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Title: Endometrial hyperplasia risk in relation to recent use of oral contraceptives and hormone therapy.
Author: Epplein M; Reed SD; Voigt LF; Newton KM; Holt VL; Weiss NS
Source: Annals of Epidemiology. 2009 Jan;19(1):1-7.
Abstract: PURPOSE: We sought to examine the relationship between recent use of oral contraceptives and hormone therapy and endometrial hyperplasia (EH) risk. METHODS: Cases comprised women diagnosed with complex EH (n = 289) or atypical EH (n = 173) between 1985 and 2003. One age-matched control was selected for each case; excluded were women with a prior hysterectomy or diagnosis of EH or endometrial cancer. Hormone use in the 6 months prior to the date of the case's first symptoms was ascertained using a pharmacy database and medical records. Odds ratios (OR) and 95% confidence intervals (CI) were calculated. RESULTS: Three (1.1%) cases had used oral contraceptives, compared to 16 (6.0%) controls (OR = 0.2, 95% CI: 0.0-0.6). Fifty-one (16.8%) cases had taken estrogen-only hormone therapy, in contrast to two (0.7%) controls (OR = 37.6, 95% CI: 8.8-160.0). The risk of EH among estrogen plus progestin hormone users did not differ from that of non-users (OR = 0.7, 95% CI: 0.4-1.1). CONCLUSIONS: This study suggests that previous findings of the association of estrogen-only hormone therapy with increased risk of EH and the lack of an association between estrogen plus progestin hormone therapy and EH risk are likely to apply to both complex EH and atypical EH. Further examination of the association between oral contraceptives and EH, with greater numbers of OC users, is warranted.
Language: English
Keywords:
WASHINGTON | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | CLINICAL RESEARCH | CASE CONTROL STUDIES | WOMEN | PREVALENCE | ENDOMETRIAL CANCER | HORMONE REPLACEMENT THERAPY | CONTRACEPTIVE SAFETY | ORAL CONTRACEPTIVES, SIDE EFFECTS | TIME FACTORS | CONTRACEPTIVE AGENTS, ESTROGEN | ORAL CONTRACEPTIVES, COMBINED | CONTRACEPTIVE AGENTS, PROGESTIN | United States of America | North America | Americas | Developed Countries | Research Methodology | Studies | Demographic Factors | Population | Measurement | Cancer | Neoplasms | Diseases | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Safety | Public Health | Population Dynamics | Contraceptive Agents, Female | Contraceptive Agents | Contraception | Family Planning | Oral Contraceptives | Contraceptive Methods
Document Number: 330386

Title: Involution of latent endometrial precancers by hormonal and nonhormonal mechanisms.
Author: Lin MC; Burkholder KA; Viswanathan AN; Neuberg D; Mutter GL
Source: Cancer. 2009 May 15;115(10):2111-8.
Abstract: BACKGROUND: Inactivation of the PTEN suppressor gene has been shown to occur in the majority of endometrial cancer cases. Somatic PTEN inactivation by deletion and/or mutation, the first detectible change of endometrial carcinogenesis, has been reported to occur at a high frequency in the endometrium of normal premenopausal women, although few of these cases progress to cancer. It was hypothesized that the 50% to 60% reduced cancer risk attributed to oral contraceptives (OCPs) and intrauterine devices (IUDs) occurred in part through their activity as negative selection factors for these subclinical mutated glands. METHODS: A total of 71 women with a history of OCP use and 80 with a history of IUD use were age matched with 191 and 119 controls, respectively. Endometrial biopsy specimens were immunostained for PTEN, and each was scored for the presence or absence of PTEN-null glands (latent precancer). RESULTS: The frequency of latent precancers was found to be significantly reduced in OCP-exposed (13%; odds ratio [OR], 0.19 [P < .001]) and IUD-exposed (18%; OR, 0.42 [P = .015]) women compared with respective matched controls (43% and 34%). The presence or absence of endometritis did not appear to be significantly correlated with PTEN status within the IUD-exposed group (P = .24). CONCLUSIONS: Normal-appearing PTEN mutated endometrial glands, which are highly prevalent in the normal population, may be targets of endometrial cancer risk-modulating exposures. Some exposures reported to diminish the incidence of endometrial cancer in epidemiologic outcome studies, including OCP and IUD use, are associated with a proportionate decline in the frequency of latent precancers. Involution of pre-existing endometrial latent precancers, as evaluated by PTEN analysis, may provide an accessible surrogate marker for long-term endometrial cancer risk.
Language: English
Keywords:
UNITED STATES OF AMERICA | RESEARCH REPORT | CASE CONTROL STUDIES | WOMEN | ENDOMETRIAL CANCER | RISK FACTORS | ENDOMETRITIS | HISTOLOGY | ORAL CONTRACEPTIVES | IUD | Developed Countries | North America | Americas | Studies | Research Methodology | Demographic Factors | Population | Cancer | Neoplasms | Diseases | Health | Reproductive Tract Infections | Infections | Biology | Contraceptive Methods | Contraception | Family Planning
Document Number: 341658

