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Vafaei S, Alkhrait S, Yang Q, Ali M, Al-Hendy A. Empowering Strategies for Lifestyle Interventions, Diet Modifications, and Environmental Practices for Uterine Fibroid Prevention; Unveiling the LIFE UP Awareness. Nutrients 2024; 16:807. [PMID: 38542717 PMCID: PMC10975324 DOI: 10.3390/nu16060807] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 02/28/2024] [Accepted: 03/07/2024] [Indexed: 04/01/2024] Open
Abstract
Uterine fibroids (UFs) are the most common prevalent benign tumor among women of reproductive age, disproportionately affecting women of color. This paper introduces an innovative management strategy for UFs, emphasizing the curbing of disease prevention and progression. Traditionally, medical intervention is deferred until advanced stages, necessitating invasive surgeries such as hysterectomy or myomectomy, leading to high recurrence rates and increased healthcare costs. The strategy, outlined in this review, emphasizes UF disease management and is named LIFE UP awareness-standing for Lifestyle Interventions, Food Modifications, and Environmental Practices for UF Prevention. These cost-effective, safe, and accessible measures hold the potential to prevent UFs, improve overall reproductive health, reduce the need for invasive procedures, and generate substantial cost savings for both individuals and healthcare systems. This review underscores the importance of a proactive UF management method, paving the way for future research and policy initiatives in this domain.
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Affiliation(s)
| | | | | | - Mohamed Ali
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL 60637, USA; (S.V.); (S.A.); (Q.Y.)
| | - Ayman Al-Hendy
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL 60637, USA; (S.V.); (S.A.); (Q.Y.)
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Zakerinasab F, Behfar Q, Parsaee R, Zadeh RH, Foroughi E, Amirbeik A, Ahmadi G. BRCA 1/2 mutations and risk of uterine cancer: a systematic review and meta-analysis. BMC Genom Data 2024; 25:13. [PMID: 38297203 PMCID: PMC10829221 DOI: 10.1186/s12863-024-01189-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: 09/26/2023] [Accepted: 01/01/2024] [Indexed: 02/02/2024] Open
Abstract
PURPOSE In this study, we aim to investigate the association between BRCA1/2 mutation and uterine cancer incidence. MATERIAL AND METHOD We systematically searched three databases including PubMed, Scopus, and Google Scholar up to August 2023; and reviewed 23 cohorts and cross-sectional studies to explore the association between BRCA1/2 mutations and uterine cancer incidence. RESULTS This systematic review comprised a total of 21 cohort studies and 2 cross-sectional studies after the screening process. According to meta-analysis the prevalence of the BRCA1/2 gene in patients with uterine cancer was 0.02 (95%CI = [0.01,0.03], P < 0.01, I2 = 94.82%) CONCLUSIONS: Our meta-analysis investigates a 2% prevalence of BRCA1/2 mutation in patients with uterine cancer. Patients with BRCA1/2 mutations might be more conscious of uterine malignancies.
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Affiliation(s)
| | - Qumars Behfar
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Reza Parsaee
- Master Student in Molecular Genetics, Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Hossein Zadeh
- Student's Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Elaheh Foroughi
- School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Amirhesam Amirbeik
- Student Research Committee, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Vafaei S, Ciebiera M, Omran MM, Ghasroldasht MM, Yang Q, Leake T, Wolfe R, Ali M, Al-Hendy A. Evidence-Based Approach for Secondary Prevention of Uterine Fibroids (The ESCAPE Approach). Int J Mol Sci 2023; 24:15972. [PMID: 37958957 PMCID: PMC10648339 DOI: 10.3390/ijms242115972] [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: 09/23/2023] [Revised: 10/30/2023] [Accepted: 10/30/2023] [Indexed: 11/15/2023] Open
Abstract
Uterine fibroids (UFs) are common tumors in women of reproductive age. It is imperative to comprehend UFs' associated risk factors to facilitate early detection and prevention. Simple relying on surgical/pharmacological treatment of advanced disease is not only highly expensive, but it also deprives patients of good quality of life (QOL). Unfortunately, even if the disease is discovered early, no medical intervention is traditionally initiated until the disease burden becomes high, and only then is surgical intervention performed. Furthermore, after myomectomy, the recurrence rate of UFs is extremely high with the need for additional surgeries and other interventions. This confused approach is invasive and extremely costly with an overall negative impact on women's health. Secondary prevention is the management of early disease to slow down its progression or even halt it completely. The current approach of watchful observation for early disease is considered a major missed opportunity in the literature. The aim of this article is to present an approach named the ESCAPE (Evidence-Based Approach for Secondary Prevention) of UF management. It comprises simple, inexpensive, and safe steps that can arrest the development of UFs, promote overall reproductive health, decrease the number of unnecessary surgeries, and save billions of health care systems' dollars worldwide.
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Affiliation(s)
- Somayeh Vafaei
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL 60637, USA; (S.V.); (M.M.O.); (M.M.G.); (Q.Y.)
| | - Michał Ciebiera
- Second Department of Obstetrics and Gynecology, Center of Postgraduate Medical Education, 00-189 Warsaw, Poland;
- Warsaw Institute of Women’s Health, 00-189 Warsaw, Poland
- Development and Research Center of Non-Invasive Therapies, Pro-Familia Hospital, 35-302 Rzeszow, Poland
| | - Mervat M. Omran
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL 60637, USA; (S.V.); (M.M.O.); (M.M.G.); (Q.Y.)
| | - Mohammad Mousaei Ghasroldasht
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL 60637, USA; (S.V.); (M.M.O.); (M.M.G.); (Q.Y.)
| | - Qiwei Yang
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL 60637, USA; (S.V.); (M.M.O.); (M.M.G.); (Q.Y.)
| | - Tanya Leake
- The White Dress Project, Atlanta, GA 30309, USA; (T.L.); (R.W.)
| | - Rochelle Wolfe
- The White Dress Project, Atlanta, GA 30309, USA; (T.L.); (R.W.)
| | - Mohamed Ali
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL 60637, USA; (S.V.); (M.M.O.); (M.M.G.); (Q.Y.)
| | - Ayman Al-Hendy
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL 60637, USA; (S.V.); (M.M.O.); (M.M.G.); (Q.Y.)
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Combs A, Singh B, Nylander E, Islam MS, Nguyen HV, Parra E, Bello A, Segars J. A Systematic Review of Vitamin D and Fibroids: Pathophysiology, Prevention, and Treatment. Reprod Sci 2023; 30:1049-1064. [PMID: 35960442 DOI: 10.1007/s43032-022-01011-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: 03/31/2022] [Accepted: 06/12/2022] [Indexed: 10/16/2022]
Abstract
Uterine fibroids are the most common tumor of reproductive-age women worldwide and cause significant morbidity in affected women. Vitamin D has emerged as a potential therapy for uterine fibroids based on experimental and epidemiologic evidence. The objective of this systematic review was to evaluate the role of vitamin D in the pathophysiology of uterine fibroids and its efficacy for prevention and treatment of fibroids. A comprehensive search was conducted of Cochrane Library, Embase, PubMed, Scopus, and Web of Science from inception to March 2022. English-language publications that evaluated vitamin D and uterine fibroids in humans, whether experimental or clinical, were considered. The search yielded 960 publications, and 89 publications met inclusion criteria: 23 preclinical studies, 25 clinical studies, and 41 review articles. Preclinical studies indicated that the vitamin D receptor was decreased in fibroid cells. Vitamin D treatment of fibroid cells decreased proliferation, extracellular matrix protein expression, and Wnt/β-catenin signaling. Fourteen clinical studies (n = 3535 participants) assessed serum vitamin D level in women with ultrasound-proven fibroids, and all found an inverse correlation between serum vitamin D level and presence of fibroids. Five clinical studies (n = 472 patients) evaluated treatment of fibroids with vitamin D. Four of five studies showed vitamin D significantly inhibited fibroid growth. One pilot study (n = 109 patients) of vitamin D for secondary prevention of fibroids demonstrated smaller recurrent fibroids in the treated group. These studies provide evidence for vitamin D as a therapy for uterine fibroids and underscore the need for well-designed, randomized, placebo-controlled clinical trials.
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Affiliation(s)
- Abigail Combs
- Department of Obstetrics and Gynecology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Bhuchitra Singh
- Division of Reproductive Sciences and Women's Health Research, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Ross Research Building, 720 Rutland AvenueRoom 624, Baltimore, MD, USA
| | - Elisabeth Nylander
- Welch Medical Library, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Md Soriful Islam
- Division of Reproductive Sciences and Women's Health Research, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Ross Research Building, 720 Rutland AvenueRoom 624, Baltimore, MD, USA
| | - Ha Vi Nguyen
- Division of Reproductive Sciences and Women's Health Research, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Ross Research Building, 720 Rutland AvenueRoom 624, Baltimore, MD, USA
| | - Elissa Parra
- Division of Reproductive Sciences and Women's Health Research, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Ross Research Building, 720 Rutland AvenueRoom 624, Baltimore, MD, USA
| | - Ameerah Bello
- Division of Reproductive Sciences and Women's Health Research, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Ross Research Building, 720 Rutland AvenueRoom 624, Baltimore, MD, USA
| | - James Segars
- Division of Reproductive Sciences and Women's Health Research, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Ross Research Building, 720 Rutland AvenueRoom 624, Baltimore, MD, USA.
