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Lee JK, Yun H, Kim H, Yun BH, Seo SK. Tibolone and Breast Cancer. J Menopausal Med 2023; 29:92-96. [PMID: 38230592 PMCID: PMC10796206 DOI: 10.6118/jmm.23032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 12/25/2023] [Accepted: 12/27/2023] [Indexed: 01/18/2024] Open
Abstract
Tibolone, a selective tissue estrogenic activity regulator, is a synthetic steroid with distinct pharmacological and clinical characteristics in contrast to conventional menopausal hormone therapy. Tibolone induces estrogenic activity in the brain, vagina, and bone but remains inactive in the endometrium and breast. In particular, several studies have investigated whether tibolone usage increases the risk of breast cancer. This study aims to determine the effects of tibolone on the breast by focusing on the relation between tibolone use and breast cancer. Our investigation emphasizes recent studies, particularly those based on Asian populations.
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Affiliation(s)
- Jae Kyung Lee
- Departments of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea
- Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Hyewon Yun
- Departments of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea
- Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Heeyon Kim
- Departments of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea
- Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Bo Hyon Yun
- Departments of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea
- Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Seok Kyo Seo
- Departments of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea
- Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea.
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Lester SP, Vegunta S. Influence of Menopausal Hormone Therapy on the Breast: Counseling Your Patients Before You Prescribe. J Womens Health (Larchmt) 2021; 31:167-170. [PMID: 34788572 DOI: 10.1089/jwh.2021.0322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Menopausal hormone therapy (HT) aims to improve a woman's quality of life by treating bothersome menopausal symptoms associated with low estrogen levels. Although HT is prescribed to millions of women worldwide, its breast-related adverse effects have always been a concern. Some of the common adverse effects of HT are breast fullness, increased breast density, and increased breast cancer (BC) risk. Health care professionals need to be aware of the influence of HT on breast tissue to provide appropriate counseling as part of informed decision making. Our review summarizes the influence of HT on breast symptoms, breast density, mammograms, and BC risk.
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Affiliation(s)
- Sara P Lester
- Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Suneela Vegunta
- Division of Women's Health Internal Medicine, Mayo Clinic, Scottsdale, Arizona, USA
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Caglayan EK, Caglayan K, Alkis I, Arslan E, Okur A, Banli O, Engin-Ustün Y. Factors Associated with Mammographic Density in Postmenopausal Women. J Menopausal Med 2015; 21:82-8. [PMID: 26357645 PMCID: PMC4561745 DOI: 10.6118/jmm.2015.21.2.82] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 05/01/2015] [Accepted: 06/22/2015] [Indexed: 12/25/2022] Open
Abstract
Objectives Breast density increases the risk of breast cancer, but also in the interpretation of mammography is also important. This study examine the risk factors affecting breast density in postmenopausal women. Methods Between January 2013 and January 2014, 215 patients admitted to The Clinics of Gynecology and Obstetrics with complaints of menopause were taken. According to the results of mammography, Group I (non-dense, n = 175) and Group II (dense, n = 40) were created. The informations of the caseswere analyzed retrospectively. Results In Group I, body mass index (BMI), number of pregnancies, parity were significantly higher than group II (P < 0.05). In group II, the withdrawal period of menstruation and progesterone levels were significantly higher (P < 0.05). In logistic regression analysis, BMI for dense breasts and number of pregnancies were found to be an independent risk factor (P < 0.05). Conclusion Increased BMI, pregnancy and parity, result of reduction in density , but longer duration of menopause and increased progesterone cause an increase in density. BMI and the number of pregnancy was found to be independent risk factors for reducing breast density.
