Diana Eccles, University of Southampton, Southampton; D. Gareth Evans, St Mary's Hospital, Manchester; Eamonn R. Maher, University of Birmingham, Birmingham; Malcolm G. Dunlop, Western General Hospital, Edinburgh; Shirley V. Hodgson, St George's Hospital; Lucy Side, University College London; Huw J.W. Thomas, St Mark's Hospital, Imperial College, London; Patrick J. Morrison, Queens University Belfast, Belfast City Hospital Health and Social Care Trust, Belfast; Victoria Murday, Yorkhill Hospital, Glasgow; John Burn and John C. Mathers, Newcastle University, Newcastle upon Tyne, United Kingdom; Finlay Macrae, Royal Melbourne Hospital, Melbourne, Victoria; Rodney J. Scott, John Hunter Hospital, New Lambton, New South Wales, Australia; Jukka-Pekka Mecklin, Jyväskylä Central Hospital, Jyväskylä, Finland; Gabriela Moeslein, HELIOS St Josefs Hospital, Bochum-Linden, Germany; Sylviane Olschwang, Institut Paoli Calmettes, Marseille, France; Lucio Bertario, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy; Marie-Luise Bisgaard, University of Copenhagen, Hvidovre, Denmark; Judy W.C. Ho, Queen Mary Hospital, Hong Kong, Special Administrative Region, People's Republic of China; Annika Lindblom, Karolinska Institutet, Stockholm, Sweden; Jan Lubinski, International Hereditary Cancer Centre, Szczecin, Poland; Raj S. Ramesar, University of Cape Town, South Africa; and Hans F. Vasen, Netherlands Foundation of the Detection of Hereditary Tumours and Leiden University, Leiden, the Netherlands
| | - Malcolm G Dunlop
- Mohammad Movahedi, Beheshti University of Medical Sciences, Tehran, Iran; Mohammad Movahedi and D. Timothy Bishop, University of Leeds, Leeds; Diana Eccles, University of Southampton, Southampton; D. Gareth Evans, St Mary's Hospital, Manchester; Eamonn R. Maher, University of Birmingham, Birmingham; Malcolm G. Dunlop, Western General Hospital, Edinburgh; Shirley V. Hodgson, St George's Hospital; Lucy Side, University College London; Huw J.W. Thomas, St Mark's Hospital, Imperial College, London; Patrick J. Morrison, Queens University Belfast, Belfast City Hospital Health and Social Care Trust, Belfast; Victoria Murday, Yorkhill Hospital, Glasgow; John Burn and John C. Mathers, Newcastle University, Newcastle upon Tyne, United Kingdom; Finlay Macrae, Royal Melbourne Hospital, Melbourne, Victoria; Rodney J. Scott, John Hunter Hospital, New Lambton, New South Wales, Australia; Jukka-Pekka Mecklin, Jyväskylä Central Hospital, Jyväskylä, Finland; Gabriela Moeslein, HELIOS St Josefs Hospital, Bochum-Linden, Germany; Sylviane Olschwang, Institut Paoli Calmettes, Marseille, France; Lucio Bertario, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy; Marie-Luise Bisgaard, University of Copenhagen, Hvidovre, Denmark; Judy W.C. Ho, Queen Mary Hospital, Hong Kong, Special Administrative Region, People's Republic of China; Annika Lindblom, Karolinska Institutet, Stockholm, Sweden; Jan Lubinski, International Hereditary Cancer Centre, Szczecin, Poland; Raj S. Ramesar, University of Cape Town, South Africa; and Hans F. Vasen, Netherlands Foundation of the Detection of Hereditary Tumours and Leiden University, Leiden, the Netherlands
| | - Judy W C Ho
- Mohammad Movahedi, Beheshti University of Medical Sciences, Tehran, Iran; Mohammad Movahedi and D. Timothy Bishop, University of Leeds, Leeds; Diana Eccles, University of Southampton, Southampton; D. Gareth Evans, St Mary's Hospital, Manchester; Eamonn R. Maher, University of Birmingham, Birmingham; Malcolm G. Dunlop, Western General Hospital, Edinburgh; Shirley V. Hodgson, St George's Hospital; Lucy Side, University College London; Huw J.W. Thomas, St Mark's Hospital, Imperial College, London; Patrick J. Morrison, Queens University Belfast, Belfast City Hospital Health and Social Care Trust, Belfast; Victoria Murday, Yorkhill Hospital, Glasgow; John Burn and John C. Mathers, Newcastle University, Newcastle upon Tyne, United Kingdom; Finlay Macrae, Royal Melbourne Hospital, Melbourne, Victoria; Rodney J. Scott, John Hunter Hospital, New Lambton, New South Wales, Australia; Jukka-Pekka Mecklin, Jyväskylä Central Hospital, Jyväskylä, Finland; Gabriela Moeslein, HELIOS St Josefs Hospital, Bochum-Linden, Germany; Sylviane Olschwang, Institut Paoli Calmettes, Marseille, France; Lucio Bertario, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy; Marie-Luise Bisgaard, University of Copenhagen, Hvidovre, Denmark; Judy W.C. Ho, Queen Mary Hospital, Hong Kong, Special Administrative Region, People's Republic of China; Annika Lindblom, Karolinska Institutet, Stockholm, Sweden; Jan Lubinski, International Hereditary Cancer Centre, Szczecin, Poland; Raj S. Ramesar, University of Cape Town, South Africa; and Hans F. Vasen, Netherlands Foundation of the Detection of Hereditary Tumours and Leiden University, Leiden, the Netherlands
| | - Shirley V Hodgson
- Mohammad Movahedi, Beheshti University of Medical Sciences, Tehran, Iran; Mohammad Movahedi and D. Timothy Bishop, University of Leeds, Leeds; Diana Eccles, University of Southampton, Southampton; D. Gareth Evans, St Mary's Hospital, Manchester; Eamonn R. Maher, University of Birmingham, Birmingham; Malcolm G. Dunlop, Western General Hospital, Edinburgh; Shirley V. Hodgson, St George's Hospital; Lucy Side, University College London; Huw J.W. Thomas, St Mark's Hospital, Imperial College, London; Patrick J. Morrison, Queens University Belfast, Belfast City Hospital Health and Social Care Trust, Belfast; Victoria Murday, Yorkhill Hospital, Glasgow; John Burn and John C. Mathers, Newcastle University, Newcastle upon Tyne, United Kingdom; Finlay Macrae, Royal Melbourne Hospital, Melbourne, Victoria; Rodney J. Scott, John Hunter Hospital, New Lambton, New South Wales, Australia; Jukka-Pekka Mecklin, Jyväskylä Central Hospital, Jyväskylä, Finland; Gabriela Moeslein, HELIOS St Josefs Hospital, Bochum-Linden, Germany; Sylviane Olschwang, Institut Paoli Calmettes, Marseille, France; Lucio Bertario, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy; Marie-Luise Bisgaard, University of Copenhagen, Hvidovre, Denmark; Judy W.C. Ho, Queen Mary Hospital, Hong Kong, Special Administrative Region, People's Republic of China; Annika Lindblom, Karolinska Institutet, Stockholm, Sweden; Jan Lubinski, International Hereditary Cancer Centre, Szczecin, Poland; Raj S. Ramesar, University of Cape Town, South Africa; and Hans F. Vasen, Netherlands Foundation of the Detection of Hereditary Tumours and Leiden University, Leiden, the Netherlands