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Xu F, Zheng YL, Lu XY, Qiao HF, Wang Y. Clinical assessment of prophylactic chemotherapy in treating with hydatidiform mole: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e26341. [PMID: 34128882 PMCID: PMC8213282 DOI: 10.1097/md.0000000000026341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 05/28/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Hydatidiform mole (HM) is more common as molar pregnancy. It is a disease classified under the category of gestational trophoblastic diseases, which could metastasize after originating in the placenta. A majority of females suffering from molar pregnancies are curable by evacuating retained products of conception and the patient's fertility is preserved. In some cases, the growth perseveres and leads to gestational trophoblastic neoplasia, which is an extremely malicious condition that needs chemo-based treatment. There is a possibility to lessen the risk of gestational trophoblastic disease in females with HM through the administration of prophylactic chemo. Yet, there is controversy regarding prophylactic chemotherapy administered pre-or-post removal of HM to curtail the malignant sequelae. Therefore, we will conduct this research to assess both the efficacy as well as security of using prophylactic chemotherapy to treat HM. METHODS In the preliminary review, the authors will search for randomized controlled trials involving prophylactic chemotherapy to treat HM. The literature search is carried out in the following electronic databases from their inception to May 2021: Chinese National Knowledge Infrastructure, Chinese BioMedical Literature, and WanFang database are the three Chinese language databases. Web of Science, PubMed, Cochrane Library, and EMBASE are the four English language databases. The authors will also perform a manual search through the bibliographies in related literature to find extra articles and ongoing studies. Two independent authors will assess the literature according to an inclusion criteria, use a specialized data collection table to extract data, and use the Cochrane 'Risk of bias' tool for evaluating any possible bias risk in the selected articles. Data synthesis and statistical operations are completed with the RevMan software (v. 5.3). RESULTS The present systematic analysis provides a rationalized synthesis of existing evidence related to the use of prophylactic chemotherapy in the treatment of HM. CONCLUSION Our findings will summarize the current evidences for prophylactic chemotherapy in the treatment of HM. ETHICS AND DISSEMINATION An ethics approval is nonrequired because pre published results will be used. REGISTRATION NUMBER DOI 10.17605/OSF.IO/6QV52 (https://osf.io/6qv52/).
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Perri T, Harel G, Dadon T, Mor-Sasson A, Yagel I, Ben-Baruch G, Korach J. Frequency and prediction of deep uterine involvement in advanced high-grade epithelial ovarian cancer: is uterine preservation an option? Int J Gynecol Cancer 2020; 31:251-256. [PMID: 33172922 DOI: 10.1136/ijgc-2020-001850] [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: 07/11/2020] [Revised: 09/16/2020] [Accepted: 09/18/2020] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Hysterectomy is traditionally part of the surgical treatment for advanced high-grade epithelial ovarian carcinomas, although the incidence of uterine involvement has not been fully investigated. Some young patients with advanced high-grade epithelial ovarian carcinomas want uterine preservation. We aimed to determine the frequency of non-serosal (deep) uterine involvement in patients with high-grade epithelial ovarian carcinomas and to establish predictive factors for such involvement. METHODS A retrospective cohort study was performed of 366 consecutive patients with advanced high-grade epithelial ovarian carcinomas who had surgery between January 2012 and December 2019. Data collected included demographic and clinical details, and surgical and pathological reports to determine macroscopic and microscopic deep uterine involvement. The characteristics of the patients with and without deep uterine involvement were compared and univariate and multivariate Cox proportional hazard models were used to assess correlations and determine risk factors. RESULTS A total of 311 patients were included in the final analysis. The mean age was 62±11.6 years, with 32 (10.3%) being younger than 45. Most (92.3%) had serous carcinoma. Uterine involvement, excluding superficial (serosa-only), was present microscopically in 194 patients (62.4%) but was detected macroscopically at surgery in only 166 patients. Deep involvement was missed at surgery in 28 patients (14.4%), including parametrial involvement (n=18), parametria plus cervix (n=2), cervical involvement (n=3), endometrium (n=3), and myometrium (n=2). Multivariate analysis identified factors associated with deep uterine involvement including residual disease at surgery (HR 2.43, 95% CI 1.13 to 4.48; p=0.004) and CA125 >1000 U (HR 1.8, 95% CI 1.09 to 2.94; p=0.02). CONCLUSIONS The incidence of deep uterine involvement in high-grade epithelial ovarian carcinomas is high. It can be diagnosed in most but not all cases on gross examination at surgery and is associated with residual disease and CA125 >1000 U. Patients who desire uterine preservation should be advised on an individual basis, given these factors and the operative findings.
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Affiliation(s)
- Tamar Perri
- Gynecologic Oncology, Sheba Medical Center, Tel Hashomer, Israel
- Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Gal Harel
- Gynecologic Oncology, Sheba Medical Center, Tel Hashomer, Israel
- Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Tal Dadon
- Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Aya Mor-Sasson
- Gynecologic Oncology, Sheba Medical Center, Tel Hashomer, Israel
- Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Itai Yagel
- Gynecologic Oncology, Sheba Medical Center, Tel Hashomer, Israel
- Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Gilad Ben-Baruch
- Gynecologic Oncology, Sheba Medical Center, Tel Hashomer, Israel
- Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Jacob Korach
- Gynecologic Oncology, Sheba Medical Center, Tel Hashomer, Israel
- Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
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Ciebiera M, Ali M, Zgliczyńska M, Skrzypczak M, Al-Hendy A. Vitamins and Uterine Fibroids: Current Data on Pathophysiology and Possible Clinical Relevance. Int J Mol Sci 2020; 21:ijms21155528. [PMID: 32752274 PMCID: PMC7432695 DOI: 10.3390/ijms21155528] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 07/27/2020] [Accepted: 07/30/2020] [Indexed: 01/27/2023] Open
Abstract
Uterine fibroid (UF) is the most common benign tumor pathology of the female reproductive organs. UFs constitute the main reason for a hysterectomy and hospitalization due to gynecological conditions. UFs consist of uterine smooth muscle immersed in a large amount of extracellular matrix (ECM). Genetic studies have demonstrated that UFs are monoclonal tumors originating from the myometrial stem cells that have underwent specific molecular changes to tumor initiating stem cells which proliferate and differentiate later under the influence of steroid hormones. There is growing interest in the role of micronutrients, for example, vitamins, in UFs. This article is a comprehensive review of publications regarding the available data concerning the role of vitamins in the biology and management of UFs. In summary, the results showed that some vitamins are important in the biology and pathophysiology of UFs. For example, vitamins A and D deserve particular attention following studies of their influence on the treatment of UF tumors. Vitamins B3, C, and E have not been as widely studied as the abovementioned vitamins. However, more research could reveal their potential role in UF biology.
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Affiliation(s)
- Michał Ciebiera
- Second Department of Obstetrics and Gynecology, The Center of Postgraduate Medical Education, 01-809 Warsaw, Poland;
- Department of Surgery, University of Illinois at Chicago, Chicago, IL 60612, USA;
- Correspondence: (M.C.); (A.A.-H.); Tel.: +48-225690274 (M.C.); +1-312-996-7006 (A.A.-H.)
| | - Mohamed Ali
- Department of Surgery, University of Illinois at Chicago, Chicago, IL 60612, USA;
- Clinical Pharmacy Department, Faculty of Pharmacy, Ain Shams University, 11566 Cairo, Egypt
| | - Magdalena Zgliczyńska
- Second Department of Obstetrics and Gynecology, The Center of Postgraduate Medical Education, 01-809 Warsaw, Poland;
| | - Maciej Skrzypczak
- Second Department of Gynecology, Medical University of Lublin, 20-954 Lublin, Poland;
| | - Ayman Al-Hendy
- Department of Surgery, University of Illinois at Chicago, Chicago, IL 60612, USA;
- Correspondence: (M.C.); (A.A.-H.); Tel.: +48-225690274 (M.C.); +1-312-996-7006 (A.A.-H.)
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Lin PH, Shih CK, Yen YT, Chiang W, Hsia SM. Adlay ( Coix lachryma-jobi L. var. ma-yuen Stapf.) Hull Extract and Active Compounds Inhibit Proliferation of Primary Human Leiomyoma Cells and Protect against Sexual Hormone-Induced Mice Smooth Muscle Hyperproliferation. Molecules 2019; 24:molecules24081556. [PMID: 31010220 PMCID: PMC6514562 DOI: 10.3390/molecules24081556] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 04/13/2019] [Accepted: 04/18/2019] [Indexed: 01/09/2023] Open
Abstract
Uterine leiomyomas, also known as fibroids, are benign neoplasms of the uterus and have a high incidence rate in women of reproductive age. Hysterectomy or myomectomy is the initial treatment, but fibroids will recur if the patient is still exposed to similar risk factors. Therefore, developing new therapeutic strategies are urgently necessary. In this study, the anti-proliferation effects of each fraction of adlay seeds were evaluated in uterine leiomyomas, and we identified the potential phytochemical compounds. We found that the ethyl acetate fraction of adlay hull (AHE-ea) appeared to be highly efficient in the anti-proliferation of rat uterine leiomyoma ELT3 cells and primary human uterine leiomyoma (hUL) cells. The proliferation of primary human normal uterine smooth muscle (UtSMC) and normal uterine myometrial (hUM) cells were also suppressed by AHE-ea. Two phytosterols, stigmasterol and β-sitosterol, were identified from AHE-ea fraction. Mice treated with AHE-ea and stigmasterol alone demonstrated reduced diethylstilbestrol/medroxyprogesterone 17-acetate (DES/MPA)-induced uterine myometrial hyperplasia, which is the critical step for the development of leiomyoma. Taken together, our results suggest that the AHE-ea fraction could be considered as a natural plant-based medicine in the prevention or treatment of uterine leiomyoma growth.
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Affiliation(s)
- Po-Han Lin
- School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, Taipei 11031, Taiwan.
| | - Chun-Kuang Shih
- School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, Taipei 11031, Taiwan.
| | - Yu-Ting Yen
- Institute of Food Science and Technology, National Taiwan University, Taipei 10617, Taiwan.
| | - Wenchang Chiang
- Institute of Food Science and Technology, National Taiwan University, Taipei 10617, Taiwan.
| | - Shih-Min Hsia
- School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, Taipei 11031, Taiwan.
- Graduate Institute of Metabolism and Obesity Sciences, College of Nutrition, Taipei Medical University, Taipei 11031, Taiwan.
- School of Food Safety, College of Nutrition, Taipei Medical University, Taipei 11031, Taiwan.
- Nutrition Research Center, Taipei Medical University Hospital, Taipei 11031, Taiwan.
