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Ning L, Liu Y, He X, Han R, Xin Y, Zhao J, Liu X. Validation of CTS5 Model in Large-scale Breast Cancer Population and Combination of CTS5 and Ki-67 Status to Develop a Novel Nomogram for Prognosis Prediction. Am J Clin Oncol 2024; 47:228-238. [PMID: 38131531 DOI: 10.1097/coc.0000000000001080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
BACKGROUND More than half of patients with early-stage estrogen receptor-positive (ER+) breast cancer relapse after completing 5 years of adjuvant endocrine therapy, so it is important to determine which patients are candidates for extended endocrine therapy. The clinical treatment score after 5 years (CTS5) is a prognostic tool developed based on postmenopausal ER+ breast cancer to assess the risk of late distant recurrence (LDR) after 5 years of adjuvant endocrine therapy for breast cancer. We aimed to externally validate the prognostic value of CTS5 in premenopausal and postmenopausal patients and combined with Ki-67 to develop a new model to improve the ability of prognosis prediction. METHODS We included a total of 516 patients with early-stage ER+ breast cancer who had received 5 years of adjuvant endocrine therapy and were recurrence-free for 5 years after surgery. According to menopausal status, we divided the study population into 2 groups: premenopausal and postmenopausal women. The CTS5 of each patient was calculated using a previously published formula, and the patients were divided into low, intermediate, and high CTS5 risk groups according to their CTS5 values. Based on the results of the univariate analysis ( P <0.01), a multivariate COX proportional hazards regression analysis was conducted to establish a nomogram with significant variables ( P <0.05). The discriminative power and accuracy of the nomograms were assessed using the concordance index (C-index), calibration curve, and area under the time-dependent receiver operating characteristic curve. Discrimination and calibration were evaluated by bootstrapping 1000 times. Finally, we utilized decision curve analysis to assess the performance of our novel predictive model in comparison to the CTS5 scoring system with regard to their respective benefits and advantages. RESULTS The median follow-up time was 7 years (6 to 9 years). The 516 women were categorized by CTS5 as follows: 246(47.7%) low risk, 179(34.7%) intermediate risk, and 91(17.6%) high risk. Using the CTS5 score as a continuous variable, patients' risk score was significantly positively associated with recurrence risk in both premenopausal and postmenopausal subgroups. For HER2- premenopausal patients and HER2+ postmenopausal patients, the CTS5 score was positively correlated with LDR risk. Patients with a Ki-67≥20% had a higher risk of LDR regardless of menopausal status. Using the CTS5 score as a categorical variable, the high-risk group of HER2- premenopausal patients had a higher risk of LDR. However, the CTS5 model could not distinguish the risk of LDR in different risk groups for HER2+ postmenopausal patients. In the high-risk group, patients with Ki-67≥20% had a higher risk of LDR, regardless of menopausal status. We developed a new nomogram model by combining the CTS5 model with Ki-67 levels. The C-indexes premenopausal and postmenopausal cohorts were 0.731 and 0.713, respectively. The nomogram model was well calibrated, and the time-dependent ROC curves indicated good specificity and sensitivity. Furthermore, decision curve analysis demonstrated that the new model had a wider and practical range of threshold probabilities, resulting in an increased net benefit compared with the CTS5 model. CONCLUSIONS Our study demonstrated that the CTS5 model can effectively predict the risk of LDR in early-stage ER+ breast cancer patients in both premenopausal and postmenopausal patients. Extended endocrine therapy is recommended for patients with Ki-67≥20% in the CTS5 high-risk group, as well as premenopausal patients with HER2-. Compared with CTS5, the new nomogram model has better identification and calibration capabilities, and further research is required to validate its efficacy in large-scale, multicenter, and prospective studies.
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Affiliation(s)
- Lizhi Ning
- Department of Medical Oncology, Xianyang Central Hospital, Shanxi
| | - Yaobang Liu
- Department of Surgical Oncology, General Hospital of Ningxia Medical University
| | - Xuefang He
- Department of Medical Oncology, General Hospital of Ningxia Medical University, Yinchuan
| | - Rui Han
- Department of Medical Oncology, General Hospital of Ningxia Medical University, Yinchuan
| | - Yuanfang Xin
- Breast Disease Diagnosis and Treatment Center of Affiliated Hospital of Qinghai University & Affiliated Cancer Hospital of Qinghai University, Xining, China
| | - Jiuda Zhao
- Breast Disease Diagnosis and Treatment Center of Affiliated Hospital of Qinghai University & Affiliated Cancer Hospital of Qinghai University, Xining, China
| | - Xinlan Liu
- Department of Medical Oncology, General Hospital of Ningxia Medical University, Yinchuan
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Kasahara K, Tanaka-Mizuno S, Tsuji S, Ohashi M, Kasahara M, Kawasaki T, Murakami T. Pregnancy and lactation-associated osteoporosis as a major type of premenopausal osteoporosis: a retrospective cohort study based on real-world data. BMC Pregnancy Childbirth 2024; 24:301. [PMID: 38649869 PMCID: PMC11034016 DOI: 10.1186/s12884-024-06520-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 04/15/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Pregnancy and lactation-associated osteoporosis (PLO), as well as premenopausal osteoporosis, might be a predictor of future fracture. This study aimed to describe the clinical features of PLO as a subtype of premenopausal osteoporosis and to evaluate medical interventions for it. METHODS From an administrative claims database including 4,224,246 people in Japan, we classified women for whom the date of childbirth had been defined and who had suffered low-trauma fracture between the ages of 18-47 years as the premenopausal osteoporosis group. A fracture site for which the odds ratio for fractures occurring between 5 months before and 12 months after childbirth (around childbirth) was greater than 1 was considered the PLO site. We classified patients with a fracture at the PLO site around childbirth as the PLO group. The control group consisted of 500 women without fragility fractures. We investigated some drugs and diseases to explore fracture-causing factors, as well as medical interventions such as osteoporosis diagnosis, bone densitometry, anti-osteoporosis pharmacotherapy, and lactation inhibitors. RESULTS In total, 231 parous women were classified into the premenopausal osteoporosis group. The most common fracture was vertebral fracture and was likely to occur around childbirth, followed by distal radius and sacral fractures, which were rare around childbirth. Considering vertebral, pelvic, and proximal femoral fractures as PLO sites, 56 women with 57 PLO fractures were classified into the PLO group. The incidence of PLO was estimated at 460 per million deliveries. Ovulation disorder and high maternal age were associated with the development of PLO. Vertebral fracture was the most common PLO fracture. It was mainly diagnosed a few months, and possibly up to 1 year, postpartum. PLO patients with vertebral fractures underwent more medical interventions than did those with other fractures, but they were still inadequate. CONCLUSIONS PLO with vertebral fracture was one of the major types of premenopausal osteoporosis. The prevalence of PLO is considered to be higher than previously thought, indicating the presence of potentially overlooked patients. More timely interventions for PLO might lead to the improved management of latent patients with premenopausal osteoporosis and reduce future fracture risk.
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Affiliation(s)
- Kyoko Kasahara
- The Department of Obstetrics and Gynecology, Shiga University of Medical Science, Otsu, Shiga, Japan.
| | - Sachiko Tanaka-Mizuno
- The Laboratory of Epidemiology and Prevention, Kobe Pharmaceutical University, Kobe, Japan
| | - Shunichiro Tsuji
- The Department of Obstetrics and Gynecology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Mizuki Ohashi
- The Department of Obstetrics and Gynecology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Makiko Kasahara
- The Department of Obstetrics and Gynecology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Taku Kawasaki
- The Department of Orthopedic Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Takashi Murakami
- The Department of Obstetrics and Gynecology, Shiga University of Medical Science, Otsu, Shiga, Japan
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Sheen M, Manjunath N, Young S, Cannon J, Baggarley T. CLO24-065: Administration of Goserelin at Alternative Anatomical Sites in Premenopausal Breast Cancer. J Natl Compr Canc Netw 2024; 22:CLO24-065. [PMID: 38580297 DOI: 10.6004/jnccn.2023.7285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2024]
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Moore SR, Cabre HE, Smith-Ryan AE. Body composition, physical activity, and menopause symptoms: how do they relate? Menopause 2024; 31:336-341. [PMID: 38442308 DOI: 10.1097/gme.0000000000002334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
OBJECTIVE This study characterized the impact of physical activity (light, moderate, and vigorous [VIG] active minutes per day) and body composition (percent body fat [%BF] and fat-free mass index) on total menopausal symptoms (TMSs) in 72 premenopausal, perimenopausal (PERI), or postmenopausal women. METHODS Activity minutes were collected from wearable fitness trackers. Body composition was evaluated using a whole-body dual-energy x-ray absorptiometry scan. TMSs were quantified using The North American Menopause Society Questionnaire. RESULTS Significant associations were observed between TMSs and %BF ( r = 0.464, P < 0.001) and VIG ( r = -0.245, P = 0.038). %BF and VIG were significant predictors for TMSs across groups ( R2 = 0.146 and R2 = 0.092, respectively), but only %BF maintained for PERI ( R2 = 0.421, P < 0.001). CONCLUSIONS %BF predicted nearly half of the variance in PERI TMSs, whereas VIG predicted 9% of the sample variance, demonstrating an important influence of body fat accumulation and intense physical activity in the menopause transition. High-intensity exercise interventions to alleviate body composition changes may also reduce menopausal-related symptoms for PERI women.
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Song M, Jayasekara H, Pelucchi C, Rabkin CS, Johnson KC, Hu J, Palli D, Ferraroni M, Liao LM, Bonzi R, Zaridze D, Maximovitch D, Aragonés N, Martin V, Castaño-Vinyals G, Guevara M, Tsugane S, Hamada GS, Hidaka A, Negri E, Ward MH, Sinha R, Lagiou A, Lagiou P, Boffetta P, Curado MP, Lunet N, Vioque J, Zhang ZF, La Vecchia C, Camargo MC. Reproductive factors, hormonal interventions, and gastric cancer risk in the Stomach cancer Pooling (StoP) Project. Cancer Causes Control 2024; 35:727-737. [PMID: 38123742 DOI: 10.1007/s10552-023-01829-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 11/10/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Gastric cancer incidence is higher in men, and a protective hormone-related effect in women is postulated. We aimed to investigate and quantify the relationship in the Stomach cancer Pooling (StoP) Project consortium. METHODS A total of 2,084 cases and 7,102 controls from 11 studies in seven countries were included. Summary odds ratios (ORs) and 95% confidence intervals (CIs) assessing associations of key reproductive factors and menopausal hormone therapy (MHT) with gastric cancer were estimated by pooling study-specific ORs using random-effects meta-analysis. RESULTS A duration of fertility of ≥ 40 years (vs. < 20), was associated with a 25% lower risk of gastric cancer (OR = 0.75; 95% CI: 0.58-0.96). Compared with never use, ever, 5-9 years and ≥ 10 years use of MHT in postmenopausal women, showed ORs of 0.73 (95% CI: 0.58-0.92), 0.53 (95% CI: 0.34-0.84) and 0.71 (95% CI: 0.50-1.00), respectively. The associations were generally similar for anatomical and histologic subtypes. CONCLUSION Our results support the hypothesis that reproductive factors and MHT use may lower the risk of gastric cancer in women, regardless of anatomical or histologic subtypes. Given the variation in hormones over the lifespan, studies should address their effects in premenopausal and postmenopausal women. Furthermore, mechanistic studies may inform potential biological processes.
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Affiliation(s)
- Minkyo Song
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Harindra Jayasekara
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, VIC, Australia
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Claudio Pelucchi
- Branch of Medical Statistics, Biometry, and Epidemiology "G. A. Maccacaro", Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Charles S Rabkin
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Kenneth C Johnson
- School of Epidemiology and Public Health, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Jinfu Hu
- Harbin Medical University, Harbin, China
| | - Domenico Palli
- Cancer Risk Factors and Life-Style Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network, ISPRO, Florence, Italy
| | - Monica Ferraroni
- Branch of Medical Statistics, Biometry, and Epidemiology "G. A. Maccacaro", Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Linda M Liao
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Rossella Bonzi
- Branch of Medical Statistics, Biometry, and Epidemiology "G. A. Maccacaro", Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - David Zaridze
- Department of Clinical Epidemiology, N.N. Blokhin National Medical Research Center for Oncology, Moscow, Russia
| | - Dmitry Maximovitch
- Department of Clinical Epidemiology, N.N. Blokhin National Medical Research Center for Oncology, Moscow, Russia
| | - Nuria Aragonés
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Cancer Registration and Surveillance Unit, Public Health Division, Department of Health of Madrid, Madrid, Spain
| | - Vicente Martin
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Instituto de Biomedicina (IBIOMED), Universidad de León, León, Spain
| | - Gemma Castaño-Vinyals
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Barcelona Institute for Global Health-ISGlobal, Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Marcela Guevara
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Instituto de Salud Pública y Laboral de Navarra, 31003, Pamplona, Spain
- Navarra Institute for Health Research (IdiSNA), 31008, Pamplona, Spain
| | - Shoichiro Tsugane
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
- National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo, Japan
| | | | - Akihisa Hidaka
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Eva Negri
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Mary H Ward
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Rashmi Sinha
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Areti Lagiou
- Department of Public and Community Health, School of Public Health, University of West Attica, Athens, Greece
| | - Pagona Lagiou
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Paolo Boffetta
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- Stony Brook Cancer Center, Stony Brook University, Stony Brook, NY, USA
| | - Maria Paula Curado
- Centro Internacional de Pesquisa, A. C. Camargo Cancer Center, São Paulo, Brazil
| | - Nuno Lunet
- EPIUnit - Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal
- Laboratório Para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Jesus Vioque
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Instituto de Investigación Sanitaria y Biomédica de Alicante, Universidad Miguel Hernandez (ISABIAL-UMH), Alicante, Spain
| | - Zuo-Feng Zhang
- Department of Epidemiology, UCLA Fielding School of Public Health and Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Carlo La Vecchia
- Branch of Medical Statistics, Biometry, and Epidemiology "G. A. Maccacaro", Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - M Constanza Camargo
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA.
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Molinelli C, Jacobs F, Nader-Marta G, Borea R, Scavone G, Ottonello S, Fregatti P, Villarreal-Garza C, Bajpai J, Kim HJ, Puglisi S, de Azambuja E, Lambertini M. Ovarian Suppression: Early Menopause and Late Effects. Curr Treat Options Oncol 2024; 25:523-542. [PMID: 38478329 PMCID: PMC10997548 DOI: 10.1007/s11864-024-01190-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2024] [Indexed: 04/06/2024]
Abstract
OPINION STATEMENT Around 90% of breast tumours are diagnosed in the early stage, with approximately 70% being hormone receptor-positive. The cornerstone of adjuvant therapy for early-stage hormone receptor-positive breast cancer is endocrine therapy, tailored according to disease stage, biological characteristics of the tumour, patient's comorbidities, preferences and age. In premenopausal patients with hormone receptor-positive breast cancer, ovarian function suppression is a key component of the adjuvant endocrine treatment in combination with an aromatase inhibitor or tamoxifen. Moreover, it can be used during chemotherapy as a standard strategy for ovarian function preservation in all breast cancer subtypes. In the metastatic setting, ovarian function suppression should be used in all premenopausal patients with hormone receptor-positive breast cancer to achieve a post-menopausal status. Despite its efficacy, ovarian function suppression may lead to several side effects that can have a major negative impact on patients' quality of life if not properly managed (e.g. hot flashes, depression, cognitive impairment, osteoporosis, sexual dysfunction, weight gain). A deep knowledge of the side effects of ovarian function suppression is necessary for clinicians. A correct counselling in this regard and proactive management should be considered a fundamental part of survivorship care to improve treatment adherence and patients' quality of life.
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Affiliation(s)
- Chiara Molinelli
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genoa, Italy
- Department of Medical Oncology, U.O. Clinical Di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, Italy
| | - Flavia Jacobs
- Humanitas Clinical and Research Center - IRCCS, Humanitas Cancer Center, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Guilherme Nader-Marta
- Academic Trials Promoting Team, Institut Jules Bordet and l'Université Libre de Bruxelles (U.L.B), 90, Rue Meylemeersch, 1070, Anderlecht, Brussels, Belgium
| | - Roberto Borea
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genoa, Italy
- Department of Medical Oncology, U.O. Clinical Di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, Italy
| | - Graziana Scavone
- Department of Medical Oncology, U.O. Clinical Di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, Italy
| | - Silvia Ottonello
- Department of Medical Oncology, U.O. Clinical Di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, Italy
| | - Piero Fregatti
- Department of Surgery, U.O. Senologia Chirurgica, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostic (DISC), School of Medicine, University of Genoa, 16132, Genoa, Italy
| | - Cynthia Villarreal-Garza
- Breast Cancer Center, Hospital Zambrano Hellion - TecSalud, Tecnologico de Monterrey, Monterrey, Mexico
| | - Jyoti Bajpai
- Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Ernest Borges Rd, Parel East, Parel, Mumbai, Maharashtra, 400012, India
| | - Hee Jeong Kim
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, South Korea
| | - Silvia Puglisi
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, Italy
| | - Evandro de Azambuja
- Academic Trials Promoting Team, Institut Jules Bordet and l'Université Libre de Bruxelles (U.L.B), 90, Rue Meylemeersch, 1070, Anderlecht, Brussels, Belgium
| | - Matteo Lambertini
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genoa, Italy.
- Department of Medical Oncology, U.O. Clinical Di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, Italy.
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Von Holle A, Adami HO, Baglietto L, Berrington de Gonzalez A, Bertrand KA, Blot W, Chen Y, DeHart JC, Dossus L, Eliassen AH, Fournier A, Garcia-Closas M, Giles G, Guevara M, Hankinson SE, Heath A, Jones ME, Joshu CE, Kaaks R, Kirsh VA, Kitahara CM, Koh WP, Linet MS, Park HL, Masala G, Mellemkjaer L, Milne RL, O'Brien KM, Palmer JR, Riboli E, Rohan TE, Shrubsole MJ, Sund M, Tamimi R, Tin Tin S, Visvanathan K, Vermeulen RC, Weiderpass E, Willett WC, Yuan JM, Zeleniuch-Jacquotte A, Nichols HB, Sandler DP, Swerdlow AJ, Schoemaker MJ, Weinberg CR. BMI and breast cancer risk around age at menopause. Cancer Epidemiol 2024; 89:102545. [PMID: 38377945 PMCID: PMC10942753 DOI: 10.1016/j.canep.2024.102545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 02/01/2024] [Accepted: 02/05/2024] [Indexed: 02/22/2024]
Abstract
BACKGROUND A high body mass index (BMI, kg/m2) is associated with decreased risk of breast cancer before menopause, but increased risk after menopause. Exactly when this reversal occurs in relation to menopause is unclear. Locating that change point could provide insight into the role of adiposity in breast cancer etiology. METHODS We examined the association between BMI and breast cancer risk in the Premenopausal Breast Cancer Collaborative Group, from age 45 up to breast cancer diagnosis, loss to follow-up, death, or age 55, whichever came first. Analyses included 609,880 women in 16 prospective studies, including 9956 who developed breast cancer before age 55. We fitted three BMI hazard ratio (HR) models over age-time: constant, linear, or nonlinear (via splines), applying piecewise exponential additive mixed models, with age as the primary time scale. We divided person-time into four strata: premenopause; postmenopause due to natural menopause; postmenopause because of interventional loss of ovarian function (bilateral oophorectomy (BO) or chemotherapy); postmenopause due to hysterectomy without BO. Sensitivity analyses included stratifying by BMI in young adulthood, or excluding women using menopausal hormone therapy. RESULTS The constant BMI HR model provided the best fit for all four menopausal status groups. Under this model, the estimated association between a five-unit increment in BMI and breast cancer risk was HR=0.87 (95% CI: 0.85, 0.89) before menopause, HR=1.00 (95% CI: 0.96, 1.04) after natural menopause, HR=0.99 (95% CI: 0.93, 1.05) after interventional loss of ovarian function, and HR=0.88 (95% CI: 0.76, 1.02) after hysterectomy without BO. CONCLUSION The BMI breast cancer HRs remained less than or near one during the 45-55 year age range indicating that the transition to a positive association between BMI and risk occurs after age 55.
