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Bibi S, Shah M, Malik MO, Goosens KA. T3 is linked to stress-associated reduction of prolactin in lactating women. J Neuroendocrinol 2021; 33:e13003. [PMID: 34241933 DOI: 10.1111/jne.13003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 06/01/2021] [Accepted: 06/13/2021] [Indexed: 11/26/2022]
Abstract
The relationship between stress responses and lactation is bidirectional. Breastfeeding confers many benefits to maternal health, including attenuated hypothalamic-pituitary-adrenal axis responsiveness to stress. However, increased stress burden can impair lactation. The mechanisms that underlie these relationships are poorly understood. The present study aimed to compare breastfeeding habits, as well as subjective and objective measures of stress, in employed and non-employed lactating women and assess the relationships between these measures and prolactin (PRL), thyroid hormones (thyroid-stimulating hormone, triiodothyronine [T3] and thyroxine), vasopressin and cortisol levels. A dexamethasone suppression test was also administered to determine the sensitivity of the hypothalamic-pituitary-adrenal axis to negative-feedback. We report that lactating employed women had lower breastfeeding rates and lower PRL than lactating non-employed women. They also had a significantly higher stress burden, indicated by elevations in blood pressure and evening cortisol, relative to lactating non-employed women. In regression analyses that controlled for feeding modality and breastfeeding duration, we found these factors differentially affected PRL in the two groups and there were significant differences in PRL across groups that were not accounted for by these factors. A mediation regression analysis suggested that group differences in PRL were best explained by differences in T3 and income levels, rather than breastfeeding duration or other variables. Our data fit a speculative model in which elevated maternal stress increases cortisol, which suppresses T3, leading to decreased PRL. The decreases in PRL are associated with higher rates of bottlefeeding, which may further contribute to decreased PRL.
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Affiliation(s)
- Safia Bibi
- Department of Physiology, Institute of Basic Medical Sciences, Khyber Medical University, Peshawar, Pakistan
| | - Mohsin Shah
- Department of Physiology, Institute of Basic Medical Sciences, Khyber Medical University, Peshawar, Pakistan
| | - Muhammad Omar Malik
- Department of Physiology, Institute of Basic Medical Sciences, Khyber Medical University, Peshawar, Pakistan
| | - Ki Ann Goosens
- Department of Psychiatry and Center for Affective Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Zhao J, Zhao Y, Xiang L, Khanal V, Binns CW, Lee AH. A two-part mixed-effects model for analyzing clustered time-to-event data with clumping at zero. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2020; 187:105196. [PMID: 31786451 DOI: 10.1016/j.cmpb.2019.105196] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 10/21/2019] [Accepted: 11/08/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND AND OBJECTIVE In longitudinal epidemiological studies consisting of a baseline stage and a follow-up stage, observations at the baseline stage may contain a countable proportion of negative responses. The time-to-event outcomes of those observations corresponding to negative responses at baseline can be denoted as zeros, which are excluded from standard survival analysis. Consequently, some important information on these subjects is therefore lost in the analysis. Furthermore, subjects are often clustered within hospitals, communities or health service centers, resulting in correlated observations. The framework of the two-part model has been developed and utilized widely to analyze semi-continuous data or count data with excess zeros, but its application to clustered time-to-event data with clumping at zero remains sparse. METHODS A two-part mixed-effects modeling approach was proposed. A logistic mixed-effects regression model was used in the first part to determine factors associated with the prevalence of the baseline event of interest. Parametric frailty models (including Weibull, exponential, log-logistic and log-normal) were used in the second part to assess associations between exposures and time-to-event outcomes. Correlated random effects were incorporated within the two regression models to accommodate the inherent correlation within each clustering unit and the correlation between the two parts. As an illustrative example, the method was applied to exclusive breastfeeding data from a community-based prospective cohort study in Nepal. RESULTS A significantly positive correlation between the baseline prevalence of exclusive breastfeeding and exclusive breastfeeding duration was confirmed (ρ = 0.67, P < 0.001). The correlated two-part model outperformed the independent two-part model (likelihood ratio test statistic = 8.6, df = 1, P = 0.003). CONCLUSIONS The proposed approach makes full use of all available information at baseline and during the follow-up, compared to the conventional survival analysis. In addition to breastfeeding studies, the method can be applied to other research areas where clustered time-to-event data with clumping at zero arise.
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Affiliation(s)
- Jian Zhao
- Department of Epidemiology and Biostatistics, School of Public Health, Curtin University, Perth, Australia; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
| | - Yun Zhao
- Department of Epidemiology and Biostatistics, School of Public Health, Curtin University, Perth, Australia.
| | - Liming Xiang
- School of Physical and Mathematical Sciences, Nanyang Technological University, Singapore.
| | - Vishnu Khanal
- Department of Epidemiology and Biostatistics, School of Public Health, Curtin University, Perth, Australia.
| | - Colin W Binns
- Department of Epidemiology and Biostatistics, School of Public Health, Curtin University, Perth, Australia.
| | - Andy H Lee
- Department of Epidemiology and Biostatistics, School of Public Health, Curtin University, Perth, Australia.
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Lassi ZS, Rind F, Irfan O, Hadi R, Das JK, Bhutta ZA. Impact of Infant and Young Child Feeding (IYCF) Nutrition Interventions on Breastfeeding Practices, Growth and Mortality in Low- and Middle-Income Countries: Systematic Review. Nutrients 2020; 12:E722. [PMID: 32164187 PMCID: PMC7146402 DOI: 10.3390/nu12030722] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 03/03/2020] [Accepted: 03/04/2020] [Indexed: 01/21/2023] Open
Abstract
Undernutrition is associated with 45% of total infant deaths, totalling 2.7 million globally per year. The vast majority of the burden is felt in low- and middle-income countries (LMICs). This review aims to assess the effectiveness of infant and young child feeding (IYCF) interventions. We searched multiple databases including Cochrane Controlled Trials Register (CENTRAL), MEDLINE, EMBASE. Title/abstract screening and full-text screening and data extraction filtered 77 studies for inclusion. Breastfeeding education interventions (n = 38) showed 20% increase in rates of early initiation of breastfeeding, 102% increase in exclusive breastfeeding (EBF) at 3 months and 53% increase in EBF at 6 months and 24% decreases in diarrheal diseases. Complementary feeding education intervention (n=12) showed a 0.41 standard deviation (SD) increase in WAZ, and 0.25 SD in HAZ in food secure setting. Complementary food provision with or without education (n=17) showed a 0.14 SD increase in HAZ and 36% decrease in stunting. Supplementary food interventions (n=12) showed a significant 0.15 SD increase in WHZ. Subgroup analyses showed healthcare professional led interventions were largely more effective, especially on breastfeeding outcomes. We believe this is a comprehensive review of the existing literature on IYCF studies in LMICs. Though breastfeeding education is well supported in its effectiveness on breastfeeding practices, limited evidence exists for growth outcomes. Supplementation interventions seem to have better effects at improving growth. However, more research is required to reach more substantial conclusions.
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Affiliation(s)
- Zohra S. Lassi
- Robinson Research Institute, University of Adelaide, Adelaide 5005, Australia
| | - Fahad Rind
- Division of Women and Child Health, Aga Khan University Hospital, Karachi 74800, Pakistan; (F.R.); (Z.A.B.)
| | - Omar Irfan
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON M5G 0A4, Canada;
| | - Rabia Hadi
- Center of Excellence in Women and Child Health, The Aga Khan University, Karachi 74800, Pakistan; (R.H.); (J.K.D.)
| | - Jai K. Das
- Center of Excellence in Women and Child Health, The Aga Khan University, Karachi 74800, Pakistan; (R.H.); (J.K.D.)
| | - Zulfiqar A. Bhutta
- Division of Women and Child Health, Aga Khan University Hospital, Karachi 74800, Pakistan; (F.R.); (Z.A.B.)