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Dhar JP, Essenmacher L, Dhar R, Magee A, Ager J, Sokol RJ. The effect of history of abnormal pap smear or preceding HPV infection on the humoral immune response to Quadrivalent Human Papilloma virus (qHPV) vaccine in women with systemic lupus erythematosus. Hum Vaccin Immunother 2018; 14:2318-2322. [PMID: 29708835 PMCID: PMC6183302 DOI: 10.1080/21645515.2018.1469592] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 11/13/2017] [Revised: 04/03/2018] [Accepted: 04/22/2018] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE To determine if natural human papillomavirus (HPV) infection would induce an anamnestic response to quadrivalent (qHPV) vaccine in women with Systemic Lupus Erythematosus (SLE). METHODS Thirty four women (19-50 years) with mild to moderate and minimally active or inactive SLE received standard qHPV vaccine. Neutralizing antibody titers to HPV 6, 11, 16 and18 were evaluated pre- and post- vaccine using HPV competitive Luminex Immunoassay. For each HPV type, logistic regressions were performed to explore the relationship between a positive titer at baseline with their final geometric mean titer and with the rise in titer. Fisher's Exact Test was used to assess the association of at least one positive HPV antibody test at baseline and history of abnormal pap. RESULTS History of abnormal pap smear/cervical neoplasia occurred in 52.9%. Baseline anti HPV antibody titers: 21% = negative for all 4 HPV types, 79% = positive for ≥1 of the HPV types. Statistical analysis showed: those with a history of abnormal pap smear/cervical neoplasia were likely to have a positive anti-HPV antibody result pre-vaccine to ≥ 1 of the 4 types, p = 0.035 Fisher's Exact Test. In general, HPV exposed women showed higher post vaccine GMTs than HPV unexposed women with higher point estimates. However, when examining the rise in titers using logistic regression, there was no evidence of an anamnestic response. CONCLUSION Prior HPV infection and cervical neoplasia in SLE are linked with no anamnestic response to HPV vaccine. This supports not checking HPV-antibodies pre-vaccine. Women with SLE should be vaccinated for HPV.
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MESH Headings
- Adolescent
- Adult
- Antibodies, Neutralizing/blood
- Antibodies, Viral/blood
- Female
- Human Papillomavirus Recombinant Vaccine Quadrivalent, Types 6, 11, 16, 18/administration & dosage
- Human Papillomavirus Recombinant Vaccine Quadrivalent, Types 6, 11, 16, 18/immunology
- Humans
- Immunity, Humoral
- Immunoassay
- Immunologic Memory
- Lupus Erythematosus, Systemic/complications
- Middle Aged
- Papanicolaou Test
- Papillomavirus Infections/immunology
- Papillomavirus Infections/prevention & control
- Uterine Cervical Neoplasms/immunology
- Uterine Cervical Neoplasms/prevention & control
- Uterine Neoplasms/immunology
- Uterine Neoplasms/prevention & control
- Young Adult
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Affiliation(s)
- J. Patricia Dhar
- Internal Medicine, Wayne State University School of Medicine, C.S. Mott Center for Human Growth and Development, Detroit, MI, USA
| | | | - Renee Dhar
- Medical student, Class 2018, Central Michigan University College of Medicine, Mt. Pleasant, MI, USA
| | - Ardella Magee
- Research, Wayne State University School of Medicine, Detroit, MI, USA
| | - Joel Ager
- Family Medicine, Wayne State University School of Medicine, Detroit, MI, USA
| | - Robert J. Sokol
- Obstetrics & Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
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Abstract
BACKGROUND Endometrial cancer is one of the most common gynaecological cancers in the world. Rates of endometrial cancer are rising, in part because of rising obesity rates. Endometrial hyperplasia is a precancerous condition in women that can lead to endometrial cancer if left untreated. Endometrial hyperplasia occurs more commonly than endometrial cancer. Progesterone tablets currently used to treat women with endometrial hyperplasia are associated with adverse effects in up to 84% of women. The levonorgestrel intrauterine device (Mirena Coil, Bayer HealthCare Pharmaceuticals, Inc., Whippany, NJ, USA) may improve compliance, but it is invasive, is not acceptable to all women, and is associated with irregular vaginal bleeding in 82% of cases. Therefore, an alternative treatment for women with endometrial hyperplasia is needed. Metformin, a drug that is often used to treat people with diabetes, has been shown in some human studies to reverse endometrial hyperplasia. However, the effectiveness and safety of metformin for treatment of endometrial hyperplasia remain uncertain. OBJECTIVES To determine the effectiveness and safety of metformin in treating women with endometrial hyperplasia. SEARCH METHODS We searched the Cochrane Gynaecology and Fertility Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, Google Scholar, OpenGrey, Latin American Caribbean Health Sciences Literature (LILACS), and two trials registers from inception to 10 January 2017. We searched the bibliographies of all included studies and reviews on this topic. We also handsearched the conference abstracts of the European Society of Human Reproduction and Embryology (ESHRE) 2015 and the American Society for Reproductive Medicine (ASRM) 2015. SELECTION CRITERIA We included randomised controlled trials (RCTs) and cross-over trials comparing metformin (used alone or in combination with other medical therapies) versus placebo or no treatment, any conventional medical treatment, or any other active intervention for women with histologically confirmed endometrial hyperplasia of any type. DATA COLLECTION AND ANALYSIS Two review authors independently assessed studies for eligibility, extracted data from included studies, and assessed the risk of bias of included studies. We resolved disagreements by discussion or by deferment to a third review author. When study details were missing, review authors contacted study authors. The primary outcome of this review was regression of endometrial hyperplasia histology (with or without atypia) towards normal histology. Secondary outcome measures included recurrence of endometrial hyperplasia, progression of endometrial hyperplasia to endometrial cancer, hysterectomy rate, abnormal uterine bleeding, health-related quality of life, and adverse effects during treatment. MAIN RESULTS We included three RCTs in which a total of 77 women took part. We rated the quality of the evidence as very low for all outcomes owing to very serious risk of bias (associated with poor reporting, attrition, and limitations in study design) and imprecision.We performed a meta-analysis of two trials with 59 participants. When metformin was compared with megestrol acetate in women with endometrial hyperplasia, we found insufficient evidence to determine whether there were differences between groups for the following outcomes: regression of endometrial hyperplasia histology towards normal histology (odds ratio (OR) 3.34, 95% confidence interval (CI) 0.97 to 11.57, two RCTs, n = 59, very low-quality evidence), hysterectomy rates (OR 0.91, 95% CI 0.05 to 15.52, two RCTs, n = 59, very low-quality evidence), and rates of abnormal uterine bleeding (OR 0.91, 95% CI 0.05 to 15.52, two RCTs, n = 44 , very low-quality evidence). We found no data for recurrence of endometrial hyperplasia or health-related quality of life. Both studies (n = 59) provided data on progression of endometrial hyperplasia to endometrial cancer as well as one (n = 16) reporting some adverse effects in the metformin arm, notably nausea, thrombosis, lactic acidosis, abnormal liver and renal function among others.Another trial including 16 participants compared metformin plus megestrol acetate versus megestrol acetate alone in women with endometrial hyperplasia. We found insufficient evidence to determine whether there were differences between groups for the following outcomes: regression of endometrial hyperplasia histology towards normal histology (OR 9.00, 95% CI 0.94 to 86.52, one RCT, n = 16, very low-quality evidence), recurrence of endometrial hyperplasia among women who achieve regression (OR not estimable, no events recorded, one RCT, n = 8, very low-quality evidence), progression of endometrial hyperplasia to endometrial cancer (OR not estimable, no events recorded, one RCT, n = 13, very low-quality evidence), or hysterectomy rates (OR 0.29, 95% CI 0.01 to 8.37, one RCT, n = 16, very low-quality evidence). Investigators provided no data on abnormal uterine bleeding or health-related quality of life. In terms of adverse effects, three of eight participants (37.5%) in the metformin plus megestrol acetate study arm reported nausea. AUTHORS' CONCLUSIONS At present, evidence is insufficient to support or refute the use of metformin alone or in combination with standard therapy - specifically, megestrol acetate - versus megestrol acetate alone, for treatment of endometrial hyperplasia. Robustly designed and adequately powered randomised controlled trials yielding long-term outcome data are needed to address this clinical question.
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Affiliation(s)
- Naomi S Clement
- University of NottinghamFaculty of Health Sciences and MedicineQueen's Medical Centre, Derby RoadNottinghamUKNG7 2UH
| | - Thomas RW Oliver
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation TrustDepartment of HistopathologyHills RoadCambridgeCambridgeshireUKCB2 0QQ
| | - Hunain Shiwani
- Leeds Teaching Hospitals NHS TrustDepartment of RadiologyGreat George StreetLeedsUKLS1 3EX
| | - Juliane RF Sanner
- The University of NottinghamFaculty of Health Sciences and MedicineQueen's Medical CentreDerby RoadNottinghamNottinhgamshireUKNG7 2UH
| | | | - William Atiomo
- The University of NottinghamFaculty of Health Sciences and MedicineQueen's Medical CentreDerby RoadNottinghamNottinhgamshireUKNG7 2UH
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11
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Katsuda SI, Yoshida M, Saarinen N, Smeds A, Nakae D, Santti R, Maekawa A. Chemopreventive Effects of Hydroxymatairesinol on Uterine Carcinogenesis in Donryu Rats. Exp Biol Med (Maywood) 2016; 229:417-24. [PMID: 15096654 DOI: 10.1177/153537020422900510] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [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: 11/16/2022] Open
Abstract
Hydroxymatairesinol (HMR), obtained from the heartwood of spruce (Picea abies), has been demonstrated to exert chemopreventive effects on the development of mammary tumors in rats. To examine the influence of HMR on uterine carcinogenesis, adult Donryu rats were initiated with a single intrauterine treatment of N-ethyl-N'-nitro-N-nitrosoguanidine (ENNG) at 11 weeks of age and fed thereafter 0, 200, or 600 ppm HMR mixed in the soy-containing diet until 15 months of age. Incidences of uterine adenocarcinoma in both 200 and 600 ppm HMR-dosed groups were significantly reduced to 11% and 15%, respectively, less than 50% of 0 ppm, at the end of the experiment (P < 0.05). A delay in the start of persistent estrus by HMR was observed at 8 months of age compared with controls given carcinogen alone. From urinalysis, HMR was metabolized mainly to enterolactone and hydroxyenterolactone. These findings suggest that HMR or its metabolites exert chemopreventive effects in the rat ENNG-uterine carcinogenesis model.
