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Goldberg C, Greenberg MR, Noveihed A, Agrawal L, Omene C, Toppmeyer D, George MA. Ovarian Suppression: Early Menopause, Late Effects. Curr Oncol Rep 2024; 26:427-438. [PMID: 38305992 DOI: 10.1007/s11912-023-01491-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2023] [Indexed: 02/03/2024]
Abstract
PURPOSE OF REVIEW Pre-menopausal women diagnosed with hormone receptor (HR) breast cancer are candidates for prolonged hypoestrogenism to improve cancer outcomes. However, the disease benefit eclipses the toxicities associated with ovarian function suppression (OFS), which are often under-reported. RECENT FINDINGS Increased risk of mortality from cardiovascular disease, bone disorders, and metabolic disorders is well reported in women with no history of cancer, after surgical oophorectomy or premature ovarian failure. Vasomotor symptoms, urogenital atrophy, weight gain, sexual dysfunction, cognitive decline, and sleep disturbances contribute to the increased non-compliance associated with OFS, especially in younger women. Balancing the toxicities of prolonged OFS with its benefits should be critically analyzed by providers when making recommendations for their patients. Supportive care to manage multi-system toxicities and to counteract the long-term impact on all-cause mortality should be emphasized by every cancer program. Future studies with OFS should incorporate patient outcomes and strategies for symptom management in addition to focusing on improving disease outcomes.
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Affiliation(s)
- Chaya Goldberg
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | | | | | | | - Coral Omene
- Rutgers Cancer Institute of New Jersey, Rutgers, 195 Little Albany Street, New Brunswick, NJ, 08901, USA
| | - Deborah Toppmeyer
- Rutgers Cancer Institute of New Jersey, Rutgers, 195 Little Albany Street, New Brunswick, NJ, 08901, USA
| | - Mridula A George
- Rutgers Cancer Institute of New Jersey, Rutgers, 195 Little Albany Street, New Brunswick, NJ, 08901, USA.
- The State University of New Jersey, 195 Little Albany Street, New Brunswick, NJ, 08901, USA.
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Kamemoto K, Yamada M, Matsuda T, Ogata H, Ishikawa A, Kanno M, Miyashita M, Sakamaki-Sunaga M. Effects of menstrual cycle on appetite-regulating hormones and energy intake in response to cycling exercise in physically active women. J Appl Physiol (1985) 2021; 132:224-235. [PMID: 34882026 DOI: 10.1152/japplphysiol.01117.2020] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Although ample evidence supports the notion that an acute bout of endurance exercise performed at or greater than 70% of maximum oxygen uptake suppresses appetite partly through changes in appetite-regulating hormones, no study has directly compared the influence between the phases of the menstrual cycle in women. The present study compared the effects of an acute bout of exercise on orexigenic hormone (acylated ghrelin) and anorexigenic hormones (peptide YY and cholecystokinin) between the early follicular phase (FP) and the mid luteal phase (LP) of the menstrual cycle in physically active women. Ten healthy women (age, 20.6 ± 0.7 years) completed two 3.5-h trials in each menstrual phase. In both trials, participants performed cycling exercises at 70% of heart rate reserve (at a corresponding intensity to 70% of maximum oxygen uptake) for 60 min followed by 90 min of rest. Following 90 min of rest, participants were provided with an ad libitum meal for a fixed duration of 30 min. Blood samples and subjective appetite were collected and assessed before, during, immediately post-, 45 min post-, and 90 min post-exercise. The exercise increased estradiol (327 %) and progesterone (681 %) in the LP more than the FP respectively (P < 0.001, f = 1.33; P < 0.001,f = 1.20). There were no between-trial differences in appetite-regulating hormones, subjective appetite, or energy intake of ad libitum meal. These findings indicate that exercise-induced increases in ovarian hormones in the LP may not influence appetite-regulating hormones in physically active women.