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON M5G 0A4, Canada;
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Abdelhakim AM, Sunoqrot M, Amin AH, Nabil H, Raslan AN, Samy A. The effect of early vs. delayed postpartum insertion of the LNG-IUS on breastfeeding continuation: a systematic review and meta-analysis of randomised controlled trials. EUR J CONTRACEP REPR 2019; 24:327-336. [DOI: 10.1080/13625187.2019.1665175] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Ahmed Mohamed Abdelhakim
- Medical Research Group of Egypt (MRGE), Cairo, Egypt
- Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohammad Sunoqrot
- Medical Research Group of Egypt (MRGE), Cairo, Egypt
- Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Hussein Amin
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hala Nabil
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ayman N. Raslan
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Samy
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Cairo University, Cairo, Egypt
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Momenimovahed Z, Tiznobaik A, Taheri S, Salehiniya H. Ovarian cancer in the world: epidemiology and risk factors. Int J Womens Health 2019; 11:287-299. [PMID: 31118829 PMCID: PMC6500433 DOI: 10.2147/ijwh.s197604] [Citation(s) in RCA: 389] [Impact Index Per Article: 77.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Accepted: 03/18/2019] [Indexed: 12/24/2022] Open
Abstract
Aim: Ovarian cancer is one of the most common gynecologic cancers that has the highest mortality rate. Considering the fact that knowledge on the incidence, mortality of ovarian cancer, as well as its risk factors is necessary for planning and preventing complications, this study was conducted with the aim of examining the epidemiology and risk factors of ovarian cancer in the world. Materials and methods: In order to access the articles, Medline, Web of Science Core Collection, and Scopus databases were searched from their start to the year 2018. Full-text, English observational studies that referred to various aspects of ovarian cancer were included in the study. Results: In total, 125 articles that had been published during the years 1925–2018 were entered into the study. Ovarian cancer is the seventh most common cancer among women. Increased risk factors of cancer have led to an upward trend in the incidence of cancer around the world. In 2018, 4.4% of entire cancer-related mortality among women was attributed to ovarian cancer. Although the incidence of cancer is higher among high Human Development Index (HDI) countries, the trend of mortality rate tends to be reversing. Various factors affect the occurrence of ovarian cancer, from which genetic factor are among the most important ones. Pregnancy, lactation, and oral contraceptive pills play a role in reducing the risk of this disease. Conclusion: This study provides significant evidence about ovarian cancer. Considering the heavy burden of ovarian cancer on women's health, preventive measures as well as health education and early detection in high risk groups of women are highly recommended. Although some risk factors cannot be changed, a focus on preventable risk factors may reduce the risk of ovarian cancer. More studies are needed to explore the role of unclear risk factors in ovarian cancer occurrence.
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Affiliation(s)
- Zohre Momenimovahed
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Qom University of Medical Sciences, Qom, Iran.,Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Azita Tiznobaik
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran.,Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Hamedan University of Medical Sciences, Hamedan, Iran
| | - Safoura Taheri
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Ilam University of Medical Sciences, Ilam, Iran
| | - Hamid Salehiniya
- Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand, Iran.,Epidemiology and Biostatistics Department, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Modugno F, Goughnour SL, Wallack D, Edwards RP, Odunsi K, Kelley JL, Moysich K, Ness RB, Brooks MM. Breastfeeding factors and risk of epithelial ovarian cancer. Gynecol Oncol 2019; 153:116-122. [PMID: 30686553 DOI: 10.1016/j.ygyno.2019.01.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 01/17/2019] [Accepted: 01/20/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Previous studies suggest that breastfeeding reduces epithelial ovarian cancer (EOC) risk. However, the effects of age, timing and episode details on the EOC-breastfeeding relationship have not been examined. The objective of this study was to examine the association between breastfeeding factors and epithelial ovarian cancer. METHODS We examined breastfeeding factors among parous women in a population-based, case-control study conducted in Pennsylvania, Ohio, and New York from 2003 to 2008. We compared 689 incident EOC cases to 1572 community controls. Multivariable unconditional logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) associated with breastfeeding patterns adjusting for potential confounders. RESULTS Compared to never breastfeeding, breastfeeding any offspring was associated with a 30% reduction in EOC risk (OR = 0.70; 95%CI = 0.58-0.85). That association lasted more than 30 years (OR = 0.69, 95%CI = 0.53-0.88). An average breastfeeding episode of 3 months was also associated with reduced risk (OR = 0.73, 95%CI = 0.58-0.80). A greater number of breastfeeding episodes was associated with greater risk reduction (OR = 0.78, 95%CI = 0.64-0.96 and OR = 0.49, 95%CI = 0.36-0.68 1-2 and 3+ episodes, respectively, compared to never breastfed, trend p = 0.01). Longer breastfeeding duration was also associated with reduced risk (OR = 0.75 and 0.62 for less than and greater than 1-year total duration, respectively, compared to never breastfed). An earlier age at first breastfeeding was further associated with increased protection (OR = 0.50-0.80, for first episode at age <25, 25-29, and 30+, respectively, trend p = 0.001). CONCLUSIONS Breastfeeding for as few as 3 months is associated with reduced EOC risk. Although this association decreases over time, it persists for more than 30 years. Longer cumulative duration, increasing number of breastfeeding episodes, and earlier age at first breastfeeding episode are each associated with increased benefit.
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Affiliation(s)
- Francesmary Modugno
- Womens Cancer Research Program, Magee-Womens Research Institute and UPMC Hillman Cancer Center, USA; Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| | - Sharon L Goughnour
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| | - Danielle Wallack
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - Robert P Edwards
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| | - Kunle Odunsi
- Roswell Park Cancer Institute, Buffalo, NY, USA.
| | - Joseph L Kelley
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| | | | - Roberta B Ness
- University of Texas School of Public Health, Houston, TX, USA.
| | - Maria Mori Brooks
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA.
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7
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Bovbjerg ML, Hill JA, Uphoff AE, Rosenberg KD. Women Who Bedshare More Frequently at 14 Weeks Postpartum Subsequently Report Longer Durations of Breastfeeding. J Midwifery Womens Health 2018; 63:418-424. [DOI: 10.1111/jmwh.12753] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 01/24/2018] [Accepted: 01/30/2018] [Indexed: 11/28/2022]
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Lassi ZS, Irfan O, Hadi R, Das JK, Bhutta ZA. PROTOCOL: Effects of interventions for infant and young child feeding (IYCF) promotion on optimal IYCF practices, nutrition, growth and health in low- and middle-income countries: a systematic review. CAMPBELL SYSTEMATIC REVIEWS 2018; 14:1-26. [PMID: 37131389 PMCID: PMC8427994 DOI: 10.1002/cl2.189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
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Reid BM, Permuth JB, Sellers TA. Epidemiology of ovarian cancer: a review. Cancer Biol Med 2017. [PMID: 28443200 DOI: 10.20892/j.issn.2095-3941.2016.0084]+[] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Ovarian cancer (OC) is the seventh most commonly diagnosed cancer among women in the world and the tenth most common in China. Epithelial OC is the most predominant pathologic subtype, with five major histotypes that differ in origination, pathogenesis, molecular alterations, risk factors, and prognosis. Genetic susceptibility is manifested by rare inherited mutations with high to moderate penetrance. Genome-wide association studies have additionally identified 29 common susceptibility alleles for OC, including 14 subtype-specific alleles. Several reproductive and hormonal factors may lower risk, including parity, oral contraceptive use, and lactation, while others such as older age at menopause and hormone replacement therapy confer increased risks. These associations differ by histotype, especially for mucinous OC, likely reflecting differences in etiology. Endometrioid and clear cell OC share a similar, unique pattern of associations with increased risks among women with endometriosis and decreased risks associated with tubal ligation. OC risks associated with other gynecological conditions and procedures, such as hysterectomy, pelvic inflammatory disease, and polycystic ovarian syndrome, are less clear. Other possible risk factors include environmental and lifestyle factors such as asbestos and talc powder exposures, and cigarette smoking. The epidemiology provides clues on etiology, primary prevention, early detection, and possibly even therapeutic strategies.