| | - Annika Lindblom
- Mohammad Movahedi, Beheshti University of Medical Sciences, Tehran, Iran; Mohammad Movahedi and D. Timothy Bishop, University of Leeds, Leeds; Diana Eccles, University of Southampton, Southampton; D. Gareth Evans, St Mary's Hospital, Manchester; Eamonn R. Maher, University of Birmingham, Birmingham; Malcolm G. Dunlop, Western General Hospital, Edinburgh; Shirley V. Hodgson, St George's Hospital; Lucy Side, University College London; Huw J.W. Thomas, St Mark's Hospital, Imperial College, London; Patrick J. Morrison, Queens University Belfast, Belfast City Hospital Health and Social Care Trust, Belfast; Victoria Murday, Yorkhill Hospital, Glasgow; John Burn and John C. Mathers, Newcastle University, Newcastle upon Tyne, United Kingdom; Finlay Macrae, Royal Melbourne Hospital, Melbourne, Victoria; Rodney J. Scott, John Hunter Hospital, New Lambton, New South Wales, Australia; Jukka-Pekka Mecklin, Jyväskylä Central Hospital, Jyväskylä, Finland; Gabriela Moeslein, HELIOS St Josefs Hospital, Bochum-Linden, Germany; Sylviane Olschwang, Institut Paoli Calmettes, Marseille, France; Lucio Bertario, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy; Marie-Luise Bisgaard, University of Copenhagen, Hvidovre, Denmark; Judy W.C. Ho, Queen Mary Hospital, Hong Kong, Special Administrative Region, People's Republic of China; Annika Lindblom, Karolinska Institutet, Stockholm, Sweden; Jan Lubinski, International Hereditary Cancer Centre, Szczecin, Poland; Raj S. Ramesar, University of Cape Town, South Africa; and Hans F. Vasen, Netherlands Foundation of the Detection of Hereditary Tumours and Leiden University, Leiden, the Netherlands
| | - Jan Lubinski
- Mohammad Movahedi, Beheshti University of Medical Sciences, Tehran, Iran; Mohammad Movahedi and D. Timothy Bishop, University of Leeds, Leeds; Diana Eccles, University of Southampton, Southampton; D. Gareth Evans, St Mary's Hospital, Manchester; Eamonn R. Maher, University of Birmingham, Birmingham; Malcolm G. Dunlop, Western General Hospital, Edinburgh; Shirley V. Hodgson, St George's Hospital; Lucy Side, University College London; Huw J.W. Thomas, St Mark's Hospital, Imperial College, London; Patrick J. Morrison, Queens University Belfast, Belfast City Hospital Health and Social Care Trust, Belfast; Victoria Murday, Yorkhill Hospital, Glasgow; John Burn and John C. Mathers, Newcastle University, Newcastle upon Tyne, United Kingdom; Finlay Macrae, Royal Melbourne Hospital, Melbourne, Victoria; Rodney J. Scott, John Hunter Hospital, New Lambton, New South Wales, Australia; Jukka-Pekka Mecklin, Jyväskylä Central Hospital, Jyväskylä, Finland; Gabriela Moeslein, HELIOS St Josefs Hospital, Bochum-Linden, Germany; Sylviane Olschwang, Institut Paoli Calmettes, Marseille, France; Lucio Bertario, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy; Marie-Luise Bisgaard, University of Copenhagen, Hvidovre, Denmark; Judy W.C. Ho, Queen Mary Hospital, Hong Kong, Special Administrative Region, People's Republic of China; Annika Lindblom, Karolinska Institutet, Stockholm, Sweden; Jan Lubinski, International Hereditary Cancer Centre, Szczecin, Poland; Raj S. Ramesar, University of Cape Town, South Africa; and Hans F. Vasen, Netherlands Foundation of the Detection of Hereditary Tumours and Leiden University, Leiden, the Netherlands
| | - Patrick J Morrison
- Mohammad Movahedi, Beheshti University of Medical Sciences, Tehran, Iran; Mohammad Movahedi and D. Timothy Bishop, University of Leeds, Leeds; Diana Eccles, University of Southampton, Southampton; D. Gareth Evans, St Mary's Hospital, Manchester; Eamonn R. Maher, University of Birmingham, Birmingham; Malcolm G. Dunlop, Western General Hospital, Edinburgh; Shirley V. Hodgson, St George's Hospital; Lucy Side, University College London; Huw J.W. Thomas, St Mark's Hospital, Imperial College, London; Patrick J. Morrison, Queens University Belfast, Belfast City Hospital Health and Social Care Trust, Belfast; Victoria Murday, Yorkhill Hospital, Glasgow; John Burn and John C. Mathers, Newcastle University, Newcastle upon Tyne, United Kingdom; Finlay Macrae, Royal Melbourne Hospital, Melbourne, Victoria; Rodney J. Scott, John Hunter Hospital, New Lambton, New South Wales, Australia; Jukka-Pekka Mecklin, Jyväskylä Central Hospital, Jyväskylä, Finland; Gabriela Moeslein, HELIOS St Josefs Hospital, Bochum-Linden, Germany; Sylviane Olschwang, Institut Paoli Calmettes, Marseille, France; Lucio Bertario, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy; Marie-Luise Bisgaard, University of Copenhagen, Hvidovre, Denmark; Judy W.C. Ho, Queen Mary Hospital, Hong Kong, Special Administrative Region, People's Republic of China; Annika Lindblom, Karolinska Institutet, Stockholm, Sweden; Jan Lubinski, International Hereditary Cancer Centre, Szczecin, Poland; Raj S. Ramesar, University of Cape Town, South Africa; and Hans F. Vasen, Netherlands Foundation of the Detection of Hereditary Tumours and Leiden University, Leiden, the Netherlands
| | - Victoria Murday
- Mohammad Movahedi, Beheshti University of Medical Sciences, Tehran, Iran; Mohammad Movahedi and D. Timothy Bishop, University of Leeds, Leeds; Diana Eccles, University of Southampton, Southampton; D. Gareth Evans, St Mary's Hospital, Manchester; Eamonn R. Maher, University of Birmingham, Birmingham; Malcolm G. Dunlop, Western General Hospital, Edinburgh; Shirley V. Hodgson, St George's Hospital; Lucy Side, University College London; Huw J.W. Thomas, St Mark's Hospital, Imperial College, London; Patrick J. Morrison, Queens University Belfast, Belfast City Hospital Health and Social Care Trust, Belfast; Victoria Murday, Yorkhill Hospital, Glasgow; John Burn and John C. Mathers, Newcastle University, Newcastle upon Tyne, United Kingdom; Finlay Macrae, Royal Melbourne Hospital, Melbourne, Victoria; Rodney J. Scott, John Hunter Hospital, New Lambton, New South Wales, Australia; Jukka-Pekka Mecklin, Jyväskylä Central Hospital, Jyväskylä, Finland; Gabriela Moeslein, HELIOS St Josefs Hospital, Bochum-Linden, Germany; Sylviane Olschwang, Institut Paoli Calmettes, Marseille, France; Lucio Bertario, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy; Marie-Luise Bisgaard, University of Copenhagen, Hvidovre, Denmark; Judy W.C. Ho, Queen Mary Hospital, Hong Kong, Special Administrative Region, People's Republic of China; Annika Lindblom, Karolinska Institutet, Stockholm, Sweden; Jan Lubinski, International Hereditary Cancer Centre, Szczecin, Poland; Raj S. Ramesar, University of Cape Town, South Africa; and Hans F. Vasen, Netherlands Foundation of the Detection of Hereditary Tumours and Leiden University, Leiden, the Netherlands