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Affiliation(s)
- Shin-ichi Katsuda
- Department of Biological Safety Research, Japan Food Research Laboratories, Tama-shi, Tokyo 206-0025, Japan.
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12
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Shu CA, Pike MC, Jotwani AR, Friebel TM, Soslow RA, Levine DA, Nathanson KL, Konner JA, Arnold AG, Bogomolniy F, Dao F, Olvera N, Bancroft EK, Goldfrank DJ, Stadler ZK, Robson ME, Brown CL, Leitao MM, Abu-Rustum NR, Aghajanian CA, Blum JL, Neuhausen SL, Garber JE, Daly MB, Isaacs C, Eeles RA, Ganz PA, Barakat RR, Offit K, Domchek SM, Rebbeck TR, Kauff ND. Uterine Cancer After Risk-Reducing Salpingo-oophorectomy Without Hysterectomy in Women With BRCA Mutations. JAMA Oncol 2016; 2:1434-1440. [PMID: 27367496 PMCID: PMC5594920 DOI: 10.1001/jamaoncol.2016.1820] [Citation(s) in RCA: 157] [Impact Index Per Article: 19.6] [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] [Indexed: 12/24/2022]
Abstract
IMPORTANCE The link between BRCA mutations and uterine cancer is unclear. Therefore, although risk-reducing salpingo-oophorectomy (RRSO) is standard treatment among women with BRCA mutations (BRCA+ women), the role of concomitant hysterectomy is controversial. OBJECTIVE To determine the risk for uterine cancer and distribution of specific histologic subtypes in BRCA+ women after RRSO without hysterectomy. DESIGN, SETTING, AND PARTICIPANTS This multicenter prospective cohort study included 1083 women with a deleterious BRCA1 or BRCA2 mutation identified from January 1, 1995, to December 31, 2011, at 9 academic medical centers in the United States and the United Kingdom who underwent RRSO without a prior or concomitant hysterectomy. Of these, 627 participants were BRCA1+; 453, BRCA2+; and 3, both. Participants were prospectively followed up for a median 5.1 (interquartile range [IQR], 3.0-8.4) years after ascertainment, BRCA testing, or RRSO (whichever occurred last). Follow up data available through October 14, 2014, were included in the analyses. Censoring occurred at uterine cancer diagnosis, hysterectomy, last follow-up, or death. New cancers were categorized by histologic subtype, and available tumors were analyzed for loss of the wild-type BRCA gene and/or protein expression. MAIN OUTCOMES AND MEASURES Incidence of uterine corpus cancer in BRCA+ women who underwent RRSO without hysterectomy compared with rates expected from the Surveillance, Epidemiology, and End Results database. RESULTS Among the 1083 women women who underwent RRSO without hysterectomy at a median age 45.6 (IQR: 40.9 - 52.5), 8 incident uterine cancers were observed (4.3 expected; observed to expected [O:E] ratio, 1.9; 95% CI, 0.8-3.7; P = .09). No increased risk for endometrioid endometrial carcinoma or sarcoma was found after stratifying by subtype. Five serous and/or serous-like (serous/serous-like) endometrial carcinomas were observed (4 BRCA1+ and 1 BRCA2+) 7.2 to 12.9 years after RRSO (BRCA1: 0.18 expected [O:E ratio, 22.2; 95% CI, 6.1-56.9; P < .001]; BRCA2: 0.16 expected [O:E ratio, 6.4; 95% CI, 0.2-35.5; P = .15]). Tumor analyses confirmed loss of the wild-type BRCA1 gene and/or protein expression in all 3 available serous/serous-like BRCA1+ tumors. CONCLUSIONS AND RELEVANCE Although the overall risk for uterine cancer after RRSO was not increased, the risk for serous/serous-like endometrial carcinoma was increased in BRCA1+ women. This risk should be considered when discussing the advantages and risks of hysterectomy at the time of RRSO in BRCA1+ women.
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Affiliation(s)
- Catherine A. Shu
- Division of Hematology/Oncology, Columbia University Medical Center, New York, NY
| | - Malcolm C. Pike
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Anjali R. Jotwani
- Clinical Genetics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Tara M. Friebel
- Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Robert A. Soslow
- Gynecologic Pathology Service, Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Douglas A. Levine
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Katherine L. Nathanson
- Basser Center for BRCA and Abramson Cancer Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Jason A. Konner
- Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Angela G. Arnold
- Clinical Genetics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Faina Bogomolniy
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Fanny Dao
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Narciso Olvera
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Deborah J. Goldfrank
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Zsofia K. Stadler
- Clinical Genetics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Mark E. Robson
- Clinical Genetics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Breast Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Carol L. Brown
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Mario M. Leitao
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Nadeem R. Abu-Rustum
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Carol A. Aghajanian
- Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Joanne L. Blum
- Baylor-Charles A. Sammons Cancer Center, Texas Oncology, Dallas, TX
| | - Susan L. Neuhausen
- Population Sciences Department, Beckman Research Institute, City of Hope National Medical Center, Duarte, CA
| | - Judy E. Garber
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Mary B. Daly
- Department of Clinical Genetics, Fox Chase Cancer Center, Philadelphia, PA
| | - Claudine Isaacs
- Department of Oncology and Medicine, Lombardi Comprehensive Cancer Center, Georgetown University School of Medicine, Washington, DC
| | - Rosalind A. Eeles
- Institute of Cancer Research, Royal Marsden NHS Foundation Trust, London, UK
| | - Patricia A. Ganz
- UCLA Schools of Public Health and Medicine, and the Center for Cancer Prevention and Control Research, Jonsson Comprehensive Cancer Center, University of California, Los Angeles, CA
| | - Richard R. Barakat
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Kenneth Offit
- Clinical Genetics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Susan M. Domchek
- Basser Center for BRCA and Abramson Cancer Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Timothy R. Rebbeck
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Noah D. Kauff
- Clinical Cancer Genetics Program, Duke Cancer Institute/Duke University Health System, Durham, NC
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13
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Ni T, Sun X, Shan B, Wang J, Liu Y, Gu SL, Wang YD. Detection of circulating tumour cells may add value in endometrial cancer management. Eur J Obstet Gynecol Reprod Biol 2016; 207:1-4. [PMID: 27756035 DOI: 10.1016/j.ejogrb.2016.09.031] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [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: 06/12/2016] [Revised: 08/02/2016] [Accepted: 09/21/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the role of circulating tumour cells (CTCs) in patients with endometrial cancer (EC). STUDY DESIGN This study included 40 patients with a pre-operative diagnosis of high-risk EC between April 2015 and May 2016. Patients were further divided into high-risk (grade 3, non-endometrioid, myometrial invasion ≥1/2 and stage III-IV) and high-intermediate-risk (grade 2-3, endometrioid, myometrial invasion <1/2 and stage I-II) groups according to postoperative pathological results. CTCs were detected using the CellSearch system, and CTC results were correlated with standard clinicopathological characteristics and serum tumour marker CA125/HE4 status using Chi-squared test, continuity correction or Fisher's exact test. The pharmacodynamic effect was detected after the first cycle of adjuvant therapy. Patients were followed up for 13 months to assess outcomes. RESULTS Fifteen percent of patients had one or more CTCs. The presence of CTCs was found to be significantly associated with cervical involvement (83.33% vs 11.76%, p=0.00). No significant difference in CTC-positive rates was detected between the high-risk and high-intermediate-risk groups, and no significant correlation was found between CTCs and serum CA125/HE4, either by positive rates or exact serum levels of the conventional tumour markers. No more CTCs were detected after the first cycle of standard chemotherapy in this study, and no distant metastases or recurrence were found in the CTC-positive patients during the follow-up period. CONCLUSION The presence of CTCs was correlated with cervical involvement. Early-stage EC patients with CTCs may benefit from additional adjuvant therapies. Assessment of CTCs may be useful in the management of high-risk EC patients.
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MESH Headings
- Adult
- Aged
- Biomarkers, Tumor/blood
- CA-125 Antigen/blood
- Carcinoma, Endometrioid/blood
- Carcinoma, Endometrioid/pathology
- Carcinoma, Endometrioid/secondary
- Carcinoma, Endometrioid/therapy
- Cervix Uteri/drug effects
- Cervix Uteri/pathology
- Cervix Uteri/surgery
- Chemotherapy, Adjuvant
- Cystadenocarcinoma, Serous/blood
- Cystadenocarcinoma, Serous/pathology
- Cystadenocarcinoma, Serous/secondary
- Cystadenocarcinoma, Serous/therapy
- Endometrial Neoplasms/blood
- Endometrial Neoplasms/pathology
- Endometrial Neoplasms/prevention & control
- Endometrial Neoplasms/therapy
- Endometrium/drug effects
- Endometrium/pathology
- Endometrium/surgery
- Female
- Follow-Up Studies
- Humans
- Membrane Proteins/blood
- Middle Aged
- Myometrium/drug effects
- Myometrium/pathology
- Myometrium/surgery
- Neoplasm Grading
- Neoplasm Invasiveness
- Neoplasm Recurrence, Local/prevention & control
- Neoplasm Staging
- Neoplastic Cells, Circulating/drug effects
- Neoplastic Cells, Circulating/pathology
- Proteins/analysis
- Uterine Cervical Neoplasms/drug therapy
- Uterine Cervical Neoplasms/prevention & control
- Uterine Cervical Neoplasms/secondary
- Uterine Cervical Neoplasms/surgery
- Uterine Neoplasms/drug therapy
- Uterine Neoplasms/prevention & control
- Uterine Neoplasms/secondary
- Uterine Neoplasms/surgery
- WAP Four-Disulfide Core Domain Protein 2
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Affiliation(s)
- T Ni
- Department of Gynaecology, International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - X Sun
- Laboratory of Gynaecologic Oncology, International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - B Shan
- Fudan University Shanghai Cancer Centre, Shanghai, China
| | - J Wang
- Department of Gynaecology, International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Y Liu
- Department of Gynaecology, International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - S-L Gu
- Department of Gynaecology, International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Y-D Wang
- Department of Gynaecology, International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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14
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Abstract
Chemicals known to disrupt the endocrine system of animal models are assessed for their potential impact on the health of menopausal and postmenopausal women. These "endocrine disrupters" consist of two groups of compounds – man-made and naturally occurring. There is some evidence to suggest that the naturally occurring phytoestrogens, derived from plant material, may have some beneficial effects on menopausal symptoms and the risk of breast cancer, cardiovascular disease and osteoporosis. Further studies are required to confirm these possibilities. Some man-made environmental pollutants appear to increase the risk of breast cancer, although again the evidence is inconclusive. Mechanistic experiments indicate that these chemicals interact with oestrogen receptors and alter metabolism in a number of different ways, some of which may be important in postmenopausal women. Further investigation of the differences in mode of action between the manmade and the natural endocrine disrupters may lead to important insights into their effects on women's health.