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Affiliation(s)
- Brett M Reid
- Department of Cancer Epidemiology, Division of Population Sciences, Moffitt Cancer Center, Tampa 33612, FL, USA
| | - Jennifer B Permuth
- Department of Cancer Epidemiology, Division of Population Sciences, Moffitt Cancer Center, Tampa 33612, FL, USA
| | - Thomas A Sellers
- Department of Cancer Epidemiology, Division of Population Sciences, Moffitt Cancer Center, Tampa 33612, FL, USA
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10
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Abstract
Ovarian cancer (OC) is the seventh most commonly diagnosed cancer among women in the world and the tenth most common in China. Epithelial OC is the most predominant pathologic subtype, with five major histotypes that differ in origination, pathogenesis, molecular alterations, risk factors, and prognosis. Genetic susceptibility is manifested by rare inherited mutations with high to moderate penetrance. Genome-wide association studies have additionally identified 29 common susceptibility alleles for OC, including 14 subtype-specific alleles. Several reproductive and hormonal factors may lower risk, including parity, oral contraceptive use, and lactation, while others such as older age at menopause and hormone replacement therapy confer increased risks. These associations differ by histotype, especially for mucinous OC, likely reflecting differences in etiology. Endometrioid and clear cell OC share a similar, unique pattern of associations with increased risks among women with endometriosis and decreased risks associated with tubal ligation. OC risks associated with other gynecological conditions and procedures, such as hysterectomy, pelvic inflammatory disease, and polycystic ovarian syndrome, are less clear. Other possible risk factors include environmental and lifestyle factors such as asbestos and talc powder exposures, and cigarette smoking. The epidemiology provides clues on etiology, primary prevention, early detection, and possibly even therapeutic strategies.
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Affiliation(s)
- Brett M Reid
- Department of Cancer Epidemiology, Division of Population Sciences, Moffitt Cancer Center, Tampa 33612, FL, USA
| | - Jennifer B Permuth
- Department of Cancer Epidemiology, Division of Population Sciences, Moffitt Cancer Center, Tampa 33612, FL, USA
| | - Thomas A Sellers
- Department of Cancer Epidemiology, Division of Population Sciences, Moffitt Cancer Center, Tampa 33612, FL, USA
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Abstract
Ovarian cancer (OC) is the seventh most commonly diagnosed cancer among women in the world and the tenth most common in China. Epithelial OC is the most predominant pathologic subtype, with five major histotypes that differ in origination, pathogenesis, molecular alterations, risk factors, and prognosis. Genetic susceptibility is manifested by rare inherited mutations with high to moderate penetrance. Genome-wide association studies have additionally identified 29 common susceptibility alleles for OC, including 14 subtype-specific alleles. Several reproductive and hormonal factors may lower risk, including parity, oral contraceptive use, and lactation, while others such as older age at menopause and hormone replacement therapy confer increased risks. These associations differ by histotype, especially for mucinous OC, likely reflecting differences in etiology. Endometrioid and clear cell OC share a similar, unique pattern of associations with increased risks among women with endometriosis and decreased risks associated with tubal ligation. OC risks associated with other gynecological conditions and procedures, such as hysterectomy, pelvic inflammatory disease, and polycystic ovarian syndrome, are less clear. Other possible risk factors include environmental and lifestyle factors such as asbestos and talc powder exposures, and cigarette smoking. The epidemiology provides clues on etiology, primary prevention, early detection, and possibly even therapeutic strategies.
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Affiliation(s)
- Brett M Reid
- Department of Cancer Epidemiology, Division of Population Sciences, Moffitt Cancer Center, Tampa 33612, FL, USA
| | - Jennifer B Permuth
- Department of Cancer Epidemiology, Division of Population Sciences, Moffitt Cancer Center, Tampa 33612, FL, USA
| | - Thomas A Sellers
- Department of Cancer Epidemiology, Division of Population Sciences, Moffitt Cancer Center, Tampa 33612, FL, USA
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Webb PM, Jordan SJ. Epidemiology of epithelial ovarian cancer. Best Pract Res Clin Obstet Gynaecol 2016; 41:3-14. [PMID: 27743768 DOI: 10.1016/j.bpobgyn.2016.08.006] [Citation(s) in RCA: 556] [Impact Index Per Article: 69.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 08/17/2016] [Indexed: 02/08/2023]
Abstract
Globally, ovarian cancer is the seventh most common cancer in women and the eighth most common cause of cancer death, with five-year survival rates below 45%. Although age-standardised rates are stable or falling in most high-income countries, they are rising in many low and middle income countries. Furthermore, with increasing life-expectancy, the number of cases diagnosed each year is increasing. To control ovarian cancer we need to understand the causes. This will allow better prediction of those at greatest risk for whom screening might be appropriate, while identification of potentially modifable causes provides an opportunity for intervention to reduce rates. In this paper we will summarise the current state of knowledge regarding the known and possible causes of epithelial ovarian cancer and discuss some of the main theories of ovarian carcinogenesis. We will also briefly review the relationship between lifestyle and survival after a diagnosis of ovarian cancer.
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Affiliation(s)
- Penelope M Webb
- QIMR Berghofer Medical Research Institute, Locked Bag 2000 Royal Brisbane Hospital, Brisbane, Queensland 4029, Australia; School of Public Health, The University of Queensland, Public Health Building, Corner of Herston Road & Wyndham Street, Herston, Queensland 4006, Australia.
| | - Susan J Jordan
- QIMR Berghofer Medical Research Institute, Locked Bag 2000 Royal Brisbane Hospital, Brisbane, Queensland 4029, Australia; School of Public Health, The University of Queensland, Public Health Building, Corner of Herston Road & Wyndham Street, Herston, Queensland 4006, Australia.
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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.
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Reproductive factors, adiposity, breastfeeding and their associations with ovarian cancer in an Asian cohort. Cancer Causes Control 2015; 26:1561-73. [PMID: 26342607 DOI: 10.1007/s10552-015-0649-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 07/30/2015] [Indexed: 12/19/2022]
Abstract
PURPOSE The aim of this study was to assess associations of breastfeeding, adiposity and reproductive risk factors with ovarian cancer risk in a Singaporean population. In addition to the main analysis, interaction effects of parity on other risk factors were examined. METHODS A retrospective cohort consisting of 28,201 women with 107 incident ovarian cancers in up to 17 years of follow-up from the Singapore Breast Cancer Screening Project (1994-1997) was studied. Hazard ratios (HRs) for risk factors were estimated using Cox proportional hazards models. RESULTS Body mass index and breastfeeding were found to have no statistical significant association with ovarian cancer risk. Gravidity was inversely associated with ovarian cancer risk [each pregnancy, adjusted HR 0.89, 95% confidence interval (CI) 0.81, 0.97], while results for parity were very similar (per delivery, HR 0.89, 95% CI 0.81, 0.98). Each additional year of ovulatory period was found to increase ovarian cancer risk by 2% (HR 1.02, 95% CI 1.00, 1.04). Each year increase in total duration of oral contraceptive use reduced ovarian cancer risk by 6% (HR 0.94, 95% CI 0.85, 1.02). CONCLUSIONS Parity, gravidity and shorter ovulatory period were associated with lower ovarian cancer risk. Breastfeeding and body mass index were not associated with ovarian cancer risk, while increased duration of oral contraceptive use resulted in borderline risk reduction. No significant evidence was found to suggest that parity had an interaction effect on any risk factor.
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Feng LP, Chen HL, Shen MY. Breastfeeding and the risk of ovarian cancer: a meta-analysis. J Midwifery Womens Health 2015; 59:428-37. [PMID: 25066743 DOI: 10.1111/jmwh.12085] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The aim of this meta-analysis was to assess the association between breastfeeding and risk of ovarian cancer. METHODS Relevant observational studies were identified by a search of the MEDLINE and EMBASE databases through December 2012. Summary odds ratios (ORs) for ovarian cancer, comparing women who had breastfed with women who had not, were calculated using a random-effects model. A dose-response meta-analysis assessed the risk of ovarian cancer by breastfeeding duration. RESULTS A total of 19 studies were included in the meta-analysis. Compared with women who had not breastfed, women who had breastfed had a significantly decreased risk of ovarian cancer, with an OR of 0.66 (95% CI, 0.57-0.76; P < .001). We observed an inverse linear relationship with breastfeeding duration: for every one-month increase in breastfeeding, the OR was 0.98 (95% CI, 0.97-0.99; P < .001). A nonlinear association was also apparent, with a sharp decrease in the OR when breastfeeding duration was 8 to 10 months. There was evidence of heterogeneity (I(2) = 83.9%). No publication bias was found (Begg test, P = 0.89; Egger test, P = 0.89). DISCUSSION Breastfeeding reduces the risk of ovarian cancer proportional to duration. Breastfeeding for 8 to 10 months may be most effective for reducing the risk of ovarian cancer.