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Affiliation(s)
- Ann Von Holle
- Biostatistics and Computational Biology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
| | - Hans-Olov Adami
- Clinical Effectiveness Group, Institute of Health and Society, University of Oslo, Oslo, Norway; Department of Medical Epidemiology and Biostatistics, Karolinksa Institutet, Stockholm, Sweden
| | - Laura Baglietto
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | | | - William Blot
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Yu Chen
- Division of Epidemiology, Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Jessica Clague DeHart
- School of Community and Global Health, Claremont Graduate University, Claremont, CA, USA
| | - Laure Dossus
- Nutrition and Metabolism Branch, International Agency for Research on Cancer, Lyon, France
| | - A Heather Eliassen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Agnes Fournier
- Centre for Research in Epidemiology and Statistics, Paris, France
| | - Montse Garcia-Closas
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, United Kingdom
| | - Graham Giles
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Marcela Guevara
- Instituto de Salud Pública y Laboral de Navarra, Pamplona, Spain
| | - Susan E Hankinson
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA, USA
| | - Alicia Heath
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
| | - Michael E Jones
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, United Kingdom
| | - Corinne E Joshu
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Rudolf Kaaks
- Division of Cancer Epidemiology, German Cancer Research Center, DKFZ, Heidelberg, Germany
| | | | - Cari M Kitahara
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Woon-Puay Koh
- Healthy Longevity Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Singapore Institute for Clinical Sciences, Agency for Science Technology and Research, Singapore
| | - Martha S Linet
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Hannah Lui Park
- Department of Pathology and Laboratory Medicine, Department of Epidemiology, UC Irvine School of Medicine, Irvine, CA, USA
| | - Giovanna Masala
- Institute for the Study and Prevention of Cancer, Florence, Italy
| | - Lene Mellemkjaer
- Diet, Cancer and Health, Danish Cancer Institute, Copenhagen, Denmark
| | - Roger L Milne
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Victoria, Australia; Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Katie M O'Brien
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
| | - Julie R Palmer
- Slone Epidemiology Center, Boston University, Boston, MA, USA
| | - Elio Riboli
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
| | | | | | - Malin Sund
- Department of Surgical and perioperative Sciences/Surgery, Umea University, Sweden
| | - Rulla Tamimi
- Department of Population Health Sciences, Weill Cornell Medical College, NY, USA
| | - Sandar Tin Tin
- Cancer Epidemiology Unit, Oxford Population Health, University of Oxford, United Kingdom
| | - Kala Visvanathan
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Roel Ch Vermeulen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Elisabete Weiderpass
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Walter C Willett
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Jian-Min Yuan
- Division of Cancer Control and Population Science, University of Pittsburgh Medical Center (UPMC) Hillman Cancer Center, Pittsburgh, PA, USA; Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Hazel B Nichols
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Dale P Sandler
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
| | - Anthony J Swerdlow
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, United Kingdom; Division of Breast Cancer Research, The Institute of Cancer Research, London, United Kingdom
| | | | - Clarice R Weinberg
- Biostatistics and Computational Biology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA.
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8
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Agrawal P, Lee YS, Grutman AJ, Dumas K, Kohn T, Kohn J, Yee AM, Clifton M. Characteristics of systemic testosterone therapy for female hypoactive sexual desire disorder-a claims database analysis. J Sex Med 2024; 21:288-293. [PMID: 38441520 DOI: 10.1093/jsxmed/qdae013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 10/08/2023] [Accepted: 11/18/2023] [Indexed: 04/04/2024]
Abstract
BACKGROUND Testosterone therapy (TTh) is recommended for postmenopausal women with hypoactive sexual desire disorder (HSDD); however, there remain insufficient data to support use of TTh in premenopausal women with sexual dysfunction. AIM In this study, we used a large national database to evaluate prescribing trends of TTh for women with HSDD. METHODS We conducted a cohort analysis of information from electronic health records acquired from the data network TriNetX Diamond. The study cohort consisted of women 18-70 years of age with a diagnosis of HSDD. We analyzed trends of testosterone prescriptions, routes of testosterone administration, and coadministration of testosterone with estrogen. OUTCOMES Despite an increase in rates of testosterone prescriptions for HSDD, there remains a high degree of variability in the duration of treatment, route of administration, and coadministration of estrogen with significant underprescription of testosterone. RESULTS Our query of the TriNetX database led to the identification of 33 418 women diagnosed with HSDD at a mean age of 44.2 ± 10.8 years, among whom 850 (2.54%) women received a testosterone prescription. The testosterone prescriptions were highly variable with regard to duration and route of administration and coadministration with estrogen. For all patients until 2015, the prevalence of testosterone prescriptions for HSDD showed a positive quadratic relation was observed. Since 2015 a linear increase in prevalence was observed, with the highest rate of increase for patients aged 41-55 years. CLINICAL IMPLICATIONS The findings of this study reveal a significant need for further research investigating the optimal use of TTh to enhance the sexual health of women with HSDD, and further studies on the long-term effects of testosterone use must be undertaken to ensure that patients have access to safe and effective treatment. STRENGTHS AND LIMITATIONS Limitations to this study include patient de-identification and lack of availability of testosterone dosage data. However, this study also has many strengths, including being the first, to our knowledge, to characterize the prescribing trends of testosterone for women with HSDD. CONCLUSION Testosterone therapy should be considered as a potential therapy for premenopausal female patients with HSDD. Further studies on the long-term effects of testosterone use must be undertaken to address disparities in the management of HSDD and to ensure patients can access treatment.
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Affiliation(s)
- Pranjal Agrawal
- Johns Hopkins University School of Medicine, Baltimore, MD 21205, United States
| | - Yeonsoo Sara Lee
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Jacksonville, FL 32256, United States
| | - Aurora J Grutman
- Johns Hopkins University School of Medicine, Baltimore, MD 21205, United States
| | - Kathryn Dumas
- Department of Obstetrics and Gynaecology, Johns Hopkins University, Baltimore, MD 21205, United States
| | - Taylor Kohn
- The James Buchanan Brady Urological Institute, Johns Hopkins University, Baltimore, MD 21205, United States
| | - Jaden Kohn
- Department of Obstetrics and Gynaecology, Johns Hopkins University, Baltimore, MD 21205, United States
| | - Alyssa M Yee
- San Diego Sexual Medicine, San Diego, CA 92120, United States
- Scripps Clinic, San Diego, CA 92108, United States
| | - Marisa Clifton
- The James Buchanan Brady Urological Institute, Johns Hopkins University, Baltimore, MD 21205, United States
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9
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Conforti F, Pala L, De Pas T, Zattarin E, Catania C, Cocorocchio E, Rossi G, Laszlo D, Colleoni M, Zambelli A, Hortobagyi GN, Cortes J, Piccart MJ, Dowsett M, Gelber RD, Viale G. Fine-Tuning Adjuvant Endocrine Therapy for Early-Stage Breast Cancer: An Expert Consensus on Open Issues for Future Research. Clin Cancer Res 2024; 30:1093-1103. [PMID: 37906083 DOI: 10.1158/1078-0432.ccr-23-1836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 08/29/2023] [Accepted: 10/19/2023] [Indexed: 11/02/2023]
Abstract
After decades of research, improving the efficacy of adjuvant endocrine therapy (ET) for early-stage breast cancer becomes increasingly difficult. Beyond technological breakthroughs and the availability of new classes of drugs, further improvement of adjuvant ET will require applying a rigorous research approach in poorly investigated areas. We critically discuss some key principles that should inform future research to improve ET efficacy, including identifying specific subgroups of patients who can benefit from escalating or de-escalating approaches, optimizing available and new treatment strategies for different clinical contexts, and dissecting the direct and indirect biological effects of therapeutic interventions. Four main issues regarding adjuvant ET were identified as relevant areas, where a better application of such principles can provide positive results in the near future: (i) tailoring the optimal duration of adjuvant ET, (ii) optimizing ovarian function suppression for premenopausal women, (iii) dissecting the biological effects of estrogen receptor manipulation, and (iv) refining the selection of patients to candidate for treatments escalation.
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Affiliation(s)
- Fabio Conforti
- Department of Medical Oncology, Cliniche Humanitas Gavazzeni, Bergamo, Italy
| | - Laura Pala
- Department of Medical Oncology, Cliniche Humanitas Gavazzeni, Bergamo, Italy
| | - Tommaso De Pas
- Department of Medical Oncology, Cliniche Humanitas Gavazzeni, Bergamo, Italy
| | - Emma Zattarin
- Department of Medical Oncology, Cliniche Humanitas Gavazzeni, Bergamo, Italy
| | - Chiara Catania
- Department of Medical Oncology, Cliniche Humanitas Gavazzeni, Bergamo, Italy
| | - Emilia Cocorocchio
- Department of Medical Oncology, Cliniche Humanitas Gavazzeni, Bergamo, Italy
| | - Giovanna Rossi
- Department of Medical Oncology, Cliniche Humanitas Gavazzeni, Bergamo, Italy
| | - Daniele Laszlo
- Department of Medical Oncology, Cliniche Humanitas Gavazzeni, Bergamo, Italy
| | - Marco Colleoni
- Division of Medical Senology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Alberto Zambelli
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- IRCCS Humanitas Research Hospital, Humanitas Cancer Center, Milan, Italy
| | - Gabriel N Hortobagyi
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Javier Cortes
- International Breast Cancer Center, Pangaea Oncology, Quironsalud Group, Madrid and Barcelona, Spain
- Universidad Europea de Madrid, Faculty of Biomedical and Health Sciences, Department of Medicine, Madrid, Spain
| | - Martine J Piccart
- Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Mitch Dowsett
- Breast Unit, Royal Marsden Hospital, London, United Kingdom
| | - Richard D Gelber
- Department of Data Science, Division of Biostatistics, Dana-Farber Cancer Institute, Harvard Medical School, Harvard T.H. Chan School of Public Health, and Frontier Science Foundation, Boston, Massachusetts
| | - Giuseppe Viale
- Department of Pathology, IEO, European Institute of Oncology, IRCCS, Milan, Italy
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10
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Han Y, Otegbeye EE, Stoll C, Hardi A, Colditz GA, Toriola AT. How does weight gain since the age of 18 years affect breast cancer risk in later life? A meta-analysis. Breast Cancer Res 2024; 26:39. [PMID: 38454466 PMCID: PMC10921610 DOI: 10.1186/s13058-024-01804-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 03/03/2024] [Indexed: 03/09/2024] Open
Abstract
Early life factors are important risk factors for breast cancer. The association between weight gain after age 18 and breast cancer risk is inconsistent across previous epidemiologic studies. To evaluate this association, we conducted a meta-analysis according to PRISMA guidelines and the established inclusion criteria. We performed a comprehensive literature search using Medline (Ovid), Embase, Scopus, Cochrane Library, and ClinicalTrials.gov to identify relevant studies published before June 3, 2022. Two reviewers independently reviewed the articles for final inclusion. Seventeen out of 4,725 unique studies met the selection criteria. The quality of studies was assessed using the Newcastle-Ottawa Scale (NOS), and all were of moderate to high quality with NOS scores ranging from 5 to 8. We included 17 studies (11 case-control, 6 cohort) in final analysis. In case-control studies, weight gain after age 18 was associated with an increased risk of breast cancer (odds ratio [OR] = 1.25; 95% CI = 1.07-1.48), when comparing the highest versus the lowest categories of weight gain. Menopausal status was a source of heterogeneity, with weight gain after age 18 associated with an increased risk of breast cancer in postmenopausal women (OR = 1.53; 95% CI = 1.40-1.68), but not in premenopausal women (OR = 1.01; 95% CI = 0.92-1.12). Additionally, a 5 kg increase in weight was positively associated with postmenopausal breast cancer risk (OR = 1.12; 95%CI = 1.05-1.21) in case-control studies. Findings from cohort studies were identical, with a positive association between weight gain after age 18 and breast cancer incidence in postmenopausal women (relative risk [RR] = 1.30; 95% CI = 1.09-1.36), but not in premenopausal women (RR = 1.06; 95% CI = 0.92-1.22). Weight gain after age 18 is a risk factor for postmenopausal breast cancer, highlighting the importance of weight control from early adulthood to reduce the incidence of postmenopausal breast cancer.
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Affiliation(s)
- Yunan Han
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8100, St. Louis, MO, 63110, USA
| | - Ebunoluwa E Otegbeye
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Carrie Stoll
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8100, St. Louis, MO, 63110, USA
| | - Angela Hardi
- Bernard Becker Medical Library, Washington University School of Medicine, St. Louis, MO, USA
| | - Graham A Colditz
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8100, St. Louis, MO, 63110, USA
- Alvin J. Siteman Cancer Center, Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO, USA
| | - Adetunji T Toriola
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8100, St. Louis, MO, 63110, USA.
- Alvin J. Siteman Cancer Center, Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO, USA.
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11
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Xia R, Fan S, Jian H, Lei C, Wendan M, Chenxu W, Yicheng F, Tavengana G, Mingfei J, Huan W, Wendan M, Yufeng W. Effect of fasting glucose levels on carotid intima-media thickness in premenopausal versus postmenopausal women. Arch Endocrinol Metab 2024; 68:e230110. [PMID: 38456951 DOI: 10.20945/2359-4292-2023-0110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
Objective To investigate the relationship between fasting blood glucose (FBG) and carotid intimamedia thickness (IMT) in premenopausal and postmenopausal women. Subjects and methods The study enrolled 2,959 women seen at the Maanshan People's Hospital of Anhui Province from December 2013 to December 2018. Carotid IMT was measured using Doppler ultrasound. Linear regression and R smoothing curves were used to analyze the relationship between blood glucose level and carotid IMT in the premenopausal and postmenopausal groups. Results Postmenopausal compared with premenopausal women had higher mean IMT (mIMT; 0.81 ± 0.23 mm versus 0.70 ± 0.14 mm, respectively, p < 0.001) and maximum IMT (maxIMT; 0.86 ± 0.35 mm versus 0.74 ± 0.16 mm, respectively, p < 0.001) values. On linear regression analysis, mIMT values increased with increasing FBG values when FBG level was ≤ 7 mmol/L, but no significance was found between FBG and maxIMT. After stratification by menopausal status, mIMT and maxIMT increased with increasing FBG when FBG was ≤ 7 mmol/L in the premenopausal group. In the postmenopausal group, mIMT and maxIMT increased with increasing FBG. After adjustment for covariate factors, the relationship between FBG and mIMT remained the same as before the adjustment, but when FBG was ≤ 11 mmol/L, the maxIMT increased with increasing FBG. In the stratification analysis, maxIMT increased with increasing FBG when FBG was ≤ 7 mmol/L in the premenopausal group, while both mIMT and maxIMT increased with increasing FBG when FBG was > 10 mmol/L in the postmenopausal group. Conclusion Levels of FBG contributed more to increased IMT in postmenopausal than premenopausal women. The influence of FBG was greater on maxIMT than mIMT. Additionally, FBG was helpful in assessing focal thickening of the carotid intima.
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Affiliation(s)
- Ren Xia
- School of Public Health, Wannan Medical College, Wuhu, Anhui Province, China
| | - Su Fan
- School of Public Health, Wannan Medical College, Wuhu, Anhui Province, China
| | - Hu Jian
- School of Public Health, Wannan Medical College, Wuhu, Anhui Province, China
| | - Cao Lei
- School of Public Health, Wannan Medical College, Wuhu, Anhui Province, China
| | - Mei Wendan
- School of Public Health, Wannan Medical College, Wuhu, Anhui Province, China
| | - Wang Chenxu
- School of Public Health, Wannan Medical College, Wuhu, Anhui Province, China
| | - Fang Yicheng
- School of Public Health, Wannan Medical College, Wuhu, Anhui Province, China
| | - Grace Tavengana
- School of Public Health, Wannan Medical College, Wuhu, Anhui Province, China
| | - Jiang Mingfei
- School of Clinical Medicine, Wannan Medical College, Wuhu, Anhui Province, China
| | - Wu Huan
- School of Laboratory Medicine, Wannan Medical College, Wuhu, Anhui Province, China
| | - Mei Wendan
- School of Public Health, Wannan Medical College, Wuhu, Anhui Province, China
| | - Wen Yufeng
- School of Public Health, Wannan Medical College, Wuhu, Anhui Province, China,
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12
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Bae SJ, Kim HJ, Kim HA, Ryu JM, Park S, Lee EG, Im SA, Jung Y, Park MH, Park KH, Kang SH, Park E, Kim SY, Lee MH, Kim LS, Lee A, Noh WC, Gwark S, Kim S, Jeong J. Breast density reduction as a predictor for prognosis in premenopausal women with estrogen receptor-positive breast cancer: an exploratory analysis of the updated ASTRRA study. Int J Surg 2024; 110:934-942. [PMID: 38000057 PMCID: PMC10871609 DOI: 10.1097/js9.0000000000000907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 11/02/2023] [Indexed: 11/26/2023]
Abstract
BACKGROUND While the relationship between mammographic breast density reduction (MDR) and endocrine therapy efficacy has been reported in estrogen receptor (ER)-positive breast cancer, it is still unclear in premenopausal women, especially in the case of adding ovarian function suppression (OFS) to antihormone therapy. The authors investigated the impact of MDR on prognosis stratified by treatment based on the updated results of the ASTRRA trial. MATERIALS AND METHODS The ASTRRA trial, a randomized phase III study, showed that adding OFS to tamoxifen (TAM) improved survival in premenopausal women with estrogen receptor-positive breast cancer after chemotherapy. The authors updated survival outcomes and assessed mammography before treatment and the annual follow-up mammography for up to 5 years after treatment initiation. Mammographic density (MD) was classified into four categories based on the Breast Imaging-Reporting and Data System. MDR-positivity was defined as a downgrade in MD grade on follow-up mammography up to 2 years after randomization, with pretreatment MD grade as a reference. RESULTS The authors evaluated MDR in 944 of the 1282 patients from the trial, and 813 (86.2%) had grade III or IV MD. There was no difference in the MDR-positivity rate between the two treatment groups [TAM-only group (106/476 (22.3%)) vs. TAM+OFS group (89/468 (19.0%)); P =0.217). MDR-positivity was significantly associated with better disease-free survival (DFS) in the TAM+OFS group (estimated 8-year DFS: 93.1% in MDR-positive vs. 82.0% in MDR-negative patients; HR: 0.37; 95% CI: 0.16-0.85; P =0.019), but not in the TAM-only group ( Pinteraction =0.039). MDR-positive patients who received TAM+OFS had a favorable DFS compared to MDR-negative patients who received only TAM (HR: 0.30; 95% CI: 0.13-0.70; P =0.005). CONCLUSION Although the proportion of MDR-positive patients was comparable between both treatment groups, MDR-positivity was independently associated with favorable outcomes only in the TAM+OFS group.