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Affiliation(s)
- Kayoko Kamemoto
- Graduate School of Health and Sport Science, Nippon Sport Science University, Tokyo, Japan
| | - Mizuki Yamada
- Department of Exercise Physiology, Nippon Sport Science University, Tokyo, Japan
| | - Tomoka Matsuda
- Graduate School of Health and Sport Science, Nippon Sport Science University, Tokyo, Japan
| | - Hazuki Ogata
- Graduate School of Health and Sport Science, Nippon Sport Science University, Tokyo, Japan
| | - Akira Ishikawa
- Graduate School of Health and Sport Science, Nippon Sport Science University, Tokyo, Japan
| | - Moe Kanno
- Graduate School of Health and Sport Science, Nippon Sport Science University, Tokyo, Japan
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3
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Wu M, Tirouvanziam R, Arora N, Tangpricha V. Findings from a feasibility study of estradiol for hypogonadal women with cystic fibrosis-related bone disease. Pilot Feasibility Stud 2021; 7:160. [PMID: 34412687 PMCID: PMC8375209 DOI: 10.1186/s40814-021-00897-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 07/30/2021] [Indexed: 11/10/2022] Open
Abstract
Background Advancements in therapies for patients with cystic fibrosis (CF) have decreased mortality, leading to increased prevalence of chronic complications including bone disease. CF-related bone disease (CFBD) is characterized by low bone mineral density (BMD) and fragility fractures. Estrogen deficiency increases bone resorption, resulting in decreased BMD that can be restored with estrogen replacement. Current CF guidelines recommend treating female hypogonadal patients with CFBD with estrogen replacement, but no prospective study has investigated the effects of estrogen supplementation on CFBD. Estrogen is known to modulate inflammatory markers and autoimmune diseases. We proposed to test the hypothesis that estrogen status plays a critical role in optimizing bone health, modulating inflammation, preserving lung function, and maximizing quality of life in premenopausal women with CF. Methods We planned a randomized, placebo-controlled, investigator- and patient-blinded, pilot trial with two parallel arms. Eligible subjects were women with CF 18–50 years old with hypogonadism and low BMD who were not taking systemic glucocorticoids, had not had a prior transplant, and did not have contraindications to oral estradiol. Subjects would be block randomized to receive oral estradiol or placebo for 6 months. The primary outcome was feasibility metrics. Secondary outcomes included relative changes in estradiol, bone turnover markers, lung function, inflammatory markers, and quality of life metrics. The study was funded through departmental funds. Results Of 233 subjects screened, 86 subjects were women with CF 18–50 years old and none were eligible for participation. Most subjects were excluded due to absent DXA report (24%), normal BMD (22%), or use of systemic estrogen (16%). Due to difficulty recruiting the planned 52 subjects, the trial was closed for recruitment and no subjects were randomized. Conclusion This study was designed to investigate the feasibility of a safety and efficacy trial of estrogen therapy for women with CF. Unfortunately, due to eligibility criteria, the study was unable to recruit subjects. This feasibility study highlights the need for improved BMD screening in young women with CF. Future study designs may require the incorporation of a screening DXA as part of subject recruitment. Trial registration The study was registered on ClinicalTrials.gov (NCT03724955).
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Affiliation(s)
- Malinda Wu
- Division of Endocrinology, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Rabindra Tirouvanziam
- Division of Pulmonology, Allergy, Cystic Fibrosis and Sleep, Department of Pediatrics, Center for CF and Airways Disease Research, Emory University School of Medicine, Atlanta, GA, USA
| | - Neha Arora
- Emory University College of Arts and Sciences, Atlanta, GA, USA
| | - Vin Tangpricha
- Division of Endocrinology, Metabolism, and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA. .,Atlanta VA Medical Center, Decatur, GA, USA.
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Lei YY, Yeo W. The risk of menopausal symptoms in premenopausal breast cancer patients and current pharmacological prevention strategies. Expert Opin Drug Saf 2021; 20:1163-1175. [PMID: 33951990 DOI: 10.1080/14740338.2021.1926980] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: For young premenopausal breast cancer (BC) patients, adjuvant chemotherapy and other anti-cancer treatments can increase the risk of menopausal symptoms and may cause chemotherapy-related amenorrhea (CRA), infertility and premature ovarian insufficiency (POI).Areas covered: In this report, menopausal symptoms related to anti-cancer treatment are described. Menstrual disturbances associated with the use of adjuvant chemotherapy, endocrine therapy, and targeted therapy against human epidermal growth factor receptor 2 (HER2) in premenopausal women withBC are discussed. To prevent menopausal symptoms, CRA and POI, data on the efficacy of temporary ovarian suppression with gonadotropin-releasing hormone analogues (GnRHa) during chemotherapy are highlighted. Pooled analyses have confirmed that concurrent administration of GnRHa during chemotherapy could significantly reduce the risk of developing chemotherapy-induced POI in premenopausal women with early-stageBC. In addition, reports have suggested that embryo/oocyte cryopreservation may increase the chance of pregnancy after the diagnosis ofBC, although such data remain limited.Expert opinion: Commonly experienced by pre-menopausal women withBC, anti-cancer treatment could cause severe menopausal symptoms. Temporary ovarian suppression with GnRHa during chemotherapy provided asafe and efficient strategy to reduce the likelihood of chemotherapy-induced POI in premenopausal patients with early-stageBC undergoing (neo)-adjuvant chemotherapy.