| | - Raj S Ramesar
- Mohammad Movahedi, Beheshti University of Medical Sciences, Tehran, Iran; Mohammad Movahedi and D. Timothy Bishop, University of Leeds, Leeds; Diana Eccles, University of Southampton, Southampton; D. Gareth Evans, St Mary's Hospital, Manchester; Eamonn R. Maher, University of Birmingham, Birmingham; Malcolm G. Dunlop, Western General Hospital, Edinburgh; Shirley V. Hodgson, St George's Hospital; Lucy Side, University College London; Huw J.W. Thomas, St Mark's Hospital, Imperial College, London; Patrick J. Morrison, Queens University Belfast, Belfast City Hospital Health and Social Care Trust, Belfast; Victoria Murday, Yorkhill Hospital, Glasgow; John Burn and John C. Mathers, Newcastle University, Newcastle upon Tyne, United Kingdom; Finlay Macrae, Royal Melbourne Hospital, Melbourne, Victoria; Rodney J. Scott, John Hunter Hospital, New Lambton, New South Wales, Australia; Jukka-Pekka Mecklin, Jyväskylä Central Hospital, Jyväskylä, Finland; Gabriela Moeslein, HELIOS St Josefs Hospital, Bochum-Linden, Germany; Sylviane Olschwang, Institut Paoli Calmettes, Marseille, France; Lucio Bertario, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy; Marie-Luise Bisgaard, University of Copenhagen, Hvidovre, Denmark; Judy W.C. Ho, Queen Mary Hospital, Hong Kong, Special Administrative Region, People's Republic of China; Annika Lindblom, Karolinska Institutet, Stockholm, Sweden; Jan Lubinski, International Hereditary Cancer Centre, Szczecin, Poland; Raj S. Ramesar, University of Cape Town, South Africa; and Hans F. Vasen, Netherlands Foundation of the Detection of Hereditary Tumours and Leiden University, Leiden, the Netherlands
| | - Lucy Side
- Mohammad Movahedi, Beheshti University of Medical Sciences, Tehran, Iran; Mohammad Movahedi and D. Timothy Bishop, University of Leeds, Leeds; Diana Eccles, University of Southampton, Southampton; D. Gareth Evans, St Mary's Hospital, Manchester; Eamonn R. Maher, University of Birmingham, Birmingham; Malcolm G. Dunlop, Western General Hospital, Edinburgh; Shirley V. Hodgson, St George's Hospital; Lucy Side, University College London; Huw J.W. Thomas, St Mark's Hospital, Imperial College, London; Patrick J. Morrison, Queens University Belfast, Belfast City Hospital Health and Social Care Trust, Belfast; Victoria Murday, Yorkhill Hospital, Glasgow; John Burn and John C. Mathers, Newcastle University, Newcastle upon Tyne, United Kingdom; Finlay Macrae, Royal Melbourne Hospital, Melbourne, Victoria; Rodney J. Scott, John Hunter Hospital, New Lambton, New South Wales, Australia; Jukka-Pekka Mecklin, Jyväskylä Central Hospital, Jyväskylä, Finland; Gabriela Moeslein, HELIOS St Josefs Hospital, Bochum-Linden, Germany; Sylviane Olschwang, Institut Paoli Calmettes, Marseille, France; Lucio Bertario, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy; Marie-Luise Bisgaard, University of Copenhagen, Hvidovre, Denmark; Judy W.C. Ho, Queen Mary Hospital, Hong Kong, Special Administrative Region, People's Republic of China; Annika Lindblom, Karolinska Institutet, Stockholm, Sweden; Jan Lubinski, International Hereditary Cancer Centre, Szczecin, Poland; Raj S. Ramesar, University of Cape Town, South Africa; and Hans F. Vasen, Netherlands Foundation of the Detection of Hereditary Tumours and Leiden University, Leiden, the Netherlands
| | - Rodney J Scott
- Mohammad Movahedi, Beheshti University of Medical Sciences, Tehran, Iran; Mohammad Movahedi and D. Timothy Bishop, University of Leeds, Leeds; Diana Eccles, University of Southampton, Southampton; D. Gareth Evans, St Mary's Hospital, Manchester; Eamonn R. Maher, University of Birmingham, Birmingham; Malcolm G. Dunlop, Western General Hospital, Edinburgh; Shirley V. Hodgson, St George's Hospital; Lucy Side, University College London; Huw J.W. Thomas, St Mark's Hospital, Imperial College, London; Patrick J. Morrison, Queens University Belfast, Belfast City Hospital Health and Social Care Trust, Belfast; Victoria Murday, Yorkhill Hospital, Glasgow; John Burn and John C. Mathers, Newcastle University, Newcastle upon Tyne, United Kingdom; Finlay Macrae, Royal Melbourne Hospital, Melbourne, Victoria; Rodney J. Scott, John Hunter Hospital, New Lambton, New South Wales, Australia; Jukka-Pekka Mecklin, Jyväskylä Central Hospital, Jyväskylä, Finland; Gabriela Moeslein, HELIOS St Josefs Hospital, Bochum-Linden, Germany; Sylviane Olschwang, Institut Paoli Calmettes, Marseille, France; Lucio Bertario, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy; Marie-Luise Bisgaard, University of Copenhagen, Hvidovre, Denmark; Judy W.C. Ho, Queen Mary Hospital, Hong Kong, Special Administrative Region, People's Republic of China; Annika Lindblom, Karolinska Institutet, Stockholm, Sweden; Jan Lubinski, International Hereditary Cancer Centre, Szczecin, Poland; Raj S. Ramesar, University of Cape Town, South Africa; and Hans F. Vasen, Netherlands Foundation of the Detection of Hereditary Tumours and Leiden University, Leiden, the Netherlands
| | - Huw J W Thomas