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Affiliation(s)
- Soong June Bae
- Department of Surgery, Gangnam Severance Hospital
- Institute for Breast Cancer Precision Medicine, Yonsei University College of Medicine
| | - Hee Jeong Kim
- Division of Breast, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine
| | - Hyun-Ah Kim
- Department of Surgery, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences
| | - Jai Min Ryu
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Seho Park
- Division of Breast Surgery, Department of Surgery, Yonsei Cancer Center, Yonsei University College of Medicine
| | - Eun-Gyeong Lee
- Center for Breast Cancer, Research Institute and Hospital, National Cancer Center, Goyang, South Korea
| | - Seock-Ah Im
- Seoul National University Hospital, Cancer Research Institute, Seoul National University, College of Medicine
| | - Yongsik Jung
- Department of Surgery, Ajou University, School of Medicine, Suwon
| | - Min Ho Park
- Department of Surgery, Chonnam National University Medical School and Chonnam National University Hwasun Hospital, Gwangju
| | - Kyong Hwa Park
- Korea University Anam Hospital, Department of internal medicine, Division of Medical Oncology/Hematology
| | | | - Eunhwa Park
- Department of Surgery, Dong-A University Hospital, Dong-A University College of Medicine, Busan
| | - Sung Yong Kim
- Department of Surgery, Soonchunhyang University Cheonan Hospital, Cheonan
| | - Min Hyuk Lee
- Department of Surgery, Soonchunhyang University Hospital, Seoul
| | - Lee Su Kim
- Department of Surgery, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong
| | - Anbok Lee
- Department of Surgery, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong
| | - Woo Chul Noh
- Department of Surgery, Konkuk Universitiy Medical Center
| | - Sungchan Gwark
- Department of Surgery, Ewha Womans University College of Medicine, Ewha Womans University Mokdong Hospital
| | - Seonok Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center
| | - Joon Jeong
- Department of Surgery, Gangnam Severance Hospital
- Institute for Breast Cancer Precision Medicine, Yonsei University College of Medicine
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13
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Zhong X, Chen P, He P, Wu Y, Suo J, Zhu K, Yan X, Tian T, Yang Q, Luo T. Cost-Effectiveness Analysis of Adjuvant Endocrine Therapy With Ovarian Suppression in Premenopausal Patients With Hormone Receptor-Positive Early Breast Cancer in China. Clin Breast Cancer 2024; 24:e41-e50. [PMID: 37865566 DOI: 10.1016/j.clbc.2023.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 09/03/2023] [Accepted: 09/16/2023] [Indexed: 10/23/2023]
Abstract
PURPOSE Endocrine therapy combined with ovarian function suppression (OFS) is recommended in intermediate- or high-risk patients among premenopausal women with hormone receptor-positive early breast cancer. However, in China, the cost-effectiveness of this strategy compared with endocrine therapy alone is unclear. This study aimed to evaluate the long-term cost-effectiveness of tamoxifen (TAM), TAM+OFS, and exemestane plus OFS (EXE+OFS). METHODS On the basis of prognostic data from the Suppression of Ovarian Function Trial (SOFT), cost data from the Hospital Information System of the West China Hospital of Sichuan University, and health utility values from the published literature, a Markov model was established. The incremental cost-effectiveness ratio (ICER) was used to compare the treatment strategies. RESULTS In a 25-year simulation of adjuvant therapy in Chinese women with early breast cancer, the total costs of TAM, TAM+OFS, and EXE+OFS were $7821, $9318, and $9445, respectively. The quality-adjusted life-years (QALYs) were 11.615, 11.896, and 11.734 years, respectively. Compared with TAM, the ICERs of TAM+OFS and EXE+OFS were $5,327.4021/QALY and $13,647.0588/QALY, respectively. The ICERs of TAM+OFS and EXE+OFS were below the threshold of $32,517/QALY. The reliability and stability of the simulation results were verified using Monte Carlo simulation and sensitivity analysis. CONCLUSION In the context of limited resources in China, TAM+OFS and EXE+OFS are cost-effective options compared with TAM.
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Affiliation(s)
- Xiaorong Zhong
- Breast Disease Center, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Ping Chen
- Nursing Department, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
| | - Ping He
- Breast Disease Center, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yanqi Wu
- Breast Disease Center, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Jiaojiao Suo
- Breast Disease Center, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Kunrui Zhu
- Breast Disease Center, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Xi Yan
- Breast Disease Center, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Tinglun Tian
- Breast Disease Center, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Qing Yang
- Nursing Department, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China.
| | - Ting Luo
- Breast Disease Center, Cancer Center, West China Hospital, Sichuan University, Chengdu, China.
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14
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Li X, Li J, Hu Q, Zhang X, Chen F. Association of physical weight statuses defined by body mass index (BMI) with molecular subtypes of premenopausal breast cancer: a systematic review and meta-analysis. Breast Cancer Res Treat 2024; 203:429-447. [PMID: 37882920 DOI: 10.1007/s10549-023-07139-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 09/25/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND AND PURPOSE The association between overweight/obesity and postmenopausal breast cancer has been proven. However, uncertainty exists regarding the association between physical weight statuses and premenopausal breast cancer subtypes. This study aimed to explore the association of body weight statuses with molecular subtypes of premenopausal breast cancer. METHOD A systematic search of Medline, PubMed, Embase, and Web of Science was performed. The Newcastle-Ottawa Scale (NOS) and the Joanna Briggs Institute (JBI) Critical Appraisal tools were used to evaluate the quality of the literature. STATA and R software were used to analyze the extracted data. RESULT The meta-analysis included 35 observational studies with a total of 41,049 premenopausal breast cancer patients. The study showed that the proportion of underweight patients was 4.8% (95% CI = 3.9-5.8%, P = 0.01), overweight was 29% (95%CI = 27.1-30.9%, P < 0.01), obesity was 17.8% (95% CI = 14.9-21.2%, P < 0.0001), and normal weight was 51.6% (95% CI = 46.7-56.5%, P < 0.0001). The pooled results showed that in comparison to the normal weight group, being physically underweight is related to a 1.44-fold risk (OR = 1.44, 95%CI = 1.28-1.63, P < 0.0001) of HER2 + breast cancer. Overweight is related to a 1.16-fold risk (OR = 1.16, 95%CI = 1.06-1.26, P = 0.002) of TNBC and a 16% lower risk (OR = 0.84, 95%CI = 0.75-0.93, P = 0.001) of ER + breast cancer. When compared to underweight/normal weight populations, both overweight (OR = 0.74, 95%CI = 0.56-0.97, P = 0.032) and obesity (OR = 0.70, 95%CI = 0.50-0.98, P = 0.037) can reduce the risk of ER + PR + breast cancer. CONCLUSION In the premenopausal breast cancer population, the distribution of patients' numbers with different weight statuses was significantly distinct among the various breast cancer subtypes. Additionally, the associations between physical weight statuses and the risk of premenopausal breast cancer subtypes are divergent.
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Affiliation(s)
- Xuchu Li
- Department of Medical, Queen Mary School, Nanchang University, 461 Bayi Avenue, Donghu District, Nanchang City, 330006, Jiangxi Province, China
| | - Jinping Li
- Department of General Medical, People's Hospital of Fu City, Yan'an, 727505, Shaanxi Province, China
| | - Qirui Hu
- College of Food Science, Nanchang University, Nanchang, 330047, Jiangxi Province, China
| | - Xu Zhang
- Jiangxi Provincial Key Laboratory of Preventive Medicine, School of Public Health, Nanchang University, Nanchang, 330006, Jiangxi Province, China
| | - Fang Chen
- College of Food Science, Nanchang University, Nanchang, 330047, Jiangxi Province, China.
- Jiangxi Provincial Key Laboratory of Preventive Medicine, School of Public Health, Nanchang University, Nanchang, 330006, Jiangxi Province, China.
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15
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Yadollahi P, Mavaddatnia S, Zarshenas M, Ghaemmaghami P. Relationship between sleep quality and marital satisfaction of working women during the premenopausal period. Sci Rep 2024; 14:1248. [PMID: 38218900 PMCID: PMC10787744 DOI: 10.1038/s41598-024-51440-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 01/04/2024] [Indexed: 01/15/2024] Open
Abstract
Sleep disorders can adversely affect physical, sexual, and marital health, particularly among middle-aged women. This study aimed to determine the relationship between sleep quality and marital satisfaction of working women during the premenopausal period. In this cross-sectional study, we selected 150 women working at Shiraz University of Medical Sciences in Iran was selected using random cluster sampling. A demographic information form, the Pittsburgh Sleep Quality Index (PSQI), and the Evaluation and Nurturing Relationship Issues, Communication, and Happiness (ENRICH) marital satisfaction scale were used for data collection. The Data were analyzed using SPSS.22 software at a significance level of P < 0.05. Multiple linear regression analysis was employed to predict sleep quality based on marital satisfaction. Our results showed that 79 (52.7%) of the participants had undesirable sleep quality, 87 (58%) had high marital satisfaction, and 32 (21.3%) had very high marital satisfaction. Regression analysis revealed that the total marital satisfaction score could not predict the sleep quality score of the participants. However, as dimensions of marital satisfaction, personality issues negatively (β = 0.327, P < 0.05) and ideological orientation positively (β = 0.336, P < 0.01) predicted the sleep quality score. Based on the prediction of the sleep quality score by personality issues and ideological orientations among the dimensions of marital satisfaction, it seems that life skills training, especially in these two dimensions, may improve the quality of sleep and, as a result, the physical and mental health of working women.
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Affiliation(s)
- P Yadollahi
- Department of Midwifery, Maternal-Fetal Medicine Research Center, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - S Mavaddatnia
- School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - M Zarshenas
- Department of Midwifery, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - P Ghaemmaghami
- School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran.
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Chikwati RP, Chikowore T, Mahyoodeen NG, Jaff NG, George JA, Crowther NJ. The association of menopause with cardiometabolic disease risk factors in low- and middle-income countries: a systematic review and meta-analyses. Menopause 2024; 31:77-85. [PMID: 38113417 PMCID: PMC7615510 DOI: 10.1097/gme.0000000000002292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
IMPORTANCE Menopause is an integral part of women's health, and studies in high-income countries have shown an increase in cardiometabolic disease (CMD) risk factors in postmenopausal compared with premenopausal women. However, to date, no study has combined and assessed such studies across low- and middle-income countries. This would better inform early monitoring and intervention strategies for reducing CMD risk factor levels in midlife women in these regions. OBJECTIVE This study aimed to evaluate evidence from the literature on differences in CMD risk factors between premenopausal and postmenopausal midlife women living in low- and middle-income countries. EVIDENCE REVIEW A systematic review with meta-analysis of original articles of all study designs from the databases PubMed, PubMed Central, Scopus, and ISI Web of Science was conducted from conception until April 24, 2023. Studies that met the inclusion criteria were included in the analysis. Quality assessment of the articles was done using the Newcastle-Ottawa Scale, adapted for each study design. The study protocol was registered with the International Prospective Register of Systematic Reviews and adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. For the meta-analysis, fixed-effects models were used to pool the odds ratios (OR), as measures of association. FINDINGS Our search identified 4,849 relevant articles: 44 for the systematic review and 16 for the meta-analysis, in accordance with our inclusion criteria. Compared with premenopausal women, the postmenopausal stage was associated with metabolic syndrome (OR, 1.18 [95% CI, 1.11-1.27]), high waist-to-hip ratio (OR, 1.22 [95% CI, 1.12-1.32]), hypertension (OR, 1.10 [95% CI, 1.04-1.16]), elevated triglycerides (OR, 1.16 [95% CI, 1.11-1.21]), and elevated plasma glucose (OR, 1.21 [95% CI, 1.15-1.28]). CONCLUSIONS AND RELEVANCE This study confirmed that CMD risk factors are present at higher levels in postmenopausal than premenopausal women. This demonstrates an urgent need for public health policies that focus on early monitoring and interventions targeted at reducing CMD risk and related adverse outcomes in midlife women in these nations.
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Affiliation(s)
| | | | - Nasrin Goolam Mahyoodeen
- Department of Internal Medicine, Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nicole G Jaff
- From the Department of Chemical Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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17
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Dhayanithi J, Rajasekar A. Comparison of Alveolar Bone Level around Osseointegrated Dental Implants among Premenopausal and Postmenopausal Women: A 2-Year Study. J Long Term Eff Med Implants 2024; 34:89-92. [PMID: 38305376 DOI: 10.1615/jlongtermeffmedimplants.2023047432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
The success of dental implants is affected by bone quality and quantity at the dental implant site. The present study was done to assess the changes in alveolar bone level around osseointegrated dental implants over a period of 2 years among the premenopausal and postmenopausal women. This prospective clinical study was conducted among 50 female patients who reported between January 2020-June 2020 and had a single missing molar in maxillary or mandibular arch. Patients were categorized into 2 groups: premenopause patients (Group A; n = 25) and postmenopause patients (Group B; n = 25). Marginal bone loss (MBL) was recorded at baseline, 12 mo and 24 mo follow-up and compared between both the groups using independent t-test. ANOVA was done to compare MBL between different time periods. On intragroup comparison, a statistically significant difference was observed between different time periods in both Group A (P = 0.05) and Group B (P = 0.04). Also, on intergroup comparison, a statistically significant difference was observed in Group B from Group A at 12 mo and 24 mo (P < 0.05). Increase in marginal bone loss was observed among postmenopausal women. Therefore, clinicians should emphasize the need for oral hygiene maintenance among postmenopausal women for peri-implant health.
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Affiliation(s)
- J Dhayanithi
- Department of Periodontology, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Chennai, India
| | - Arvina Rajasekar
- Department of Periodontology, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Chennai, India
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18
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Heredia A, Walbaum B, Vidal M, Itriago L, Camus M, Dominguez F, Manzor M, Martínez R, Murature G, Muñiz S, Navarro M, Guerra C, Merino T, Medina L, Ibañez C, Ramirez K, Acevedo F, Sánchez C. Suboptimal use of ovarian function suppression in very young women with early breast cancer: a real-world data study. Breast Cancer Res Treat 2024; 203:173-179. [PMID: 37733187 DOI: 10.1007/s10549-023-07117-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 08/24/2023] [Indexed: 09/22/2023]
Abstract
PURPOSE The incidence of breast cancer in young women (BCYW) has increased in recent decades. Malignant disease in this subset is characterized by its aggressiveness and poor prognosis. Ovarian function suppression (OFS) in these patients improves survival especially in hormone receptor-positive (HR +) cases. The Regan Composite Risk (RCR) is a prognostic tool to identify high-risk HR + BC candidates for OFS. Our study sought to characterize a Chilean cohort of early HR + BCYW assessing the use of OFS and its related prognosis and the utility of RCR in our patients. METHODS This was a retrospective population cohort study that included ≤ 35-year-old early HR + /human epidermal growth factor receptor 2 -negative (HER2-) BC patients treated between 2001 and 2021. Analysis included clinical-pathological characteristics, treatment strategies, and survival. Also, we evaluated the association between RCR and survival. RESULTS A total of 143 patients were included into our study, representing 2.9% of all early BC cases in our registry. Median age was 31 years old (range: 19-35). Most patients (93%) received endocrine therapy (ET). Of these, 18% received OFS. No survival differences were observed among treatment strategies. Median RCR score for patients treated with CT plus ET was significantly higher vs. ET alone (2.95 vs. 1.91; p = 0.0001). Conversely, patients treated with tamoxifen alone had significantly lower RCR scores vs. OFS (2.72 vs. 3.14; p = 0.04). Higher RCR scores were associated with poorer overall survival. CONCLUSION Less than 20% of very young women with early HR + /HER2-BC in our cohort received OFS, in most cases, this involved surgical oophorectomy. RCR score was higher in patients that underwent CT and OFS and was associated with survival, regardless of treatment. We confirm the RCR score as a valuable prognostic tool to identify high-risk BC patients who could benefit from OFS.
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Affiliation(s)
- Ana Heredia
- Departamento de Hematología-Oncología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, Santiago, Chile
- Unidad de Oncología Hospital Herminda Martín, Chillán, Chile
| | - Benjamín Walbaum
- Departamento de Hematología-Oncología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, Santiago, Chile
- Fundación ChileSinCáncer, Santiago, Chile
- Oncología Médica, Hospital Dr. Sótero del Río, Santiago, Chile
| | - María Vidal
- Translational Genomics and Targeted Therapeutics in Solid Tumors Lab - IDIBAPS, Hospital Clinic Barcelona, Universidad de Barcelona, Barcelona, España
| | - Laura Itriago
- Departamento de Hematología-Oncología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, Santiago, Chile
| | - Mauricio Camus
- Departamento de Cirugía Oncológica, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Francisco Dominguez
- Departamento de Cirugía Oncológica, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Manuel Manzor
- Cirugía Oncológica, Hospital Dr. Sótero del Río, Santiago, Chile
| | - Raúl Martínez
- Cirugía Oncológica, Hospital Dr. Sótero del Río, Santiago, Chile
| | - Geraldine Murature
- Cirugía Oncológica, Hospital Dra. Eloísa Díaz La Florida, Santiago, Chile
| | - Sabrina Muñiz
- Departamento de Hematología-Oncología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, Santiago, Chile
| | - Marisel Navarro
- Cirugía Oncológica, Hospital Dr. Sótero del Río, Santiago, Chile
| | - Constanza Guerra
- Cirugía Oncológica, Hospital Dr. Sótero del Río, Santiago, Chile
| | - Tomas Merino
- Departamento de Hematología-Oncología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, Santiago, Chile
| | - Lidia Medina
- Departamento de Hematología-Oncología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, Santiago, Chile
| | - Carolina Ibañez
- Departamento de Hematología-Oncología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, Santiago, Chile
| | - Karol Ramirez
- Departamento de Hematología-Oncología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, Santiago, Chile
- Fundación ChileSinCáncer, Santiago, Chile
- Oncología Médica, Hospital Dr. Sótero del Río, Santiago, Chile
| | - Francisco Acevedo
- Departamento de Hematología-Oncología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, Santiago, Chile
| | - César Sánchez
- Departamento de Hematología-Oncología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, Santiago, Chile.