Peer Reviewed

Title: Long-term oral contraceptive pills and postoperative pain management after laparoscopic excision of ovarian endometrioma: a randomized controlled trial.
Author: Seracchioli R; Mabrouk M; Frasca C; Manuzzi L; Savelli L; Venturoli S
Source: Fertility and Sterility. 2009 May 12;
Abstract: OBJECTIVE: To evaluate postoperative long-term cyclic and continuous administration of combined oral contraceptive (OC) pills in preventing endometriosis-related pain recurrence. DESIGN: Prospective, randomized, controlled trial. SETTING: Tertiary care university hospital. PATIENT(S): Three hundred eleven women who underwent laparoscopic excision for symptomatic ovarian endometrioma. INTERVENTION(S): Patients were randomly divided into three groups: nonuser group receiving no therapy, and cyclic user group and continuous user group receiving low-dose, monophasic OC pills for 24 months in either cyclic or continuous administration. MAIN OUTCOME MEASURE(S): Presence and intensity of dysmenorrhea, dyspareunia, and chronic pelvic pain were assessed by a 10-point visual analogue scale (VAS) at 6, 12, 18, and 24 months postoperatively. RESULT(S): A significant reduction in recurrence rate and VAS scores for dysmenorrhea was evident in the continuous users versus the other groups at 6 months, and in cyclic users versus nonusers at 18 months postoperatively. No significant differences in recurrence rate and VAS scores for dyspareunia and chronic pelvic pain were demonstrated among the groups. The increase of VAS scores from 6-24 months during the study period for dysmenorrhea, dyspareunia, and chronic pelvic pain was significantly higher in nonusers than in the other groups. CONCLUSION(S): Long-term postoperative use of OC pills can reduce the frequency and the severity of recurrent endometriosis-related dysmenorrhea.
Language: English
Keywords:
ITALY | RESEARCH REPORT | CLINICAL TRIALS | WOMEN | LONGTERM EFFECTS | PAIN | GYNECOLOGIC SURGERY | POSTOPERATIVE PROCEDURES | LAPAROSCOPY | OVARIAN CANCER | ORAL CONTRACEPTIVES, COMBINED | ANALGESIA | ENDOMETRIAL CANCER | ENDOMETRIOSIS | DYSMENORRHEA | Developed Countries | Europe, Southern | Europe | Clinical Research | Research Methodology | Demographic Factors | Population | Time Factors | Population Dynamics | Signs and Symptoms | Diseases | Urogenital Surgery | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Endoscopy | Physical Examinations and Diagnoses | Examinations and Diagnoses | Cancer | Neoplasms | Oral Contraceptives | Contraceptive Methods | Contraception | Family Planning | Menstruation Disorders
Document Number: 341141