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Affiliation(s)
- Philip Holmes
- MRC Institute for Environment and Health, University of Leicester, 94 Regent Road, Leicester, LE1 7DD, UK
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15
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16
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Tseng JH, Long Roche K, Jernigan AM, Salani R, Bristow RE, Fader AN. Lifestyle and Weight Management Counseling in Uterine Cancer Survivors: A Study of the Uterine Cancer Action Network. Int J Gynecol Cancer 2015; 25:1285-91. [PMID: 25966932 DOI: 10.1097/igc.0000000000000475] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [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: 01/29/2023] Open
Abstract
OBJECTIVE The purpose of this study was to examine the experiences, attitudes, and preferences of uterine cancer survivors with regard to weight and lifestyle counseling. MATERIALS AND METHODS Members of the US Uterine Cancer Action Network of the Foundation for Women's Cancer were invited to complete a 45-item, Web-based survey. Standard descriptive statistical methods and χ tests were used to analyze responses. RESULTS One hundred eighty (28.3%) uterine cancer survivors completed the survey. Median age was 58 years, 85% were white, and median survivorship period was 4.4 years. Most had stage I-II disease (69%) and were overweight or obese (65%). Eighty-nine percent of respondents received care by a gynecologic oncologist. Increased respondent body mass index was associated with decreased exercise frequency (P = 0.016). Only 50% of respondents underwent any weight/lifestyle counseling, with those living in the West and Southwest reporting the highest rates (70.8% and 69.2%, P = 0.011). Most who received counseling felt that discussions were motivating, performed in a sensitive manner, and did not undermine the patient-physician relationship. Specific recommendations were rarely offered; there were no reported referrals to weight loss programs or bariatric specialists, and few (6%) reported referrals to nutritionists. Respondents (85%) preferred their gynecologic oncologist address weight using direct, face-to-face counseling with specific recommendations regarding interventions and referral to specialists. Finally, self-reported overweight respondents experienced greater success with weight loss compared to those reporting obesity or morbid obesity (30.8% vs 15.8% vs 12.5%, P = 0.011). CONCLUSIONS Uterine cancer survivors reported high obesity, low activity rates, and a desire for substantive weight loss counseling from their gynecologic oncologists. Respondents suggested that current counseling practices are inadequate and incongruent with their needs. Further research to define optimal timing, interventional strategies, and specific recommendations for successful lifestyle changes in this population is warranted.
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Affiliation(s)
- Jill H Tseng
- *The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD; †Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, OH; and ‡Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California-Irvine, Orange, CA
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17
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Phillips S, Nonzee N, Tom L, Murphy K, Hajjar N, Bularzik C, Dong X, Simon MA. Patient navigators' reflections on the navigator-patient relationship. J Cancer Educ 2014; 29:337-44. [PMID: 24493636 PMCID: PMC4029856 DOI: 10.1007/s13187-014-0612-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Patient navigation emerged as a strategy to reduce cancer disparities among low-income and minority patients and has demonstrated efficacy in improving clinical outcomes. Observational studies have contributed valuable evaluations of navigation processes and tasks; however, few have offered in-depth reflections about the relationship between patient and navigator from the navigators' perspective. These approaches have addressed the emotional and relational components of patient navigation through the lens of process factors, relegating the navigator-patient relationship to a siloed, compartmentalized functionality. To expand upon existing task-oriented definitions of navigation, we conducted qualitative interviews among community-based patient navigators who coordinated care for uninsured, predominantly Hispanic, women receiving cancer screening and follow-up care in a county outside Chicago. Interviews were recorded, transcribed, and analyzed for themes within the navigator-patient relationship domain. The main themes that emerged centered on relational roles, relational boundaries, and ideal navigator relational qualities. While patient navigators described engaging with patients in a manner similar to a friend, they stressed the importance of maintaining professional boundaries. Navigators' support assisted patients in bridging their hospital and community lives, a result of navigators' investment in both hemispheres. We conclude that the navigator-patient relationship is not a self-contained utility, but rather the medium through which all other navigator functions are enabled. These insights further characterize the navigator-patient relationship, which will help shape the development of future navigation programs and support the need for further research on the impact of relationship factors on clinical and psychosocial outcome measures.
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Affiliation(s)
- Sara Phillips
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, 633 N St. Clair Street, Suite 1800, Chicago, IL, 60611, USA
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18
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Stankiewicz A, Pogany L, Popadiuk C. Prevalence of self-reported hysterectomy among Canadian women, 2000/2001-2008. Chronic Dis Inj Can 2014; 34:30-35. [PMID: 24618379] [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: 06/03/2023]
Abstract
BACKGROUND Hysterectomy is one of the most frequently performed surgical procedures among Canadian women. The consequence is a population that no longer requires cervical cancer screening. The objective of our analysis was to provide more accurate estimates of eligible participation in cervical screening by estimating the age-specific prevalence of hysterectomy among Canadian women aged 20 to 69 by province and territory between 2000/2001 and 2008. METHODS Self-reported hysterectomy prevalence was obtained from the 2000/2001, 2003 and 2008 Canadian Community Health Survey. Age-specific prevalence and 95% confidence intervals (CIs) were estimated for Canada and provinces and territories for the three time periods. RESULTS Interprovincial variations in hysterectomy prevalence were observed among women in each age group and time period. Among women aged 50 to 59, prevalence was as high as 35.1% (95% CI: 25.8-44.3) (p<.01) in 2008 and appeared to decrease in all provinces from 2000/2001 to 2008. CONCLUSION Interprovincial and time period variation suggest that using hysterectomy prevalence to adjust the population eligible for cervical cancer screening may be helpful to inform more comparable screening participation rates. In addition, both cervical cancer incidence and mortality rates can be adjusted by hysterectomy to ensure estimates across time and provinces and territories are also comparable.
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Affiliation(s)
- A Stankiewicz
- Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - L Pogany
- Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - C Popadiuk
- Department of Women's Health, Memorial University, St John's, Newfoundland and Labrador, Canada
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PaIanidi IG, Sel'chuk VI, Zhordaniia KI, Kazubskaia TP, Kashurnikov AI. [Simultaneous prophylactic surgery for colon cancer in women. Viewpoint of the gynecologist]. Vopr Onkol 2014; 60:313-318. [PMID: 25033682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
A 5-year survival of patients with Stage III colon cancer with prophylactic panhysterectomy in anamnesis was 83.3%, significantly higher than that of patients with Stage III colon cancer without panhysterectomy (69.3%) and than in colon cancer patients with metachronous ovarian metastases (42%). In families of patients with primary multiple malignant tumors (PMMT) of colon, endometrium and/or ovaries as well as in cases of accumulation in the same family of solitary tumors of the above locations it is necessary to carry out genetic testing to identify mutations in genes MSH2, MLH1, MSH6. Carriers of mutations in genes of mismatch repair MSH2, MLH1, MSH6 should be assumed to the high-risk group for the development of malignancies both PMMT of colon and organs of the female reproductive system and solitary tumors of the above locations. All women suffering from colon cancer, especially in the presence of mutations in genes of mismatch repair, in pre- and menopause should be undergone simultaneous prophylactic surgery: panhysterectomy. The question about the greater omentum should be decided situationally.
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20
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Noguès C, Mouret-Fourme E. [Prophylactic surgery in common hereditary cancer syndromes]. Bull Acad Natl Med 2012; 196:1237-1245. [PMID: 23815011] [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: 06/02/2023]
Abstract
Preventive surgery is a mainstay of treatment for persons with genetic risk factors for cancer The indications of preventive surgery are based on a thorough risk assessment, clinical characteristics of the different hereditary cancer susceptibility syndromes, the types of mutation, and the possibility of watchful waiting for early cancer detection. Preventive surgery may either be recommended or represent one possible option. Bilateral prophylactic mastectomy can reduce the risk of breast cancer by up to 95% in BRCA1/BRCA2 mutation carriers. Bilateral prophylactic salpingo-oophorectomy is recommended for BRCA1/ BRCA2 carriers: women who undergo this preventive surgery have a reduced risk of ovarian cancer but also of breast cancer (around 50% for breast cancer). Patients with Lynch syndrome are at high risk of endometrial cancer, and prophylactic hysterectomy may be proposed to women for whom surgery is indicated for a uterine disorder (fibroma). Prophylactic surgery may be proposed to patients at risk of hereditary gastrointestinal malignancies, either on a case-by-case basis (Lynch syndrome) or more systematically for patients with the familial adenomatous polyposis syndrome or hereditary difuse gastric cancer Despite its efficacy, prophylactic surgery in a healthy individual, albeit at high risk of cancer, remains a difficult, multidisciplinary decision. Psychological support is needed to anticipate the possible physical psychological and social complications--and benefits.
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Affiliation(s)
- Catherine Noguès
- Institut Curie, Département de Santé Publique, Oncogénétique, St-Cloud.