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de Oliveira L, Vignozzi L, Giraldi A, Varod S, Corona G, Reisman Y. What Women Want? The State of the Art regarding the Treatment of Young Women with Hypoactive Sexual Desire Disorder. Pharmacology 2023; 109:69-75. [PMID: 38151009 PMCID: PMC11006276 DOI: 10.1159/000535587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 11/29/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND Hypoactive sexual desire disorder (HSDD) in premenopausal women involves biological, psychological, and social aspects. In the European Society for Sexual Medicine meeting in Rotterdam in February 2023, several leading experts in the field discussed the multifaceted nature of this disorder and the state of the art regarding treatment at a round table. This review reflects the information discussed at this event and further discusses current controversies. SUMMARY HSDD is the most prevalent female-estimated sexual disorder reported by 28% of the 40% premenopausal women with sexual dysfunction. Flibanserin and bremelanotide are the only approved medications to treat HSDD in the USA, and none are approved in Europe. Lybrido, Lybridos, and Lorexys are under development. There are several psychological factors with impact in sexual desire, including depression and sexual abuse. Feminine sexual scripts, the pleasure gap, and structural inequalities also affect sexual desire. Evidence strongly supports the value of combining medical and psychological approaches in the treatment of HSDD, but there is ongoing controversy regarding the pharmacological treatment of young women with HSDD. However, some women seem open and would like to have access to drug treatment. KEY MESSAGES The treatment of HSDD in young women requires a mixed treatment approach that addresses the disorder's complexity. Despite clinicians seeming to be divided between using pharmacological and/or psychosocial approaches, some women might respond better to one type of intervention over the others. This calls for the development of tools that assess the best approach for each person, including their will and informed choice.
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Affiliation(s)
- Leonor de Oliveira
- Center for Psychology at Porto University, Faculty of Psychology and Educational Sciences, Porto, Portugal,
| | - Linda Vignozzi
- Unit - Careggi Hospital, University of Florence, Florence, Italy
| | - Annamaria Giraldi
- Sexological Clinic, Mental Health Center Copenhagen, Copenhagen University Hospital, Mental Health Services, CPH, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Shelly Varod
- Center for Sexual Health, Reuth Rehabilitation Hospital, Tel Aviv-Yafo, Israel
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20
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Langås JR, Eskild A, Hofvind S, Bjelland EK. The dose-response relationship of pre-menopausal alcohol consumption with age at menopause: a population study of 280 497 women in Norway. Int J Epidemiol 2023; 52:1951-1958. [PMID: 37789587 PMCID: PMC10749754 DOI: 10.1093/ije/dyad129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 09/12/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND Previous research suggests that alcohol consumption is associated with high age at menopause. Yet, knowledge about the dose-response relationship is inconsistent. Thus, we studied the pattern of the association of pre-menopausal alcohol consumption with age at natural menopause. METHODS We performed a retrospective population-based study using self-reported data from 280 497 women aged 50-69 years attending the Norwegian breast cancer screening programme (BreastScreen Norway) during 2006-15. Associations of weekly alcohol consumption between the age of 20 and 49 years with age at menopause were estimated as hazard ratios (HRs) using Cox proportional hazard models with restricted cubic splines to allow for non-linear associations. We adjusted for year and place of birth, number of childbirths, educational level, body mass index and smoking habits. RESULTS Mean age at natural menopause was 51.20 years (interquartile range: 49-54 years). The adjusted HR of reaching menopause was highest for women with no alcohol consumption (reference) and the HR decreased by alcohol consumption up to 50 grams per week (adjusted HR 0.87; 95% CI: 0.86-0.88). Above 50 grams, there was no further decrease in the HR of reaching menopause (P for non-linearity of <0.001). CONCLUSIONS Women who did not consume alcohol were youngest at menopause. The lack of a dose-response association among alcohol consumers implies virtually no relation of alcohol consumption with age at menopause. Our findings may suggest that characteristics of the women who did not consume alcohol, not accounted for in the data analyses, explain their younger age at menopause.
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Affiliation(s)
- Julie R Langås
- Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Norway
| | - Anne Eskild
- Department of Obstetrics and Gynecology, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, Campus Ahus, University of Oslo, Lørenskog, Norway
| | - Solveig Hofvind
- Section of Mammographic Screening, Cancer Registry of Norway, Oslo, Norway
- Department of Health and Care Sciences, Faculty of Health Sciences, The Arctic University of Norway, Tromsø, Norway
| | - Elisabeth K Bjelland
- Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Norway
- Department of Obstetrics and Gynecology, Akershus University Hospital, Lørenskog, Norway
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21
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Barker LC, Vigod SN. Reproductive Health Among Those with Schizophrenia Spectrum Disorders: An Overview of Considerations Related to the Premenopausal Period, Pregnancy and Postpartum, and the Menopausal Transition, with a Focus on Recent Findings. Curr Psychiatry Rep 2023; 25:793-802. [PMID: 37906350 DOI: 10.1007/s11920-023-01472-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/11/2023] [Indexed: 11/02/2023]
Abstract
PURPOSE OF REVIEW Schizophrenia spectrum disorders (SSD) impact many aspects of reproductive health for women and non-binary and transgender individuals assigned female at birth. In this narrative review, we highlight considerations and recent research related to (1) the premenopausal period, (2) pregnancy and postpartum, and (3) the menopausal transition. RECENT FINDINGS Most recent research has focused on pregnancy and the postpartum period, and specifically on elucidating perinatal risk factors, adverse obstetrical and neonatal outcomes (and modifiable contributors such as smoking), long-term child health, and psychotropic medications (with reassuring results related antipsychotic-associated gestational diabetes mellitus and neurodevelopmental outcomes). Much less recent focus has been on menstruation and menopause, although some research has highlighted the relative worsening of illness peri-menstrually and peri-menopausally. Despite the many important reproductive considerations for those with SSD, many aspects including menstruation and menopause have received very little attention. Further research is needed on how to best support women, non-binary, and transgender people assigned female at birth with SSD throughout the lifespan.
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Affiliation(s)
- Lucy C Barker
- Department of Psychiatry, University of Toronto, Toronto, Canada.
- Women's College Hospital, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada.
| | - Simone N Vigod
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Women's College Hospital, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada
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22
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Zhong X, Lu K, Liang W, Jihu L, Zeng A, Ding M, Chen D, Xie M. The impact of SARS-COV-2 infection on menstruation. BMC Womens Health 2023; 23:611. [PMID: 37974147 PMCID: PMC10655360 DOI: 10.1186/s12905-023-02697-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 10/09/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Recent study has demonstrated that the GnRH system in patients with post-COVID syndrome may be influenced by SARS-CoV-2. However, the impact of COVID-19 infection on women's menstruation is still unknown. OBJECTIVE We aimed to investigate the the relationship between coronavirus disease 2019 (COVID-19) and menstruation in premenopausal women. METHODS This was a retrospective cohort study. Pre-menopausal women were invited to participate in the online questionnaire on wechat. Participants were divided into four groups according to whether they were infected with severe acute respiratory syndrome coronavirus-2 (SARS-COV-2) and whether they had menstrual changes during the pandemic. Sociodemographic characteristics, history of COVID-19, menstruation and menstrual changes of the participants were collected. Statistical analyses were performed using SPSS, version 25.0 (SPSS Inc., Chicago, IL, USA). RESULTS A total of 1946 women were included in the study. 1800 participants had been or were currently infected with SARS-COV-2, and 146 people had not been infected. Among 1800 patients with COVID-19, 666 (37.0%) had changes in menstruation, and 1134 (63.0%) did not, which was significantly higher than the uninfected participants (c2 = 12.161, P = 0.000). The proportion of participants with menstrual cycle changes (450/67.6%) is larger than that of uninfected participants (c2 = 6.904, P = 0.009). COVID-19 vaccination was associated with lower odds of menstrual cycle change (OR, 0.855; 95% CI, 0.750-0.976). Participants who reported chest pain (OR, 1.750, 95% CI, 1.209-2.533) and dyspnea (OR, 1.446; 95% CI, 1.052-1.988) during infection had greater odds of changes to their menstrual cycle compared with the participants who did not. CONCLUSIONS The association between the COVID-19 and increased prevalence of menstrual cycle irregularity. COVID-19 vaccination is a protective factor in the long term, and participants with chest pain and dyspnea are more likely to develop AUB.
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Affiliation(s)
- Xiaozhu Zhong
- Department of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou City, 510120, China
| | - Keji Lu
- Department of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou City, 510120, China
| | - Weiying Liang
- Department of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou City, 510120, China
| | - Luozi Jihu
- Department of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou City, 510120, China
| | - Anqi Zeng
- Department of Obstetrics & Gynaecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou City, 510080, China
| | - Miao Ding
- Department of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou City, 510120, China
| | - Dongmei Chen
- Department of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou City, 510120, China.
| | - Meiqing Xie
- Department of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou City, 510120, China.
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23
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Baek SY, Noh WC, Ahn SH, Kim HA, Ryu JM, Kim SI, Lee EG, Im SA, Jung Y, Park MH, Park KH, Kang SH, Jeong J, Park E, Kim SY, Lee MH, Kim LS, Lim W, Kim S, Kim HJ. Adding Ovarian Suppression to Tamoxifen for Premenopausal Women With Hormone Receptor-Positive Breast Cancer After Chemotherapy: An 8-Year Follow-Up of the ASTRRA Trial. J Clin Oncol 2023; 41:4864-4871. [PMID: 37607321 DOI: 10.1200/jco.23.00557] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/30/2023] [Accepted: 07/17/2023] [Indexed: 08/24/2023] Open
Abstract
PURPOSE To determine the updated long-term outcomes of the Addition of Ovarian Suppression to Tamoxifen in Young Women With Hormone-Sensitive Breast Cancer Who Remain Premenopausal or Regain Vaginal Bleeding After Chemotherapy (ASTRRA) trial. PATIENTS AND METHODS This study is a post-trial follow-up of the ASTRRA trial, involving 1,483 premenopausal women younger than 45 years treated with definitive surgery after completing adjuvant or neoadjuvant chemotherapy for estrogen receptor-positive breast cancer. Patients were randomly assigned in a 1:1 ratio to complete 5 years of tamoxifen (TAM) alone (TAM-only) or 5 years of TAM with ovarian function suppression (OFS) for 2 years (TAM + OFS). The primary end point was disease-free survival (DFS), and the secondary end point was overall survival (OS). RESULTS At 106.4 months of median follow-up, there was a continuous significant reduction in the DFS event rate in the TAM + OFS group. The 8-year DFS rate was 85.4% in the TAM + OFS group and 80.2% in the TAM-only group (hazard ratio [HR], 0.67; 95% CI, 0.51 to 0.87). There were no significant differences in OS between the two groups. The OS rate was 96.5% in the TAM + OFS group and 95.3% in the TAM-only group (HR, 0.78; 95% CI, 0.49 to 1.25). CONCLUSION Adding OFS for 2 years to adjuvant TAM with a longer follow-up resulted in consistent DFS benefits, suggesting that adding OFS to TAM should be considered for patients who remain in a premenopausal state or resume ovarian function after chemotherapy.
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Affiliation(s)
- Soo Yeon Baek
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
- Department of Surgery, Ajou University School of Medicine, Suwon, South Korea
| | - Woo Chul Noh
- Department of Surgery, Konkuk University Medical Center, Seoul, South Korea
| | - Sei-Hyun Ahn
- Department of Surgery, Ewha Womans University College of Medicine, Ewha Womans University Mokdong Hospital, Seoul, South Korea
| | - Hyun-Ah Kim
- Department of Surgery, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, South Korea
| | - Jai Min Ryu
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Seung Il Kim
- Division of Breast Surgery, Department of Surgery, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Eun-Gyeong Lee
- Center for Breast Cancer, Research Institute and Hospital, National Cancer Center, Goyang, South Korea
| | - Seock-Ah Im
- Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - Yongsik Jung
- Department of Surgery, Ajou University School of Medicine, Suwon, South Korea
| | - Min Ho Park
- Department of Surgery, Chonnam National University Medical School, Chonnam National University Hwasun Hospital, Gwangju, South Korea
| | - Kyong Hwa Park
- Department of Internal Medicine, Division of Medical Oncology/Hematology, Korea University Anam Hospital, Seoul, South Korea
| | - Su Hwan Kang
- Yeungnam University College of Medicine, Daegu, South Korea
| | - Joon Jeong
- Division of Breast Surgery, Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Eunhwa Park
- Dong-A University Hospital, Dong-A University College of Medicine, Busan, South Korea
| | - Sung Yong Kim
- Department of Surgery, Soonchunhyang University Cheonan Hospital, Cheonan, South Korea
| | - Min Hyuk Lee
- Department of Surgery, Soonchunhyang University Hospital, Seoul, South Korea
| | - Lee Su Kim
- Department of Surgery, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, South Korea
| | - Woosung Lim
- Department of Surgery, Ewha Womans University College of Medicine, Ewha Womans University Mokdong Hospital, Seoul, South Korea
| | - Seonok Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, Seoul, South Korea
| | - Hee Jeong Kim
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Nebgen DR, Domchek SM, Kotsopoulos J, de Hullu JA, Crosbie EJ, Paramanandam VS, Brood-van Zanten MMA, Norquist BM, Guise T, Rozenberg S, Kurian AW, Pederson HJ, Yuksel N, Michaelson-Cohen R, Bober SL, da Silva Filho AL, Johansen N, Guidozzi F, Evans DG, Menon U, Kingsberg SA, Powell CB, Grandi G, Marchetti C, Jacobson M, Brennan DJ, Hickey M. Care after premenopausal risk-reducing salpingo-oophorectomy in high-risk women: Scoping review and international consensus recommendations. BJOG 2023; 130:1437-1450. [PMID: 37132126 DOI: 10.1111/1471-0528.17511] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 03/27/2023] [Accepted: 04/06/2023] [Indexed: 05/04/2023]
Abstract
Women at high inherited risk of ovarian cancer are offered risk-reducing salpingo-oophorectomy (RRSO) from age 35 to 45 years. Although potentially life-saving, RRSO may induce symptoms that negatively affect quality of life and impair long-term health. Clinical care following RRSO is often suboptimal. This scoping review describes how RRSO affects short- and long-term health and provides evidence-based international consensus recommendations for care from preoperative counselling to long-term disease prevention. This includes the efficacy and safety of hormonal and non-hormonal treatments for vasomotor symptoms, sleep disturbance and sexual dysfunction and effective approaches to prevent bone and cardiovascular disease.
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Affiliation(s)
- Denise R Nebgen
- Department of Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Susan M Domchek
- Basser Center for BRCA, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Joanne Kotsopoulos
- Women's College Research Institute, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Joanne A de Hullu
- Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Emma J Crosbie
- Division of Cancer Sciences, University of Manchester, St Mary's Hospital, Manchester, UK
| | - Vincent Singh Paramanandam
- Department of Obstetrics and Gynaecology, The Royal Women's Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - Monique M A Brood-van Zanten
- Department of Gynecology, The Netherlands Cancer Institute, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Barbara M Norquist
- Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington, USA
| | - Theresa Guise
- Department of Endocrine Neoplasia and Hormone Disorders, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Serge Rozenberg
- Department of Obstetrics and Gynaecology, Universite Libre de Bruxelles, Brussels, Belgium
| | - Allison W Kurian
- Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California, USA
| | - Holly J Pederson
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio, USA
| | - Nese Yuksel
- Faculty of Pharmacy and Pharmaceutical Sciences, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Rachel Michaelson-Cohen
- Department of Gynaecology and Medical Genetics Institute, Hebrew University Faculty of Medicine, Shaare Zedek Medical Centre, Jerusalem, Israel
| | - Sharon L Bober
- Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts, USA
| | | | - Nora Johansen
- Department of Gynaecology and Obstetrics, Sørlandet Hospital HF Arendal, Arendal, Norway
| | - F Guidozzi
- Deparment of Obstetrics and Gynaecology, University of Witwatersrand, Johanesburg, South Africa
| | - D Gareth Evans
- University of Manchester, Prevent Breast Cancer Centre, Manchester, UK
| | - Usha Menon
- MRC Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Sheryl A Kingsberg
- University Hospitals Cleveland Medical Center, Case Western University School of Medicine, Cleveland, Ohio, USA
| | - C Bethan Powell
- Kaiser Permanente Northern California, Hereditary Cancer Program, San Francisco, California, USA
| | - Giovanni Grandi
- Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy
| | - Claudia Marchetti
- Department of Women's and Children's Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS-Catholic University Sacred Heart, Rome, Italy
| | - Michelle Jacobson
- Women's College Hospital and Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Donal J Brennan
- UCD Gynaecological Oncology Group, UCD School of Medicine, Mater University Hospital, Dublin, Ireland
| | - Martha Hickey
- Department of Obstetrics and Gynaecology, Research Precinct, Level 7, The Royal Women's Hospital, University of Melbourne, Parkville, Victoria, Australia
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25
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Rautenberg TA, Ng SKA, Downes M. A cross-sectional study of symptoms and health-related quality of life in menopausal-aged women in China. BMC Womens Health 2023; 23:563. [PMID: 37915020 PMCID: PMC10621238 DOI: 10.1186/s12905-023-02728-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 10/24/2023] [Indexed: 11/03/2023] Open
Abstract
OBJECTIVE To measure symptoms and health-related quality of life in a cross-sectional cohort of menopausal-aged women in China. METHOD A cross-sectional survey was conducted in a general population cohort of 2,000 Chinese females over the age of 45 years. Patients completed the Chinese version of the EuroQol-5D five level (EQ5D5L) health-related quality of life instrument via Personal Digital Assistant. Raw scores were converted to utility tariffs using value sets for China. Statistical analysis included Pearson's chi-square test, z test for multiple comparisons with adjustment by the Bonferroni method, independent-sample t-test, ANOVA, and adjustment by the Tukey method for multiple comparison. Results were considered statistically significant when p < 0.05 and the study was reported according to the STROBE recommendations. RESULTS In a cohort of 2000 women, 732 (37%) were premenopausal, 798 (40%) were perimenopausal and 470 (23%) were postmenopausal. Perimenopausal women reported significantly more symptoms (91%) compared to premenopausal (77%) and postmenopausal (81%) women. Health-related quality of life was significantly lower in symptomatic perimenopausal women compared to premenopausal (0.919, p < 0.05) and postmenopausal (0.877, p < 0.05) women. Within each group there was a statistically significant difference between the health-related quality of life of women with symptoms compared to without symptoms. CONCLUSION The perimenopausal phase of menopause is associated with significantly more symptoms and significantly lower HRQoL compared to premenopausal and postmenopausal phases.
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Affiliation(s)
- Tamlyn A Rautenberg
- Centre for Applied Health Economics, Griffith University, Brisbane, Australia.
- Menzies Health Institute Queensland, Brisbane, Australia.