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Affiliation(s)
- Yuan-Yuan Lei
- Department of Clinical Oncology, Prince of Wales Hospital, the Chinese University of Hong Kong, New Territories, Hong Kong SAR, China
| | - Winnie Yeo
- Department of Clinical Oncology, Prince of Wales Hospital, the Chinese University of Hong Kong, New Territories, Hong Kong SAR, China.,Hong Kong Cancer Institute, State Key Laboratory in Oncology in South China, Faculty of Medicine, The Chinese University of Hong Kong, New Territories, Hong Kong SAR, China
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Schaefer SL, Strong AL, Bahroloomi S, Han J, Whisman MK, Wilkowski JM, Angeles CV. Large intraperitoneal lipoleiomyoma in a pre-menopausal woman: a case report. World J Surg Oncol 2021; 19:144. [PMID: 33964957 PMCID: PMC8106865 DOI: 10.1186/s12957-021-02256-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 04/30/2021] [Indexed: 11/13/2022] Open
Abstract
Background Lipoleiomyoma is a rare, benign variant of the commonplace uterine leiomyoma. Unlike leiomyoma, these tumors are composed of smooth muscle cells admixed with mature adipose tissue. While rare, they are most frequently identified in the uterus, but even more infrequently have been described in extrauterine locations. Case presentation We describe a case report of a 45-year-old woman with a history of in vitro fertilization pregnancy presenting 6 years later with abdominal distention and weight loss found to have a 30-cm intra-abdominal lipoleiomyoma. While cross-sectional imaging can narrow the differential diagnosis, histopathological analysis with stains positive for smooth muscle actin, desmin, and estrogen receptor, but negative for HMB-45 confirms the diagnosis of lipoleiomyoma. The large encapsulated tumor was resected en bloc. The patients post-operative course was uneventful and her symptoms resolved. Conclusions Lipoleiomyoma should be considered on the differential diagnosis in a woman with a large intra-abdominal mass. While considered benign, resection should be considered if the mass is symptomatic, and the diagnosis is unclear or there is a concern for malignancy.
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Affiliation(s)
- Sara L Schaefer
- Department of Surgery, University of Michigan School of Medicine, 1500 E. Medical Center Drive, Ann Arbor, Michigan, 48109-5932, USA
| | - Amy L Strong
- Department of Surgery, University of Michigan School of Medicine, 1500 E. Medical Center Drive, Ann Arbor, Michigan, 48109-5932, USA
| | - Sheena Bahroloomi
- Department of Surgery, University of Michigan School of Medicine, 1500 E. Medical Center Drive, Ann Arbor, Michigan, 48109-5932, USA
| | - Jichang Han
- Department of Microbiology and Immunology, The Geisel School of Medicine at Dartmouth, 1 Rope Ferry Road, Hanover, New Hampshire, 03755, USA
| | - Michella K Whisman
- Department of Pathology, University of Michigan School of Medicine, 1500 E. Medical Center Drive, Ann Arbor, Michigan, 48109-5932, USA
| | - Jodi M Wilkowski
- Department of Surgery, University of Michigan School of Medicine, 1500 E. Medical Center Drive, Ann Arbor, Michigan, 48109-5932, USA
| | - Christina V Angeles
- Department of Surgery, University of Michigan School of Medicine, 1500 E. Medical Center Drive, Ann Arbor, Michigan, 48109-5932, USA.
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Leonard AN, Shill AL, Thackray AE, Stensel DJ, Bishop NC. Fasted plasma asprosin concentrations are associated with menstrual cycle phase, oral contraceptive use and training status in healthy women. Eur J Appl Physiol 2020; 121:793-801. [PMID: 33289860 PMCID: PMC7892699 DOI: 10.1007/s00421-020-04570-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 11/21/2020] [Indexed: 12/22/2022]
Abstract
Purpose Asprosin, an orexigenic hormone that stimulates hepatic glucose release, is elevated in insulin resistance and associated with obesity. Plasma asprosin concentrations may also be related to female sex hormone levels; higher levels are reported in women with polycystic ovary syndrome (PCOS) but this may be related to peripheral insulin resistance also associated with PCOS. Clarification of female-specific factors influence on the plasma asprosin response is crucial for studies investigating asprosin. Therefore, this study determined the association of menstrual phase, oral contraceptive (OC) use (as a pharmacological influence on sex hormone levels) and training status (as a physiological influence on sex hormone levels) on plasma asprosin levels in pre-menopausal women. Methods Fasting plasma asprosin, 17β-estradiol (E2) and progesterone, were assessed in 32 healthy untrained and trained women with regular menstrual cycles (non-OC; n = 8 untrained, n = 6 trained) or using OC (n = 10 untrained, n = 8 trained) during early follicular, late follicular and mid-luteal menstrual phases (or the time-period equivalent for OC users). Results Asprosin was lower in OC (0.75 ± 0.38 ng mL−1) than non-OC users (1.00 ± 0.37 ng mL−1; p = 0.022). Across a cycle, asprosin was highest in the early follicular equivalent time-point in OC users (0.87 ± 0.37 ng mL−1) but highest in the mid-luteal phase in non-OC users (1.09 ± 0.40 ng mL−1). Asprosin concentrations varied more across a cycle in untrained than trained women, with higher concentrations in the early follicular phase compared to the late follicular and mid-luteal (training status-by-menstrual phase interaction p = 0.028). Conclusion These findings highlight the importance of considering OC use, menstrual cycle phase and to a lesser extent training status when investigating circulating asprosin concentrations in females. Supplementary Information The online version contains supplementary material available at 10.1007/s00421-020-04570-8.