5.
Title: Ineffective attempt to preserve fertility with a levonorgestrel-releasing intrauterine device in a young woman with endometrioid endometrial carcinoma: a case report and review of the literature.
Author: Vandenput I; Van Eygen K; Moerman P; Vergote I; Amant F
Source: European Journal of Gynaecological Oncology. 2009;30(3):313-6.
Abstract: BACKGROUND: The treatment of endometrial cancer in young women who want to preserve their fertility is challenging. CASE: A 25-year-old woman (A0P0G0) was diagnosed with grade 1 endometrioid endometrial carcinoma (EEC). Imaging studies including transvaginal ultrasound (TVS), computed tomography and magnetic resonance imaging (MRI) could not detect myometrial invasion or metastatic disease. The immunohistochemical expression of the estrogen and progesterone receptor in the tumor was strongly positive, whereas p53 staining was negative. After extensive counseling, we decided to use a levonorgestrel-releasing intrauterine device to preserve her fertility. Follow-up was organized every three months and consisted of serum CA125 levels, TVS, endometrial biopsy and MRI. The tumor regressed after ten months and the intrauterine device was removed. However, nine months later, recurrent EEC was diagnosed and a hysterectomy performed. Pathological examination confirmed Stage Ia EEC. CONCLUSION: Despite the presence of favorable prognostic factors of EEC as determined by grade and immunohistochemistry, the levonorgestrel-releasing intrauterine device was unable to preserve fertility.
Language: English
Keywords:
BELGIUM | SUMMARY REPORT | LITERATURE REVIEW | CASE HISTORIES | CLIENTS | ENDOMETRIAL CANCER | TREATMENT | FECUNDITY | IUD, HORMONE RELEASING | LEVONORGESTREL | ULTRASONICS | HYSTERECTOMY | Europe, Western | Europe | Developed Countries | Data Collection | Research Methodology | Program Activities | Programs | Organization and Administration | Cancer | Neoplasms | Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Reproduction | IUD | Contraceptive Methods | Contraception | Family Planning | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Gynecologic Surgery | Urogenital Surgery | Surgery
Document Number: 342780

Title: Meta-analysis of intrauterine device use and risk of endometrial cancer.
Author: Beining RM; Dennis LK; Smith EM; Dokras A
Source: Annals of Epidemiology. 2008 Jun;18(6):492-499.
Abstract: We sought to study the association between intrauterine device (IUD) use and endometrial cancer. A comprehensive search of literature published through April 2007 was conducted, studies reviewed, and data abstracted. Data from ten studies were pooled and analyzed using both fixed- and random-effects models to examine the association of ever use of an IUD and endometrial cancer. Based on the random effects model, a protective crude association between IUD use and endometrial cancer was observed (odds ratio [OR] = 0.39; 95% confidence interval [CI] = 0.29-0.51; heterogeneity p less than 0.001) with a pooled adjusted risk of OR = 0.54 (95% CI, 0.47-0.63; heterogeneity p = 0.40). A decreased risk of endometrial cancer also was seen for increased years of IUD use (OR for 5 years of use 0.88; 95% CI = 0.84-0.92; n = 5; heterogeneity p = 0.14), increased years since last IUD use (OR for 5 years of use 0.91; 95% CI, 0.86-0.95; n = 4; heterogeneity p = 0.02), and increased years since first IUD use (OR for5 years of use 0.89; 95% CI, 0.83-0.95; n = 4; heterogeneity p = 0.04). Our results suggest that nonhormonal IUD use may be associated with a decreased risk for endometrial cancer; however, the exact mechanism for this association is unclear. Future investigations should address the difference in the proposed association by specific type of IUDs. (author's)
Language: English
Keywords:
GLOBAL | RESEARCH REPORT | LITERATURE REVIEW | IUD | ENDOMETRIAL CANCER | Contraceptive Methods | Contraception | Family Planning | Cancer | Neoplasms | Diseases
Document Number: 327032

Peer Reviewed

Title: Validity of pipelle endometrial sampling in patients with abnormal uterine bleeding.
Author: Fakhar S; Saeed G; Khan AH; Alam AY
Source: Annals of Saudi Medicine. 2008 May-Jun;28(3):188-191.
Abstract: The authors compared endometrial sampling by pipelle endometrial curette with conventional dilatation and curettage (D&C) in patients with abnormal uterine bleeding. Endometrial sampling with pipelle curette was performed on 100 patients followed by formal D&C. Samples were labeled as A and B, respectively, and sent to a histopathologist who was blinded as to the method of sampling. The histopathology reports of both samples were compared, taking D&C as the gold standard. An adequate sample was obtained in 98% of cases by pipelle and in 100% of cases by D&C. Pipelle had a sensitivity, specificity, positive predictive value and negative predictive value of 100% for diagnosing endometrial carcinoma, hyperplasia and secretory endometrium. Pipelle also had high diagnostic sensitivity, specificity and negative predictive value (100%, 98% and 100%, respectively) for hyperplasia with atypia, and low sensitivity (57%) and positive predictive value (57%), but high specificity (97%) and negative predictive value (97%) for endometritis. Similarly, for proliferative endometrium, the pipelle technique had values of 94% and 93% for sensitivity and specificity, respectively. Both samples labeled as inadequate for histology by pipelle were polyps on the D&C report. Difficult endotracheal intubation was encountered in two cases of D&C. No other complications of the procedure were observed. The pipelle is a safe device for getting an adequate endometrial sample for histology, with a high sensitivity and specificity for detection of hyperplasia and malignancy.
Language: English
Keywords:
PAKISTAN | RESEARCH REPORT | METHODOLOGICAL STUDIES | CLINICAL RESEARCH | COMPARATIVE STUDIES | WOMEN IN DEVELOPMENT | ENDOMETRIAL EFFECTS | BLEEDING | CURETTAGE | VALIDITY | PHYSICAL EXAMINATIONS AND DIAGNOSES | ENDOMETRIAL CANCER | UTERUS | Developing Countries | Asia, Southern | Asia | Research Methodology | Studies | Economic Development | Economic Factors | Endometrium | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Signs and Symptoms | Diseases | Obstetrical Surgery | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Measurement | Examinations and Diagnoses | Cancer | Neoplasms
Document Number: 327457