- Metro North Hospital and Health Service, Brisbane, Australia.
| | - Shu Kay Angus Ng
- Centre for Applied Health Economics, Griffith University, Brisbane, Australia
| | - Martin Downes
- Centre for Applied Health Economics, Griffith University, Brisbane, Australia
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26
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Zhu C, Thomas EH, Li Q, Arunogiri S, Thomas N, Gurvich C. Evaluation of the Everyday Memory Questionnaire-Revised in a menopausal population: understanding the brain fog during menopause. Menopause 2023; 30:1147-1156. [PMID: 37788429 DOI: 10.1097/gme.0000000000002256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
OBJECTIVE Brain fog (ie, memory complaints and concentration difficulties) is frequently reported during the menopausal transition. There is lack of standardized scales available to measure brain fog across the menopausal transition. This study aimed to evaluate the factor structure of the Everyday Memory Questionnaire-Revised (EMQ-R) and to determine the most commonly reported everyday cognitive symptoms in a menopausal population. METHODS Four hundred seventeen eligible women aged from 40 to 60 years (107 premenopausal, 149 perimenopausal, and 161 early postmenopausal) were recruited from the general community and were included in the analyses. Confirmatory factor analysis was conducted to test the model fit of the bifactor structure (ie, 4-item attentional subscale ranged 0-16, 7-item retrieval subscale ranged 0-28) of the 13-item EMQ-R (ranged 0-52) in a menopausal populations. Typical items in the retrieval subscale include "difficulty finding words," the attentional subscale include "difficulty following the thread of a story," and analysis of variance and multivariate analysis of covariance were used to investigate the group differences of individual items and two subscales. RESULTS Confirmatory factor analysis indicated the bifactor structure of the EMQ-R has a good fit in all three groups. A significant difference was identified in the mean retrieval scores (pre: 11.8, peri: 13.6, early post: 11.7) but not in the mean attentional scores (pre: 4.53, peri: 5.01, early post: 4.65). CONCLUSIONS The EMQ-R retrieval subscale may serve as a potential instrument to assess memory retrieval symptoms that contribute to "brain fog" in menopause. Increased memory retrieval complaints reported by the perimenopausal group suggests a transition-related memory retrieval dysfunction during menopausal transition.
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Affiliation(s)
- Chen Zhu
- From the HER Centre Australia, Department of Psychiatry, Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University and The Alfred Hospital, Melbourne, Australia
| | - Elizabeth Hx Thomas
- From the HER Centre Australia, Department of Psychiatry, Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University and The Alfred Hospital, Melbourne, Australia
| | - Qi Li
- From the HER Centre Australia, Department of Psychiatry, Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University and The Alfred Hospital, Melbourne, Australia
| | - Shalini Arunogiri
- Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences, Turning Point, Melbourne, Australia
| | - Natalie Thomas
- Department of Biochemistry and Pharmacology, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Caroline Gurvich
- From the HER Centre Australia, Department of Psychiatry, Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University and The Alfred Hospital, Melbourne, Australia
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27
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Mohamed A, Olsson LT, Geradts J. Differential distribution of actual and surrogate oncotype DX recurrence scores in breast cancer patients by age, menopausal status, race, and body mass index. Breast Cancer Res Treat 2023; 201:447-460. [PMID: 37453958 DOI: 10.1007/s10549-023-07025-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 06/26/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE The Oncotype DX Recurrence Score (RS) is a widely used prognostic tool for estrogen receptor-positive breast cancer patients. Multiple surrogate models can predict RS with good accuracy. In this study we aimed to determine whether the RS and two surrogate indices were differentially distributed by age, menopausal status, race, and body mass index (BMI). METHODS 516 breast cancer cases treated at a single institution were analyzed. Epidemiologic data, RS, tumor size, grade, and biomarker data were abstracted. Breast Cancer Prognostic Score (BCPS) and modified Magee equation 2 were used to calculate surrogate RS. Patients were stratified into different groups based on age, menopausal status, race, BMI, or a combination of strata. Mean and standard deviation were calculated for each group/subgroup. RESULTS Age below median (< 63) was associated with higher RS, especially in obese and Black patients. RS was also higher in obese and Black patients in the premenopausal subgroup. Black patients had a higher RS compared to White women in the premenopausal and non-obese subgroups. BMI < 30 was associated with higher RS, especially in older, postmenopausal, and Black patients. Some of these observations were replicated by the two surrogate models. The surrogate recurrence scores were higher in the younger age group, in non-obese older/postmenopausal women, and in younger/premenopausal obese individuals. CONCLUSIONS Higher RS was observed in younger and premenopausal breast cancer patients, especially among the Black and obese subgroups, and in non-obese patients, especially among Black and older/postmenopausal women, suggesting more aggressive disease in these subgroups. Some statistical differences could be replicated by both surrogate models, suggesting that they may have utility in breast cancer epidemiology studies that do not have access to Oncotype DX RS or patient outcome data.
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Affiliation(s)
- Anas Mohamed
- Department of Pathology and Laboratory Medicine, East Carolina University Brody School of Medicine, 600 Moye Blvd, Mailstop 642, Greenville, NC, 27834, USA
| | - Linnea T Olsson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Joseph Geradts
- Department of Pathology and Laboratory Medicine, East Carolina University Brody School of Medicine, 600 Moye Blvd, Mailstop 642, Greenville, NC, 27834, USA.
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Huang MC, Huang TT, Feng HC, Chen IC, Chang CI, Wang TN, Kuo WH, Wang MY, Tsai LW, Li SY, Huang CS, Lu YS, Lin CH. Lifestyle Factors and Energy Intakes with Risks of Breast Cancer among Pre- and Post- Menopausal Women in Taiwan. Nutrients 2023; 15:3900. [PMID: 37764684 PMCID: PMC10534793 DOI: 10.3390/nu15183900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 08/24/2023] [Accepted: 09/03/2023] [Indexed: 09/29/2023] Open
Abstract
Although the incidence of invasive breast cancer (BC) among women in Asian is generally lower than that in Western countries, the incidence of BC has been on the rise in the past three decades in Asian countries. This hospital-based case-control study aimed to explore the relationship between dietary and metabolic factors and BC risk in pre- and post-menopausal women. We enrolled 285 patients with newly diagnosed BC at the National Taiwan University Hospital and 297 controls from the local community and hospital staff. Before receiving anticancer therapy, all patients with BC and control participants completed a 57-question semi-quantitative Food Frequency Questionnaire. For pre-menopausal women, plant-based factor scores rich in seeds and nuts, soy, fruits, and seaweeds correlated significantly with reduced BC risks, whereas menarche occurring at <12 years of age, reduced physical activity, and high-density lipoprotein <40 mg/dL were associated with increased BC risks. For post-menopausal women, plant-based dietary factor scores were also associated with reduced risks, whereas increased body mass index and energy intake levels correlated with increased BC risks. Diets rich in plant-based dietary patterns are protective against BC risk, regardless of menopausal status. Habitual physical activity is protective against BC risk among pre-menopausal Taiwanese women. Maintaining optimal weight and caloric intake is beneficial for reducing post-menopausal BC risk.
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Affiliation(s)
- Meng-Chuan Huang
- Department of Nutrition and Dietetics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (M.-C.H.); (T.-T.H.)
- Department of Public Health and Environmental Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan;
| | - Tz-Ting Huang
- Department of Nutrition and Dietetics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (M.-C.H.); (T.-T.H.)
| | - Hsin-Chun Feng
- Department of Nutrition, National Taiwan University Hospital, Taipei 100, Taiwan;
| | - I-Chun Chen
- Graduate Institute of Oncology, National Taiwan University, Taipei 100, Taiwan; (I.-C.C.); (S.-Y.L.)
- Department of Medical Oncology, National Taiwan University Hospital, Cancer Center Branch, Taipei 100, Taiwan
- Department of Oncology, National Taiwan University Hospital, Taipei 100, Taiwan
| | - Chiao-I Chang
- Department of Public Health and Environmental Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan;
| | - Tsu-Nai Wang
- Department of Public Health, College of Health Science, Kaohsiung Medical University, Kaohsiung 807, Taiwan;
| | - Wen-Hung Kuo
- Department of Surgery, National Taiwan University Hospital, Taipei 100, Taiwan; (W.-H.K.); (C.-S.H.)
| | - Ming-Yang Wang
- Department of Surgical Oncology, National Taiwan University Hospital, Cancer Center Branch, Taipei 100, Taiwan; (M.-Y.W.); (L.-W.T.)
| | - Li-Wei Tsai
- Department of Surgical Oncology, National Taiwan University Hospital, Cancer Center Branch, Taipei 100, Taiwan; (M.-Y.W.); (L.-W.T.)
| | - Szu-Yi Li
- Graduate Institute of Oncology, National Taiwan University, Taipei 100, Taiwan; (I.-C.C.); (S.-Y.L.)
- Department of Oncology, National Taiwan University Hospital, Taipei 100, Taiwan
| | - Chiun-Sheng Huang
- Department of Surgery, National Taiwan University Hospital, Taipei 100, Taiwan; (W.-H.K.); (C.-S.H.)
| | - Yen-Shen Lu
- Department of Oncology, National Taiwan University Hospital, Taipei 100, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Taipei 100, Taiwan
| | - Ching-Hung Lin
- Department of Medical Oncology, National Taiwan University Hospital, Cancer Center Branch, Taipei 100, Taiwan
- Department of Oncology, National Taiwan University Hospital, Taipei 100, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Taipei 100, Taiwan
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Balazard F, Bertaut A, Bordet É, Mulard S, Blanc J, Briot N, Paux G, Dhaini Merimeche A, Rigal O, Coutant C, Fournier M, Jouannaud C, Soulie P, Lerebours F, Cottu PH, Tredan O, Vanlemmens L, Levy C, Mouret-Reynier MA, Campone M, Brady KJS, Sasane M, Rice M, Coulouvrat C, Martin AL, Jacquet A, Vaz-Luis I, Herold C, Pistilli B. Adjuvant endocrine therapy uptake, toxicity, quality of life, and prediction of early discontinuation. J Natl Cancer Inst 2023; 115:1099-1108. [PMID: 37434306 PMCID: PMC10483331 DOI: 10.1093/jnci/djad109] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 03/09/2023] [Accepted: 06/05/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND Many patients receiving adjuvant endocrine therapy (ET) for breast cancer experience side effects and reduced quality of life (QoL) and discontinue ET. We sought to describe these issues and develop a prediction model of early discontinuation of ET. METHODS Among patients with hormone receptor-positive and HER2-negative stage I-III breast cancer of the Cancer Toxicities cohort (NCT01993498) who were prescribed adjuvant ET between 2012 and 2017, upon stratification by menopausal status, we evaluated adjuvant ET patterns including treatment change and patient-reported discontinuation and ET-associated toxicities and impact on QoL. Independent variables included clinical and demographic features, toxicities, and patient-reported outcomes. A machine-learning model to predict time to early discontinuation was trained and evaluated on a held-out validation set. RESULTS Patient-reported discontinuation rate of the first prescribed ET at 4 years was 30% and 35% in 4122 postmenopausal and 2087 premenopausal patients, respectively. Switching to a new ET was associated with higher symptom burden, poorer QoL, and higher discontinuation rate. Early discontinuation rate of adjuvant ET before treatment completion was 13% in postmenopausal and 15% in premenopausal patients. The early discontinuation model obtained a C index of 0.62 in the held-out validation set. Many aspects of QoL, most importantly fatigue and insomnia (European Organization for Research and Treatment of Cancer QoL questionnaire 30), were associated with early discontinuation. CONCLUSION Tolerability and adherence to ET remains a challenge for patients who switch to a second ET. An early discontinuation model using patient-reported outcomes identifies patients likely to discontinue their adjuvant ET. Improved management of toxicities and novel more tolerable adjuvant ETs are needed for maintaining patients on treatment.
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Affiliation(s)
| | | | - Élise Bordet
- Sanofi Research and Development, Chilly-Mazarin, France
| | | | - Julie Blanc
- Centre George François Leclerc, Dijon, France
| | | | - Gautier Paux
- Sanofi Research and Development, Cambridge, MA, USA
| | | | | | | | | | | | - Patrick Soulie
- Institut de Cancérologie de L’Ouest—Centre Paul Papin, Angers, France
| | | | | | | | | | | | | | - Mario Campone
- Institut de Cancérologie de l’Ouest—Centre René Gauducheau, Nantes Saint Herblain, France
| | | | - Medha Sasane
- Sanofi Research and Development, Cambridge, MA, USA
| | - Megan Rice
- Sanofi Research and Development, Cambridge, MA, USA
| | | | | | | | - Ines Vaz-Luis
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | | | - Barbara Pistilli
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
- Department of Supportive care and pathways (DIOPP) Oncology, Gustave Roussy, Villejuif, France
- INSERM 981, Gustave Roussy, Villejuif, France
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30
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Dai Y, Chen T, Li X, Zhang C, Li T, Zhao Y, Wang Y, Chen S, Yu L, Jiang M, Wu Z, Yang J, Chen W. Evaluation of the clinical performance of p16/Ki-67 dual-staining cytology for cervical lesion detection in premenopausal and postmenopausal Chinese women. J Cancer Res Clin Oncol 2023; 149:10645-10658. [PMID: 37302113 DOI: 10.1007/s00432-023-04938-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 05/24/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND Studies on the clinical performance of p16/Ki-67 dual-staining in detecting cervical lesions by menopausal status were limited. METHODS 4364 eligible women were enrolled with valid p16/Ki-67, HR-HPV, and LBC test results, including 542 cancer and 217 CIN2/3 cases. The positivity rates of p16 and Ki-67 single staining and p16/ Ki-67 dual-staining were analyzed by different pathological grades and age groups. The sensitivity (SEN), specificity (SPE), positive predictive value (PPV), and negative predictive value (NPV) of each test in different subgroups were calculated and compared. RESULTS P16/Ki-67 dual-staining positivity increased with histopathological severity in premenopausal and postmenopausal women (P < 0.05), while no increasing trends of individual expression of p16 single staining and Ki-67 single staining were observed in postmenopausal women. P16/Ki-67 showed higher SPE (88.09% vs. 81.91%, P < 0.001) and PPV (33.8% vs. 13.18%, P < 0.001) in detecting CIN2/3, and higher SEN (89.97% vs. 82.61%, P = 0.012) and SPE (83.22% vs. 79.89%, P = 0.011) in detecting cancer in premenopausal women than postmenopausal women. For triaging the HR-HPV+ population to identify CIN2/3, p16/Ki-67 performed comparably to LBC in the premenopausal women, and showed higher PPV (51.14% vs. 23.08%, P < 0.001) in premenopausal than postmenopausal women. For triaging ASC-US/LSIL population, p16/Ki-67 demonstrated higher SPE and lower colposcopy referral rate than HR-HPV in both premenopausal and postmenopausal women. CONCLUSIONS Expressions of p16/Ki-67 dual-staining between premenopausal and postmenopausal women are varied. P16/Ki-67 performs better in detecting cervical lesions in premenopausal women. For triaging, p16/Ki-67 is suitable for HR-HPV+ women, especially premenopausal women, to identify CIN2/3 and women with ASC-US/LSIL.
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Affiliation(s)
- Yu Dai
- Department of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Tingting Chen
- Shenzhen Hospital of Integrated Traditional Chinese and Western Medicine, Shenzhen, 518104, China
| | - Xinyue Li
- College of Life Sciences, Institute of Life Science and Green Development, Hebei University, Baoding, 071000, China
| | - Changning Zhang
- College of Life Sciences, Institute of Life Science and Green Development, Hebei University, Baoding, 071000, China
| | - Tingyuan Li
- Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, 610041, China
| | - Yuqian Zhao
- Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, 610041, China
| | - Yakun Wang
- Department of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Simiao Chen
- Department of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Lulu Yu
- Department of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Mingyue Jiang
- Department of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Zeni Wu
- Department of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Jinghong Yang
- Mianyang Maternity and Child Health Care Hospital, Mianyang, 621000, China.
| | - Wen Chen
- Department of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
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Walankar P, Kini R, Panhale V, Desai N. Influence of menopausal status on physical function and performance: A cross-sectional study. Post Reprod Health 2023; 29:129-133. [PMID: 37345315 DOI: 10.1177/20533691231185414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
OBJECTIVE To compare the physical function and performance in pre-, peri-, and postmenopausal women. STUDY DESIGN A cross sectional study using convenience sampling method was conducted in 210 women categorized into premenopausal, perimenopausal, and postmenopausal. MAIN OUTCOME MEASURES Flexibility, muscle strength, muscle endurance, cardiovascular endurance, static balance, dynamic balance, and gait speed. RESULTS The mean age of the premenopausal, perimenopausal, and postmenopausal women was 46.55 ± 1.77, 49.54 ± 3.38 and 54.85 ± 3.77 years respectively. There is significant difference observed between premenopausal, perimenopausal, and postmenopausal women in muscle strength, upper limb endurance, lower limb endurance, static balance, dynamic balance, gait speed, and cardiovascular endurance (p < .05) using Kruskal Wallis test. There is no significant difference observed between the groups for flexibility (p > .05). CONCLUSION It was observed that physical function and performance was impaired in postmenopausal women when compared to pre- and perimenopausal women. Hence, these components should be included during assessment which will provide a holistic and multimodal approach toward the understanding, planning and management of postmenopausal women in community settings.
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Affiliation(s)
- Prachita Walankar
- Department of Musculoskeletal Physiotherapy, MGM College of Physiotherapy, Navi Mumbai, India
| | - Raveena Kini
- Department of Musculoskeletal Physiotherapy, MGM College of Physiotherapy, Navi Mumbai, India
| | - Vrushali Panhale
- Department of Musculoskeletal Physiotherapy, MGM College of Physiotherapy, Navi Mumbai, India
| | - Nidhi Desai
- Department of Musculoskeletal Physiotherapy, MGM College of Physiotherapy, Navi Mumbai, India
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Mielke GI, Doust J, Chan HW, Mishra GD. Physical Activity Accumulated Across Adulthood and Resting Heart Rate at Age 41-46 Years in Women: Findings From the Menarche to Premenopause Study. J Phys Act Health 2023; 20:823-831. [PMID: 37567574 DOI: 10.1123/jpah.2023-0082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 06/07/2023] [Accepted: 06/19/2023] [Indexed: 08/13/2023]
Abstract
OBJECTIVE To investigate the association between physical activity accumulated from early (age 22-27 y) to mid (age 40-45 y) adulthood and resting heart rate at age 41-46 years in women. METHODS Data were from 479 participants in the 1973-1978 cohort of the Australian Longitudinal Study on Women's Health. Participants reported physical activity every 3 years from age 22-27 years to 40-45 years. Linear regression models were used to investigate the associations of a cumulative physical activity score (average physical activity across 18 y; up to 7 surveys) and changes in physical activity from age 22-33 years to 34-45 years with resting heart rate at age 41-46 years. RESULTS Average resting heart rate at age 41-46 years was 75 (SD: 11) beats per minute. An inverse nonlinear dose-response association between cumulative physical activity and resting heart rate was observed. Overall, accumulation of physical activity was associated with lower resting heart rate regardless of the age when physical activity was accumulated. Women in the highest tertile of physical activity at both age 22-33 years and 34-45 years had a resting heart rate, on average, 8 beats per minute lower (95% confidence interval, -11.42 to -4.69) than those consistently in the lowest tertile of physical activity. CONCLUSION Accumulating physical activity, irrespective of timing, appears to provide cardiovascular health benefits for women before the transition to menopause.