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Mori M, Asakura S, Otokozawa S, Minatoya M. [Cancer prevention]. Nihon Rinsho 2012; 70 Suppl 4:10-16. [PMID: 23156211] [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] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Mitsuru Mori
- Department of Public Health, Sapporo Medical University School of Medicine
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Fukuhara R, Fukui A, Mizunuma H. [Oral contraceptives as gynecological cancer prevention]. Nihon Rinsho 2012; 70 Suppl 4:800-804. [PMID: 23156353] [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] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Rie Fukuhara
- Department of Obstetrics and Gynecology, Hirosaki University, School of Medicine
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Serber DW, Rogala A, Makarem M, Rosson GB, Simin K, Godfrey V, Van Dyke T, Eaves CJ, Bultman SJ. The BRG1 chromatin remodeler protects against ovarian cysts, uterine tumors, and mammary tumors in a lineage-specific manner. PLoS One 2012; 7:e31346. [PMID: 22363625 PMCID: PMC3283619 DOI: 10.1371/journal.pone.0031346] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Accepted: 01/06/2012] [Indexed: 12/27/2022] Open
Abstract
The BRG1 catalytic subunit of SWI/SNF-related complexes is required for mammalian development as exemplified by the early embryonic lethality of Brg1 null homozygous mice. BRG1 is also a tumor suppressor and, in mice, 10% of heterozygous (Brg1(null/+)) females develop mammary tumors. We now demonstrate that BRG1 mRNA and protein are expressed in both the luminal and basal cells of the mammary gland, raising the question of which lineage requires BRG1 to promote mammary homeostasis and prevent oncogenic transformation. To investigate this question, we utilized Wap-Cre to mutate both Brg1 floxed alleles in the luminal cells of the mammary epithelium of pregnant mice where WAP is exclusively expressed within the mammary gland. Interestingly, we found that Brg1(Wap-Cre) conditional homozygotes lactated normally and did not develop mammary tumors even when they were maintained on a Brm-deficient background. However, Brg1(Wap-Cre) mutants did develop ovarian cysts and uterine tumors. Analysis of these latter tissues showed that both, like the mammary gland, contain cells that normally express Brg1 and Wap. Thus, tumor formation in Brg1 mutant mice appears to be confined to particular cell types that require BRG1 and also express Wap. Our results now show that such cells exist both in the ovary and the uterus but not in either the luminal or the basal compartments of the mammary gland. Taken together, these findings indicate that SWI/SNF-related complexes are dispensable in the luminal cells of the mammary gland and therefore argue against the notion that SWI/SNF-related complexes are essential for cell survival. These findings also suggest that the tumor-suppressor activity of BRG1 is restricted to the basal cells of the mammary gland and demonstrate that this function extends to other female reproductive organs, consistent with recent observations of recurrent ARID1A/BAF250a mutations in human ovarian and endometrial tumors.
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Affiliation(s)
- Daniel W. Serber
- Department of Genetics, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Allison Rogala
- Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Maisam Makarem
- Terry Fox Laboratory, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
- Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Gary B. Rosson
- Department of Genetics, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Karl Simin
- Department of Genetics, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Virginia Godfrey
- Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Terry Van Dyke
- Department of Genetics, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Connie J. Eaves
- Terry Fox Laboratory, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
- Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Scott J. Bultman
- Department of Genetics, University of North Carolina, Chapel Hill, North Carolina, United States of America
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Ramanathan M, Jesani A. The legacy of scandals and non-scandals in research and its lessons for bioethics in India. Indian J Med Ethics 2012; 9:4-6. [PMID: 22319844 DOI: 10.20529/ijme.2012.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Cai HL, Ding XC, Qian RR, Yu RF, Sun LM, Li Q. [Effects of levonorgestrel intrauterine system on endometrial tissue after endometrial polyps resection by hysteroscopy]. Zhonghua Yi Xue Za Zhi 2012; 92:200-202. [PMID: 22490745] [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: 05/31/2023]
Abstract
OBJECTIVE To explore the changes of endometrial tissues after the insertion of levonorgestrel intrauterine system (LNG-IUS). METHODS The endometrial tissues were harvested from 21 cases after endometrial polyps resection by hysteroscopy. And the patients received a 1-year follow-up. The immunohistochemical stains for estrogen receptor (ER), progesterone receptor (PR), Ki-67, bcl-2 and bax were used for semi-quantitative analyses. The changes of endometrial thickness were monitored and uterine weight was observed with a 3-year follow-up. RESULTS The endometrial thickness and uterine weight declined continuously after the insertion of LNG-IUS. The endometrial thickness decreased from the preoperative level of (9.8 ± 1.2) mm to (3.5 ± 1.0) mm while the uterine weight dropped from the preoperative level of (98.8 ± 8.6) g to (66.6 ± 9.8) g. The expressions of ER, PR and Ki-67 were significantly lower than those of the para-polyps endometrial tissue (P < 0.05). The expressions of bcl-2 and bax were significantly higher than those of the para-polyps endometrial tissue (P < 0.05). CONCLUSION LNG-IUS may prevent the recurrence of uterine endometrial polyps through its inhibited expressions of ER, PR and Ki-67 and induced endometrial apoptosis.
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Affiliation(s)
- Hui-lan Cai
- Ruian People's Hospital, Ruian 325200, China.
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Observational study of cervical cancer. Indian J Med Ethics 2012; 9:50-1. [PMID: 22319854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Wise LA, Radin RG, Palmer JR, Kumanyika SK, Boggs DA, Rosenberg L. Intake of fruit, vegetables, and carotenoids in relation to risk of uterine leiomyomata. Am J Clin Nutr 2011; 94:1620-31. [PMID: 22071705 PMCID: PMC3252555 DOI: 10.3945/ajcn.111.016600] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [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: 04/29/2011] [Accepted: 09/19/2011] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND US black women have higher rates of uterine leiomyomata (UL) and lower intakes of fruit and vegetables than do white women. Whether fruit and vegetable intake is associated with UL in black women has not been studied. OBJECTIVE We assessed the association of dietary intake of fruit, vegetables, carotenoids, folate, fiber, and vitamins A, C, and E with UL in the Black Women's Health Study. DESIGN In this prospective cohort study, we followed 22,583 premenopausal women for incident UL (1997-2009). Diet was estimated by using food-frequency questionnaires in 1995 and 2001. Cox regression was used to derive incidence rate ratios (IRRs) and 95% CIs for the association between each dietary variable (in quintiles) and UL. RESULTS There were 6627 incident cases of UL diagnosed by ultrasonography (n = 4346) or surgery (n = 2281). Fruit and vegetable intake was inversely associated with UL (≥4 compared with <1 serving/d; IRR: 0.90; 95% CI: 0.82, 0.98; P-trend = 0.03). The association was stronger for fruit (≥2 servings/d compared with <2 servings/wk; IRR: 0.89; 95% CI: 0.81, 0.98; P-trend = 0.07) than for vegetables (≥2 servings/d compared with <4 servings/wk: IRR: 0.97; 95% CI: 0.89, 1.05; P-trend = 0.51). Citrus fruit intake was inversely associated with UL (≥3 servings/wk compared with <1 serving/mo: IRR: 0.92; 95% CI: 0.86, 1.00; P-trend = 0.01). The inverse association for dietary vitamin A (upper compared with lower quintiles: IRR: 0.89; 95% CI: 0.83, 0.97; P-trend = 0.01) appeared to be driven by preformed vitamin A (animal sources), not provitamin A (fruit and vegetable sources). UL was not materially associated with dietary intake of vitamins C and E, folate, fiber, or any of the carotenoids, including lycopene. CONCLUSION These data suggest a reduced risk of UL among women with a greater dietary intake of fruit and preformed vitamin A.
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Affiliation(s)
- Lauren A Wise
- Slone Epidemiology Center at Boston University, MA 02215, USA.
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Runowicz CD, Costantino JP, Wickerham DL, Cecchini RS, Cronin WM, Ford LG, Vogel VG, Wolmark N. Gynecologic conditions in participants in the NSABP breast cancer prevention study of tamoxifen and raloxifene (STAR). Am J Obstet Gynecol 2011; 205:535.e1-5. [PMID: 21872200 DOI: 10.1016/j.ajog.2011.06.067] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [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: 12/15/2010] [Revised: 03/22/2011] [Accepted: 06/13/2011] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This study reports the gynecologic conditions in postmenopausal women (intact uterus on enrollment) in the National Surgical Adjuvant Breast and Bowel Project (NSABP) study of tamoxifen and raloxifene (STAR)/P-2 trial. STUDY DESIGN This study, with a median follow-up period of 81 months, evaluated the incidence rates/risks of gynecologic conditions among women who were treated with tamoxifen and raloxifene. RESULTS Compared with women who received tamoxifen therapy, women who received raloxifene therapy had a lower incidence of uterine cancer (relative risk, 0.55)/endometrial hyperplasia (relative risk, 0.19), leiomyomas (relative risk, 0.55), ovarian cysts (relative risk, 0.60), and endometrial polyps (relative risk, 0.30) and had fewer procedures performed. Women receiving tamoxifen therapy had more hot flashes (P < .0001), vaginal discharge (P < .0001), and vaginal bleeding (P < .0001). CONCLUSION Our results suggest that tamoxifen has more of an estrogenic effect on the gynecologic reproductive organs. These effects should be considered in counseling women on options for breast cancer prevention.
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Affiliation(s)
- Carolyn D Runowicz
- National Surgical Adjuvant Breast and Bowel Project, National Cancer Institute, Pittsburgh, PA, USA.
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Geng S, Feng FZ, Xiang Y, Wan XR, Zhou Y. [Analysis of prophylactic chemotherapy outcome and clinical characteristics in patients of high-risk hydatidiform mole]. Zhonghua Fu Chan Ke Za Zhi 2011; 46:24-27. [PMID: 21429430] [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: 05/30/2023]
Abstract
OBJECTIVE To analyze prophylactic chemotherapy outcome and clinical characteristics in patients of high-risk hydatidiform mole. METHODS Twenty-three patients who were diagnosed as high-risk hydatidiform mole and undergone prophylactic chemotherapy in our hospital were retrospectively analyzed. After prophylactic chemotherapy, 11 patients didn't develop to gestational trophoblastic neoplasia (GTN), while the other 12 patients developed to GTN and needed a regimen change to combination chemotherapy. The clinical characteristics of these patients and outcome of prophylactic chemotherapy were compared between two groups. RESULTS There was no significant difference between the two groups on patients' age, weeks of delayed menses, enlarged uterine size excessive for gestational age, and incidence of theca-lutein cysts of ovaries. However, the median levels of pre-evacuation serum β-hCG in two groups were 469 144 U/L and 768 044 U/L respectively, and median days needed for β-hCG declining to normal (≤ 2 U/L) at the first time were 71 and 120 days respectively, which were both significantly different between two groups. Analyzed with receiver operating characteristics (ROC), the level of serum β-hCG could be a predictor for prognosis. Choosing 750,000 U/L as the cut-off value, we could expect the serum β-hCG to have a specificity of 91% and a sensitivity of 58% to predict whether prophylactic chemotherapy will be successful. CONCLUSIONS For those patients who have to receive prophylactic chemotherapy because of risk factors and unavailable hCG assessments for follow-up, it's better to use double-agent or combination chemotherapy if the level of serum β-hCG reached 750 000 U/L so as to reduce therapy duration and prevent relevant chemoresistance.