Title: Treatment of endometrial hyperplasia without atypia in peri- and postmenopausal women with a levonorgestrel intrauterine device.
Author: Haimovich S; Checa MA; Mancebo G; Fuste P; Carreras R
Source: Menopause. 2008 Sep-Oct;15(5):1002-4.
Abstract: OBJECTIVE: To assess the effectiveness of the Mirena levonorgestrel-releasing intrauterine system (LNG-IUS) in peri- and postmenopausal women with endometrial hyperplasia without atypia. DESIGN: All consecutive women with histologically documented endometrial hyperplasia without atypia recruited during a 1-year period participated in an open, prospective, single-center study. They were followed for at least 2 years after levonorgestrel-releasing intrauterine system insertion. The pattern of uterine bleeding was evaluated on a 4-point qualitative scale (1 = amenorrhea, 2 = scarce, 3 = normal, 4 = abundant). RESULTS: The study population consisted of 15 women with a mean (SD) age of 49 (2.7) years. Compared with baseline, bleeding decreased quantitatively from a mean score of 3 at baseline (normal bleeding) to 2 (scarce) at 3and 6 months, and 1 (amenorrhea) at 24 months. Endometrial biopsies performed at 12 months revealed atrophicendometrium in 14 women (93.3%) and secretory endometrium in 1 (6.7%)(P < 0.001). At 24 months, endometrial atrophy was documented in 100% of women. CONCLUSIONS: The levonorgestrel-releasing intrauterine system seems to be an effective and safe alternative in the treatment of peri- and postmenopausal women with (simple) endometrial hyperplasia without atypia.
Language: English
Keywords:
SPAIN | RESEARCH REPORT | CLINICAL RESEARCH | WOMEN | MENOPAUSE | LEVONORGESTREL | IUD, HORMONE RELEASING | HORMONE REPLACEMENT THERAPY | BLEEDING | AMENORRHEA | ENDOMETRIAL CANCER | Europe, Southwestern | Europe | Developed Countries | Research Methodology | Demographic Factors | Population | Reproduction | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Contraception | Family Planning | IUD | Contraceptive Methods | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Signs and Symptoms | Diseases | Menstruation Disorders | Cancer | Neoplasms
Document Number: 329631

Title: Non-contraceptive benefits of oral contraceptives.
Author: Huber JC; Bentz EK; Ott J; Tempfer CB
Source: Expert Opinion On Pharmacotherapy. 2008 Sep;9(13):2317-25.
Abstract: BACKGROUND: There is increasing awareness of the opportunity that many contraceptive interventions may provide for additional health benefits. However, treatment of medical problems with oral contraceptives (OCs) is often an 'off-label' practice. OBJECTIVE: The aim of this review is to summarize available data on non-contraceptive benefits of OCs. METHODS: Review of the literature. RESULTS: OCs have been shown to reduce the risk of ovarian, endometrial, and colorectal cancer. It has been suggested that OCs may be used in treatment of endometriosis, menorrhagia, and uterine leiomyomas. Pelvic inflammatory disease, dysmenorrhea, premenstrual syndrome, and acne have been shown to improve under OCs. CONCLUSION: OCs are important for global and female health. Besides contraception, non-contraceptive effects of OCs are evidence based, well established, and commonly used in clinical practice.
Language: English
Keywords:
GLOBAL | RESEARCH REPORT | ENDOMETRIOSIS | ACNE | ENDOMETRIAL CANCER | MENSTRUATION DISORDERS | OVARIAN CANCER | PELVIC INFECTIONS | PREMENSTRUAL TENSION | ORAL CONTRACEPTIVES | Diseases | Dermatitis | Cancer | Neoplasms | Infections | Contraceptive Methods | Contraception | Family Planning
Document Number: 328808