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Affiliation(s)
- Gregore I Mielke
- School of Public Health, The University of Queensland, Brisbane, QLD,Australia
| | - Jenny Doust
- School of Public Health, The University of Queensland, Brisbane, QLD,Australia
| | - Hsiu-Wen Chan
- School of Public Health, The University of Queensland, Brisbane, QLD,Australia
| | - Gita D Mishra
- School of Public Health, The University of Queensland, Brisbane, QLD,Australia
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Park J, Son MK, Park HY. Substantial Lipid Increases During Menopausal Transition in Korean Middle-Aged Women. J Korean Med Sci 2023; 38:e238. [PMID: 37550806 PMCID: PMC10412034 DOI: 10.3346/jkms.2023.38.e238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 04/06/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND Adverse lipid profiles are observed in postmenopausal women. However, there is insufficient evidence of the association between lipids and reproductive aging in Korean women. We aimed to characterize lipid changes with respect to timing relative to menopause in Korean middle-aged women. METHODS This study included 1,436 premenopausal women who had a natural menopause during the follow-up period (median = 15.76 years) from the Korean Genome and Epidemiology Study (KoGES) Ansan and Anseong cohort. Lipid levels were measured every 2 years, and the magnitudes of annual lipid changes and differences in the changes by premenopausal body mass index were estimated using piecewise linear mixed-effects models. RESULTS All lipid levels increased greatly from 3 or 5 years before menopause to 1 year after menopause in all women, regardless of their premenopausal body mass index. During the period, high-density lipoprotein cholesterol (HDL-C) levels increased at 0.42 mg/dL per year (95% confidence interval [CI], 0.29 to 0.55 mg/dL). Nevertheless, non-HDL-C levels simultaneously increased at 3.42 mg/dL per year (95% CI, 3.11 to 3.72 mg/dL), and an annual change in the non-HDL-C to HDL-C ratio was 0.05 (95% CI, 0.04 to 0.06). One year after menopause, changes in all lipid parameters significantly slowed down, except for the non-HDL-C to HDL-C ratio (P < 0.001 for all). The ratio continued to increase until 3 years after menopause, but thereafter, the change leveled off. CONCLUSION Women experienced remarkable increases in lipid levels during menopausal transition, highlighting the need for early intervention strategies for cardiovascular disease prevention in women.
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Affiliation(s)
- Jungeun Park
- Division of Population Health Research, Department of Precision Medicine, Korea National Institute of Health, Korea Disease Control and Prevention Agency (KDCA), Cheongju, Korea
| | - Mi Kyoung Son
- Division of Population Health Research, Department of Precision Medicine, Korea National Institute of Health, Korea Disease Control and Prevention Agency (KDCA), Cheongju, Korea
| | - Hyun-Young Park
- Korea National Institute of Health, Korea Disease Control and Prevention Agency (KDCA), Cheongju, Korea.
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Stabile G, Topouzova GA, De Seta F. The role of microbiota in the management of genitourinary syndrome of menopause. Climacteric 2023; 26:353-360. [PMID: 37366082 DOI: 10.1080/13697137.2023.2223923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/27/2023] [Accepted: 06/01/2023] [Indexed: 06/28/2023]
Abstract
It is estimated that the 25-50% of women who are reaching menopause every year report symptoms related to the genitourinary syndrome of menopause (GSM). The symptoms are not due simply to lack of estrogen. One possible contributing cause of symptoms is the vaginal microbiota. The vaginal microbiota is a dynamic entity and plays a critical role in the pathogenic interplay of postmenopausal changes. Treatment of this syndrome depends on the severity and type of the symptoms and on the preferences and expectations of women. As there are many treatment options, therapy should be individualized. While new evidence on the role of Lactobacilli in premenopause is emerging, the role of Lactobacilli is still unclear in GSM and the impact of microbiota on vaginal health remains conflictual. However, some reports show promising data on the effect of probiotic therapy in menopause. In the literature there are few studies and small population samples on the role of an exclusive therapy with Lactobacilli and further data will be mandatory. Studies involving large numbers of patients and different intervention periods will be necessary to obtain evidence of the preventive and curative role of vaginal probiotics.
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Affiliation(s)
- G Stabile
- Institute for Maternal and Child Health, IRCCS 'Burlo Garofolo', Trieste, Italy
| | - G A Topouzova
- UCO ClinicaOstetrica e Ginecologica, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - F De Seta
- Institute for Maternal and Child Health, IRCCS 'Burlo Garofolo', Trieste, Italy
- UCO ClinicaOstetrica e Ginecologica, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
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Nishimura T, Kakiuchi N, Yoshida K, Sakurai T, Kataoka TR, Kondoh E, Chigusa Y, Kawai M, Sawada M, Inoue T, Takeuchi Y, Maeda H, Baba S, Shiozawa Y, Saiki R, Nakagawa MM, Nannya Y, Ochi Y, Hirano T, Nakagawa T, Inagaki-Kawata Y, Aoki K, Hirata M, Nanki K, Matano M, Saito M, Suzuki E, Takada M, Kawashima M, Kawaguchi K, Chiba K, Shiraishi Y, Takita J, Miyano S, Mandai M, Sato T, Takeuchi K, Haga H, Toi M, Ogawa S. Evolutionary histories of breast cancer and related clones. Nature 2023; 620:607-614. [PMID: 37495687 PMCID: PMC10432280 DOI: 10.1038/s41586-023-06333-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 06/15/2023] [Indexed: 07/28/2023]
Abstract
Recent studies have documented frequent evolution of clones carrying common cancer mutations in apparently normal tissues, which are implicated in cancer development1-3. However, our knowledge is still missing with regard to what additional driver events take place in what order, before one or more of these clones in normal tissues ultimately evolve to cancer. Here, using phylogenetic analyses of multiple microdissected samples from both cancer and non-cancer lesions, we show unique evolutionary histories of breast cancers harbouring der(1;16), a common driver alteration found in roughly 20% of breast cancers. The approximate timing of early evolutionary events was estimated from the mutation rate measured in normal epithelial cells. In der(1;16)(+) cancers, the derivative chromosome was acquired from early puberty to late adolescence, followed by the emergence of a common ancestor by the patient's early 30s, from which both cancer and non-cancer clones evolved. Replacing the pre-existing mammary epithelium in the following years, these clones occupied a large area within the premenopausal breast tissues by the time of cancer diagnosis. Evolution of multiple independent cancer founders from the non-cancer ancestors was common, contributing to intratumour heterogeneity. The number of driver events did not correlate with histology, suggesting the role of local microenvironments and/or epigenetic driver events. A similar evolutionary pattern was also observed in another case evolving from an AKT1-mutated founder. Taken together, our findings provide new insight into how breast cancer evolves.
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Affiliation(s)
- Tomomi Nishimura
- Department of Pathology and Tumour Biology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Department of Next-generation Clinical Genomic Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Department of Breast Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Nobuyuki Kakiuchi
- Department of Pathology and Tumour Biology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- The Hakubi Center for Advanced Research, Kyoto University, Kyoto, Japan
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kenichi Yoshida
- Department of Pathology and Tumour Biology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Division of Cancer Evolution, National Cancer Center Research Institute, Tokyo, Japan
| | - Takaki Sakurai
- Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan
- Department of Diagnostic Pathology, Osaka Red Cross Hospital, Osaka, Japan
| | - Tatsuki R Kataoka
- Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan
- Department of Pathology, Iwate Medical University, Iwate, Japan
| | - Eiji Kondoh
- Department of Gynecology and Obstetrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Department of Obstetrics and Gynecology Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Yoshitsugu Chigusa
- Department of Gynecology and Obstetrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masahiko Kawai
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | | | | | - Yasuhide Takeuchi
- Department of Pathology and Tumour Biology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan
| | - Hirona Maeda
- Department of Pathology and Tumour Biology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan
| | - Satoko Baba
- Pathology Project for Molecular Targets, Cancer Institute, Japanese Foundation for Cancer Research, Tokyo, Japan
- Division of Pathology, Cancer Institute, Japanese Foundation for Cancer Research, Tokyo, Japan
- Department of Pathology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yusuke Shiozawa
- Department of Pathology and Tumour Biology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Ryunosuke Saiki
- Department of Pathology and Tumour Biology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masahiro M Nakagawa
- Department of Pathology and Tumour Biology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Department of Next-generation Clinical Genomic Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yasuhito Nannya
- Department of Pathology and Tumour Biology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Division of Hematopoietic Disease Control, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Yotaro Ochi
- Department of Pathology and Tumour Biology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tomonori Hirano
- Department of Pathology and Tumour Biology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Institute for the Advanced Study of Human Biology (WPI-ASHBi), Kyoto University, Kyoto, Japan
| | - Tomoe Nakagawa
- Department of Pathology and Tumour Biology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Institute for the Advanced Study of Human Biology (WPI-ASHBi), Kyoto University, Kyoto, Japan
| | - Yukiko Inagaki-Kawata
- Department of Pathology and Tumour Biology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Department of Breast Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kosuke Aoki
- Department of Pathology and Tumour Biology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masahiro Hirata
- Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan
| | - Kosaku Nanki
- Department of Organoid Medicine, Sakaguchi Laboratory, Keio University School of Medicine, Tokyo, Japan
| | - Mami Matano
- Department of Organoid Medicine, Sakaguchi Laboratory, Keio University School of Medicine, Tokyo, Japan
| | - Megumu Saito
- Department of Organoid Medicine, Sakaguchi Laboratory, Keio University School of Medicine, Tokyo, Japan
- Osaka Research Center for Drug Discovery, Otsuka Pharmaceutical Company, Limited, Osaka, Japan
| | - Eiji Suzuki
- Department of Breast Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Breast Surgery Department, Kobe City Medical Center General Hospital, Hyogo, Japan
| | - Masahiro Takada
- Department of Breast Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masahiro Kawashima
- Department of Breast Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kosuke Kawaguchi
- Department of Breast Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kenichi Chiba
- Division of Genome Analysis Platform Development, National Cancer Center Research Institute, Tokyo, Japan
| | - Yuichi Shiraishi
- Division of Genome Analysis Platform Development, National Cancer Center Research Institute, Tokyo, Japan
| | - Junko Takita
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Satoru Miyano
- Department of Integrated Analytics, M&D Data Science Center, Tokyo Medical and Dental University, Tokyo, Japan
- Human Genome Center, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Masaki Mandai
- Department of Gynecology and Obstetrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Toshiro Sato
- Department of Organoid Medicine, Sakaguchi Laboratory, Keio University School of Medicine, Tokyo, Japan
| | - Kengo Takeuchi
- Pathology Project for Molecular Targets, Cancer Institute, Japanese Foundation for Cancer Research, Tokyo, Japan
- Division of Pathology, Cancer Institute, Japanese Foundation for Cancer Research, Tokyo, Japan
- Department of Pathology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Hironori Haga
- Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan
| | - Masakazu Toi
- Department of Breast Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Seishi Ogawa
- Department of Pathology and Tumour Biology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
- Institute for the Advanced Study of Human Biology (WPI-ASHBi), Kyoto University, Kyoto, Japan.
- Department of Medicine, Centre for Haematology and Regenerative Medicine, Karolinska Institute, Stockholm, Sweden.
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Pan Y, Du R, Han X, Zhu W, Peng D, Tu Y, Han J, Bao Y, Yu H. Machine Learning Prediction of Iron Deficiency Anemia in Chinese Premenopausal Women 12 Months after Sleeve Gastrectomy. Nutrients 2023; 15:3385. [PMID: 37571322 PMCID: PMC10421369 DOI: 10.3390/nu15153385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 07/07/2023] [Accepted: 07/21/2023] [Indexed: 08/13/2023] Open
Abstract
Premenopausal women, who account for more than half of patients for bariatric surgery, are at higher risk of developing postoperative iron deficiency anemia (IDA) than postmenopausal women and men. We aimed at establishing a machine learning model to evaluate the risk of newly onset IDA in premenopausal women 12 months after sleeve gastrectomy (SG). Premenopausal women with complete clinical records and undergoing SG were enrolled in this retrospective study. Newly onset IDA after surgery, the main outcome, was defined according to the age- and gender-specific World Health Organization criteria. A linear support vector machine model was developed to predict the risk of IDA after SG with the top five important features identified during feature selection. Four hundred and seven subjects aged 31.0 (Interquartile range (IQR): 26.0-36.0) years with a median follow-up period of 12 (IQR 7-13) months were analyzed. They were divided into a training set and a validation set with 285 and 122 individuals, respectively. Preoperative ferritin, age, hemoglobin, creatinine, and fasting C-peptide were included. The model showed moderate discrimination in both sets (area under curve 0.858 and 0.799, respectively, p < 0.001). The calibration curve indicated acceptable consistency between observed and predicted results in both sets. Moreover, decision curve analysis showed substantial clinical benefits of the model in both sets. Our machine learning model could accurately predict newly onset IDA in Chinese premenopausal women with obesity 12 months after SG. External validation was required before the model was used in clinical practice.
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Affiliation(s)
- Yunhui Pan
- Department of Endocrinology and Metabolism, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Center of Diabetes, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Key Clinical Center for Metabolic Disease, Shanghai 200233, China
| | - Ronghui Du
- Department of Endocrinology and Metabolism, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Center of Diabetes, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Key Clinical Center for Metabolic Disease, Shanghai 200233, China
| | - Xiaodong Han
- Department of General Surgery, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, China
| | - Wei Zhu
- Department of Endocrinology and Metabolism, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Center of Diabetes, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Key Clinical Center for Metabolic Disease, Shanghai 200233, China
| | - Danfeng Peng
- Department of Endocrinology and Metabolism, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Center of Diabetes, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Key Clinical Center for Metabolic Disease, Shanghai 200233, China
| | - Yinfang Tu
- Department of Endocrinology and Metabolism, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Center of Diabetes, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Key Clinical Center for Metabolic Disease, Shanghai 200233, China
- Department of Endocrinology and Metabolism, Haikou Orthopedic and Diabetes Hospital of Shanghai Sixth People’s Hospital, Haikou 570300, China
| | - Junfeng Han
- Department of Endocrinology and Metabolism, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200065, China
| | - Yuqian Bao
- Department of Endocrinology and Metabolism, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Center of Diabetes, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Key Clinical Center for Metabolic Disease, Shanghai 200233, China
| | - Haoyong Yu
- Department of Endocrinology and Metabolism, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Center of Diabetes, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Key Clinical Center for Metabolic Disease, Shanghai 200233, China
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Reddy R, Guo Y, Raju V, Faghih RT. Characterization of Leptin Secretion in Premenopausal Obese Women Treated with Bromocriptine. Annu Int Conf IEEE Eng Med Biol Soc 2023; 2023:1-6. [PMID: 38082631 DOI: 10.1109/embc40787.2023.10340951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Leptin, a hormone secreted by adipose tissue, is primarily responsible for inhibiting hunger and maintaining energy balance. Improper leptin secretion may result in hyperleptinemia (excess secretion of leptin) or leptin resistance, both of which contribute to obesity. Diagnosing abnormal leptin secretion may help treat this underlying cause of obesity. Therefore, continuous monitoring of the level of leptin may help characterize its secretion dynamics and also help devise an appropriate treatment. In this research, we consider leptin hormone concentration data taken over a 24 hour time period from eighteen healthy premenopausal obese women before and after treatment with a dopamine agonist, bromocriptine, and deconvolve the observed leptin hormone levels to estimate the number, timing, and magnitude of the underlying leptin secretory pulses. We find that there is an overall decrease in leptin secretion, particularly during sleep, but the changes in the secretory and clearance rates, and the number of pulses underlying the secretion process are not statistically significant.Clinical relevance- This work seeks to understand the effect of bromocriptine on leptin secretory dynamics and will help further current understanding of the effect of bromocriptine in relation to obesity.
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Garashchenko O, Konovalenko V. ANALYSIS OF PLASMA MIRNA-497 LEVELS IN THE BLOOD OF PATIENTS WITH BREAST CANCER. Georgian Med News 2023:212-216. [PMID: 37805900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 10/09/2023]
Abstract
Breast cancer is a heterogeneous disease with a variable clinical course, morphological and clinical features. In clinical observation, we attempted to study the correlation between clinical characteristics of breast cancer patients and plasma miRNA-497 concentration as a possible pathogenic molecular disease factor and a diagnostic indicator. It was established that miRNA-497 levels were significantly higher in the plasma of premenopausal compared to menopausal women, while the opposite is true for healthy women. We did not find a link between miRNA-497 levels and tumor size and clinical stage, though a weak positive correlation between miRNA-497 levels and the N0-N3 stage was noted, with a pronounced increase at the N3 stage, which was reliable in the group of patients after APCT. miRNA-497 levels after the first and second courses of NPCT did not differ statistically significant. There was no correlation between miRNA-497 concentration and the molecular subtype of breast cancer, and the difference between patients with HER2+ type and the triple-negative type was not convincing due to the small patient sample size. Also, no connection was found between the analyzed miRNA-497 levels and follow-up results, and positive initial results require additional research and analysis. In conclusion, analysis of miRNA-497 levels can be useful in the study of the molecular type and stage of breast cancer. Prospects for further research are in analyzing this indicator in a larger sample of breast cancer patients, obtaining remote follow-up results, and comparison with other types of miRNA.
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Affiliation(s)
- O Garashchenko
- Institute of Experimental Pathology, Oncology and Radiobiology named after RE. Kavetsky National Academy of Sciences of Ukraine
| | - V Konovalenko
- Institute of Experimental Pathology, Oncology and Radiobiology named after RE. Kavetsky National Academy of Sciences of Ukraine
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Tsapadikou VK, Zacharis K, Barbarousi AP, Chondros S, Kravvaritis S, Fouka A, Charitos T. Ovarian cyst torsion in a pre-menopausal woman causing intestinal obstruction: a case report. Pan Afr Med J 2023; 45:93. [PMID: 37692981 PMCID: PMC10491711 DOI: 10.11604/pamj.2023.45.93.38690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 01/17/2023] [Indexed: 09/12/2023] Open
Abstract
Intestinal obstruction due to adnexal torsion is a rare complication that can be occurred during torsion of an ovarian cyst. A premenopausal woman presented to the emergency department with complaints of abdominal distension, abdominal pain, and obstipation for 2 days. An abdominal radiograph showed signs of large bowel partial obstruction. Hence admission to the surgical department was ordered. Due to deterioration of the patient, a gynaecological evaluation took place. Ultrasonography demonstrated a large ovarian cyst, which was also confirmed by an abdominal computed tomography scan and thus immediate laparotomy was decided. Abdominal hysterectomy with bilateral salpingo-oophorectomy was performed due to torsion of a giant ovarian cyst, which caused intestinal obstruction by compression. The post-operative course of the patient was uneventful. Ovarian torsion should not be eliminated from differential diagnosis when it comes to female patients with clinical presentation relevant to small and/or large bowel obstruction.