- Mohammad Movahedi, Beheshti University of Medical Sciences, Tehran, Iran; Mohammad Movahedi and D. Timothy Bishop, University of Leeds, Leeds; Diana Eccles, University of Southampton, Southampton; D. Gareth Evans, St Mary's Hospital, Manchester; Eamonn R. Maher, University of Birmingham, Birmingham; Malcolm G. Dunlop, Western General Hospital, Edinburgh; Shirley V. Hodgson, St George's Hospital; Lucy Side, University College London; Huw J.W. Thomas, St Mark's Hospital, Imperial College, London; Patrick J. Morrison, Queens University Belfast, Belfast City Hospital Health and Social Care Trust, Belfast; Victoria Murday, Yorkhill Hospital, Glasgow; John Burn and John C. Mathers, Newcastle University, Newcastle upon Tyne, United Kingdom; Finlay Macrae, Royal Melbourne Hospital, Melbourne, Victoria; Rodney J. Scott, John Hunter Hospital, New Lambton, New South Wales, Australia; Jukka-Pekka Mecklin, Jyväskylä Central Hospital, Jyväskylä, Finland; Gabriela Moeslein, HELIOS St Josefs Hospital, Bochum-Linden, Germany; Sylviane Olschwang, Institut Paoli Calmettes, Marseille, France; Lucio Bertario, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy; Marie-Luise Bisgaard, University of Copenhagen, Hvidovre, Denmark; Judy W.C. Ho, Queen Mary Hospital, Hong Kong, Special Administrative Region, People's Republic of China; Annika Lindblom, Karolinska Institutet, Stockholm, Sweden; Jan Lubinski, International Hereditary Cancer Centre, Szczecin, Poland; Raj S. Ramesar, University of Cape Town, South Africa; and Hans F. Vasen, Netherlands Foundation of the Detection of Hereditary Tumours and Leiden University, Leiden, the Netherlands
| | - Hans F Vasen
- Mohammad Movahedi, Beheshti University of Medical Sciences, Tehran, Iran; Mohammad Movahedi and D. Timothy Bishop, University of Leeds, Leeds; Diana Eccles, University of Southampton, Southampton; D. Gareth Evans, St Mary's Hospital, Manchester; Eamonn R. Maher, University of Birmingham, Birmingham; Malcolm G. Dunlop, Western General Hospital, Edinburgh; Shirley V. Hodgson, St George's Hospital; Lucy Side, University College London; Huw J.W. Thomas, St Mark's Hospital, Imperial College, London; Patrick J. Morrison, Queens University Belfast, Belfast City Hospital Health and Social Care Trust, Belfast; Victoria Murday, Yorkhill Hospital, Glasgow; John Burn and John C. Mathers, Newcastle University, Newcastle upon Tyne, United Kingdom; Finlay Macrae, Royal Melbourne Hospital, Melbourne, Victoria; Rodney J. Scott, John Hunter Hospital, New Lambton, New South Wales, Australia; Jukka-Pekka Mecklin, Jyväskylä Central Hospital, Jyväskylä, Finland; Gabriela Moeslein, HELIOS St Josefs Hospital, Bochum-Linden, Germany; Sylviane Olschwang, Institut Paoli Calmettes, Marseille, France; Lucio Bertario, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy; Marie-Luise Bisgaard, University of Copenhagen, Hvidovre, Denmark; Judy W.C. Ho, Queen Mary Hospital, Hong Kong, Special Administrative Region, People's Republic of China; Annika Lindblom, Karolinska Institutet, Stockholm, Sweden; Jan Lubinski, International Hereditary Cancer Centre, Szczecin, Poland; Raj S. Ramesar, University of Cape Town, South Africa; and Hans F. Vasen, Netherlands Foundation of the Detection of Hereditary Tumours and Leiden University, Leiden, the Netherlands
| | - John Burn
- Mohammad Movahedi, Beheshti University of Medical Sciences, Tehran, Iran; Mohammad Movahedi and D. Timothy Bishop, University of Leeds, Leeds; Diana Eccles, University of Southampton, Southampton; D. Gareth Evans, St Mary's Hospital, Manchester; Eamonn R. Maher, University of Birmingham, Birmingham; Malcolm G. Dunlop, Western General Hospital, Edinburgh; Shirley V. Hodgson, St George's Hospital; Lucy Side, University College London; Huw J.W. Thomas, St Mark's Hospital, Imperial College, London; Patrick J. Morrison, Queens University Belfast, Belfast City Hospital Health and Social Care Trust, Belfast; Victoria Murday, Yorkhill Hospital, Glasgow; John Burn and John C. Mathers, Newcastle University, Newcastle upon Tyne, United Kingdom; Finlay Macrae, Royal Melbourne Hospital, Melbourne, Victoria; Rodney J. Scott, John Hunter Hospital, New Lambton, New South Wales, Australia; Jukka-Pekka Mecklin, Jyväskylä Central Hospital, Jyväskylä, Finland; Gabriela Moeslein, HELIOS St Josefs Hospital, Bochum-Linden, Germany; Sylviane Olschwang, Institut Paoli Calmettes, Marseille, France; Lucio Bertario, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy; Marie-Luise Bisgaard, University of Copenhagen, Hvidovre, Denmark; Judy W.C. Ho, Queen Mary Hospital, Hong Kong, Special Administrative Region, People's Republic of China; Annika Lindblom, Karolinska Institutet, Stockholm, Sweden; Jan Lubinski, International Hereditary Cancer Centre, Szczecin, Poland; Raj S. Ramesar, University of Cape Town, South Africa; and Hans F. Vasen, Netherlands Foundation of the Detection of Hereditary Tumours and Leiden University, Leiden, the Netherlands
| | - John C Mathers
- Mohammad Movahedi, Beheshti University of Medical Sciences, Tehran, Iran; Mohammad Movahedi and D. Timothy Bishop, University of Leeds, Leeds; Diana Eccles, University of Southampton, Southampton; D. Gareth Evans, St Mary's Hospital, Manchester; Eamonn R. Maher, University of Birmingham, Birmingham; Malcolm G. Dunlop, Western General Hospital, Edinburgh; Shirley V. Hodgson, St George's Hospital; Lucy Side, University College London; Huw J.W. Thomas, St Mark's Hospital, Imperial College, London; Patrick J. Morrison, Queens University Belfast, Belfast City Hospital Health and Social Care Trust, Belfast; Victoria Murday, Yorkhill Hospital, Glasgow; John Burn and John C. Mathers, Newcastle University, Newcastle upon Tyne, United Kingdom; Finlay Macrae, Royal Melbourne Hospital, Melbourne, Victoria; Rodney J. Scott, John Hunter Hospital, New Lambton, New South Wales, Australia; Jukka-Pekka Mecklin, Jyväskylä Central Hospital, Jyväskylä, Finland; Gabriela Moeslein, HELIOS St Josefs Hospital, Bochum-Linden, Germany; Sylviane Olschwang, Institut Paoli Calmettes, Marseille, France; Lucio Bertario, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy; Marie-Luise Bisgaard, University of Copenhagen, Hvidovre, Denmark; Judy W.C. Ho, Queen Mary Hospital, Hong Kong, Special Administrative Region, People's Republic of China; Annika Lindblom, Karolinska Institutet, Stockholm, Sweden; Jan Lubinski, International Hereditary Cancer Centre, Szczecin, Poland; Raj S. Ramesar, University of Cape Town, South Africa; and Hans F. Vasen, Netherlands Foundation of the Detection of Hereditary Tumours and Leiden University, Leiden, the Netherlands.