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Li DP, Du C, Zhang ZM, Li GX, Yu ZF, Wang X, Li PF, Cheng C, Liu YP, Zhao YS. Breastfeeding and ovarian cancer risk: a systematic review and meta-analysis of 40 epidemiological studies. Asian Pac J Cancer Prev 2015; 15:4829-37. [PMID: 24998548 DOI: 10.7314/apjcp.2014.15.12.4829] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The present systematic review and meta-analysis was conducted to assess any association between breastfeeding and the risk of ovarian cancer. A systematic search of published studies was performed in PUBMED and EMBASE and by reviewing reference lists from retrieved articles through March 2013. Data extraction was conducted independently by two authors. Pooled relative risk ratios were calculated using random-effect models. Totals of 5 cohort studies and 35 case-control studies including 17,139 women with ovarian cancer showed a 30% reduced risk of ovarian cancer when comparing the women who had breastfed with those who had never breastfed (pooled RR = 0.70, 95% CI: 0.64-0.76; p = 0.00), with significant heterogeneity in the studies (p = 0.00; I2 = 76.29%). A significant decreasd in risk of epithelial ovarian cancer was also observed (pooled RR = 0.68, 95% CI: 0.61-0.76). When the participants were restricted to only parous women, there was a slightly attenuated but still significant risk reduction of ovarian cancer (pooled RR = 0.76, 95% CI: 0.69-0.83). For total breastfeeding duration, the pooled RRs in the < 6 months, 6-12 months and > 12 months of breastfeeding subgroups were 0.85 (95% CI: 0.77-0.93), 0.73 (95% CI: 0.65-0.82) and 0.64 (95%CI: 0.56-0.73), respectively. Meta-regression of total breastfeeding duration indicated an increasing linear trend of risk reduction of ovarian cancer with the increasing total breastfeeding duration (p = 0.00). Breastfeeding was inversely associated with the risk of ovarian cancer, especially long-term breastfeeding duration that demonstrated a stronger protective effect.
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Affiliation(s)
- Da-Peng Li
- Department of Epidemiology, School of Public Health, Harbin Medical University, Harbin, China E-mail : ,
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Abstract
Clinical outcomes, such as recurrence-free survival and overall survival, in ovarian cancer are quite variable, independent of common characteristics such as stage, response to therapy, and grade. This disparity in outcomes warrants further exploration and therapeutic targeting into the interaction between the tumor and host. One compelling host characteristic that contributes both to the initiation and progression of ovarian cancer is the immune system. Hundreds of studies have confirmed a prominent role for the immune system in modifying the clinical course of the disease. Recent studies also show that anti-tumor immunity is often negated by immune regulatory cells present in the tumor microenvironment. Regulatory immune cells also directly enhance the pathogenesis through the release of various cytokines and chemokines, which together form an integrated pathological network. Thus, in the future, research into immunotherapy targeting ovarian cancer will probably become increasingly focused on combination approaches that simultaneously augment immunity while preventing local immune suppression. In this article, we summarize important immunological targets that influence ovarian cancer outcome as well as include an update on newer immunotherapeutic strategies.
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Affiliation(s)
- Keith L Knutson
- Cancer Vaccines and Immune Therapies Program, The Vaccine and Gene Therapy Institute of Florida, 9801 SW Discovery Way, Port St. Lucie, FL, 34949, USA,
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Furuta M, Sandall J, Cooper D, Bick D. Severe maternal morbidity and breastfeeding outcomes in the early post-natal period: a prospective cohort study from one English maternity unit. MATERNAL AND CHILD NUTRITION 2015; 12:808-25. [PMID: 25720327 DOI: 10.1111/mcn.12176] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Previous research has identified potential issues of establishing and maintaining breastfeeding among women who experience severe maternal morbidity associated with pregnancy and birth, but evidence in the UK maternity population was scarce. We explored the association between severe maternal morbidity and breastfeeding outcomes (uptake and prevalence of partial and exclusive breastfeeding) at 6 to 8 weeks post-partum in a UK sample. Data on breastfeeding outcomes were obtained from a large cohort study of women who gave birth in one maternity unit in England to assess the impact of women's experiences of severe maternal morbidity (defined as major obstetric haemorrhage, severe hypertensive disorder or high dependency unit/intensive care unit admission) on their post-natal health and other important outcomes including infant feeding. Results indicated that among women who responded (n = 1824, response rate = 53%), there were no statistically significant differences in breastfeeding outcomes between women who did or did not experience severe morbidity, except for women with severe hypertensive disorder who were less likely to breastfeed either partially or exclusively at 6 to 8 weeks post-partum. Rather, breastfeeding outcomes were related to multi-dimensional factors including sociodemographic (age, ethnicity, living arrangement), other pregnancy outcomes (neonatal intensive care unit admission, mode of birth, women's perceived control during birth) and post-natal psychological factors (depressive symptoms). Women who experience severe maternal morbidity can be reassured that establishing successful breastfeeding can be achieved. More studies are required to understand what support is best for women who have complex health/social needs to establish breastfeeding.
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Affiliation(s)
- Marie Furuta
- Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| | - Jane Sandall
- School of Medicine, King's College London, Women's Health Academic Centre KHP, St. Thomas' Hospital, London, UK
| | - Derek Cooper
- Florence Nightingale School of Nursing and Midwifery, King's College London, London, UK
| | - Debra Bick
- Florence Nightingale School of Nursing and Midwifery, King's College London, London, UK
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Abstract
PURPOSE OF REVIEW The purpose of this review is to highlight recent research and insights into the relationship between fertility drug use and ovarian cancer risk. RECENT FINDINGS Results from two large case-control studies provided further evidence that fertility drug use does not significantly contribute to risk of ovarian cancer among the majority of women when adjusting for known confounding factors. However, questions regarding the effect on certain subgroups, including long-term fertility drug users, women who remain nulligravid after fertility treatment, women with BRCA1 or BRCA2 mutations and borderline ovarian tumours, still remain. In addition, it may currently just be too early to determine whether there is an association between fertility drug use and ovarian cancer risk given that many of the exposed women are only now beginning to reach the ovarian cancer age range. SUMMARY Whether use of fertility drugs increases the risk of ovarian cancer is an important question that requires further investigation, in particular given the large number of women utilizing fertility treatments. Fortunately, results from recent studies have been mainly reassuring. Large well designed studies with sufficient follow-up time are needed to further evaluate the effects of fertility treatments within subgroups defined by patient and tumour characteristics.
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Chen S, Chen X, Xiu YL, Sun KX, Zong ZH, Zhao Y. microRNA 490-3P enhances the drug-resistance of human ovarian cancer cells. J Ovarian Res 2014; 7:84. [PMID: 25297343 PMCID: PMC4158041 DOI: 10.1186/s13048-014-0084-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Accepted: 08/22/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND MicroRNAs (miRNAs) are non-coding, single-stranded small RNAs that regulate gene expression negatively, which is involved in fundamental cellular processes. In this study, we investigated the role of miR-490-3P in the development of drug resistance in ovarian cancer cells. METHODS The human ovarian carcinoma cell line A2780 and A2780/Taxol were exposed to paclitaxel in the presence or absence of microRNA 490-3P transfection, after which cell viability were performed by CCK-8 assay. Reverse transcription polymerase chain reaction (RT-PCR) and western blotting were used to assess the mRNA and protein expression levels of GST-π, MDR1 or P-gp. RESULTS Our results showed higher miR-490-3P mRNA expression level in A2780/Taxol cells than in A2780 cells (p < 0.05). Following miR-490-3P transfection, both A2780 and A2780/Taxol cells showed decreased sensitivity to paclitaxel. The mRNA expression levels of MDR1, GST-π (p < 0.05) and protein expression levels of P-gp, GST-π were up-regulated [corrected] after miR-490-3P transfection in comparison to mock and negative control cancer cells. CONCLUSION Our results demonstrate for the first time that microRNA 490-3P may be involved in the development of drug resistance in ovarian cancer.