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Affiliation(s)
| | | | | | - Spyridon Chondros
- Department of Obstetrics and Gynaecology, General Hospital of Lamia, Lamia, Greece
| | - Stavros Kravvaritis
- Department of Obstetrics and Gynaecology, General Hospital of Lamia, Lamia, Greece
| | - Anastasia Fouka
- Department of Obstetrics and Gynaecology, General Hospital of Lamia, Lamia, Greece
| | - Theodoros Charitos
- Department of Obstetrics and Gynaecology, General Hospital of Lamia, Lamia, Greece
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Faubion SS, Ghaith S, Kling JM, Mara K, Enders F, Starling AJ, Kapoor E. Migraine and sleep quality: does the association change in midlife women? Menopause 2023; 30:376-382. [PMID: 36720087 PMCID: PMC10038841 DOI: 10.1097/gme.0000000000002149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The aim of this study was to compare the association between migraine and sleep quality in premenopausal versus perimenopausal women. METHODS A cross-sectional analysis from the Data Registry on the Experiences of Aging, Menopause and Sexuality was conducted using questionnaire data from premenopausal and perimenopausal women seen at women's health clinics at 3 geographic locations from 2015 to 2021. Sleep quality and duration were assessed with the Pittsburgh Sleep Quality Index. Associations between poor sleep quality (Pittsburgh Sleep Quality Index >5) and self-reported migraine history (Y/N) were evaluated using a multivariable logistic regression model, adjusting for body mass index, anxiety, depression, and vasomotor symptoms. RESULTS Of 2,067 women (mean age 43.2 years) included in the analysis, 594 (28.7%) reported a migraine history. Women were mostly white (92.2%), partnered (75.1%), and educated (86% with at least some college); 46.5% (n = 962) were premenopausal, 53.5% (n = 1,105) were perimenopausal, and 71.2% met the criteria for poor sleep. In univariate analysis, migraine history predicted poor sleep in both premenopausal and perimenopausal women ( P = 0.005 and P = 0.004, respectively). However, in multivariable analysis, migraine history remained associated with poor sleep in premenopausal women ( P = 0.044), but not in perimenopausal women ( P = 0.46). CONCLUSIONS A migraine history was associated with poor sleep in premenopausal women. The relationship in perimenopausal women seemed to be influenced by confounding factors that are more prevalent during the menopause transition and are known to affect the frequency of migraine and sleep disturbances, such as anxiety, depression, and vasomotor symptoms. These conditions may need to be the focus of management in migraineurs with sleep disturbances during the menopause transition.
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Affiliation(s)
- Stephanie S. Faubion
- Division of General Internal Medicine, Mayo Clinic, Jacksonville, FL
- Mayo Clinic Center for Women’s Health, Rochester, MN
| | - Summer Ghaith
- Mayo Clinic Alix School of Medicine, Scottsdale/Phoenix, AZ
| | - Juliana M. Kling
- Mayo Clinic Center for Women’s Health, Rochester, MN
- Division of Women’s Health Internal Medicine, Mayo Clinic, Scottsdale, AZ
| | - Kristin Mara
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Felicity Enders
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | | | - Ekta Kapoor
- Mayo Clinic Center for Women’s Health, Rochester, MN
- Women’s Health Research Center, Mayo Clinic, Rochester, MN
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN
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Page CE, Soreth B, Metcalf CA, Johnson RL, Duffy KA, Sammel MD, Loughead J, Epperson CN. Natural vs. surgical postmenopause and psychological symptoms confound the effect of menopause on executive functioning domains of cognitive experience. Maturitas 2023; 170:64-73. [PMID: 36806931 DOI: 10.1016/j.maturitas.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 11/23/2022] [Accepted: 01/06/2023] [Indexed: 02/09/2023]
Abstract
OBJECTIVE The menopause transition is associated with difficulties in executive function. However, it is unclear whether these difficulties persist past perimenopause. This study investigated whether potential confounders, including natural vs. surgical postmenopause and menopause-related psychological symptoms, influence whether executive dysfunction persists into postmenopause. STUDY DESIGN A cross-sectional sample of women aged 35-65 years (N = 1971) in one of four groups, premenopause, perimenopause, natural postmenopause, and surgical postmenopause, were surveyed. Participants self-reported executive functioning with the Brown Attention Deficit Disorder Scale (BADDS), anxiety symptom severity with the Generalized Anxiety Disorder Questionnaire (GAD-7), and depression symptom severity with the Center for Epidemiologic Studies Depression Scale (CESD). MAIN OUTCOME MEASURES We analyzed the association between group and BADDS scores using linear regression models - first, by controlling for age, education, and self-reported attention deficit hyperactivity disorder (ADHD) diagnosis (Model #1) and, second, by further controlling for current difficulty sleeping, anxiety, and depression (Model #2). RESULTS In both models, BADDS scores were significantly elevated (indicating more difficulties in executive function) among women in the perimenopausal and surgical postmenopausal groups compared with those in the premenopausal group. Likewise, the perimenopausal and surgical postmenopausal groups had the highest proportions of participants who reported difficulty sleeping and clinical levels of anxiety and depression. BADDS scores were significantly higher in natural postmenopausal vs. premenopausal women without controlling for difficulty sleeping, anxiety, and depression (Model #1), but not when adjusting for these variables (Model #2). CONCLUSIONS The type of menopause and psychological symptoms are important confounders of the relationship between the menopause transition and executive dysfunction, and help explain whether executive dysfunction persists or recovers in postmenopause.
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Affiliation(s)
- Chloe E Page
- Department of Psychiatry, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, CO, United States
| | - Brianna Soreth
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Christina A Metcalf
- Department of Psychiatry, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, CO, United States
| | - Rachel L Johnson
- Department of Biostatistics and Informatics, Anschutz Medical Campus, University of Colorado School of Public Health, Aurora, CO, United States
| | - Korrina A Duffy
- Department of Psychiatry, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, CO, United States
| | - Mary D Sammel
- Department of Psychiatry, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, CO, United States; Department of Biostatistics and Informatics, Anschutz Medical Campus, University of Colorado School of Public Health, Aurora, CO, United States
| | - James Loughead
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - C Neill Epperson
- Department of Psychiatry, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, CO, United States; Department of Family Medicine, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, CO, United States.
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Nagata C, Wada K, Yamakawa M, Nakashima Y, Sugino M, Mori T. Sleep duration and the onset of menopause in Japanese women. Menopause 2023; 30:437-440. [PMID: 36787529 DOI: 10.1097/gme.0000000000002156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
OBJECTIVE Sleep characteristics may potentially affect the hormonal environment related to follicular degeneration. The present study aimed to examine the association between sleep duration and the onset of menopause in Japanese women. METHODS We conducted a prospective study among 3,090 premenopausal Japanese women aged 35 to 56 years derived from participants in the Takayama Study. Habitual sleep duration was determined by a self-administered questionnaire at the baseline. Menopausal status was defined as the absence of menstruation for 12 months or more. The Cox proportional hazard model was used to estimate the hazard ratio of the occurrence of menopause for each category of sleep duration (≤6, 8, and ≥9 h) as compared with 7 hours of sleep after controlling for age, parity, body mass index, smoking status, years of education, and lifelong irregular menstrual cycle. RESULTS During the 10 follow-up years, 1,776 women experienced natural menopause. Sleep duration of ≤6 hours was significantly associated with decreased hazard ratio of menopause (0.88; 95% confidence interval, 0.78-0.99). CONCLUSIONS The data suggest that short sleep duration is associated with later onset of menopause.
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Affiliation(s)
- Chisato Nagata
- Department of Epidemiology and Preventive Medicine, Gifu University Graduate School of Medicine, Gifu, Japan
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Nagata C, Wada K, Yamakawa M, Nakashima Y, Hayashi M, Takeda N, Yasuda K. Sleep-related factors and circulating levels of sex hormones in premenopausal Japanese women. Endocr J 2023; 70:267-273. [PMID: 36384969 DOI: 10.1507/endocrj.ej22-0337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Sleep disruption and circadian disruption have been proposed to be risk factors of breast cancer. The present study examined the associations of sleep-related factors, referring to night shift work, sleep habits, and sleep disturbances, with the plasma levels of sex hormones in premenopausal Japanese women. Study participants were 432 women who had regular menstrual cycles less than 40 days long. Information on their history of night shift work and sleep disturbances was obtained using a self-administered questionnaire. Information on their sleep habits, such as usual wake-up times, bedtimes, and ambient light level while sleeping, was obtained in an interview. The participants' height and weight were measured. Plasma concentrations of estradiol, testosterone, dehydroepiandrosterone sulfate, sex hormone-binding globulin (SHBG), FSH, and LH were also measured. After controlling for the phase of the menstrual cycle and other covariates, more years of night shift work ≥ once a week during the past 10 years was significantly associated with a lower SHBG and a higher free estradiol level. Shorter sleep duration was significantly associated with the higher total, bioavailable, and free testosterone levels. Sleep disturbance by awaking after sleep onset was significantly associated with a high free estradiol level. The data suggest that long-term night shift work, short sleep duration, and arousal during sleep are associated with higher estradiol or testosterone levels in premenopausal women.
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Affiliation(s)
- Chisato Nagata
- Department of Epidemiology and Preventive Medicine, Gifu University Graduate School of Medicine, Gifu 501-1194, Japan
| | - Keiko Wada
- Department of Epidemiology and Preventive Medicine, Gifu University Graduate School of Medicine, Gifu 501-1194, Japan
| | - Michiyo Yamakawa
- Department of Epidemiology and Preventive Medicine, Gifu University Graduate School of Medicine, Gifu 501-1194, Japan
| | - Yuma Nakashima
- Department of Epidemiology and Preventive Medicine, Gifu University Graduate School of Medicine, Gifu 501-1194, Japan
| | - Makoto Hayashi
- Department of Internal Medicine, Matsunami General Hospital, Gifu 501-6062, Japan
| | - Noriyuki Takeda
- Department of Endocrinology and Metabolism, Murakami Memorial Hospital, Asahi University, Gifu 500-8523, Japan
| | - Keigo Yasuda
- Department of Internal Medicine, Matsunami General Hospital, Gifu 501-6062, Japan
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Finch JE, Xu Z, Girdler S, Baker JH. Network analysis of eating disorder symptoms in women in perimenopause and early postmenopause. Menopause 2023; 30:275-282. [PMID: 36728103 PMCID: PMC9974533 DOI: 10.1097/gme.0000000000002141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Eating disorders (EDs) are often stereotyped as disorders of adolescence and young adulthood; however, they can occur at any age. Prevalence of EDs at midlife are approximately 3.5% and specific symptoms at midlife can have prevalences as high as 29.3%. Studies also inconsistently suggest that EDs and related symptoms may be more prevalent in midlife aged women during perimenopause compared with midlife aged women at pre-menopause. To date few studies have examined the structure of and associations between ED symptoms in women specifically during perimenopause and early postmenopause. Thus, the purpose of the current study is to investigate the structure of ED symptoms specifically during perimenopause and early postmenopause. METHODS Participants included 36 participants (45-61 y old) in a larger clinical trial who completed the Eating Disorder Examination Questionnaire (EDE-Q) at a baseline study visit. Network analysis statistical models were used to examine the structure of and associations between ED symptoms assessed via the EDE-Q. RESULTS Shape dissatisfaction and weight dissatisfaction were the top 2 central symptoms in the network. CONCLUSIONS Results corroborate previous studies and indicate that, similar to young adult samples, dissatisfaction with body image is a core feature of ED pathology across the lifespan.
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Affiliation(s)
- Jody E. Finch
- Department of Psychology, Georgia State University, P.O. Box 5010, Atlanta, GA 30302-5010, USA
| | - Ziqian Xu
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, 235 E. Cameron Avenue, Chapel Hill, NC 27515, USA
| | - Susan Girdler
- Department of Psychiatry, University of North Carolina at Chapel Hill, CB #7160, 101 Manning Drive, Chapel Hill, NC 27599-7160, USA
| | - Jessica H. Baker
- Department of Psychiatry, University of North Carolina at Chapel Hill, CB #7160, 101 Manning Drive, Chapel Hill, NC 27599-7160, USA
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Francis PA, Fleming GF, Láng I, Ciruelos EM, Bonnefoi HR, Bellet M, Bernardo A, Climent MA, Martino S, Bermejo B, Burstein HJ, Davidson NE, Geyer CE, Walley BA, Ingle JN, Coleman RE, Müller B, Le Du F, Loibl S, Winer EP, Ruepp B, Loi S, Colleoni M, Coates AS, Gelber RD, Goldhirsch A, Regan MM. Adjuvant Endocrine Therapy in Premenopausal Breast Cancer: 12-Year Results From SOFT. J Clin Oncol 2023; 41:1370-1375. [PMID: 36493334 PMCID: PMC10419521 DOI: 10.1200/jco.22.01065] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 09/08/2022] [Accepted: 11/02/2022] [Indexed: 12/13/2022] Open
Abstract
Clinical trials frequently include multiple end points that mature at different times. The initial report, typically based on the primary end point, may be published when key planned co-primary or secondary analyses are not yet available. Clinical Trial Updates provide an opportunity to disseminate additional results from studies, published in JCO or elsewhere, for which the primary end point has already been reported.The Suppression of Ovarian Function Trial (SOFT; ClinicalTrials.gov identifier: NCT00066690) randomly assigned premenopausal women with hormone receptor-positive breast cancer to 5 years of adjuvant tamoxifen, tamoxifen plus ovarian function suppression (OFS), or exemestane plus OFS. The primary analysis compared disease-free survival (DFS) between tamoxifen plus OFS versus tamoxifen alone; exemestane plus OFS versus tamoxifen was a secondary objective. After 8 years, SOFT reported a significant reduction in recurrence and improved overall survival (OS) with adjuvant tamoxifen plus OFS versus tamoxifen alone. Here, we report outcomes after median follow-up of 12 years. DFS remained significantly improved with tamoxifen plus OFS versus tamoxifen (hazard ratio, 0.82; 95% CI, 0.69 to 0.98) with a 12-year DFS of 71.9% with tamoxifen, 76.1% with tamoxifen plus OFS, and 79.0% with exemestane plus OFS. OS was improved with tamoxifen plus OFS versus tamoxifen (hazard ratio, 0.78; 95% CI, 0.60 to 1.01) and was 86.8% with tamoxifen, 89.0% with tamoxifen plus OFS, and 89.4% with exemestane plus OFS at 12 years. Among those who received prior chemotherapy for human epidermal growth factor receptor-2-negative tumors, OS was 78.8% with tamoxifen, 81.1% with tamoxifen plus OFS, and 84.4% with exemestane plus OFS. In conclusion, after 12 years, there remains a benefit from including OFS in adjuvant endocrine therapy, with an absolute improvement in OS more apparent with higher baseline risk of recurrence.[Media: see text].
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Affiliation(s)
- Prudence A. Francis
- Sir Peter MacCallum Department of Oncology, Peter MacCallum Cancer Center, St Vincent's Hospital, University of Melbourne, Melbourne, Australia
- Breast Cancer Trials Australia & New Zealand, University of Newcastle, Callaghan, Newcastle, Australia
- International Breast Cancer Study Group, Bern, Switzerland
| | - Gini F. Fleming
- The University of Chicago Medical Center and Alliance for Clinical Trials in Oncology, Chicago, IL
| | - István Láng
- Clinexpert-Research, Budapest, Hungary
- National Institute of Oncology and International Breast Cancer Study Group, Budapest, Hungary
| | - Eva M. Ciruelos
- Medical Oncology Department, University Hospital and SOLTI Breast Cancer Research Cooperative Group, Madrid, Spain
| | - Hervé R. Bonnefoi
- Institut Bergonié Comprehensive Cancer Centre, Université de Bordeaux, INSERM U1312, and European Organisation for Research and Treatment of Cancer (EORTC), Bordeaux, France
| | - Meritxell Bellet
- Vall d'Hebron Institute of Oncology (VHIO) and Vall d'Hebron University Hospital, and SOLTI Breast Cancer Research Cooperative Group, Barcelona, Spain
| | | | - Miguel A. Climent
- Instituto Valenciano de Oncologia, Valencia and SOLTI Breast Cancer Research Cooperative Group, Barcelona, Spain
| | - Silvana Martino
- The Angeles Clinic and Research Institute and SWOG, Santa Monica, CA
| | - Begoña Bermejo
- Department of Medical Oncology, Hospital Clínico Universitario de Valencia, Incliva, Barcelona, Spain
- Medicine Department Universidad de Valencia, Valencia and SOLTI Breast Cancer Cooperative Group, Barcelona, Spain
| | - Harold J. Burstein
- Susan F. Smith Center for Women's Cancers, Dana-Farber Cancer Institute, Harvard Medical School and Alliance for Clinical Trials in Oncology, Boston, MA
| | - Nancy E. Davidson
- Fred Hutchinson Cancer Center, University of Washington and ECOG-ACRIN, Seattle, WA
| | - Charles E. Geyer
- University of Pittsburgh Medical Center Hillman Cancer Center and NRG Oncology, Pittsburgh, PA
| | - Barbara A. Walley
- University of Calgary and Canadian Cancer Trials Group, Calgary, Alberta, Canada
| | - James N. Ingle
- Mayo Clinic and Alliance for Clinical Trials in Oncology, Rochester, MN
| | - Robert E. Coleman
- Weston Park Hospital, Sheffield, United Kingdom
- NCRI Breast Cancer Clinical Studies Group, London, United Kingdom
- ICR-CTSU, London, United Kingdom
| | - Bettina Müller
- Chilean Cooperative Group for Oncological Research (GOCCHI), Santiago, Chile
| | - Fanny Le Du
- Department of Medical Oncology, Centre Eugène Marquis, Rennes, France
| | - Sibylle Loibl
- German Breast Group, Neu-Isenburg, Germany
- Goethe University of Frankfurt, Frankfurt, Germany
| | - Eric P. Winer
- Susan F. Smith Center for Women's Cancers, Dana-Farber Cancer Institute, Harvard Medical School and Alliance for Clinical Trials in Oncology, Boston, MA
- Yale Cancer Center, Yale School of Medicine, New Haven, CT
- Smilow Cancer Hospital, New Haven, CT
| | - Barbara Ruepp
- International Breast Cancer Study Group Coordinating Center, Bern, Switzerland
| | - Sherene Loi
- International Breast Cancer Study Group and Peter MacCallum Cancer Center, University of Melbourne, Melbourne, Victoria, Australia
| | - Marco Colleoni
- Division of Medical Senology, IEO, European Institute of Oncology, IRCCS and International Breast Cancer Study Group, Milan, Italy
| | - Alan S. Coates
- International Breast Cancer Study Group and University of Sydney, Sydney, Australia
| | - Richard D. Gelber
- International Breast Cancer Study Group Statistical Center, Dana-Farber Cancer Institute, Harvard Medical School, Harvard TH Chan School of Public Health, Frontier Science Foundation, Boston, MA
| | - Aron Goldhirsch
- IEO, European Institute of Oncology, IRCCS and International Breast Cancer Study Group, Milan, Italy
| | - Meredith M. Regan
- International Breast Cancer Study Group Statistical Center, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
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Pagani O, Walley BA, Fleming GF, Colleoni M, Láng I, Gomez HL, Tondini C, Burstein HJ, Goetz MP, Ciruelos EM, Stearns V, Bonnefoi HR, Martino S, Geyer CE, Chini C, Puglisi F, Spazzapan S, Ruhstaller T, Winer EP, Ruepp B, Loi S, Coates AS, Gelber RD, Goldhirsch A, Regan MM, Francis PA. Adjuvant Exemestane With Ovarian Suppression in Premenopausal Breast Cancer: Long-Term Follow-Up of the Combined TEXT and SOFT Trials. J Clin Oncol 2023; 41:1376-1382. [PMID: 36521078 PMCID: PMC10419413 DOI: 10.1200/jco.22.01064] [Citation(s) in RCA: 26] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 09/08/2022] [Accepted: 11/02/2022] [Indexed: 12/23/2022] Open
Abstract
Clinical trials frequently include multiple end points that mature at different times. The initial report, typically based on the primary end point, may be published when key planned co-primary or secondary analyses are not yet available. Clinical Trial Updates provide an opportunity to disseminate additional results from studies, published in JCO or elsewhere, for which the primary end point has already been reported.The combined analysis of SOFT-TEXT compared outcomes in 4,690 premenopausal women with estrogen/progesterone receptor-positive (ER/PgR+) early breast cancer randomly assigned to 5 years of exemestane + ovarian function suppression (OFS) versus tamoxifen + OFS. After a median follow-up of 9 years, exemestane + OFS significantly improved disease-free survival (DFS) and distant recurrence-free interval (DRFI), but not overall survival, compared with tamoxifen + OFS. We now report DFS, DRFI, and overall survival after a median follow-up of 13 years. In the intention-to-treat (ITT) population, the 12-year DFS (4.6% absolute improvement, hazard ratio [HR], 0.79; 95% CI, 0.70 to 0.90; P < .001) and DRFI (1.8% absolute improvement, HR, 0.83; 95% CI, 0.70 to 0.98; P = .03), but not overall survival (90.1% v 89.1%, HR, 0.93; 95% CI, 0.78 to 1.11), continued to be significantly improved for patients assigned exemestane + OFS over tamoxifen + OFS. Among patients with human epidermal growth factor receptor 2-negative tumors (86.0% of the ITT population), the absolute improvement in 12-year overall survival with exemestane + OFS was 2.0% (HR, 0.85; 95% CI, 0.70 to 1.04) and 3.3% in those who received chemotherapy (45.9% of the ITT population). Overall survival benefit was clinically significant in high-risk patients, eg, women age < 35 years (4.0%) and those with > 2 cm (4.5%) or grade 3 tumors (5.5%). These sustained reductions of the risk of recurrence with adjuvant exemestane + OFS, compared with tamoxifen + OFS, provide guidance for selecting patients for whom exemestane should be preferred over tamoxifen in the setting of OFS.[Media: see text].
