Menopausal hormone therapy use and risk of ovarian cancer by race: the ovarian cancer in women of African ancestry consortium

BACKGROUND

Most studies examining post-menopausal menopausal hormone therapy (MHT) use and ovarian cancer risk have focused on White women and few have included Black women.

METHODS

We evaluated MHT use and ovarian cancer risk in Black (n = 800 cases, 1783 controls) and White women (n = 2710 cases, 8556 controls), using data from the Ovarian Cancer in Women of African Ancestry consortium. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the association of MHT use with ovarian cancer risk, examining histotype, MHT type and duration of use.

RESULTS

Long-term MHT use, ≥10 years, was associated with an increased ovarian cancer risk for White women (OR = 1.38, 95%CI: 1.22-1.57) and the association was consistent for Black women (OR = 1.20, 95%CI: 0.81-1.78, pinteraction = 0.4). For White women, the associations between long-term unopposed estrogen or estrogen plus progesterone use and ovarian cancer risk were similar; the increased risk associated with long-term MHT use was confined to high-grade serous and endometroid tumors. Based on smaller numbers for Black women, the increased ovarian cancer risk associated with long-term MHT use was apparent for unopposed estrogen use and was predominately confined to other epithelial histotypes.

CONCLUSION

The association between long-term MHT use and ovarian cancer risk was consistent for Black and White women.

Diet Quality and Inflammatory Index Score Among Women's Cancer Survivors

Objectives

In 2018, women's cancers accounted for 38.6% of new cases and 26.9% of cancer deaths in females worldwide. The risk of recurrence is partially attributed to lifestyle factors linked to inflammation, including diet quality. Adherence to U.S Department of Agriculture Dietary Guidelines, measured with the Healthy Eating Index (HEI-2015), and consuming an anti-inflammatory diet, measured with the Energy-adjusted Dietary Inflammatory Index (E-DII), are found to improve quality of life and reduce recurrence risk. The purpose of this study was to investigate HEI-2015 and E-DII scores in women's cancer survivors.

Methods

Survivors of women's cancers (N = 52, 65 ± 12 yrs) were recruited to complete a demographic questionnaire and three 24-hour dietary recalls using the Nutrient Data System for Research (NDSR). HEI-2015 and E-DII scores were calculated from average intakes. Linear regression analysis was used to examine the association between demographic factors (age, BMI, education, rurality, income, financial security, years since active treatment, and weight goals) and HEI-2015 and E-DII scores. Pearson Correlation was used to examine correlation between the two.

Results

On average, HEI-2015 score was 55 ± 13.5 (29.7–84.6), lower than the national average, and E-DII score was -1.14 ± 2.24 (−5.66–3.22). 54% of women had anti- inflammatory (<−1), 17% had pro-inflammatory (>1), and 29% women had relatively neutral (−1 to 1) diets. Women with a graduate degree (P = 0.03) and who completed treatment more than 4 years prior (P = 0.01) had higher HEI-2015 scores. There were no associations between SES and E-DII scores. Most notably, higher diet quality was associated with more anti-inflammatory diets (r = −0.67, P < 0.001).

Conclusions

While diet quality of women cancer survivors is comparatively low, the association with its inflammatory potential is a promising avenue for preventing recurrence. Higher E-DII scores are correlated with increased inflammatory markers, cardiovascular disease and metabolic syndrome risk, greater risk ratio and 75% increased mortality for several cancers. Guidelines for reducing inflammation will allow Registered Dietitians to provide specific, evidence-based oncology nutrition services, such as education, counseling, and medical nutrition therapy (MNT).

Funding Sources

This was funded by the University of Virginia Cancer Center.

Pharmacological characterization of a novel factor Xa inhibitor, FXV673

FXV673 is a novel, potent, and selective factor Xa (FXa) inhibitor. FXV673 inhibited human, dog, and rabbit FXa with a K(i) of 0.52, 1.41, and 0.27 nM, respectively. FXV673 also displayed excellent specificity toward FXa relative to other serine proteases. It showed selectivity of more than 1000-fold over thrombin, activated protein C (aPC), plasmin, and tissue-plasminogen activator (t-PA). FXV673 prolonged plasma activated partial thromboplastin time (APTT) and prothrombin time (PT) in a dose-dependent fashion. In the APTT assays, the concentrations (microM) required for doubling coagulation time were 0.41 (human), 0.65 (monkey), 1.12 (dog), 0.25 (rabbit), and 0.80 (rat). The concentrations (microM) required in the PT assays were 1.1 (human), 1.32 (monkey), 2.31 (dog), 0.92 (rabbit), and 1.69 (rat). A coupled-enzyme assay was performed to measure thrombin activity following prothrombinase conversion of prothrombin to thrombin. FXV673 showed IC(50)s of 1.38 and 2.55 nM, respectively, when artificial phosphatidylserine/phosphatidylcholine (PS/PC) liposomes or fresh platelets were used as the phospholipid source for prothrombinase complex formation. It was demonstrated that FXV673 could inhibit further thrombin generation in the prothrombinase complex using PS/PC liposomes. FXV673 dose-dependently prolonged the time to vessel occlusion and inhibited thrombus formation in well-characterized canine models of thrombosis. Interspecies extrapolation (approximately 2.5-fold higher sensitivity for FXa inhibition in human than in dog) suggested that 100 ng/ml of FXV673 would be an effective plasma concentration for clinical studies. Currently FXV673 is undergoing clinical studies to be developed as an antithrombotic agent.