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Affiliation(s)
- Emel Kiyak Caglayan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Bozok University, Yozgat, Turkey
| | - Kasim Caglayan
- Department of Surgery, Faculty of Medicine, Bozok University, Yozgat, Turkey
| | - Ismet Alkis
- Department of Obstetrics and Gynecology, Faculty of Medicine, Yüzüncü Yıl Üniversity, Van, Turkey
| | - Ergin Arslan
- Department of Surgery, Faculty of Medicine, Bozok University, Yozgat, Turkey
| | - Aylin Okur
- Department of Radiology, Faculty of Medicine, Bozok University, Yozgat, Turkey
| | - Oktay Banli
- Department of Surgery, Faculty of Medicine, Bozok University, Yozgat, Turkey
| | - Yaprak Engin-Ustün
- Department of Obstetrics and Gynecology, Faculty of Medicine, Bozok University, Yozgat, Turkey
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Columnar cell lesions, mammographic density and breast cancer risk. Breast Cancer Res Treat 2008; 115:561-71. [PMID: 18587641 DOI: 10.1007/s10549-008-0099-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2008] [Accepted: 06/11/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Mammographic density is the third largest risk factor for ductal carcinoma in-situ (DCIS) and invasive breast cancer. However, the question of whether risk-mediating precursor histological changes, such as columnar cell lesions (CCLs), can be found in dense but non-malignant breast tissues has not been systematically addressed. We hypothesized that CCLs may be related to breast composition, in particular breast density, in non-tumour containing breast tissue. PATIENTS AND METHODS We examined randomly selected tissue samples obtained by bilateral subcutaneous mastectomy from a forensic autopsy series, where tissue composition was assessed, and in which there had been no selection of subjects or histological specimens for breast disease. We reviewed H&E slides for the presence of atypical and non-atypical CCLs and correlated with histological features measured using quantitative microscopy. RESULTS CCLs were seen in 40 out of 236 cases (17%). The presence of CCLs was found to be associated with several measures of breast tissue composition, including radiographic density: high Faxitron Wolfe Density (P = 0.037), high density estimated by percentage non-adipose tissue area (P = 0.037), high percentage collagen (P = 9.2E-05) and high percentage glandular area (P = 2E-05). DCIS was identified in two atypical CCL cases. The extent of CCL was not associated with any of the examined variables. CONCLUSION Our study is the first to report a possible association between CCLs and breast tissue composition, including mammographic density. Our data suggest that prospective elucidation of the strength and nature of the clinicopathological correlation may lead to an enhanced understanding of mammographic density and evidence based management strategies.
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Kloosterboer HJ, Löfgren L, von Schoulz E, von Schoultz B, Verheul HAM. Estrogen and tibolone metabolite levels in blood and breast tissue of postmenopausal women recently diagnosed with early-stage breast cancer and treated with tibolone or placebo for 14 days. Reprod Sci 2007; 14:151-9. [PMID: 17636226 DOI: 10.1177/1933719106298679] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Unlike estrogens plus progestagens, tibolone, a selective tissue estrogenic activity regulator, does not increase breast tenderness and mammographic density. To elucidate this, serum and breast levels of tibolone and estrogenic metabolites are measured. Postmenopausal women (n = 102) with early-stage, ER(+ve), primary breast cancer received tibolone or placebo for 14 days in an exploratory, double-blind, randomized trial (STEM carcinoma tissue). Baseline and presurgery sera were collected; tumor tissues were obtained at surgery. E(1) (estrone), E(2) (estradiol), E(1)S (estrone-sulfate), tibolone-its nonsulfated, monosulfated, and disulfated 3-hydroxymetabolites-and Delta(4)-tibolone were measured by validated gas chromatography and mass spectrometry and liquid chromatography with tandem mass spectrometry assays. More than 12 hours after the final dose, serum E(1), E(2), and E(1)S levels were unchanged with placebo, whereas tibolone significantly increased E(1)S and the E(1)S/(E(1) + E(2)) ratio. In tumors, E(1) and E(2) levels were higher than in serum, and E(1)S levels were lower, with placebo and tibolone administration. The percentage of E(1)S was about 90% in serum and 16% in tissue. Tibolone did not affect tissue levels of endogenous estrogens. Serum levels of estrogenic 3alpha- and 3beta-hydroxytibolone, progestagenic/androgenic Delta(4)-tibolone, and monosulfate metabolites were low. Serum 3alphaS,17betaS-tibolone and 3 betaS,17betaS-tibolone levels were 250 and 52 ng/mL, respectively. Tumor levels of 3alpha- and 3beta-hydroxytibolone and Delta(4)-tibolone were higher than in serum, but disulfate levels were lower. The percentage of sulfated tibolone metabolites was 99% in serum and 96% in tumor. Serum metabolite patterns of estradiol and tibolone are different from those in tissues and are compatible with neutral effects of tibolone on breast Ki67 expression.
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Seeger H, Kloosterboer HJ, Studen M, Wallwiener D, Mueck AO. In vitro effects of tibolone and its metabolites on human vascular coronary cells. Maturitas 2007; 58:42-9. [PMID: 17572028 DOI: 10.1016/j.maturitas.2007.04.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2007] [Revised: 04/03/2007] [Accepted: 04/29/2007] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Tibolone is a tissue selective compound with estrogenic, androgenic and progestogenic properties in classical bioassays. It is used for alleviation of menopausal symptoms and for osteoporosis prophylaxis in postmenopausal women. Only few data are available regarding the effects of tibolone on the cardiovascular system. We investigated therefore the in vitro effects of tibolone and its metabolites on the vasculature under special controlled conditions, using human female coronary endothelial and smooth muscle cells. METHODS The effect on the production of the following markers in endothelial cells from human female coronary arteries was evaluated: nitric oxide synthase, prostacyclin, endothelin, plasminogen-activator-inhibitor-1 (PAI-1), E-Selectin, Intercellular adhesion molecule (ICAM-1), monocyte attracting protein-1 (MCP-1) and the precursor of matrix metalloproteinase-1 (pro-MMP-1). Tibolone, its metabolites, estradiol (E2), E2/norethisterone (NET) and E2/medroxyprogesterone acetate (MPA) were tested at 0.1 microM and 1 microM. The markers were determined by enzyme immunoassays in the cell supernatant. Cell proliferation of smooth muscle cells from female coronary artery was measured by an adenosine triphosphate-assay. RESULTS Tibolone, its 3-hydroxy metabolites, E2/NET, E2/MPA and estradiol alone had significant effects on the synthesis of all markers tested. The magnitude of the tibolone effects, however, was mostly smaller than that of E2/NET and E2/MPA. Concerning smooth muscle cells tibolone and its 3-hydroxy metabolites also elicited an inhibition of the proliferation compared to control values. The strongest effect here was found for E2/NET and E2 alone, whereas E2/MPA had no effect. CONCLUSION The results of this in vitro study conducted with cells of the most important vascular bed with respect to the problem of cardiovascular risk suggest that tibolone can positively influence the vasculature. However, these tibolone effects may depend on intact vascular cells and may vary due to the different atherosclerotic stages of the vessels. Thus, experimental studies are useful to explore mechanisms, but clearly cannot replace clinical studies.