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Affiliation(s)
- A N Leonard
- School of Sport, Exercise and Health Sciences, National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, UK
| | - A L Shill
- School of Sport, Exercise and Health Sciences, National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, UK
- English Institute of Sport, Loughborough, UK
| | - A E Thackray
- School of Sport, Exercise and Health Sciences, National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, UK
| | - D J Stensel
- School of Sport, Exercise and Health Sciences, National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, UK
| | - Nicolette C Bishop
- School of Sport, Exercise and Health Sciences, National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, UK.
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R L, A Y, J M, L F, V J. The affect of goserelin on the QoL of women having chemotherapy for EBC: Results from the OPTION trial. Breast 2020; 52:122-131. [PMID: 32505861 PMCID: PMC7303950 DOI: 10.1016/j.breast.2020.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 05/19/2020] [Accepted: 05/22/2020] [Indexed: 11/30/2022] Open
Abstract
Background The OPTION trial results showed that premenopausal women with early stage breast cancer (EBC) receiving chemotherapy benefited from ovarian function protection with goserelin. The impact of treatments on patient reported Quality of Life (QoL) were also examined. Patients and methods 227 pre-menopausal women with EBC, were randomly assigned to chemotherapy±goserelin (C±G); 132 (58%) were ER-ve. Patients were stratified by age (≤40 years and >40 years). QoL was assessed with the Functional Assessment of Cancer Therapy – Breast, and Endocrine Symptom checklist at baseline (pre-treatment), 3, 6, 12, 18 and 24 months, then annually to 5 years. Treatment Outcome Index (TOI) score was the primary outcome. Results 213 patients were available for QoL analysis. There was a significant decrease in TOI scores for both treatment groups at 3 and 6 months that returned to pre-treatment levels at 12 months, then continued to increase reflecting improved QoL. By 3 months there was a significant difference from baseline in both groups for menopausal symptoms, and between groups in the proportion experiencing hot flushes at any time. The C + G group experienced higher levels of vasomotor symptoms generally during the treatment phase; by 24 months, the short-term negative effect of goserelin was reversed, with hot flushes twice as frequent in the chemotherapy only group (40.9% vs 21.3%). Conclusions These results show that young women diagnosed with breast cancer experienced only a short-term decrease in QoL from the addition of goserelin, in order to preserve ovarian function during chemotherapy treatment. Ovarian damage from breast cancer chemotherapy is a concern for the younger patient. OPTION showed goserelin reduced the rate of premature ovarian insufficiency in the ≤40yrs. Patient reported QoL is an important consideration in evaluating these treatments. OPTION QoL revealed greater vasomotor symptoms with goserelin at 3 and 6 mths. Overall goserelin treatment resulted in only a short term decrease in QoL.
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Affiliation(s)
- Leonard R
- Department of Surgery and Cancer, Imperial College, London, United Kingdom
| | - Yellowlees A
- Quantics Consulting Ltd, Edinburgh, United Kingdom
| | - Mansi J
- Department of Oncology, Guy's and St Thomas' NHS Foundation Hospital, London, United Kingdom
| | - Fallowfield L
- Sussex Health Outcomes Research & Education in Cancer (SHORE -C) University of Sussex, United Kingdom
| | - Jenkins V
- Sussex Health Outcomes Research & Education in Cancer (SHORE -C) University of Sussex, United Kingdom.
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Jiang T, Yuan Q, Zhou Q, Zhu Y, Lv S, Cao Y, Wang Q, Li K, Zhao D. Do endometrial lesions require removal? A retrospective study. BMC Womens Health 2019; 19:61. [PMID: 31060530 PMCID: PMC6501327 DOI: 10.1186/s12905-019-0756-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 04/12/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND This study aimed to evaluate the management of asymptomatic intrauterine lesions detected by ultrasonography. METHODS Patients who underwent diagnostic hysteroscopy for asymptomatic lesions, including pre- and post-menopausal endometrial polyps, post-menopausal endometrial thickening (ET ≥5 mm) and reduplicative endometrial heterogeneity detected by transvaginal ultrasonography (TVUS), were recruited for this study. RESULTS In the 792 recruited patients, the symptom-free focal masses within the uterine cavity detected by TVUS included 558 patients with pre- or post-menopausal endometrial polyps and 234 patients with postmenopausal endometrial thickening. No pre-menopausal patient presented with carcinoma. The polyp diameter (PD) was not identified as an independent risk factor for malignancy in this study. A significant difference (P = 0.036, < 0.05) in both benign and malignant endometrial lesions was observed between two groups of post-menopausal women stratified using an endometrial thickness cut-off of ≥11 mm. The TVUS was highly sensitive (94%) for pre-menopausal polyps. This technique had a specificity and positive predictive value of 84.4 and 92.7%, respectively, for postmenopausal polyps. The TVUS was clearly valuable for ruling out polyps, as indicated by a negative likelihood ratio (LR-) of 0.087. Among postmenopausal women with endometrial thickening, the area under the receiver operating characteristic curve was 0.828 (P < 0.001). An ET cut-off value of 12.5 mm yielded a sensitivity of 72.7% and specificity of 86%. CONCLUSION We recommend follow-up alone for women with asymptomatic uterine polyps, particularly those who are pre-menopausal. Additionally, gynaecologists should consider risk factors such as age, obesity, polycystic ovarian syndrome, and diabetes. Prospective long-term follow-up studies should be conducted after hysteroscopic polypectomy to evaluate the recurrence rate of endometrial lesions.