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Bica OC, Giugliani ERJ. Influence of counseling sessions on the prevalence of breastfeeding in the first year of life: a randomized clinical trial with adolescent mothers and grandmothers. Birth 2014; 41:39-45. [PMID: 24654636 DOI: 10.1111/birt.12097] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/25/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Adolescent mothers living with their mothers may be at greater risk of early weaning. This study aims to assess the influence of a breastfeeding promotion strategy directed at adolescent mothers living with their mothers on the prevalence of breastfeeding in the first year of life. METHOD A randomized clinical trial with 323 adolescent mothers. Participants were divided into two groups: those who lived with their mothers and those who did not. Participants were randomly assigned to control or intervention groups. Intervention consisted of breastfeeding counseling sessions held at the maternity ward and at home (at 7, 15, 30, 60, and 120 days postpartum). The intervention effect was assessed by comparing survival curves for breastfeeding in the first 12 months of life. RESULTS The risk of weaning before 12 months of age was significantly lower in the intervention group for adolescent mothers not living with their mothers; whereas the risk was not statistically different between intervention and control groups for those living with their mothers. CONCLUSIONS The positive influence of systematic counseling sessions on the prevalence of breastfeeding in the first year of life was significant for adolescent mothers. Living with their mothers reduced such influence.
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Affiliation(s)
- Olga Claudino Bica
- Nurse at Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, Santa Cecília, Porto Alegre, RS, Brazil
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Sim TF, Sherriff J, Hattingh HL, Parsons R, Tee LBG. The use of herbal medicines during breastfeeding: a population-based survey in Western Australia. Altern Ther Health Med 2013; 13:317. [PMID: 24219150 PMCID: PMC3835544 DOI: 10.1186/1472-6882-13-317] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Accepted: 11/06/2013] [Indexed: 11/10/2022]
Abstract
BACKGROUND Main concerns for lactating women about medications include the safety of their breastfed infants and the potential effects of medication on quantity and quality of breast milk. While medicine treatments include conventional and complementary medicines, most studies to date have focused on evaluating the safety aspect of conventional medicines. Despite increasing popularity of herbal medicines, there are currently limited data available on the pattern of use and safety of these medicines during breastfeeding. This study aimed to identify the pattern of use of herbal medicines during breastfeeding in Perth, Western Australia, and to identify aspects which require further clinical research. METHODS This study was conducted using a self-administered questionnaire validated through two pilot studies. Participants were 18 years or older, breastfeeding or had breastfed in the past 12 months. Participants were recruited from various community and health centres, and through advertising in newspapers. Simple descriptive statistics were used to summarise the demographic profile and attitudes of respondents, using the SPSS statistical software. RESULTS A total of 304 questionnaires from eligible participants were returned (27.2% response rate) and analysed. Amongst the respondents, 59.9% took at least one herb for medicinal purposes during breastfeeding, whilst 24.3% reported the use of at least one herb to increase breast milk supply. Most commonly used herbs were fenugreek (18.4%), ginger (11.8%), dong quai (7.9%), chamomile (7.2%), garlic (6.6%) and blessed thistle (5.9%). The majority of participants (70.1%) believed that there was a lack of information resources, whilst 43.4% perceived herbal medicines to be safer than conventional medicines. Only 28.6% of users notified their doctor of their decision to use herbal medicine(s) during breastfeeding; 71.6% had previously refused or avoided conventional medicine treatments due to concerns regarding safety of their breastfed infants. CONCLUSIONS The use of herbal medicines is common amongst breastfeeding women, while information supporting their safety and efficacy is lacking. This study has demonstrated the need for further research into commonly used herbal medicines. Evidence-based information should be available to breastfeeding women who wish to consider use of all medicines, including complementary medicines, to avoid unnecessary cessation of breastfeeding or compromising of pharmacotherapy.
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Charbonneau B, Goode EL, Kalli KR, Knutson KL, Derycke MS. The immune system in the pathogenesis of ovarian cancer. Crit Rev Immunol 2013; 33:137-64. [PMID: 23582060 DOI: 10.1615/critrevimmunol.2013006813] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Clinical outcomes in ovarian cancer are heterogeneous even when considering common features such as stage, response to therapy, and grade. This disparity in outcomes warrants further exploration into tumor and host characteristics. One compelling host characteristic is the immune response to ovarian cancer. While several studies have confirmed a prominent role for the immune system in modifying the clinical course of the disease, recent genetic and protein analyses also suggest a role in disease incidence. Recent studies also show that anti-tumor immunity is often negated by immune suppressive cells present in the tumor microenvironment. These suppressive immune cells also directly enhance the pathogenesis through the release of various cytokines and chemokines, which together form an integrated pathologic network. Thus, future research into immunotherapy targeting ovarian cancer will likely become increasingly focused on combination approaches that simultaneously augment immunity while preventing local immune suppression or by disrupting critical cytokine networks.
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Affiliation(s)
- Bridget Charbonneau
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN 55905, USA
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Luan NN, Wu QJ, Gong TT, Vogtmann E, Wang YL, Lin B. Breastfeeding and ovarian cancer risk: a meta-analysis of epidemiologic studies. Am J Clin Nutr 2013; 98:1020-31. [PMID: 23966430 PMCID: PMC3778857 DOI: 10.3945/ajcn.113.062794] [Citation(s) in RCA: 110] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Epidemiologic studies have yielded inconsistent findings between breastfeeding and epithelial ovarian cancer (EOC) risk. OBJECTIVE We performed a meta-analysis to summarize available evidence of the association between breastfeeding and breastfeeding duration and EOC risk from published cohort and case-control studies. DESIGN Relevant published studies were identified by a search of MEDLINE through December 2012. Two authors (T-TG and Q-JW) independently performed the eligibility evaluation and data abstraction. Study-specific RRs from individual studies were pooled by using a random-effects model, and heterogeneity and publication-bias analyses were conducted. RESULTS Five prospective and 30 case-control studies were included in this analysis. The pooled RR for ever compared with never breastfeeding was 0.76 (95% CI: 0.69, 0.83), with moderate heterogeneity (Q = 69.4, P < 0.001, I(2) = 55.3%). Risk of EOC decreased by 8% for every 5-mo increase in the duration of breastfeeding (RR: 0.92; 95% CI: 0.90, 0.95). The risk reduction was similar for borderline and invasive EOC and was consistent within case-control and cohort studies. CONCLUSIONS Results of this meta-analysis support the hypothesis that ever breastfeeding and a longer duration of breastfeeding are associated with lower risks of EOC. Additional research is warranted to focus on the association with cancer grade and histologic subtypes of EOC.
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Affiliation(s)
- Nan-Nan Luan
- Department of Obstetrics and Gynecology, Shengjing Hospital, China Medical University, Shenyang, China and the State Key Laboratory of Oncogene and Related Genes, Shanghai Cancer Institute, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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25
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Abstract
Breastfeeding is a critical public health intervention. Nurses play a vital role in promoting and supporting optimal breastfeeding practices in infants and young children. An analysis following the eight-part Walker & Avant method provides clarity and context to the concept of breastfeeding. The antecedents of the concept of breastfeeding indicate nurse interventions to facilitate and the consequences provide key points for education related to the benefits of breastfeeding.