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Affiliation(s)
- Shuo Geng
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
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Baussano I, Garnett G, Segnan N, Ronco G, Vineis P. Modelling patterns of clearance of HPV-16 infection and vaccination efficacy. Vaccine 2010; 29:1270-7. [PMID: 21145375 DOI: 10.1016/j.vaccine.2010.11.082] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [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: 04/26/2010] [Revised: 09/16/2010] [Accepted: 11/24/2010] [Indexed: 11/19/2022]
Abstract
A model representing carcinogenic HPV infection transmission dynamics and cervical cancer natural history was adapted to assess the consequences of introducing vaccination against HPV-16 infection. Alternative scenarios either allowing repeated infections with the HPV-16 (i.e. SIS scenario) or assuming that clearance of infection occurs through the development of a long lasting, specific immune response which protects against re-infection (i.e. SIR scenario) were investigated. The difference in reduction in lifetime cervical cancer achieved through vaccination of 12-year-old girls, between SIS and SIR scenarios, was up to 25% of expected cases in an unscreened population. This difference increased to 30% when vaccination of 12-year-old boys was also included as an intervention. The role of SIS or SIR dynamics should be accounted for in the assessment of model-based projections of the effectiveness of vaccination programmes, until available data about the transmission dynamics support the accuracy of model predictions.
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Affiliation(s)
- Iacopo Baussano
- SCDU di Epidemiologia dei Tumori, Servizio di Statistica Medica, CPO Piemonte, Novara, Italy.
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Schindler AE. Non-contraceptive benefits of hormonal contraceptives. Minerva Ginecol 2010; 62:319-329. [PMID: 20827249] [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: 05/29/2023]
Abstract
Besides the contraceptive effect of the various hormonal contraceptives, it is intended to demonstrate the non-contraceptive health benefits for treatment and prevention of bleeding problems, menstruation-related pain and other disorders, such as premenstrual syndrome and signs of androgenization. The effectiveness can be improved by choosing the proper progestogen with antiandrogenic action. Treatment but also prevention can be achieved with hormonal contraceptives in benign proliferative diseases of women, such as ovarian cysts, endometriosis, adenomyosis, endometrial hyperplasia, myoma and benign breast disease. Furthermore, hormonal contraceptives such as estrogen/progestogen combinations reduce pelvic inflammatory disease, rheumatoid arthritis, asthma symptoms and preserve bone density. In addition, a major impact in oncological prevention seems to be possible for ovarian, endometrial and colon cancer and these positive preventive effects seem to persist also after discontinuation of hormonal contraceptives. In addition, practical concepts for hormonal contraceptive selection will be outlined.
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Affiliation(s)
- A E Schindler
- Institute for Medical Research and Education, Essen, Germany.
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Jabłonowska D, Marszałek A. [Uterine cervix cancer--profilactic activities and tobacco smoking. State 2010]. Przegl Lek 2010; 67:843-846. [PMID: 21360911] [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: 05/30/2023]
Abstract
There are conducted several different prophylactic programs with the target to decrease the incidence as well as mortality according neoplastic diseases. In Poland since 2005 early detection of cervical cancer program have been held. It is directed to women between 25 and 59 years of age. Beside the cytological examination of the uterine cervix smear, for better definition of risk groups, all patients are requested to fill the questionnaire. Among factors that could be related to development of cancer in this localization is tobacco smoking. In this studies authors analized the changes of cervical cytology in respect of tobacco smoking by female patients. The results revealed a significant increase of high grade squamous intraepithelial lesion (HSIL) in smokers than in nonsmokers. In Non-smoking females or those who quite smoking the preneoplastic lesion of low or high grade decreased.
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Andrijono A, Muhilal M. Prevention of post-mole malignant trophoblastic disease with vitamin A. Asian Pac J Cancer Prev 2010; 11:567-570. [PMID: 20843153] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Abstract
OBJECTIVE Around 15-28% of hydatidiform mole patients suffer from malignant degeneration following evacuation. Since retinoic acid can control cell proliferation and stimulate apoptosis, vitamin A could be used as a therapy for preventing such malignant transformation. The objective of this study was to demonstrate the use of vitamin A as a chemoprevention following hydatidiform mole development. MATERIALS AND METHODS The study made use of a randomized clinical trial, double blind protocol. Subjects were patients with complete hydatidiform moles, not receiving cytostatics. The intervention was administration of placebo or vitamin A at 200,000 IU per day, performed until the patients were declared as having recovered or having malignant trophoblastic disease (MTD). The outcome variables were the incidence of regression and MTD, established based on WHO criteria. RESULTS At clinical trial as many as 67 cases met the requirements for the study. Two cases were lost from observation and three experienced pregnancy. The incidence rate of malignant trophoblastic disease in the control group was 28.6%, and in the therapy group was 6.3%. No difference was found in the changes of SGOT and SGPT levels of the therapy group compared with the control group. CONCLUSION The rate of malignant trophoblastic disease (MTD) was reduced in the group receiving vitamin A therapy.
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Affiliation(s)
- Andri Andrijono
- Division of Oncology, Department Obstetric and Gynecologic, Cipto Mangunkumo Hospital, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia.
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Ben-Arie A, Deutsch H, Volach V, Peer G, Husar M, Lavie O, Gemer O. Reduction of postmolar gestational trophoblastic neoplasia by early diagnosis and treatment. J Reprod Med 2009; 54:151-154. [PMID: 19370899] [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: 05/27/2023]
Abstract
OBJECTIVE To compare contemporary and historical clinical presentation of complete moles (CMs) and the rates of gestational trophoblastic neoplasia (GTN). STUDY DESIGN A study was conducted of a current cohort of 108 consecutive cases of CM from 3 medical centers in Israel accrued during a 5-year period and 87 CM cases reported by the New England Trophoblastic Disease Center (NETDC) from the years 1988 to 1993. Clinical presentation and the rate of GTN of our cohort of CM and cases from the NETDC were compared. RESULTS Fewer current CMs presented with vaginal bleeding than historic NETDC cases (52% vs. 84%, p <0.001, respectively), and a greater proportion of current patients with CM were referred to termination of the pregnancy due solely to ultrasonographic findings (38% vs. 9%, p < 0.001, respectively). GTN rates were significantly lower in the current patients with CM compared to NETDC controls (14% vs. 23%, p<0.05, respectively). CONCLUSION First-trimester ultrasound examination leads to early diagnosis of molar and of nonviable pregnancies subsequently histologically diagnosed as CM. The early evacuation of the molar pregnancy is associated with a reduction in the rate of GTN.
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Affiliation(s)
- Alon Ben-Arie
- Department of Obstetrics and Gynecology, Kaplan Medical Center, Rehovot, Israel
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Wright A, Poon EG, Wald J, Schnipper JL, Grant R, Gandhi TK, Volk LA, Bloom A, Williams DH, Gardner K, Epstein M, Nelson L, Businger A, Li Q, Bates DW, Middleton B. Effectiveness of health maintenance reminders provided directly to patients. AMIA Annu Symp Proc 2008:1183. [PMID: 18999087] [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] [Grants] [Subscribe] [Scholar Register] [Received: 03/14/2008] [Revised: 06/19/2008] [Indexed: 05/27/2023]
Abstract
Provider-centric Electronic Health Records (EHRs) with clinical decision support have had a modest impact on improving quality care. However, they do not directly engage patients in promoting guideline adherence. Tethered Personal Health Records (PHRs) in contrast, can deliver decision support to both patients and providers. We conducted a randomized controlled trial to determine the effectiveness of providing seven screening reminders directly to patients via a PHR. Patients receiving the intervention were significantly more likely to receive Pap smears. No difference was seen for the other reminders.
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Affiliation(s)
- Adam Wright
- Partners HealthCare System, Brigham and Women's Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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[How is prevention changing in Italy?]. Epidemiol Prev 2008; 32:277. [PMID: 19353959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Abstract
With careful selection of procedures, frequencies and risk groups, the periodic screening of adults for cancer can be a highly cost-effective medical activity. This paper summarizes the evidence of effectiveness of screening, the expected reduction in mortality, the risks and costs of screening, and the cost-effectiveness of screening strategies for cancer of the breast, colon, lung, cervix, endometrium and oral cavity. Some of the most pressing questions to be discussed concern the value of mammography, the frequency of the Pap smear, sigmoidoscopy, the value of chest X-rays and sputum cytology in the detection of lung cancer, and the current status of screening for cancers of the endometrium and oral cavity.
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Madelenat P, Jamin C. [Help! Everything's all right...]. Gynecol Obstet Fertil 2007; 35:1187-1188. [PMID: 18024126 DOI: 10.1016/j.gyobfe.2007.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
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Labrie F. Drug Insight: breast cancer prevention and tissue-targeted hormone replacement therapy. ACTA ACUST UNITED AC 2007; 3:584-93. [PMID: 17643129 DOI: 10.1038/ncpendmet0559] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [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: 02/14/2006] [Accepted: 03/27/2007] [Indexed: 02/07/2023]
Abstract
The first-generation selective estrogen receptor modulator (SERM) tamoxifen has been the mainstream hormone therapy in breast cancer. Tamoxifen benefits all stages of the disease, but its use increases the risk of uterine cancer and thromboembolic events and it can only be administered for 5 years. Aromatase inhibitors are superior to tamoxifen at advanced stages of disease and as adjuvants; however, because they increase fractures, aromatase inhibitors are unlikely to be used to prevent disease. Raloxifene, a second-generation SERM, leads, like tamoxifen, to approximately 50% fewer cases of invasive breast cancer in high risk women, with a lower incidence of thromboembolic events. Several other SERMs are in development to improve tissue specificity, efficacy and tolerance. Raloxifene shows protection against vertebral fractures similar to bisphosphonates; however, no significant effect has been observed on nonvertebral fractures. Many SERMs are in development for prevention and treatment of osteoporosis. As breast cancer metastasizes early and advanced disease cannot be cured, prevention is essential. To avoid the concerns about the use of traditional hormone replacement therapy, dehydroepiandrosterone--a tissue-targeted precursor of sex steroid formation--offers hope of a physiological tissue-targeted hormone replacement that, combined with a SERM, would simultaneously prevent breast and uterine cancer.