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Affiliation(s)
- Ting Jiang
- Department of Gynecology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, #2699 West Gaoke Road, Pudong New District, Shanghai, 200040, People's Republic of China.,Department of Gynecology, Obstetrics and Gynaecology Hospital of Fudan University, #419 of Fangxie Road, Huangpu District, Shanghai, 200011, People's Republic of China
| | - Qing Yuan
- Department of Gynecology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, #2699 West Gaoke Road, Pudong New District, Shanghai, 200040, People's Republic of China
| | - Qin Zhou
- Department of Biostatistics, School of Public Health Fudan University, 138# Yixueyuan Road, Shanghai, 200032, People's Republic of China
| | - Yiping Zhu
- Department of Gynecology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, #2699 West Gaoke Road, Pudong New District, Shanghai, 200040, People's Republic of China
| | - Siji Lv
- Department of Gynecology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, #2699 West Gaoke Road, Pudong New District, Shanghai, 200040, People's Republic of China
| | - Yanling Cao
- Department of Gynecology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, #2699 West Gaoke Road, Pudong New District, Shanghai, 200040, People's Republic of China
| | - Qin Wang
- Department of Gynecology and Obstetrics, Punan Hospital of Shanghai, #219 of Linyi Road, Pudong New District, Shanghai, 200125, People's Republic of China
| | - Kunming Li
- Center of Reproductive Medicine, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, #2699 of Gaoke Road (west), Pudong New District, Shanghai, 200040, People's Republic of China.
| | - Dong Zhao
- Department of Gynecology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, #2699 West Gaoke Road, Pudong New District, Shanghai, 200040, People's Republic of China. .,Department of Obstetrics and Gynecology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, #639 Zhi Zao Ju Road, Huangpu District, Shanghai, 200011, People's Republic of China.
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Anderson JJ, Darwis NDM, Mackay DF, Celis-Morales CA, Lyall DM, Sattar N, Gill JMR, Pell JP. Red and processed meat consumption and breast cancer: UK Biobank cohort study and meta-analysis. Eur J Cancer 2017; 90:73-82. [PMID: 29274927 DOI: 10.1016/j.ejca.2017.11.022] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 10/25/2017] [Accepted: 11/22/2017] [Indexed: 02/05/2023]
Abstract
AIM Red and processed meat may be risk factors for breast cancer due to their iron content, administration of oestrogens to cattle or mutagens created during cooking. We studied the associations in UK Biobank and then included the results in a meta-analysis of published cohort studies. METHODS UK Biobank, a general population cohort study, recruited participants aged 40-69 years. Incident breast cancer was ascertained via linkage to routine hospital admission, cancer registry and death certificate data. Univariate and multivariable Cox proportional hazard models were used to explore the associations between red and processed meat consumption and breast cancer. Previously published cohort studies were identified from a systematic review using PubMed and Ovid and a meta-analysis conducted using a random effects model. RESULTS Over a median of 7 years follow-up, 4819 of the 262,195 women developed breast cancer. The risk was increased in the highest tertile (>9 g/day) of processed meat consumption (adjusted hazard ratio [HR] 1.21, 95% confidence interval [CI] 1.08-1.35, p = 0.001). Collation with 10 previous cohort studies provided data on 40,257 incident breast cancers in 1.65 million women. On meta-analysis, processed meat consumption was associated with overall (relative risk [RR] 1.06, 95% CI 1.01-1.11) and post-menopausal (RR 1.09, 95% CI 1.03-1.15), but not pre-menopausal (RR 0.99, 95% CI 0.88-1.10), breast cancer. In UK Biobank and the meta-analysis, red meat consumption was not associated with breast cancer (adjusted HR 0.99 95% CI 0.88-1.12 and RR 1.03, 95% CI 0.99-1.08, respectively). CONCLUSIONS Consumption of processed meat, but not red meat, may increase the risk of breast cancer.
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Affiliation(s)
- Jana J Anderson
- Institute of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow, UK
| | - Narisa D M Darwis
- Institute of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow, UK
| | - Daniel F Mackay
- Institute of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow, UK
| | | | - Donald M Lyall
- Institute of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow, UK
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Jason M R Gill
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Jill P Pell
- Institute of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow, UK.