| |
Collapse
|
41
|
Yang HP, Meeker A, Guido R, Gunter MJ, Huang GS, Luhn P, d'Ambrosio L, Wentzensen N, Sherman ME. PTEN expression in benign human endometrial tissue and cancer in relation to endometrial cancer risk factors. Cancer Causes Control 2015; 26:1729-36. [PMID: 26376893 DOI: 10.1007/s10552-015-0666-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 09/03/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Clonal loss of PTEN expression occurs frequently in endometrial carcinoma and endometrial hyperplasia. Limited data from immunohistochemical studies suggest that PTEN-null appearing endometrial glands are detectable in women without pathologic abnormalities, but the relationship of PTEN expression to endometrial cancer risk factors has not been extensively explored. We evaluated relationships between endometrial cancer risk factors and loss of PTEN expression in a set of benign endometrial samples prospectively collected from women undergoing hysterectomy and in endometrial cancer tissues from a population-based case-control study. METHODS We used a validated PTEN immunohistochemical assay to assess expression in epidemiological studies designed to assess benign endometrium [Benign Reproductive Tissue Evaluation Study (n = 73); Einstein Endometrium Study (n = 19)], and endometrial cancer [Polish Endometrial Cancer Study (n = 148)] tissues. Associations between endometrial cancer risk factors (collected via study-specific risk factor questionnaires) and PTEN expression in endometrial tissues were determined using Fisher's exact tests. RESULTS PTEN loss was detected in 19% of benign endometrial tissues versus 55% in endometrial cancers. NSAID use was statistically significantly associated with PTEN loss in the benign endometrium (p = 0.02). CONCLUSION Our data demonstrate that PTEN loss is detectable in endometrial tissues that are benign and malignant, with substantially more frequent loss in endometrial cancer compared with benign endometrium. However, alterations in expression were unrelated to most risk factors in this analysis, except for the association with NSAID use, which may represent a chance finding or reverse causality among patients with endometriosis who may have PTEN pathway abnormalities in eutopic endometrium. Further evaluation of factors associated with PTEN loss and long-term follow-up of women with PTEN-null endometrial glands may be useful in understanding early events in endometrial carcinogenesis.
Collapse
Affiliation(s)
- Hannah P Yang
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, Room #7E238, Bethesda, MD, 20892-9774, USA.
| | - Alan Meeker
- Johns Hopkins University, Baltimore, MD, USA
| | - Richard Guido
- Magee Women's Hospital of the UPMC System, Pittsburgh, PA, USA
| | | | - Gloria S Huang
- Obstetrics and Gynecology and Women's Health; and Molecular Pharmacology, Albert Einstein Cancer Center, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Patricia Luhn
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, Room #7E238, Bethesda, MD, 20892-9774, USA
| | - Lori d'Ambrosio
- Magee Women's Hospital of the UPMC System, Pittsburgh, PA, USA
| | - Nicolas Wentzensen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, Room #7E238, Bethesda, MD, 20892-9774, USA
| | - Mark E Sherman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, Room #7E238, Bethesda, MD, 20892-9774, USA.,Division of Cancer Prevention, National Cancer Institute, Bethesda, MD, USA
| |
Collapse
|
42
|
Webb PM. Environmental (nongenetic) factors in gynecological cancers: update and future perspectives. Future Oncol 2015; 11:295-307. [PMID: 25591840 DOI: 10.2217/fon.14.142] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Globally, gynecological cancers comprise three of the seven most common female cancers and are responsible for more than 1,000,000 new cases and 500,000 deaths annually. This review summarizes current knowledge regarding the role of environmental factors in gynecological cancer etiology and survival, focusing on those that are potentially amenable to intervention. Strong associations with use of exogenous hormones are countered by opposing risks of breast cancer, thus current hormonal preparations are not an option for prevention. Weight control would reduce risk of endometrial cancer but this and other lifestyle modifications are unlikely to have a major effect on gynecological cancer mortality rates. There is little information regarding the potential for lifestyle changes to improve outcomes for women with gynecological cancer.
Collapse
|
43
|
Zhong S, Chen L, Zhang X, Yu D, Tang J, Zhao J. Aspirin Use and Risk of Breast Cancer: Systematic Review and Meta-analysis of Observational Studies. Cancer Epidemiol Biomarkers Prev 2015; 24:1645-55. [PMID: 26315555 DOI: 10.1158/1055-9965.epi-15-0452] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 08/04/2015] [Indexed: 11/16/2022] Open
Affiliation(s)
- Shanliang Zhong
- Center of Clinical Laboratory Science, Jiangsu Cancer Hospital Affiliated to Nanjing Medical University, Nanjing, China
| | - Lin Chen
- Department of Oncology, Xuzhou Medical College, Xuzhou, China
| | - Xiaohui Zhang
- Center of Clinical Laboratory Science, Jiangsu Cancer Hospital Affiliated to Nanjing Medical University, Nanjing, China
| | - Dandan Yu
- Department of General Surgery, Jiangsu Cancer Hospital Affiliated to Nanjing Medical University, Nanjing, China
| | - Jinhai Tang
- Department of General Surgery, Jiangsu Cancer Hospital Affiliated to Nanjing Medical University, Nanjing, China
| | - Jianhua Zhao
- Center of Clinical Laboratory Science, Jiangsu Cancer Hospital Affiliated to Nanjing Medical University, Nanjing, China.
| |
Collapse
|
44
|
Yang TK, Chung CJ, Chung SD, Muo CH, Chang CH, Huang CY. Risk of Endometrial Cancer in Women With Pelvic Inflammatory Disease: A Nationwide Population-Based Retrospective Cohort Study. Medicine (Baltimore) 2015; 94:e1278. [PMID: 26313769 PMCID: PMC4602931 DOI: 10.1097/md.0000000000001278] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
To investigate the association between pelvic inflammatory disease (PID) and endometrial cancer (EC).We conducted a nationwide population-based retrospective cohort study, and data were obtained from the National Health Insurance Research Database. We defined 41,065 patients with PID as the PID cohort and 82,130 randomly selected patients as the control cohort through frequency matching by age and index year. PID and EC were diagnosed in accordance with the International Classification of Diseases, Ninth Revision, and Clinical Modification. Cox proportional hazards regression and Kaplan-Meier method were used in the analysis.Incidence rates of 16.1 and 9.6 per 100,000 person-years and mean follow-up durations of 4.84 and 6.63 years were observed in the PID and non-PID cohorts, respectively. After adjusting for potential risk factors, the PID cohort had a 1.79-fold higher risk of developing EC than the non-PID cohort. The incidence of EC increased with age, particularly for those aged >50 years (HR=2.45, 95% CI=1.29-4.65). Higher EC risk was also observed in the PID cohort with hypertension than in the non-PID cohort.The results of this large-scale population-based study showed an increased risk of EC in PID patients, particularly in older patients or those with hypertension. Future large-scale clinical trials are warranted to clarify the function of medication in PID-related EC progression.