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26
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Behrend SW. Update on … Gynecologic Cancer. Oncol Nurs Forum 2013. [DOI: 10.1188/13.onf.407-408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Tang L, Binns CW, Lee AH, Pan X, Chen S, Yu C. Low prevalence of breastfeeding initiation within the first hour of life in a rural area of Sichuan Province, China. Birth 2013; 40:134-42. [PMID: 24635468 DOI: 10.1111/birt.12038] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/16/2012] [Indexed: 01/15/2023]
Abstract
BACKGROUND The World Health Organization recommends that newborn infants be breastfed within the first hour of life, a practice that improves infant health and reduces neonatal mortality. The objectives of this study were to report the rate of breastfeeding initiation within 1 hour of birth in Jiangyou, China, to determine its impact on "full breastfeeding" at discharge, and to investigate factors associated with early breastfeeding initiation. METHODS A prospective cohort study of infant feeding practices was undertaken during 2010 and 2011 in Jiangyou, 2 years after an earthquake caused extensive damage. A total of 695 mothers were recruited from hospitals and health centers and interviewed at discharge. RESULTS In this study, 9.1 percent of women began breastfeeding within 1 hour postpartum. Mothers who initiated breastfeeding early were more likely to be fully breastfeeding at discharge (OR 2.10, 95% CI 1.23-3.60). Multivariate logistic regression analysis revealed that giving birth at a health center was associated with delayed breastfeeding initiation (OR 0.11, 95% CI 0.04-0.32), whereas attending antenatal classes (OR 2.57, 95% CI 1.36-4.87) and receiving encouragement from hospital staff to initiate breastfeeding (OR 5.60, 95% CI 2.31-13.55) were correlated with putting the baby to the breast soon after delivery. CONCLUSIONS Early breastfeeding initiation rate was low and the use of prelacteal foods was widespread in Jiangyou. Early breastfeeding initiation was associated with higher "full breastfeeding" rates at discharge. It is important to educate doctors and nurses to assist mothers with early breastfeeding initiation and to discourage the use of non-breastmilk prelacteal feeds.
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Affiliation(s)
- Li Tang
- School of Public Health, Curtin University, Perth, Australia
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Schüler S, Ponnath M, Engel J, Ortmann O. Ovarian epithelial tumors and reproductive factors: a systematic review. Arch Gynecol Obstet 2013; 287:1187-204. [PMID: 23503972 DOI: 10.1007/s00404-013-2784-1] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Accepted: 02/28/2013] [Indexed: 12/11/2022]
Abstract
PURPOSE The aim of this systematic review is to summarize the current knowledge about the etiology and pathogenesis of borderline tumors ovarian cancer with special emphasis on the role of endocrine treatments and reproductive factors to establish a foundation for future studies. METHODS We performed a systematic review on the relation between ovarian epithelial tumors (OET) and reproductive factors using the keywords: ovarian cancer, ovarian tumor, ovarian borderline tumor, age at menarche, age at menopause, parity, infertility, PCO syndrome, oral contraception, menopausal hormone therapy, fertility treatment. Totally, 3,290 abstracts were scanned for their relevance in this publication and 127 were finally included. RESULTS The incidence of ovarian epithelial cancer and ovarian borderline tumors is influenced by certain reproductive factors. The strongest protective effects are conferred by parity and use of oral contraceptive pills. Recent molecular biologic and histopathologic studies prove that OET represent a diverse group of tumors, each histologic type with a different genetic background. This is at least partly reflected in epidemiologic and clinical studies showing different risk modulating effects of reproductive factors and endocrine therapies on OET. CONCLUSIONS The etiology and pathogenesis of ovarian cancer are still not fully understood. None of the so far proposed hypothesis on the development of OET can fully account for the epidemiologic and clinical findings in the context of reproductive factors and OET development. Further research approaches are warranted and need to put more weight on the clinical and genetical diversity of OET to yield a more detailed insight into their pathogenesis.
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Affiliation(s)
- Susanne Schüler
- Department of Obstetrics and Gynecology, University of Regensburg, Caritas-Hospital St. Josef, Landshuter Straße 65, 93053 Regensburg, Germany.
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Su D, Pasalich M, Lee AH, Binns CW. Ovarian cancer risk is reduced by prolonged lactation: a case-control study in southern China. Am J Clin Nutr 2013; 97:354-9. [PMID: 23283498 DOI: 10.3945/ajcn.112.044719] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Ovarian cancer is an important neoplasm that is difficult to diagnose and treat; therefore, prevention is the preferable strategy. Growing evidence indicates a protective effect of breastfeeding on ovarian cancer risk. OBJECTIVE The objective was to investigate the association between lactation and the risk of ovarian cancer among southern Chinese women. DESIGN A case-control study was undertaken in Guangzhou, Guangdong Province, between August 2006 and July 2008. A validated and reliable questionnaire was used to obtain information on the months of lactation and number of children breastfed in a sample of 493 incident ovarian cancer patients and 472 hospital-based controls (mean age: 59 y). Logistic regression analyses were performed to assess the association between breastfeeding and the risk of ovarian cancer. RESULTS Significant inverse dose-response relations were found for both duration of lactation and the number of children breastfed. The adjusted ORs were 0.09 (95% CI: 0.04, 0.19) for women with ≥31 mo of total lactation and those with ≤10 mo of lactation and 0.38 (95% CI: 0.27, 0.55) for women with ≥3 children breastfed compared with those with one child breastfed. CONCLUSION Prolonged lactation is associated with a lower risk of ovarian cancer in parous Chinese women.
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Affiliation(s)
- Dada Su
- School of Public Health, Curtin University, Perth, Australia
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Overexpression of runt-related transcription factor-2 is associated with advanced tumor progression and poor prognosis in epithelial ovarian cancer. J Biomed Biotechnol 2012; 2012:456534. [PMID: 23093845 PMCID: PMC3475129 DOI: 10.1155/2012/456534] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2012] [Revised: 08/04/2012] [Accepted: 08/04/2012] [Indexed: 12/29/2022] Open
Abstract
Aim. To investigate clinical significance of runt-related transcription factor (RUNX)-2 in epithelial ovarian cancer (EOC).
Methods. RUNX2 protein expression and its subcellular localization were detected by immunohistochemistry in 116 patients with EOC.
Results. RUNX2 protein was predominantly expressed in cell nucleus of EOC tissues. The expression level of RUNX2 in EOC tissues was significantly higher than that in normal ovarian tissues (P < 0.001). In addition, the nuclear labeling index (LI) of RUNX2 in tumor cells was significantly associated with the advanced clinical stage of EOC tissues (P = 0.001). Moreover, EOC patients with high RUNX2 LI had significantly shorter overall (P < 0.001) and progression-free (P = 0.002) survival than those with low RUNX2 LI. Especially, subgroup analysis revealed that EOC patients with high clinical stages (III~IV) in high RUNX2 expression group demonstrated a significantly worse clinical outcome than those in low RUNX2 expression group, but patients with low clinical stages (I~II) had no significantly different prognosis between high and low RUNX2 expression groups.
Conclusions. Our data suggest for the first time that RUNX2 overexpression is associated with advanced tumor progression and poor clinical outcome of EOC patients. RUNX2 might be a novel prognostic marker of EOC.
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Racial/ethnic variation in breastfeeding across the US: a multilevel analysis from the National Survey of Children's Health, 2007. Matern Child Health J 2012; 16 Suppl 1:S14-26. [PMID: 22466719 DOI: 10.1007/s10995-012-0991-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
We examined whether differences across states in race/ethnicity-specific breastfeeding rates are due solely to state differences in individual factors associated with breastfeeding or additionally, certain state "contextual" factors. Using data from the 2007 National Survey of Children's Health, multilevel models examined whether state variability in race/ethnicity specific breastfeeding initiation and duration to 6 months were explained by (1) individual sociodemographic characteristics of women in states, and (2) an aggregate state measure of the availability of evidence-based maternity care services related to breastfeeding. Observed variability of race/ethnicity-specific breastfeeding rates was only minimally reduced after adjusting for sociodemographic characteristics (Median Odds Ratios (MOR), breastfeeding initiation: non-Hispanic White = 1.46, non-Hispanic Black = 2.26; Hispanic = 1.89. MOR, breastfeeding for 6 months: non-Hispanic White = 1.36, non-Hispanic Black = 1.84; Hispanic = 1.56). Overall variability in the degree of state gaps changed little in adjusted models (breastfeeding initiation: non-Hispanic Black σ(2) = 0.74, se 0.28, Hispanic σ(2) = 0.45, se 0.11; breastfeeding to 6-months: non-Hispanic Black σ(2) = 0.41, se 0.10, Hispanic σ(2) = 0.22, se 0.05). The measure of maternity care services was positively associated with breastfeeding overall but generally did not explain a substantial portion of between-state variability nor the overall variability in racial/ethnic gaps. Contextual sources of variation in state breastfeeding practices and disparities remain poorly understood. Differences in the socioeconomic makeup of states do not fully explain variability. The association of state breastfeeding rates and disparities with relevant policy and practice factors should be further investigated.