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Mattioli AV, Coppi F, Migaldi M, Scicchitano P, Ciccone MM, Farinetti A. Relationship between Mediterranean diet and asymptomatic peripheral arterial disease in a population of pre-menopausal women. Nutr Metab Cardiovasc Dis 2017; 27:985-990. [PMID: 29074382 DOI: 10.1016/j.numecd.2017.09.011] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 09/23/2017] [Accepted: 09/25/2017] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND AIMS The Mediterranean Diet (MedD) is considered a very healthy diet useful in the prevention of cardiovascular disease. The present study aims to evaluate adherence to MedD in unselected premenopausal women and its relation with ankle-brachial index (ABI), an index of preclinical atherosclerosis. METHODS AND RESULTS A group of 425 patients (age range 45-54 years) was investigated. They were enrolled only if they were asymptomatic for cardiovascular disease. Nutritional parameters were assessed by a self-administered food frequency validated questionnaire (116 items) completed by an interviewer administered 24 h diet recall. They all underwent ABI measurement. The mean MedD Score was 32.2 ± 6.1 (Q1-Q3 range 26-37) comparing with data from Italian population (46 ± 8.3) was significantly lower. Intake of food categories sources of antioxidants was higher in patients with a greater adherence to Med D and was mainly related to fruit and vegetables. Patients were categorized in quartile according to MedD Score and we evaluate the distribution of ABI index within quartile. 31.4% of women in Q1 (lower adherence to MedD) had an ABI lower than 0.9 compared to 18.3% of women in Q4 (higher adherence to MedD): p < 0.01. Obesity was more frequent in Q1 compared to Q4 and in women with lower ABI. CONCLUSIONS Women with a low MedD Score were more obese and showed instrumental sign of preclinical peripheral atherosclerosis. MedD rich in antioxidants from fruit, vegetables and nuts influenced the development of atherosclerosis and was associated with a lower incidence of asymptomatic atherosclerosis.
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Affiliation(s)
- A V Mattioli
- Department of Surgical, Medical and Dental Department of Morphological Sciences related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy.
| | - F Coppi
- Cardiology Division, Azienda Ospedaliera Universitaria, Modena, Italy
| | - M Migaldi
- Department of Diagnostics, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Italy
| | - P Scicchitano
- Section of Cardiovascular Diseases, Department of Emergency and Organ Transplantation, University of Bari, Italy
| | - M M Ciccone
- Section of Cardiovascular Diseases, Department of Emergency and Organ Transplantation, University of Bari, Italy
| | - A Farinetti
- Department of Surgical, Medical and Dental Department of Morphological Sciences related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
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Klemp JR, Myers JS, Fabian CJ, Kimler BF, Khan QJ, Sereika SM, Stanton AL. Cognitive functioning and quality of life following chemotherapy in pre- and peri-menopausal women with breast cancer. Support Care Cancer 2017; 26:575-583. [PMID: 28849337 DOI: 10.1007/s00520-017-3869-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 08/21/2017] [Indexed: 11/12/2022]
Abstract
PURPOSE The purpose of the study was to prospectively examine changes in subjective and objective cognitive functions and quality of life (QOL) for pre- and peri-menopausal women receiving chemotherapy for breast cancer and to explore potential predictors of cognitive changes. METHODS Participants were assessed as follows: prior to chemotherapy (T1), after cycle 3 (T2), within 2-3 weeks of completing adjuvant chemotherapy (T3) (N = 20), and 8+ years later (T4; n = 18). Objective cognitive function was measured with the High Sensitivity Cognitive Screen (T1, T3, T4). Subjective measures for cognitive function, depressive symptoms, fatigue, and mental and physical QOL were assessed at all time points. Estradiol levels were measured at T1, T2, and T3. The Functional Assessment of Cancer Therapy-Cognition and the MD Anderson Cancer Symptom Inventory item for neuropathy were administered at T4. RESULTS No significant changes in objective cognitive function were found. However, participants reported decreased cognitive function over the course of treatment accompanied by depressive symptoms and fatigue. Depression and fatigue returned to near-baseline levels at T4, but over half of the participants continued to report mild to moderate depression. Estradiol levels were not associated with cognitive function. Neuropathy and higher body mass index (BMI) were associated with persistent cognitive complaints at T4 (adjusted R 2 = 0.712, p = 0.001). Higher QOL was correlated with better subjective cognitive function (r = 0.705, p = 0.002) and lower body mass index (r = - 0.502, p = 0.017) at T4. CONCLUSIONS Further investigation of BMI, neuropathy, and depressive symptoms as predictors of persistent cognitive dysfunction following chemotherapy for breast cancer is warranted.
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Affiliation(s)
- Jennifer R Klemp
- University of Kansas Cancer Center, 2330 Shawnee Mission, Parkway, Westwood, KS, 66205, USA
| | - Jamie S Myers
- University of Kansas School of Nursing, 3901 Rainbow Blvd, MS 4043, Kansas City, KS, 66160, USA. .,School of Nursing, University of Pittsburgh, 360 Victoria Building, 3500 Victoria Street, Pittsburgh, PA, 15261, USA.