Collapse
Affiliation(s)
- Teng-Kai Yang
- From the Surgery Department (T-KY), Yonghe Cardinal Hospital; School of Medicine, College of Medicine (T-KY, S-DC), Fu Jen Catholic University, New Taipei City; Department of Health Risk Management (C-JC), College of Public Health, China Medical University; Department of Medical Research (C-JC), China Medical University Hospital, Taichung; Division of Urology Department of Surgery (S-DC), Far Eastern Memorial Hospital, New Taipei; College of Medicine (C-HM, C-HC), China Medical University; Management Office for Health Data (C-HM), China Medical University and Hospital; Department of Urology (C-HC), China Medical University and Hospital, Taichung; and Department of Urology (C-YH), National Taiwan University Hospital, Taipei, Taiwan
| | | | | | | | | | | |
Collapse
|
45
|
Matsuo K, Hom MS, Moeini A, Machida H, Takeshima N, Roman LD, Sood AK. Significance of monocyte counts on tumor characteristics and survival outcome of women with endometrial cancer. Gynecol Oncol 2015; 138:332-8. [PMID: 26013698 DOI: 10.1016/j.ygyno.2015.05.019] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 05/16/2015] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Tumor-associated macrophages are known to be associated with decreased survival of patients with endometrial cancer. Given the physiological link of circulating monocytes as a progenitor of tumor-associated macrophages, monocyte counts were examined for tumor characteristics and survival in endometrial cancer. METHODS A retrospective study was conducted to examine consecutive patients with endometrial cancer with all histologic types who underwent hysterectomy-based surgical staging between 2003 and 2013 (n=541). Preoperative monocyte counts were correlated to patient demographics, pathological findings, complete blood count results, and survival outcomes. RESULTS Median monocyte counts were 0.5×10(9)/L. Monocyte counts significantly correlated with all other complete blood count components, with neutrophil counts having the most significant association (r=0.52, p<0.001). Elevated monocyte counts (defined as >0.7×10(9)/L) when compared to lower counts were significantly associated with an increased risk of >50% myometrial tumor invasion (29.2% versus 22.0%, odds ratio [OR] 1.59, 95% confidence interval [CI] 1.01-2.45, p=0.045), pelvic lymph node metastasis (39.0% versus 18.8%, OR 2.76, 95%CI 1.35-5.62, p=0.007), and advanced-stage (stage I through IV, 18.5%, 24.6%, 32.5%, and 41.5%, p=0.001). In survival analysis, elevated monocyte counts were associated with decreased disease-free survival (5-year rates, 71.0% versus 84.5%, p=0.001) and overall survival (77.2% versus 89.3%, p<0.001). In multivariate analysis, elevated monocyte counts remained an independent prognostic factor for decreased disease-free (hazard ratio [HR] 1.74, 95% CI 1.02-2.96, p=0.041) and overall (HR 2.63, 95% CI 1.37-5.05, p=0.004) survival. CONCLUSIONS Elevated monocyte counts were associated with aggressive tumor features and poor survival outcomes of patients with endometrial cancer.
Collapse
Affiliation(s)
- Koji Matsuo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA.
| | - Marianne S Hom
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Aida Moeini
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Hiroko Machida
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | | | - Lynda D Roman
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Anil K Sood
- Department of Gynecologic Oncology, University of Texas, MD-Anderson Cancer Center, Houston, TX, USA; Center for RNA Interference and Non-Coding RNAs, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| |
Collapse
|
46
|
Brøns N, Baandrup L, Dehlendorff C, Kjaer SK. Use of nonsteroidal anti-inflammatory drugs and risk of endometrial cancer: a nationwide case-control study. Cancer Causes Control 2015; 26:973-81. [PMID: 25895439 DOI: 10.1007/s10552-015-0578-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 04/07/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE We examined the association between use of low-dose aspirin and non-aspirin nonsteroidal anti-inflammatory drugs (NSAIDs) and endometrial cancer risk in a nationwide case-control study. METHODS Cases were all women in Denmark diagnosed with endometrial cancer during 2000-2009. Age-matched female controls were randomly selected by risk-set sampling. Information on NSAID use was collected from the Prescription Registry and classified according to duration and intensity. Conditional logistic regression was used to calculate odds ratios (ORs) and 95 % confidence intervals (CIs), adjusting for potential confounders. Analyses were stratified by endometrial cancer type, and potential effect modification by parity, obesity, and hormone replacement therapy (HRT) use was investigated. RESULTS We identified 5,382 endometrial cancer cases and 72,127 controls. Endometrial cancer was not associated with use of low-dose aspirin (OR 0.97, 95 % CI 0.89-1.05) or non-aspirin NSAIDs (OR 0.96, 95 % CI 0.91-1.02) compared with nonuse. The ORs did not vary with increasing duration or intensity of NSAID use or with type of endometrial cancer. Interaction analyses showed reduced endometrial cancer risk associated with low-dose aspirin use among nulliparous women (OR 0.82, 95 % CI 0.70-0.95) and with non-aspirin NSAID use among women having used HRT (OR 0.90, 95 % CI 0.82-0.99). CONCLUSIONS We found no association between use of NSAIDs and endometrial cancer risk overall, although there were some indications of risk reductions associated with low-dose aspirin use among nulliparous women and with non-aspirin NSAID use among women having used HRT.
Collapse
Affiliation(s)
- Nanna Brøns
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark
| | | | | | | |
Collapse
|
47
|
Brasky TM, Rodabough RJ, Liu J, Kurta ML, Wise LA, Orchard TS, Cohn DE, Belury MA, White E, Manson JE, Neuhouser ML. Long-chain ω-3 fatty acid intake and endometrial cancer risk in the Women's Health Initiative. Am J Clin Nutr 2015; 101:824-34. [PMID: 25739930 PMCID: PMC4381777 DOI: 10.3945/ajcn.114.098988] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 02/05/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Inflammation may be important in endometrial cancer development. Long-chain ω-3 (n-3) polyunsaturated fatty acids (LCω-3PUFAs) may reduce inflammation and, therefore, reduce cancer risk. Because body mass is associated with both inflammation and endometrial cancer risk, it may modify the association of fat intake on risk. OBJECTIVE We examined whether intakes of LCω-3PUFAs were associated with endometrial cancer risk overall and stratified by body size and histologic subtype. DESIGN Women were n = 87,360 participants of the Women's Health Initiative Observational Study and Clinical Trials who were aged 50-79 y, had an intact uterus, and completed a baseline food-frequency questionnaire. After 13 y of follow-up, n = 1253 incident invasive endometrial cancers were identified. Cox regression models were used to estimate HRs and 95% CIs for the association of intakes of individual ω-3 fatty acids and fish with endometrial cancer risk. RESULTS Intakes of individual LCω-3PUFAs were associated with 15-23% linear reductions in endometrial cancer risk. In women with body mass index (BMI; in kg/m(2)) <25, those in the upper compared with lowest quintiles of total LCω-3PUFA intake (sum of eicosapentaenoic, docosapentaenoic, and docosahexaenoic acids) had significantly reduced endometrial cancer risk (HR: 0.59; 95% CI: 0.40, 0.82; P-trend = 0.001), whereas there was little evidence of an association in overweight or obese women. The reduction in risk observed in normal-weight women was further specific to type I cancers. CONCLUSIONS Long-chain ω-3 intake was associated with reduced endometrial cancer risk only in normal-weight women. Additional studies that use biomarkers of ω-3 intake are needed to more accurately estimate their effects on endometrial cancer risk. This trial was registered at clinicaltrials.gov as NCT00000611.