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Affiliation(s)
- Olivia Pagani
- Interdisciplinary Cancer Service Hospital Riviera-Chablais Rennaz, Vaud, Switzerland
- Geneva University Hospitals, Lugano University and Swiss Group for Clinical Cancer Research (SAKK), Vaud, Switzerland
| | - Barbara A. Walley
- University of Calgary and Canadian Cancer Trials Group, Calgary, AB, Canada
| | - Gini F. Fleming
- The University of Chicago Medical Center and Alliance for Clinical Trials in Oncology, Chicago, IL
| | - Marco Colleoni
- Division of Medical Senology, IEO, European Institute of Oncology, IRCCS, and International Breast Cancer Study Group, Milan, Italy
| | - István Láng
- Clinexpert-research, Budapest, Hungary (prior affiliation)
- National Institute of Oncology and International Breast Cancer Study Group, Budapest, Hungary
| | - Henry L. Gomez
- Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
- International Breast Cancer Study Group, Lima, Peru
| | - Carlo Tondini
- Osp. Papa Giovanni XXIII and International Breast Cancer Study Group, Bergamo, Italy
| | - Harold J. Burstein
- Susan F. Smith Center for Women's Cancers, Dana-Farber Cancer Institute, Harvard Medical School and Alliance for Clinical Trials in Oncology, Boston, MA
| | - Matthew P. Goetz
- Mayo Clinic and Alliance for Clinical Trials in Oncology, Rochester, MN
| | - Eva M. Ciruelos
- Medical Oncology Department, University Hospital 12 de Octubre and SOLTI Breast Cancer Research Cooperative Group, Madrid, Spain
| | - Vered Stearns
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center and ECOG-ACRIN, Baltimore, MD
| | - Hervé R. Bonnefoi
- Institut Bergonié Comprehensive Cancer Centre, Université de Bordeaux, INSERM U1312, and European Organisation for Research and Treatment of Cancer (EORTC), Bordeaux, France
| | - Silvana Martino
- The Angeles Clinic and Research Institute and SWOG, Santa Monica, CA
| | - Charles E. Geyer
- University of Pittsburgh Medical Center Hillman Cancer Center and NRG Oncology, Pittsburgh, PA
| | - Claudio Chini
- Deaprment of Medical Oncology, Ospedale di Circolo e Fondazione, Lombardy, Italy
| | - Fabio Puglisi
- Department of Medicine (DAME), University of Udine, Italy and Department of Medical Oncology, IRCCS, Centro di Riferimento Oncologico CRO di Aviano, Aviano, Italy
| | - Simon Spazzapan
- Department of Medical Oncology, IRCCS, Centro di Riferimento Oncologico CRO di Aviano, Aviano, Italy
| | - Thomas Ruhstaller
- University of Basel, Swiss Group for Clinical Cancer Research (SAKK) and International Breast Cancer Study Group, Basel, Switzerland
| | - Eric P. Winer
- Susan F. Smith Center for Women's Cancers, Dana-Farber Cancer Institute, Harvard Medical School and Alliance for Clinical Trials in Oncology, Boston, MA
- Yale Cancer Center, Yale School of Medicine; Smilow Cancer Hospital, New Haven, CT (prior affiliation)
| | - Barbara Ruepp
- International Breast Cancer Study Group Coordinating Center, Bern, Switzerland
| | - Sherene Loi
- International Breast Cancer Study Group and Peter MacCallum Cancer Center, University of Melbourne, Melbourne, Victoria, Australia
| | - Alan S. Coates
- International Breast Cancer Study Group and University of Sydney, Sydney, Australia
| | - Richard D. Gelber
- International Breast Cancer Study Group Statistical Center, Dana-Farber Cancer Institute, Harvard Medical School, Harvard TH Chan School of Public Health, Frontier Science Foundation, Boston, MA
| | - Aron Goldhirsch
- European Institute of Oncology, IRCCS, International Breast Cancer Study Group, Milan, Italy
- Deceased
| | - Meredith M. Regan
- International Breast Cancer Study Group Statistical Center, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Prudence A. Francis
- Peter MacCallum Cancer Center, St Vincent's Hospital, Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
- Breast Cancer Trials Australia & New Zealand, University of Newcastle, Australia; International Breast Cancer Study Group, Melbourne, Australia
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Wu M, Wang Q, Zhang M, Cao J, Chen Y, Zheng J, Luo L, Su M, Lin X, Kuang X, Zhang X. Does Combing O-RADS US and CA-125 Improve Diagnostic Accuracy in Assessing Adnexal Malignancy Risk in Women With Different Menopausal Status? J Ultrasound Med 2023; 42:675-685. [PMID: 35880406 DOI: 10.1002/jum.16065] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 07/03/2022] [Accepted: 07/10/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES To evaluate the individual and combined performances of the Ovarian-adnexal Reporting and Data System Ultrasound (O-RADS US) and serum cancer antigen 125 (CA-125) in assessing adnexal malignancy risk in women with different menopausal status. METHODS This retrospective study included patients with adnexal masses scheduled for surgery based on their preoperative US and histopathology results between January 2018 and January 2020. O-RADS were used to assess adnexal malignancy by two experienced radiologists. The area under the receiver operating characteristic curves (AUCs) were used to compare the accuracy of O-RADS and a combination of O-RADS and CA-125. The weighted κ index was used to evaluate the inter-reviewer agreement. RESULTS Overall, the data of 443 lesions in 443 patients were included, involving 312 benign lesions and 131 malignant lesions. There were 361 premenopausal and 82 postmenopausal patients. The inter-reviewer agreement for the two radiologists was very good (weighted κ: 0.833). Combing O-RADS US and CA-125 significantly increased diagnostic accuracy for classifying malignant from benign adnexal masses, compared with O-RADS US alone (AUC: 0.97 vs 0.95, P < .001 for premenopausal population and AUC: 0.93 vs 0.85, P < .001 for postmenopausal population). The AUCs of O-RADS with and without CA-125 ranged from 0.50 to 0.99 for different adnexal pathology subtypes (ie, benign, borderline, Stage I-IV, and metastatic tumors). CONCLUSION The addition of CA-125 helps improve discrimination of O-RADS US between benign and malignant adnexal masses, especially in postmenopausal women.
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Affiliation(s)
- Manli Wu
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Qingjuan Wang
- Department of Ultrasound, Third Hospital of Longgang, Shenzhen, Guangdong Province, China
| | - Man Zhang
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Junyan Cao
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Ying Chen
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Jian Zheng
- Department of Ultrasound, Third Hospital of Longgang, Shenzhen, Guangdong Province, China
| | - Liping Luo
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Manting Su
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Xin Lin
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Xiaohong Kuang
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Xinling Zhang
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
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Vilendecic Z, Radojevic M, Stefanovic K, Dotlic J, Likic Ladjevic I, Dugalic S, Stefanovic A. Accuracy of IOTA simple rules, IOTA ADNEX model, RMI and subjective assessment for preoperative adnexal mass evaluation - the experience of a tertiary care referral hospital. Gynecol Obstet Invest 2023; 88:116-122. [PMID: 36716716 DOI: 10.1159/000529355] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 01/23/2023] [Indexed: 02/01/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate the accuracy of IOTA Simple Rules (SR), IOTA ADNEX model, Risk of Malignancy Index (RMI), and subjective assessment (SA) which is used for adnexal mass assessment in our institution. DESIGN Prospective observational study. PARTICIPANTS/MATERIALS, SETTING, METHODS We included patients with at least one adnexal mass who needed elective surgical evaluation based on clinical and laboratory findings. Patients admitted to Clinic for Gynecology and Obstetrics, University Clinical Center of Serbia were recruited for the study between January 2019 and June 2021. Level II ultrasonographers performed a gray-scale and Doppler exam for each patient. Preoperative classification of adnexal masses (benign or malignant) was performed by subjective assessment (SA), the International Ovarian Analysis Group (IOTA) Simple Rules (SR), IOTA ADNEX model and Risk of Malignancy Index (RMI). Postoperatively obtained histological findings were used as a reference. Results During the study period, we enrolled 179 premenopausal and 217 postmenopausal patients, representing 396 patients in our sample. Prevalence of malignant disease in pre and postmenopausal groups was 16.2% (29/179) and 41% (89/217), respectively. Malignant disease was diagnosed in 29.8% (118/396) of patients. SA achieved the highest discrimination accuracy between benign and malignant tumors (AUC of 0.928, 95% CI (0.898-0.952)). For SA, the overall diagnostic accuracy, sensitivity, specificity, positive likelihood ratio (LR+), and negative likelihood ratio (LR-) were 91.4%, 88.1%, 92.8%, 12.25, and 0.13. The AUC for SR+SA was 0.912 (95% CI (0.880-0.938)). Regarding SR+SA, diagnostic accuracy, sensitivity, specificity, LR+, and LR - were 92.4%, 88.1%, 94.2%, 15.31, and 0.13. The ADNEX model had the AUC of 0.914 (95% CI (0.882-0.940)). Binary classification using the ADNEX model at a cut-off value of 10% for malignancy, had the sensitivity, specificity, LR+ and LR- of 92.4%, 73.0%, 3.42, and 0.10. This resulted in the lowest overall accuracy of 78.8%. The AUC for RMI was 0.854 (95% CI (0.815-0.887)), with overall accuracy, sensitivity, specificity, LR+ and LR- of 82.3%, 73.7%, 86.0%, 5.26, and 0.31. There was no difference in the AUCs of the SA and IOTA models for the whole group, premenopausal, and postmenopausal groups. RMI performed worse compared to SA and the IOTA models. The ADNEX model achieved the highest accuracy at the cut-off value of 35%. Limitations The data generalizability is limited by a single institution-dependent sampling. Conclusions The IOTA Simple Rules and ADNEX model were reliable and comparable with the subjective assessment and performed better than the RMI. The IOTA SR model offers the potential for immediate and reliable diagnosis, even in the hands of less experienced ultrasonographers. Both IOTA models studied can be a valuable adjunct to a clinician's decision-making process.
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Affiliation(s)
- Zoran Vilendecic
- First Surgical Department, Clinic of Obstetrics and Gynecology, University Clinical Center of Serbia, Belgrade, Serbia
- Department of Gynecology and Obstetrics, Medical Faculty, University of Belgrade, Belgrade, Serbia
| | - Milos Radojevic
- First Surgical Department, Clinic of Obstetrics and Gynecology, University Clinical Center of Serbia, Belgrade, Serbia
- Department of Gynecology and Obstetrics, Medical Faculty, University of Belgrade, Belgrade, Serbia
| | - Katarina Stefanovic
- First Surgical Department, Clinic of Obstetrics and Gynecology, University Clinical Center of Serbia, Belgrade, Serbia
- Department of Gynecology and Obstetrics, Medical Faculty, University of Belgrade, Belgrade, Serbia
| | - Jelena Dotlic
- First Surgical Department, Clinic of Obstetrics and Gynecology, University Clinical Center of Serbia, Belgrade, Serbia
- Department of Gynecology and Obstetrics, Medical Faculty, University of Belgrade, Belgrade, Serbia
| | - Ivana Likic Ladjevic
- First Surgical Department, Clinic of Obstetrics and Gynecology, University Clinical Center of Serbia, Belgrade, Serbia
- Department of Gynecology and Obstetrics, Medical Faculty, University of Belgrade, Belgrade, Serbia
| | - Stefan Dugalic
- First Surgical Department, Clinic of Obstetrics and Gynecology, University Clinical Center of Serbia, Belgrade, Serbia
- Department of Gynecology and Obstetrics, Medical Faculty, University of Belgrade, Belgrade, Serbia
| | - Aleksandar Stefanovic
- First Surgical Department, Clinic of Obstetrics and Gynecology, University Clinical Center of Serbia, Belgrade, Serbia
- Department of Gynecology and Obstetrics, Medical Faculty, University of Belgrade, Belgrade, Serbia
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Pavlović Mavić M, Šeparović R, Vazdar L, Tečić Vuger A, Banović M. IMPACT OF BODY COMPOSITION ON THE QUALITY OF LIFE OF PREMENOPAUSAL PATIENTS WITH EARLY STAGE BREAST CANCER DURING CHEMOTHERAPY. Acta Clin Croat 2022; 61:605-612. [PMID: 37868172 PMCID: PMC10588385 DOI: 10.20471/acc.2022.61.04.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 03/02/2021] [Indexed: 10/24/2023] Open
Abstract
Body composition has been studied relatively recently as part of oncology trials in different types of tumors. There are numerous studies that define the impact of chemotherapy side effects on the quality of life (QoL) of breast cancer patients, however, there are few studies that analyze the impact of body composition on the QoL of premenopausal patients in the course of cytotoxic treatment. The study was performed on a sample of premenopausal patients treated with neoadjuvant or adjuvant AC chemotherapy for early-stage breast cancer at Day Hospital of the Department of Medical Oncology, University Hospital for Tumors in Zagreb. The study included 68 patients, median age 46.6 years. Analysis of the QoL questionnaires and their association with body composition indicated several interesting results. At the beginning of treatment, most pronounced was the connection between body composition and physical and sexual functioning and hair loss, while in subsequent treatment cycles the effect on other QoL subdomains, in particular fatigue and diarrhea, was more pronounced. In conclusion, we found body composition to have a significant impact on certain QoL subdomains during treatment.
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Affiliation(s)
- Mirjana Pavlović Mavić
- Sestre milosrdnice University Hospital Center, University Hospital for Tumors, Zagreb, Croatia
| | - Robert Šeparović
- Sestre milosrdnice University Hospital Center, University Hospital for Tumors, Zagreb, Croatia
| | - Ljubica Vazdar
- Sestre milosrdnice University Hospital Center, University Hospital for Tumors, Zagreb, Croatia
| | - Ana Tečić Vuger
- Sestre milosrdnice University Hospital Center, University Hospital for Tumors, Zagreb, Croatia
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50
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Lu LJW, Chen NW, Brunder DG, Nayeem F, Nagamani M, Nishino TK, Anderson KE, Khamapirad T. Soy isoflavones decrease fibroglandular breast tissue measured by magnetic resonance imaging in premenopausal women: A 2-year randomized double-blind placebo controlled clinical trial. Clin Nutr ESPEN 2022; 52:158-168. [PMID: 36513449 PMCID: PMC9825101 DOI: 10.1016/j.clnesp.2022.10.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 10/14/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND & AIMS Populations consuming soy have reduced risk for breast cancer, but the mechanisms are unclear. We tested the hypothesis that soy isoflavones, which have ovarian hormone-like effects, can reduce fibroglandular breast tissue (FGBT, 'breast density'), a strong risk marker for breast cancer. METHODS Premenopausal women (age 30-42 years) were randomized to consume isoflavones (136.6 mg as aglycone equivalents, n = 99) or placebo (n = 98) for 5 days per week up to 2 years, and changes in breast composition measured by magnetic resonance imaging at baseline and yearly intervals were compared after square root transformation using linear mixed effects regression models. RESULTS By intention-to-treat analyses (n = 194), regression coefficients (β estimates) of the interaction of time and isoflavone treatment were -0.238 (P = 0.06) and -0.258 (P < 0.05) before and after BMI adjustment, respectively for FGBT, 0.620 (P < 0.05) and 0.248 (P = 0.160), respectively for fatty breast tissue (FBT), and -0.155 (P < 0.05) and -0.107 (P < 0.05), respectively for FGBT as percent of total breast (FGBT%). β Estimates for interaction of treatment with serum calcium were -2.705 for FBT, and 0.588 for FGBT% (P < 0.05, before but not after BMI adjustment). BMI (not transformed) was related to the interaction of treatment with time (β = 0.298) or with calcium (β = -1.248) (P < 0.05). Urinary excretion of isoflavones in adherent subjects (n = 135) significantly predicted these changes in breast composition. Based on the modeling results, after an average of 1.2, 2.2 and 3.3 years of supplementation, a mean decrease of FGBT by 5.3, 12.1, and 19.3 cc, respectively, and a mean decrease of FGBT% by 1.37, 2.43, and 3.50%, respectively, were estimated for isoflavone exposure compared to placebo treatment. Subjects with maximum isoflavone excretion were estimated to have 38 cc less FGBT (or ∼3.13% less FGBT%) than subjects without isoflavone excretion. Decrease in FGBT and FGBT% was more precise with daidzein than genistein. CONCLUSIONS Soy isoflavones can induce a time- and concentration-dependent decrease in FGBT, a biomarker for breast cancer risk, in premenopausal women, and moderate effects of calcium on BMI and breast fat, suggesting a beneficial effect of soy consumption. TRIAL REGISTRATION www. CLINICALTRIALS gov identifier: NCT00204490. TRIAL REGISTRATION www. CLINICALTRIALS gov identifier: NCT00204490.
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Affiliation(s)
- Lee-Jane W Lu
- Department of Preventive Medicine and Community Health, The University of Texas Medical Branch, Galveston, TX 77555-1109, USA.
| | - Nai-Wei Chen
- Department of Preventive Medicine and Community Health, The University of Texas Medical Branch, Galveston, TX 77555-1109, USA.
| | - Donald G Brunder
- Academic Computing, The University of Texas Medical Branch, Galveston, TX 77555-1035, USA
| | - Fatima Nayeem
- Department of Preventive Medicine and Community Health, The University of Texas Medical Branch, Galveston, TX 77555-1109, USA
| | - Manubai Nagamani
- Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Thomas K Nishino
- Radiology, The University of Texas Medical Branch, Galveston, TX 77555, USA.
| | - Karl E Anderson
- Department of Preventive Medicine and Community Health, The University of Texas Medical Branch, Galveston, TX 77555-1109, USA.
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