| | - Carol J Fabian
- University of Kansas Cancer Center, 2330 Shawnee Mission, Parkway, Westwood, KS, 66205, USA
| | - Bruce F Kimler
- University of Kansas Medical Center, 3901 Rainbow Blvd, MS 4033, Kansas City, KS, 66160, USA
| | - Qamar J Khan
- University of Kansas Cancer Center, 2330 Shawnee Mission, Parkway, Westwood, KS, 66205, USA
| | - Susan M Sereika
- School of Nursing, University of Pittsburgh, 360 Victoria Building, 3500 Victoria Street, Pittsburgh, PA, 15261, USA
| | - Annette L Stanton
- Department of Psychology, University of California, 1285 Franz Hall, Los Angeles, CA, 90095-1563, USA
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Busana MC, De Stavola BL, Sovio U, Li J, Moss S, Humphreys K, dos-Santos-Silva I. Assessing within-woman changes in mammographic density: a comparison of fully versus semi-automated area-based approaches. Cancer Causes Control 2016; 27:481-91. [PMID: 26847236 DOI: 10.1007/s10552-016-0722-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 01/16/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Mammographic density (MD) varies throughout a woman's life. We compared the performance of a fully automated (ImageJ-based) method to the observer-dependent Cumulus approach in the assessment of within-woman changes in MD over time. METHODS MD was assessed in annual pre-diagnostic films (from age 40 to early 50s) from 313 breast cancer cases and 452 matched controls using Cumulus (left medio-lateral oblique (MLO) readings) and the ImageJ-based method (mean left-right MLO readings). Linear mixed models were used to compare within-woman changes in MD among controls. Associations between individual-specific MD trajectories and breast cancer were examined using conditional logistic regression. RESULTS The age-related trajectories predicted by Cumulus and the ImageJ-based method were similar for all MD measures, except that the ImageJ-based method yielded slightly higher (by 2.54%, 95% CI 2.07%, 3.00%) estimates for percent MD. For both methods, the yearly rate of change in percent MD was twice faster after menopause than before, and higher BMI was associated with lower mean percent MD, but not associated with rate of change. Both methods yielded similar associations of individual-specific MD trajectories with breast cancer risk. CONCLUSIONS The ImageJ-based method is a valid fully automated alternative to Cumulus for measuring within-woman changes in MD in digitized films. The Age Trial is registered as an International Standard Randomized Controlled Trial, number ISRCTN24647151.
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Noguchi S, Kim HJ, Jesena A, Parmar V, Sato N, Wang HC, Lokejaroenlarb S, Isidro J, Kim KS, Itoh Y, Shin E. Phase 3, open-label, randomized study comparing 3-monthly with monthly goserelin in pre-menopausal women with estrogen receptor-positive advanced breast cancer. Breast Cancer 2015; 23:771-9. [PMID: 26350351 PMCID: PMC4999470 DOI: 10.1007/s12282-015-0637-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 08/20/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Monthly goserelin 3.6 mg dosing suppresses estradiol (E2) production and has proven efficacy in pre-menopausal women with estrogen receptor (ER)-positive breast cancer. This non-inferiority study evaluated the efficacy and safety of 3-monthly goserelin 10.8 mg compared with monthly goserelin 3.6 mg. METHODS This was a Phase 3, open-label, multicenter trial. Pre-menopausal women with ER-positive advanced breast cancer were randomized to 3-monthly goserelin 10.8 mg or monthly goserelin 3.6 mg; all patients received concomitant tamoxifen (20 mg daily). The primary endpoint was progression-free survival (PFS) rate at 24 weeks; non-inferiority was to be confirmed if the entire 95 % confidence interval (CI) for the treatment difference was above -17.5 %. Secondary endpoints included objective response rate (ORR), serum E2 levels, safety, and tolerability. RESULTS In total, 222 patients were randomized (goserelin 10.8 mg, n = 109; goserelin 3.6 mg, n = 113). PFS rate at week 24 was 61.5 % (goserelin 10.8 mg) and 60.2 % (goserelin 3.6 mg); treatment difference (95 % CI) was 1.3 % (-11.4, 13.9), confirming non-inferiority of goserelin 10.8 mg compared with goserelin 3.6 mg. ORR was 23.9 % (goserelin 10.8 mg) and 26.9 % (goserelin 3.6 mg); treatment difference (95 % CI) was -3.0 % (-15.5, 9.7). At week 24, mean serum E2 concentrations were similar in the goserelin 10.8 mg and goserelin 3.6 mg groups (20.3 pg/mL and 24.8 pg/mL, respectively). CONCLUSION A regimen of 3-monthly goserelin 10.8 mg demonstrated non-inferiority compared with monthly goserelin 3.6 mg for PFS rate at 24 weeks, with similar pharmacodynamic and safety profiles, in pre-menopausal women with ER-positive breast cancer.