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Abstract
Little is known regarding the early aspects of ovarian carcinogenesis. As a consequence, the identification of women at risk for the disease is based primarily on clinical grounds, with family history being the most important risk factor. In this review, we will discuss the various hypotheses regarding ovarian etiology and pathogenesis. In addition, we will discuss the epidemiology of ovarian cancer, including hereditary, reproductive, hormonal, inflammatory, dietary, surgical, and geographic factors that influence ovarian cancer risk.
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Kurta ML, Moysich KB, Weissfeld JL, Youk AO, Bunker CH, Edwards RP, Modugno F, Ness RB, Diergaarde B. Use of fertility drugs and risk of ovarian cancer: results from a U.S.-based case-control study. Cancer Epidemiol Biomarkers Prev 2012; 21:1282-92. [PMID: 22707710 DOI: 10.1158/1055-9965.epi-12-0426] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Previous studies examining associations between use of fertility drugs and ovarian cancer risk have provided conflicting results. We used data from a large case-control study to determine whether fertility drug use significantly impacts ovarian cancer risk when taking into account parity, gravidity, and cause of infertility. METHODS Data from the Hormones and Ovarian Cancer Prediction (HOPE) study were used (902 cases, 1,802 controls). Medical and reproductive histories were collected via in-person interviews. Logistic regression was used to calculate ORs and 95% confidence intervals (CI). Models were adjusted for age, race, education, age at menarche, parity, oral contraceptive use, breastfeeding, talc use, tubal ligation, and family history of breast/ovarian cancer. RESULTS Ever use of fertility drugs was not significantly associated with ovarian cancer within the total HOPE population (OR, 0.93; 95% CI, 0.65-1.35) or among women who reported seeking medical attention for infertility (OR, 0.87; 95% CI, 0.54-1.40). We did observe a statistically significant increased risk of ovarian cancer for ever use of fertility drugs among women who, despite seeking medical attention for problems getting pregnant, remained nulligravid (OR, 3.13; 95% CI, 1.01-9.67). CONCLUSIONS These results provide further evidence that fertility drug use does not significantly contribute to ovarian cancer risk among the majority of women; however, women who despite infertility evaluation and fertility drug use remain nulligravid, may have an elevated risk for ovarian cancer. IMPACT Our results suggest that fertility drug use does not significantly contribute to overall risk of ovarian cancer when adjusting for known confounding factors.
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Affiliation(s)
- Michelle L Kurta
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Le DC, Kubo T, Fujino Y, Sokal DC, Vach TH, Pham TM, Matsuda S. Reproductive factors in relation to ovarian cancer: a case-control study in Northern Vietnam. Contraception 2012; 86:494-9. [PMID: 22579106 DOI: 10.1016/j.contraception.2012.02.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Revised: 02/22/2012] [Accepted: 02/27/2012] [Indexed: 12/26/2022]
Abstract
BACKGROUND Ovarian cancer, one of the most common cancers in women and the most serious gynecologic cancer, is known to be influenced by reproductive factors, but these factors have not previously been examined in Vietnamese women. STUDY DESIGN We analyzed 262 ovarian cancer patients recruited from 27 hospitals in 12 provinces and Ha Noi City from April 2001 to May 2006, plus 755 controls matched by age and residential address. RESULTS The risk of ovarian cancer was significantly lower in parous women than nulliparous women. Use of an intrauterine contraceptive device was also associated with a reduced risk. In contrast, induced abortion, late menopause and years of ovulation were significantly associated with an increased risk of cancer. CONCLUSIONS Parity and intrauterine device use were associated with a reduced risk of ovarian cancer in Vietnamese women, whereas induced abortion, late menopause and years of ovulation were associated with an increased risk.
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Affiliation(s)
- Duc-Cuong Le
- Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health, Kitakyu shu, Japan.
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Jordan SJ, Cushing-Haugen KL, Wicklund KG, Doherty JA, Rossing MA. Breast-feeding and risk of epithelial ovarian cancer. Cancer Causes Control 2012; 23:919-27. [PMID: 22527170 DOI: 10.1007/s10552-012-9963-4] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2012] [Accepted: 04/06/2012] [Indexed: 02/02/2023]
Abstract
PURPOSE Evidence suggests that breast-feeding may decrease the risk of epithelial ovarian cancer but it is not clear whether there is a relationship with duration of breast-feeding, patterns of breast-feeding, or particular histological subtypes of ovarian cancer. We sought to investigate these issues in detail. METHODS Data from participants in a population-based study of ovarian cancer in western Washington State, USA (2002-2007) who had had at least one birth (881 cases and 1,345 controls) were used to assess relations between patterns of breast-feeding and ovarian cancer. Logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals (CI). RESULTS Women who ever breast-fed had a 22 % reduction in risk of ovarian cancer compared with those who never breast-fed (OR = 0.78, 95% CI 0.64-0.96) and risk reduction appeared greater with longer durations of feeding per child breast-fed (OR = 0.56, 95% CI 0.32-0.98 for 18 months average duration breast-feeding versus none). Introduction of supplementary feeds did not substantially alter these effects. The overall risk reduction appeared greatest for the endometrioid and clear cell subtypes (OR per month of average breast-feeding per child breast-fed = 0.944, 95% CI 0.903-0.987). CONCLUSIONS Among women who have had the opportunity to breast-feed, ever breast-feeding and increasing durations of episodes of breast-feeding for each breast-fed child are associated with a decrease in the risk of ovarian cancer independent of numbers of births, which may be strongest for the endometrioid subtype.
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Affiliation(s)
- S J Jordan
- School of Population Health, The University of Queensland, Herston, Australia.
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Wilailak S, Vipupinyo C, Suraseranivong V, Chotivanich K, Kietpeerakool C, Tanapat Y, Therasakvichya S, Hamontri S, Linasmita V, Bunyapipat S, Chindavijak S, Ittiwisavakul K, Khemapech N, Suekwattana P, Thanapprapasr D, Lumbiganon P. Depot medroxyprogesterone acetate and epithelial ovarian cancer: a multicentre case-control study. BJOG 2012; 119:672-7. [DOI: 10.1111/j.1471-0528.2012.03298.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Ebrahim B, Al-Enezi H, Al-Turki M, Al-Turki A, Al-Rabah F, Hammoud MS, Al-Taiar A. Knowledge, misconceptions, and future intentions towards breastfeeding among female university students in Kuwait. J Hum Lact 2011; 27:358-66. [PMID: 21813801 DOI: 10.1177/0890334411411163] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A cross-sectional study using a self-administered questionnaire was conducted on female university students (N = 1106) to explore their knowledge and misconceptions on breastfeeding. Most participants recognized the benefits of breastfeeding, but only a few were aware of the recommendation for exclusive breastfeeding in the first 6 months of life. Misconceptions were common; 66%, 60%, and 55% of participants thought mothers should temporarily stop breastfeeding if they had a fever, skin rash, or sore throat, respectively. Approximately 20% thought mothers should stop breastfeeding if the child had diarrhea, vomiting, or skin rash. Support of breastfeeding in public places was low, but 38% supported breastfeeding in female prayer rooms in public places. Efforts should be made to correct common misconceptions on breastfeeding and increase the support of breastfeeding in public places among university students. Female prayer rooms that exist in all public places in Kuwait can be used to promote breastfeeding in public places in Kuwait.