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Affiliation(s)
- Fernand Labrie
- Molecular Endocrinology and Oncology Research Center, Laval University Hospital Research Center (CRCHUL), Quebec City, Quebec, Canada.
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41
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García G, de Laguna JC, Alvarez Fuentes G. [Progesterone based cervical-uterine-cancer therapy essay. Clinical, cytological, and histological study. Outcomes.1952]. Ginecol Obstet Mex 2007; 75:364-369. [PMID: 18297862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
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Sebire NJ, Foskett M, Short D, Savage P, Stewart W, Thomson M, Seckl MJ. Shortened duration of human chorionic gonadotrophin surveillance following complete or partial hydatidiform mole: evidence for revised protocol of a UK regional trophoblastic disease unit. BJOG 2007; 114:760-2. [PMID: 17516969 DOI: 10.1111/j.1471-0528.2007.01320.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [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: 11/28/2022]
Abstract
Following hydatidiform mole, women are at increased risk of persistent gestational trophoblastic neoplasia (pGTN) and are therefore monitored using serum human chorionic gonadotrophin (hCG) concentration measurements. We retrospectively evaluated the policy of extended (2 year) follow up for women with hCG concentrations returning to normal >56 days after evacuation. Of 6701 women registered for hCG follow up, 422 (6%) developed pGTN, 412 (98%) of these women presented within 6 months after evacuation. Three developed pGTN at 402, 677 and 1267 days after evacuation following spontaneous normalisation of hCG levels. Only one woman was detected by routine extended follow up. Prolonged surveillance after molar pregnancy causes significant anxiety and is not cost-effective. Therefore, the current revised protocol comprises hCG follow up for 6 months after spontaneous return of hCG levels to normal for all women.
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Affiliation(s)
- N J Sebire
- Trophoblastic Disease Unit, Department of Cancer Medicine, Charing Cross Hospital, London, UK
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Geisler JP. Patients having prophylactic surgery for family history or known genetic mutations: Why save the uterus? Gynecol Oncol 2007; 104:780-1. [PMID: 17240434 DOI: 10.1016/j.ygyno.2006.08.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2006] [Accepted: 08/14/2006] [Indexed: 11/18/2022]
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Sheth SS. Prophylactic vaginal hysterectomy for benign hydatidiform mole. Int J Gynaecol Obstet 2007; 96:38-9. [PMID: 17207803 DOI: 10.1016/j.ijgo.2006.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2006] [Revised: 08/31/2006] [Accepted: 09/06/2006] [Indexed: 11/18/2022]
Affiliation(s)
- S S Sheth
- Department of Gynecology, Breach Candy Hospital and Sir Hurkisondas Nurrotamdas Hospital and Sheth Nursing Home, Mumbai, Maharashtra, India.
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Schaerling E. [13th European Congress of Medical Oncology. Prevention of uterine cancer, adjuvant treatment of early prostate cancer and the promises of nanotechnology]. Rev Med Suisse 2006; 2:418-20. [PMID: 16521719] [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] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Affiliation(s)
- E Schaerling
- Cedos international 23, rue Gourgas, 1205 Genève
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Garrido Martínez JL, Díaz MM, Villarreal A. Twenty years of contributions to the study and prevention of uterine cancer. EUR J GYNAECOL ONCOL 2006; 27:600-2. [PMID: 17290591] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
During 20 years of preventive study of the oncogenic risk of cervix-uterine cancer in the Republic of Panama, applying the protocol of the Gynecology Institute of the University of Padua, Italy, we diagnosed 5,009 cases out of the 9,312 patients studied. We classified them according to the degree of the pathology, guiding the patients to the appropriate treatment and the respective follow-up, and concluding that those women who do not follow recommendations have five times more probability of suffering from cervix-uterine cancer. Moreover, the age groups between 20 and 40 years old with HPV infection that do not have access to these procedures are highly vulnerable.
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Affiliation(s)
- J L Garrido Martínez
- National Association Against Cancer (ANCEC), Social Security Foundation (CSS), Chemsa Foundation, Panama City, Panama
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Kossoy G, Ben-Hur H, Elhayany A, Schneider DF, Kossoy N, Zusman I. Preventive effect of the soluble tumor-associated antigens on DMBA induced tumorigenesis in C3H/He mice. Oncol Rep 2005; 14:1625-9. [PMID: 16273267] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023] Open
Abstract
In our previous studies, we showed that soluble tumor-associated antigens (sTAA) of 66 kDa and 51 kDa have distinct tumor-preventive effects on chemically induced mammary cancer in rats and are able to repair the damage caused by tumorigenesis in its early stages. In the present study, we investigated whether these proteins can prevent the development of chemically induced tumors in mice. The study was performed on C3H/He mice which have the ability to develop many spontaneous tumors with age. Forty-four, 6-week-old mice were exposed twice at a 2-week interval to the carcinogen 9,10-dimethyl-1,2-benz(alpha)anthracene (DMBA), at a dose of 2 mg/mouse administered intragastrically. Two months later, the mice were divided into two groups. One group received sterile saline twice a week at a dose of 0.2 ml/mouse, intraperitoneally (i.p.). The other group received sTAA twice a week at a dose of about 10 microl in 0.2 ml of sterile saline/mouse, i.p. Periodically, all mice were checked for the presence of tumors. The experiment was terminated at week 35. Vaccination with sTAA increased the time of involvement of mice in the experiment, prevented the tumorigenic effect of DMBA, and inhibited further development of existing tumors.
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MESH Headings
- 9,10-Dimethyl-1,2-benzanthracene
- Animals
- Antigens, Neoplasm/administration & dosage
- Antigens, Neoplasm/immunology
- Cancer Vaccines/administration & dosage
- Cancer Vaccines/immunology
- Female
- Mammary Neoplasms, Experimental/chemically induced
- Mammary Neoplasms, Experimental/immunology
- Mammary Neoplasms, Experimental/prevention & control
- Mice
- Mice, Inbred C3H
- Neoplasms, Experimental/chemically induced
- Neoplasms, Experimental/immunology
- Neoplasms, Experimental/prevention & control
- Ovarian Neoplasms/chemically induced
- Ovarian Neoplasms/immunology
- Ovarian Neoplasms/prevention & control
- Stomach Neoplasms/chemically induced
- Stomach Neoplasms/immunology
- Stomach Neoplasms/prevention & control
- Time Factors
- Uterine Neoplasms/chemically induced
- Uterine Neoplasms/immunology
- Uterine Neoplasms/prevention & control
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Affiliation(s)
- George Kossoy
- The Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, P.O. Box 12, Rehovot 76100, Israel
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Akaza H, Tsuruo T, Saijo N, Sone S, Isonishi S, Ohashi Y, Noguchi S, Kurebayashi J, Kakehi Y, Ishikawa H, Blackledge G. [Cancer prevention]. Gan To Kagaku Ryoho 2005; 32:1499-506. [PMID: 16227757] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
The 12 th Oncology Forum discussed the progress and future strategy of cancer prevention in Japan. The National Cancer Center has established a research center for screening focusing on the most common six cancer, stomach, lung, liver, colon, breast and uterus cancer. The program so far had a cumulative detection rate of 3.3%, which is high,and may reflect the selection of subjects. Screening and chemoprevention is also being investigated in prostate cancer, but the issues centre on how to make this widely available. High risk subjects can also be identified for breast cancer. Obesity and family history are especially important. In colorectal cancer studies are evaluating different diets, but general application is not yet possible and the infrastructure to implement any general screening and prevention does not exist. Development of pharmaceutical treatments for prevention is difficult because of the need for very safe treatments, and also because of the length of time needed to carry out studies. Overall, cancer prevention is still in evolution. New approaches are needed, and new infrastructure will be needed at a government level to implement this.
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Affiliation(s)
- Hideyuki Akaza
- Dept. of Urology, Institute of Clinical Medicine, University of Tsukuba
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Mizutani T, Sugihara A, Honma H, Komura H, Nakamuro K, Terada N. Effect of steroid add-back therapy on the proliferative activity of uterine leiomyoma cells under gonadotropin-releasing hormone agonist therapy. Gynecol Endocrinol 2005; 20:80-3. [PMID: 15823826 DOI: 10.1080/09513590400021029] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Short-term treatment with gonadotropin-releasing hormone agonist (GnRHa) is a useful preoperative medical therapy of uterine leiomyomas. However, adverse effects caused by the hypo-estrogen state sometimes appear, suggesting the necessity of add-back therapy. In this study, we investigated effects of three kinds of add-back therapies on the proliferative activity of uterine leiomyoma cells by examining the expression of Ki-67 in leiomyoma cells by immunostaining. Thirty patients who were to undergo hysterectomy or myomectomy were injected with 3.75 mg depot leuprolide acetate every four weeks until the end of the 12th week. Twenty patients underwent add-back therapy from the 5th week to the end of the 12th week, 8 patients receiving 0.625 mg of conjugated equine estrogen (CEE) /day, 6 patients 5.0 mg of medroxyprogesterone acetate (MPA)/day, 6 patients 0.625 mg CEE plus 2.5 mg of MPA /day. The add-back of CEE or CEE plus MPA suppressed decreases in the proliferative activity of leiomyoma cells caused by GnRHa therapy, but that of MPA did not. These results suggest that the add-back therapy with MPA is of use in preventing the adverse effects caused by hypo-estrogen in the preoperative short-term GnRHa therapy.
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Affiliation(s)
- T Mizutani
- Department of Obstetrics and Gynecology, Yao Municipal Hospital, Yao, Osaka, Japan
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