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MESH Headings
- Biomarkers/blood
- Cells, Cultured
- Coronary Vessels/cytology
- Coronary Vessels/drug effects
- E-Selectin/blood
- Endothelins/blood
- Endothelium, Vascular/cytology
- Endothelium, Vascular/drug effects
- Endothelium, Vascular/metabolism
- Enzyme-Linked Immunosorbent Assay
- Epoprostenol/blood
- Estradiol/pharmacology
- Female
- Humans
- Intercellular Adhesion Molecule-1/blood
- Matrix Metalloproteinase 1/blood
- Medroxyprogesterone Acetate/pharmacology
- Muscle, Smooth, Vascular/cytology
- Muscle, Smooth, Vascular/drug effects
- Muscle, Smooth, Vascular/metabolism
- Nitric Oxide Synthase/blood
- Norethindrone/pharmacology
- Norpregnenes/pharmacology
- Plasminogen Activator Inhibitor 1/blood
- Vascular Resistance/drug effects
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Affiliation(s)
- H Seeger
- Department of Endocrinology and Menopause, University's Women Hospital, Calwerstrasse 7, 72 076 Tuebingen, Germany
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Schatz F, Kuczynski E, Kloosterbooer L, Krikun G, Buchwalder LF, Rahman M, Lockwood CJ. Tibolone exerts progestational inhibition of matrix metalloproteinase expression in human endometrial stromal cells. Steroids 2006; 71:768-75. [PMID: 16806336 DOI: 10.1016/j.steroids.2006.05.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2006] [Revised: 05/08/2006] [Accepted: 05/09/2006] [Indexed: 11/22/2022]
Abstract
Tibolone and its metabolites were evaluated on matrix metalloproteinase (MMP) expression in human endometrial stromal cells (HESCs) under the hypothesis that these steroids would act as progestins on MMP-1, -2, and -3 expression. After 7 days of priming and 24h experimental incubation of confluent cultured HESCs, 10(-7) M medroxyprogesterone acetate (P) reduced MMP-1 to 49+/-34% (p<0.05) and MMP-3 to 33+/-22% of basal levels (mean+/-S.E.M., p<0.05, n=5). Although HESCs were unaffected by 10(-8) M estradiol (E), E+P reduced MMP-1 and MMP-3 levels an additional 2.5-fold from P alone. Tibolone and Delta-4 tibolone were equivalent to E+P in inhibiting MMP-1 and MMP-3 output, whereas 10(-6)M of 3alpha-OH or 3beta-OH tibolone was required to elicit significant inhibition of both MMPs (p<0.05). By contrast, none of the treatments affected HESC-secreted MMP-2 output. The ELISA results were confirmed by Western blotting and by substrate gel zymography. Quantitative RT-PCR demonstrated corresponding changes in MMP-1 and MMP-3 mRNA levels. Inhibition of MMP-1 and MMP-3 expression by tibolone and Delta-4 tibolone is consistent with the metabolism of tibolone to Delta-4 tibolone, and subsequent binding of Delta-4 tibolone to the progesterone receptor. Since 3alpha-OH and 3beta-OH tibolone bind exclusively to the estrogen receptor, their inhibition of MMP-1 and MMP-3 suggests metabolism by HESCs to Delta-4 tibolone. These observations help to explain the paradox that the endometrium becomes atrophic after tibolone administration despite the persistence in the circulation of 3alpha-OH and 3beta-OH tibolone, but not tibolone or Delta-4 tibolone.
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Affiliation(s)
- Frederick Schatz
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, 333 Cedar Street Room 334 FMB, PO Box 208063, New Haven, CT 06520-8063, USA.
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Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2005. [DOI: 10.1002/pds.1025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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