10.
Peer Reviewed

Title: Cost-effectiveness analysis of endometrial cancer prevention strategies for obese women.
Author: Kwon JS; Lu KH
Source: Obstetrics and Gynecology. 2008 Jul;112(1):56-63.
Abstract: OBJECTIVE: It is unknown whether obese women would benefit from oral contraceptives or screening as endometrial cancer prevention strategies. We estimated the net health benefits and cost-effectiveness of these strategies in a hypothetical cohort of obese women. METHODS: A Markov decision-analytic model evaluated 4 strategies: 1) no prevention (reference strategy); 2) oral contraceptive pills (OCPs) for 5 years; 3) annual screening with endometrial biopsy from age 30; 4) biennial screening from age 30. Net health benefit was life expectancy and primary outcome was the incremental cost-effectiveness ratio. Baseline and transition probabilities were obtained from published literature and the Surveillance Epidemiology and End Results database, and costs were from the U.S. Department of Health and Human Services and Agency for Healthcare Research and Quality. Sensitivity analyses were performed for uncertainty around various measures. RESULTS: Average life expectancy for all strategies ranged from 74.52 to 74.60 years. None of the strategies had an incremental cost-effectiveness ratio less than $50,000 per year of life saved relative to the next best strategy. Endometrial cancer risk in obese women had to be 13 times greater than the general population risk before OCPs were a cost-effective intervention. CONCLUSION: Oral contraceptives and current screening methods are not cost-effective endometrial cancer prevention strategies for obese women. Risk factors such as morbid obesity and longstanding anovulation may define a subgroup at highest risk of endometrial cancer for whom OCPs may be a cost-effective strategy. Interventions that reduce endometrial cancer risk further or those with additional health benefits are needed in this population. LEVEL OF EVIDENCE: III. (author's)
Language: English
Keywords:
UNITED STATES OF AMERICA | RESEARCH REPORT | COST BENEFIT ANALYSIS | WOMEN | OBESITY | COMPLICATIONS | ENDOMETRIAL CANCER | SCREENING | COST EFFECTIVENESS | PREVENTION AND CONTROL | ORAL CONTRACEPTIVES | NONCONTRACEPTIVE BENEFITS | Developed Countries | North America | Americas | Quantitative Evaluation | Evaluation | Demographic Factors | Population | Body Weight | Physiology | Biology | Diseases | Cancer | Neoplasms | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Evaluation Indexes | Contraceptive Methods | Contraception | Family Planning | Contraceptive Agents
Document Number: 328326

11.

Peer Reviewed

Title: Non-contraceptive health benefits of oral contraceptives.
Author: Maia H Jr; Casoy J
Source: European Journal of Contraception and Reproductive Health Care. 2008 Mar;13(1):17-24.
Abstract: The use of combined oral contraceptives (COCs) is associated with a reduced risk of developing endometriosis, myomas, and endometrial and ovarian carcinoma. The mechanisms involved are multiple; next to ovulation suppression, a reduction in inflammation in the genital tract is involved. This is accomplished through inhibition of the endometrial expression of enzymes related to the biosynthesis of prostaglandin and oestrogen, particularly cyclooxygenase type II (Cox-2) and aromatase. The blockade of these enzymatic systems by COCs explains the beneficial effects of these compounds in treating the symptoms, and halting the progression of myomas, endometriosis and adenomyosis, all of which are characterized by increased inflammation. Inhibition of aromatase and Cox-2 expression in the endometrium by COCs may explain their efficacy in controlling the pain and excessive uterine bleeding caused by these pathologies. The reduction of inflammation in the endometrium may also be the mechanism behind the lower incidence of endometrial carcinoma in COC users. The blockade of ovulation and ovarian steroidogenesis, on the other hand, may explain the lesser incidence of ovarian cancer and the improvement of acne in users. In conclusion, inflammation appears to play a pivotal role in the development of various benign and malignant gynecological diseases. COCs reduce inflammation in the female genital tract by blocking enzymes such as Cox-2 and aromatase. (author's)
Language: English
Keywords:
BRAZIL | LITERATURE REVIEW | WOMEN | ORAL CONTRACEPTIVES | ENDOMETRIOSIS | MENORRHAGIA | ENDOMETRIAL CANCER | OVARIAN CANCER | ACNE | MENOPAUSE | South America, Eastern | South America | Latin America | Americas | Developing Countries | Demographic Factors | Population | Contraceptive Methods | Contraception | Family Planning | Diseases | Menstruation Disorders | Cancer | Neoplasms | Dermatitis | Reproduction
Document Number: 324655