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Affiliation(s)
- Shinzaburo Noguchi
- Department of Breast and Endocrine Surgery, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita City, Osaka, 565-0871, Japan.
| | - Hee Jeong Kim
- Department of Surgery, Asan Medical Center, Seoul, Korea
| | | | - Vani Parmar
- Breast Disease Management Group, Tata Memorial Hospital, Mumbai, India
| | - Nobuaki Sato
- Department of Breast Oncology, Niigata Cancer Center Hospital, Niigata, Japan
| | - Hwei-Chung Wang
- Department of Surgery, China Medical University Hospital, Taichung, Taiwan
| | | | - Jofel Isidro
- Great Saviour International Hospital, Iloilo, Philippines
| | - Ku Sang Kim
- Department of Breast and Thyroid Surgery, Ulsan City Hospital, Ulsan, Korea
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Abstract
Endocrine treatments are key component of the adjuvant strategy for pre-menopausal patients with luminal tumors. Treatment options should be based not only upon the risk of relapse and level of endocrine responsiveness, but also on co-morbidities, preferences of the patient and degree of side effects. Tamoxifen should still be considered as an appropriate endocrine therapy in a large group of premenopausal patients (e.g. lower risk patient, presence of co-morbidities, patient preference). However, the results of the SOFT and TEXT trials, evaluating the value of ovarian function suppression (OFS) as well as the role of adjuvant aromatase inhibitor (AI), raised questions about the use of tamoxifen alone in selected higher risk patient. In the SOFT study, premenopausal patients did not benefit from the addition of OFS, but for those women at sufficient risk of recurrence to deserve adjuvant chemotherapy and who maintained pre-menopausal estradiol, the addition of OFS to tamoxifen reduced the risk of recurrence. Moreover, in the TEXT trial, adjuvant treatment with exemestane plus OFS, as compared with tamoxifen plus OFS, significantly improved disease-free survival, breast cancer-free interval and distant disease-free survival, thus representing a new treatment option. Recent available information on endocrine options for younger patients with luminal tumors support the use of tailored endocrine treatments. Issues specific for younger patients related to pregnancies desire, family planning, safety, quality of life and subjective side effects should be a priority in the therapeutic algorithm.
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Affiliation(s)
- Marco Colleoni
- Division of Medical Senology, European Institute of Oncology, Italy; International Breast Cancer Study Group, Italy.
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Mahboub SM, Al-Muammar MN, Elareefy AA. Evaluation of the prevalence and correlated factors for decreased bone mass density among pre- and post-menopausal educated working women in Saudi Arabia. J Health Popul Nutr 2014; 32:513-519. [PMID: 25395914 PMCID: PMC4221457] [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] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Most of the previous studies on osteoporosis have focused on post-menopausal women, and more research is needed to evaluate its prevalence in pre-menopausal women. This study was carried out to evaluate the prevalence and correlated factors for decreased bone mass density among pre- and post-menopausal women. This was a cross-sectional study carried out in Applied Medical Sciences College under King Saud University. All pre- and post-menopausal women working there were invited to participate in the study. Measurement of bone mass density was done by quantitative ultrasound densitometry. One-fourth of the pre-menopausal females had osteopaenia. There was a significant correlation between having osteoporosis and increasing age, fertility period, parity, menopausal duration, gynaecological age, and presence of co-morbidity, especially hypertension and diabetes mellitus. Pre-menopausal females had high prevalence of osteopaenia (24.8%), and it is recommended to implement health education campaigns demonstrating the preventive measures of osteoporosis.
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Affiliation(s)
- Samira M Mahboub
- Department of Tropical Health, High Institute of Public Health, Alexandria University, Egypt
| | - May N Al-Muammar
- Community Health Sciences Department, Applied Medical Sciences College, King Saud University, Kingdom of Saudi Arabia
| | - Azza A Elareefy
- Nutrition and Food Science Department, College of Home Economics, Helwan University, Egypt
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Abstract
BACKGROUND Currently breast cancer (BRCA) still remain the most commonly diagnosed female cancer globally with a significant geographic, racial and ethnical variations in its incidence. AIM This article examines the frequency and histological types and grades of BRCA in a pioneer teaching Hospital in Delta State, Nigeria. MATERIALS AND METHODS H and E stained-slides of breast biopsies diagnosed at the Central Hospital, Warri from 2005 to 2011 were archived and studied. Request forms were scrutinized for clinical bio-data, diagnosis and histological sections were analyzed. Data obtained were analyzed using the Statistical Package for the Social Sciences version 17 statistical package (SPSS) Incorporated, Chicago, Illinois, USA, and value presented descriptively. RESULTS During this period, 905 breast lesions were seen. Out of this, 261 were BRCAs, of which 260 cases were females and one case was a male. The peak age incidence for BRCA and its variants was 40-49 years accounting for (n = 94/261; 36%). The mean age of BRCA was 46 years (6.2). Invasive carcinoma of no special type (NST) was the most commonly encountered histological group of breast carcinoma constituting (n = 203/261, 77.7%) with the high grade invasive ductal carcinoma as the leading diagnosis. CONCLUSION Majority of BRCAs encounter was invasive ductal carcinoma of NST with bulk of patients presenting in Stages III and IV.
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Affiliation(s)
- Gd Forae
- Department of Pathology, University of Benin Teaching Hospital, Benin-City, Edo, Nigeria
| | - Fn Nwachokor
- Department of Pathology, Delta State University, Abraka, Delta, Nigeria
| | - Ap Igbe
- Department of Pathology, Ambrose Alli University, Ekpoma, Edo, Nigeria
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