Collapse
Affiliation(s)
- Theodore M Brasky
- From the Department of Internal Medicine, Division of Cancer Prevention and Control, College of Medicine (TMB), the Department of Human Sciences, College of Education and Human Ecology (TSO and MAB), and the Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, College of Medicine (DEC), The Ohio State University, Columbus, OH; the Women's Health Initiative Clinical Coordinating Center(RJR and JL) and the Cancer Prevention Program (EW and MLN), Fred Hutchinson Cancer Research Center, Seattle, WA; the Office of Epidemiology and Biostatistics, Allegheny County Health Department, Pittsburgh, PA (MLK); the Department of Epidemiology, Slone Epidemiology Center at Boston University, Boston University School of Public Health, Boston, MA (LAW); and the Department of Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, MA (JEM)
| | - Rebecca J Rodabough
- From the Department of Internal Medicine, Division of Cancer Prevention and Control, College of Medicine (TMB), the Department of Human Sciences, College of Education and Human Ecology (TSO and MAB), and the Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, College of Medicine (DEC), The Ohio State University, Columbus, OH; the Women's Health Initiative Clinical Coordinating Center(RJR and JL) and the Cancer Prevention Program (EW and MLN), Fred Hutchinson Cancer Research Center, Seattle, WA; the Office of Epidemiology and Biostatistics, Allegheny County Health Department, Pittsburgh, PA (MLK); the Department of Epidemiology, Slone Epidemiology Center at Boston University, Boston University School of Public Health, Boston, MA (LAW); and the Department of Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, MA (JEM)
| | - Jingmin Liu
- From the Department of Internal Medicine, Division of Cancer Prevention and Control, College of Medicine (TMB), the Department of Human Sciences, College of Education and Human Ecology (TSO and MAB), and the Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, College of Medicine (DEC), The Ohio State University, Columbus, OH; the Women's Health Initiative Clinical Coordinating Center(RJR and JL) and the Cancer Prevention Program (EW and MLN), Fred Hutchinson Cancer Research Center, Seattle, WA; the Office of Epidemiology and Biostatistics, Allegheny County Health Department, Pittsburgh, PA (MLK); the Department of Epidemiology, Slone Epidemiology Center at Boston University, Boston University School of Public Health, Boston, MA (LAW); and the Department of Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, MA (JEM)
| | - Michelle L Kurta
- From the Department of Internal Medicine, Division of Cancer Prevention and Control, College of Medicine (TMB), the Department of Human Sciences, College of Education and Human Ecology (TSO and MAB), and the Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, College of Medicine (DEC), The Ohio State University, Columbus, OH; the Women's Health Initiative Clinical Coordinating Center(RJR and JL) and the Cancer Prevention Program (EW and MLN), Fred Hutchinson Cancer Research Center, Seattle, WA; the Office of Epidemiology and Biostatistics, Allegheny County Health Department, Pittsburgh, PA (MLK); the Department of Epidemiology, Slone Epidemiology Center at Boston University, Boston University School of Public Health, Boston, MA (LAW); and the Department of Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, MA (JEM)
| | - Lauren A Wise
- From the Department of Internal Medicine, Division of Cancer Prevention and Control, College of Medicine (TMB), the Department of Human Sciences, College of Education and Human Ecology (TSO and MAB), and the Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, College of Medicine (DEC), The Ohio State University, Columbus, OH; the Women's Health Initiative Clinical Coordinating Center(RJR and JL) and the Cancer Prevention Program (EW and MLN), Fred Hutchinson Cancer Research Center, Seattle, WA; the Office of Epidemiology and Biostatistics, Allegheny County Health Department, Pittsburgh, PA (MLK); the Department of Epidemiology, Slone Epidemiology Center at Boston University, Boston University School of Public Health, Boston, MA (LAW); and the Department of Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, MA (JEM)
| | - Tonya S Orchard
- From the Department of Internal Medicine, Division of Cancer Prevention and Control, College of Medicine (TMB), the Department of Human Sciences, College of Education and Human Ecology (TSO and MAB), and the Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, College of Medicine (DEC), The Ohio State University, Columbus, OH; the Women's Health Initiative Clinical Coordinating Center(RJR and JL) and the Cancer Prevention Program (EW and MLN), Fred Hutchinson Cancer Research Center, Seattle, WA; the Office of Epidemiology and Biostatistics, Allegheny County Health Department, Pittsburgh, PA (MLK); the Department of Epidemiology, Slone Epidemiology Center at Boston University, Boston University School of Public Health, Boston, MA (LAW); and the Department of Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, MA (JEM)
| | - David E Cohn
- From the Department of Internal Medicine, Division of Cancer Prevention and Control, College of Medicine (TMB), the Department of Human Sciences, College of Education and Human Ecology (TSO and MAB), and the Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, College of Medicine (DEC), The Ohio State University, Columbus, OH; the Women's Health Initiative Clinical Coordinating Center(RJR and JL) and the Cancer Prevention Program (EW and MLN), Fred Hutchinson Cancer Research Center, Seattle, WA; the Office of Epidemiology and Biostatistics, Allegheny County Health Department, Pittsburgh, PA (MLK); the Department of Epidemiology, Slone Epidemiology Center at Boston University, Boston University School of Public Health, Boston, MA (LAW); and the Department of Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, MA (JEM)
| | - Martha A Belury
- From the Department of Internal Medicine, Division of Cancer Prevention and Control, College of Medicine (TMB), the Department of Human Sciences, College of Education and Human Ecology (TSO and MAB), and the Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, College of Medicine (DEC), The Ohio State University, Columbus, OH; the Women's Health Initiative Clinical Coordinating Center(RJR and JL) and the Cancer Prevention Program (EW and MLN), Fred Hutchinson Cancer Research Center, Seattle, WA; the Office of Epidemiology and Biostatistics, Allegheny County Health Department, Pittsburgh, PA (MLK); the Department of Epidemiology, Slone Epidemiology Center at Boston University, Boston University School of Public Health, Boston, MA (LAW); and the Department of Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, MA (JEM)
| | - Emily White
- From the Department of Internal Medicine, Division of Cancer Prevention and Control, College of Medicine (TMB), the Department of Human Sciences, College of Education and Human Ecology (TSO and MAB), and the Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, College of Medicine (DEC), The Ohio State University, Columbus, OH; the Women's Health Initiative Clinical Coordinating Center(RJR and JL) and the Cancer Prevention Program (EW and MLN), Fred Hutchinson Cancer Research Center, Seattle, WA; the Office of Epidemiology and Biostatistics, Allegheny County Health Department, Pittsburgh, PA (MLK); the Department of Epidemiology, Slone Epidemiology Center at Boston University, Boston University School of Public Health, Boston, MA (LAW); and the Department of Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, MA (JEM)