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Affiliation(s)
- Bader Ebrahim
- Department of Community Medicine and Behavioural Sciences, Faculty of Medicine, Kuwait University
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Oral contraceptive use and reproductive factors and risk of ovarian cancer in the European Prospective Investigation into Cancer and Nutrition. Br J Cancer 2011; 105:1436-42. [PMID: 21915124 PMCID: PMC3241548 DOI: 10.1038/bjc.2011.371] [Citation(s) in RCA: 135] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND It is well established that parity and use of oral contraceptives reduce the risk of ovarian cancer, but the associations with other reproductive variables are less clear. METHODS We examined the associations of oral contraceptive use and reproductive factors with ovarian cancer risk in the European Prospective Investigation into Cancer and Nutrition. Among 327,396 eligible women, 878 developed ovarian cancer over an average of 9 years. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazard models stratified by centre and age, and adjusted for smoking status, body mass index, unilateral ovariectomy, simple hysterectomy, menopausal hormone therapy, and mutually adjusted for age at menarche, age at menopause, number of full-term pregnancies and duration of oral contraceptive use. RESULTS Women who used oral contraceptives for 10 or more years had a significant 45% (HR, 0.55; 95% CI, 0.41-0.75) lower risk compared with users of 1 year or less (P-trend, <0.01). Compared with nulliparous women, parous women had a 29% (HR, 0.71; 95% CI, 0.59-0.87) lower risk, with an 8% reduction in risk for each additional pregnancy. A high age at menopause was associated with a higher risk of ovarian cancer (>52 vs ≤ 45 years: HR, 1.46; 95% CI, 1.06-1.99; P-trend, 0.02). Age at menarche, age at first full-term pregnancy, incomplete pregnancies and breastfeeding were not associated with risk. CONCLUSION This study shows a strong protective association of oral contraceptives and parity with ovarian cancer risk, a higher risk with a late age at menopause, and no association with other reproductive factors.
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Chen BA, Reeves MF, Creinin MD, Schwarz EB. Postplacental or delayed levonorgestrel intrauterine device insertion and breast-feeding duration. Contraception 2011; 84:499-504. [PMID: 22018124 DOI: 10.1016/j.contraception.2011.01.022] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2010] [Revised: 01/28/2011] [Accepted: 01/28/2011] [Indexed: 12/20/2022]
Abstract
BACKGROUND The objective of this study was to assess the effect of timing of postpartum levonorgestrel-releasing intrauterine device (IUD) insertion on breast-feeding continuation. STUDY DESIGN Women interested in using a levonorgestrel IUD postpartum were randomized to immediate postplacental insertion (postplacental group) or insertion 6-8 weeks after vaginal delivery (delayed group). Duration and exclusivity of breast-feeding were assessed at 6-8 weeks, 3 months, and 6 months postpartum. Only women who received an IUD were included in this analysis. RESULTS Breast-feeding was initiated by 32 (64%) of 50 of women receiving a postplacental IUD and 27 (58.7%) of 46 of women receiving a delayed IUD (p=.59). More women in the delayed group compared with the postplacental group continued to breast-feed at 6-8 weeks (16/46 vs. 15/50, p=.62), 3 months (13/46 vs. 7/50, p=.13), and 6 months postpartum (11/46 vs. 3/50, p=.02). The results did not differ when only women who initiated breast-feeding or only primiparous women with no prior breast-feeding experience were analyzed. CONCLUSIONS Immediate postplacental insertion of the levonorgestrel IUD is associated with shorter duration of breast-feeding and less exclusive breast-feeding. Further studies on the effects of early initiation of progestin-only methods on women's lactation experience are needed.
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Affiliation(s)
- Beatrice A Chen
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA.
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Braem MGM, Onland-Moret NC, van den Brandt PA, Goldbohm RA, Peeters PHM, Kruitwagen RFPM, Schouten LJ. Reproductive and hormonal factors in association with ovarian cancer in the Netherlands cohort study. Am J Epidemiol 2010; 172:1181-9. [PMID: 20861144 PMCID: PMC2970782 DOI: 10.1093/aje/kwq264] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Parity, oral contraceptive use, and hysterectomy are known to protect against ovarian cancer, whereas the effect of other reproductive factors remains unclear. The authors investigated the association between several reproductive and hormonal factors and the risk of epithelial invasive ovarian cancer among postmenopausal women participating in the Netherlands Cohort Study on Diet and Cancer. Information on reproductive history and exogenous hormone use was obtained through a self-administered questionnaire at baseline in 1986. After 16.3 years of follow-up, 375 cases and 2,331 subcohort members were available for case-cohort analysis. Ovarian cancer risk was reduced for parous women, with increasing parity, and for hysterectomized women. Moreover, the authors found evidence that oral contraceptive use is protective against ovarian cancer, even when initiated at an older age. In addition, a reduced risk was observed for each year reduction in age at natural menopause and per year reduction in total menstrual life span. A small increased risk was observed with prolonged time to pregnancy, but no difference was found between ever-married nulliparous women and never-married nulliparous women. Moreover, no associations were observed for age at first birth, age at menarche, age at first and last use of oral contraceptives, and use of hormone replacement therapy.
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Affiliation(s)
| | | | | | | | | | | | - L. J. Schouten
- Correspondence to Dr. L. J. Schouten, Department of Epidemiology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands (e-mail: )
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Pérez-López FR, Chedraui P, Troyano-Luque JM. Peri- and post-menopausal incidental adnexal masses and the risk of sporadic ovarian malignancy: new insights and clinical management. Gynecol Endocrinol 2010; 26:631-43. [PMID: 20500106 DOI: 10.3109/09513590.2010.487611] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Adnexal masses are common among peri- and post-menopausal women. Although ovarian cancer is a significant cause of mortality in menopausal women, large population-based studies demonstrate that the majority of adnexal masses are benign. Despite this, the appearance of an adnexal mass is a concern for the patient and an insight exercise for physicians. In most cases, an adnexal enlargement is an incidental finding, generally corresponding to a benign cyst and easily diagnosed by conventional ultrasound. Exceptionally an ovarian tumour may be malignant and should be treated as early as possible. When conventional ultrasound renders complex morphology other diagnostic tools must be used such as: colour Doppler and functional tumour vessel properties, serum CA 125 levels, nuclear magnetic resonance imaging and in some cases laparoscopy. Several new tumour markers are being studied for clinical application, although there are presently no clear recommendations. Adnexal masses with benign morphological and functional properties must be periodically monitored as an alternative to surgery since malignant transformation is exceptional.
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Affiliation(s)
- Faustino R Pérez-López
- Department of Obstetrics and Gynaecology, Facultad de Medicina, Universidad de Zaragoza, Hospital Clínico de Zaragoza, Zaragoza 50009, Spain.
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Shulman LP. Hereditary breast and ovarian cancer (HBOC): clinical features and counseling for BRCA1 and BRCA2, Lynch syndrome, Cowden syndrome, and Li-Fraumeni syndrome. Obstet Gynecol Clin North Am 2010; 37:109-33, Table of Contents. [PMID: 20494261 DOI: 10.1016/j.ogc.2010.03.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
This article provides an overview of the molecular changes associated with inherited gynecologic malignancies and the incorporation of this information in the counseling of individuals at increased risk for developing malignancies, as well as conventional and emerging approaches to the screening of the general population. Cancer genetic counseling and its role in women's health care is examined. The focus is hereditary breast and ovarian cancer; however, cancer predisposition caused by genes other than BRCA1 and BRCA2 is also considered. The aim is to provide a foundation for counseling based on fundamental knowledge of the genes and their clinical consequences. The reader is then guided through the mechanics of risk assessment for individual patients, concluding with the psychosocial implications of counseling.
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Affiliation(s)
- Lee P Shulman
- Division of Clinical Genetics, Feinberg School of Medicine of Northwestern University, Chicago, IL, USA.
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