| | - JoAnn E Manson
- From the Department of Internal Medicine, Division of Cancer Prevention and Control, College of Medicine (TMB), the Department of Human Sciences, College of Education and Human Ecology (TSO and MAB), and the Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, College of Medicine (DEC), The Ohio State University, Columbus, OH; the Women's Health Initiative Clinical Coordinating Center(RJR and JL) and the Cancer Prevention Program (EW and MLN), Fred Hutchinson Cancer Research Center, Seattle, WA; the Office of Epidemiology and Biostatistics, Allegheny County Health Department, Pittsburgh, PA (MLK); the Department of Epidemiology, Slone Epidemiology Center at Boston University, Boston University School of Public Health, Boston, MA (LAW); and the Department of Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, MA (JEM)
| | - Marian L Neuhouser
- From the Department of Internal Medicine, Division of Cancer Prevention and Control, College of Medicine (TMB), the Department of Human Sciences, College of Education and Human Ecology (TSO and MAB), and the Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, College of Medicine (DEC), The Ohio State University, Columbus, OH; the Women's Health Initiative Clinical Coordinating Center(RJR and JL) and the Cancer Prevention Program (EW and MLN), Fred Hutchinson Cancer Research Center, Seattle, WA; the Office of Epidemiology and Biostatistics, Allegheny County Health Department, Pittsburgh, PA (MLK); the Department of Epidemiology, Slone Epidemiology Center at Boston University, Boston University School of Public Health, Boston, MA (LAW); and the Department of Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, MA (JEM)
| |
Collapse
|
48
|
Aspirin underuse, non-compliance or cessation: Definition, extent, impact and potential solutions in the primary and secondary prevention of cardiovascular disease. Int J Cardiol 2015; 182:148-54. [PMID: 25577751 DOI: 10.1016/j.ijcard.2014.12.091] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 12/01/2014] [Accepted: 12/25/2014] [Indexed: 02/08/2023]
|
49
|
Brasky TM, Liu J, White E, Peters U, Potter JD, Walter RB, Baik CS, Lane DS, Manson JE, Vitolins MZ, Allison MA, Tang JY, Wactawski-Wende J. Non-steroidal anti-inflammatory drugs and cancer risk in women: results from the Women's Health Initiative. Int J Cancer 2014; 135:1869-83. [PMID: 24599876 PMCID: PMC5592086 DOI: 10.1002/ijc.28823] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 02/17/2014] [Indexed: 12/12/2022]
Abstract
The use of non-steroidal anti-inflammatory drugs (NSAIDs) has been associated with reduced risks of cancers at several sites in some studies; however, we recently reported no association between their use and total cancer risk in women in a prospective study. Here we examine the association between NSAIDs and total and site-specific cancer incidence in the large, prospective Women's Health Initiative (WHI). Women (129,013) were recruited to participate in the WHI at 40 US clinical centers from 1993 to 1998 and followed prospectively. After 9.7 years of follow-up, 12,998 incident, first primary, invasive cancers were diagnosed. NSAID use was systematically collected at study visits. We used Cox proportional hazards regression models to estimate multivariable-adjusted hazard ratios (HR) and 95% confidence intervals (CI) for associations between NSAIDs use and total and site-specific cancer risk. Relative to non-use, consistent use (i.e., use at baseline and year 3 of follow-up) of any NSAID was not associated with total cancer risk (HR 1.00, 95% CI: 0.94-1.06). Results for individual NSAIDs were similar to the aggregate measure. In site-specific analyses, NSAIDs were associated with reduced risks of colorectal cancer, ovarian cancer, and melanoma. Our study confirms a chemopreventive benefit for colorectal cancer in women and gives preliminary evidence for a reduction of the risk of some rarer cancers. NSAIDs' benefit on cancer risk was therefore limited to specific sites and not evident when total cancer risk was examined. This information may be of importance when NSAIDs are considered as chemopreventive agents.
Collapse
Affiliation(s)
- Theodore M. Brasky
- The Ohio State University College of Medicine, Department of Internal Medicine, Division of Cancer Prevention and Control; Columbus, OH
- Fred Hutchinson Cancer Research Center, Clinical Research Division; Seattle, WA
| | - Jingmin Liu
- Fred Hutchinson Cancer Research Center, WHI Clinical Coordinating Center; Seattle, WA
| | - Emily White
- Fred Hutchinson Cancer Research Center, Clinical Research Division; Seattle, WA
- University of Washington, Department of Epidemiology; Seattle, WA
| | - Ulrike Peters
- Fred Hutchinson Cancer Research Center, Clinical Research Division; Seattle, WA
| | - John D. Potter
- Fred Hutchinson Cancer Research Center, Clinical Research Division; Seattle, WA
- Centre for Public Health Research, Massey University, Wellington, New Zealand
| | - Roland B. Walter
- Fred Hutchinson Cancer Research Center, Clinical Research Division; Seattle, WA
- University of Washington, Department of Epidemiology; Seattle, WA
- University of Washington, Division of Hematology/Department of Medicine; Seattle, WA
| | - Christina S. Baik
- Fred Hutchinson Cancer Research Center, Clinical Research Division; Seattle, WA
| | - Dorothy S. Lane
- Stony Brook University School of Medicine, Department of Preventive Medicine; Stony Brook, NY
| | - JoAnn E. Manson
- Harvard Medical School and Brigham and Women’s Hospital, Department of Medicine; Boston, MA
| | - Mara Z. Vitolins
- Wake Forest School of Medicine, Division of Public Health Sciences; Winston-Salem, NC
| | - Matthew A. Allison
- University of California - San Diego School of Medicine, Department of Family and Preventive Medicine, Division of Preventive Medicine; San Diego, CA
| | - Jean Y. Tang
- Stanford University School of Medicine, Department of Dermatology; Redwood City, CA
| | - Jean Wactawski-Wende
- Department of Social and Preventive Medicine, University at Buffalo, SUNY; Buffalo, NY
| |
Collapse
|
50
|
Black JD, English DP, Roque DM, Santin AD. Targeted therapy in uterine serous carcinoma: an aggressive variant of endometrial cancer. ACTA ACUST UNITED AC 2014; 10:45-57. [PMID: 24328598 DOI: 10.2217/whe.13.72] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Uterine serous carcinoma (USC) is a highly aggressive variant of endometrial cancer. Although it only represents less than 10% of all cases, it accounts for a disproportionate number of deaths from endometrial cancer. Comprehensive surgical staging followed by carboplatin and paclitaxel chemotherapy represents the mainstay of USC therapy. Vaginal cuff brachytherapy is also of potential benefit in USC. Recent whole-exome sequencing studies have demonstrated gain of function of the HER2/NEU gene, as well as driver mutations in the PIK3CA/AKT/mTOR and cyclin E/FBXW7 oncogenic pathways in a large number of USCs. These results emphasize the relevance of these novel therapeutic targets for biologic therapy of chemotherapy-resistant recurrent USC.
Collapse
Affiliation(s)
- Jonathan D Black
- Yale University School of Medicine, Department of Obstetrics, Gynecology & Reproductive Sciences, Room 305 Laboratory for Surgery, Obstetrics & Gynecology, 333 Cedar Street; PO Box 208063, New Haven, CT 06520-8063, USA
| | | | | | | |
Collapse
|