12.

Peer Reviewed

Title: Expression of aquaporin-1 in normal, hyperplasic, and carcinomatous endometria.
Author: Pan H; Sun CC; Zhou CY; Huang HF
Source: International Journal of Gynecology and Obstetrics. 2008 Jun;101(3):239-244.
Abstract: The objective was to explore the relationship between aquaporin-1 (AQP1) and endometrial adenocarcinoma. Intratumoral microvessel density (IMD) was assessed as well as AQP1 and vascular endothelial growth factor expression in samples from 117 women, 75 with endometrioid adenocarcinoma, 17 with endometrial hyperplasia, and 25 with normal proliferative endometria. AQP1 was located in the epithelial cells of microvessels and small vessels in all samples. The AQP1/IMD ratio was highest in samples from the first, less in samples from the second, and least in samples from the third group. In samples from endometrioid adenocarcinoma, the AQP1/ IMD ratio was significantly correlated with histologic grade, surgical stage, myometrial invasion, and extrauterine metastasis. There was a positive correlation between AQP1 expression and IMD and between AQP1/IMD ratio and VEGF expression. AQP1 may be involved in the tumorigenesis and progression of endometrioid adenocarcinoma by promoting angiogenesis, and AQP1 level may be both a tumor indicator and a new therapeutic target. (author's)
Language: English
Keywords:
CHINA | RESEARCH REPORT | CLINICAL RESEARCH | WOMEN | ENDOMETRIUM | ENDOMETRIAL CANCER | LABORATORY EXAMINATIONS AND DIAGNOSES | Asia, Eastern | Asia | Developing Countries | Research Methodology | Demographic Factors | Population | Uterus | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Cancer | Neoplasms | Diseases | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 326719

13.
Title: [Use of oral contraceptives and increased risk of cervical cancer] Pilgebruik en een verhoogde kans op cervixcarcinoom.
Author: Schmeink CE; Lenselink CH; Bekkers RL
Source: Nederlands Tijdschrift Voor Geneeskunde. 2008 Aug 2;152(31):1717-8.
Abstract: A recently published meta-analysis and a large cohort study showed independently that use of oral contraceptives (OC) leads to an increased relative risk (RR) of cervical cancer. This RR increased with the duration of OC use and was 1.90 after 5 years or more (95% CI: 1.69-2.13). The increased RR decreased after cessation of OC use and was normal again Io years later. Longstanding OC use enhances human papillomavirus (HPV) transcription and decreases HPV clearance, resulting in more frequent persistence of HPV, an increase of cervical intraepithelial neoplasia, and an increased RR of cervical cancer. The increase in cervical cancer by OC is, however, associated with a fully compensatory decrease in the incidence of other malignancies, in particular ovarian cancer and endometrial cancer. Based on these findings, there are no reasons to discourage the use of OC by women in the Netherlands.
Language: Dutch
Keywords:
NETHERLANDS | RESEARCH REPORT | COHORT ANALYSIS | INCIDENCE | WOMEN | ORAL CONTRACEPTIVES | CERVICAL CANCER | HPV | OVARIAN CANCER | ENDOMETRIAL CANCER | RISK FACTORS | Developed Countries | Europe, Western | Europe | Research Methodology | Measurement | Demographic Factors | Population | Contraceptive Methods | Contraception | Family Planning | Cancer | Neoplasms | Diseases | Viral Diseases | Biology
Document Number: 328939

14.

Title: Genital cancer and oral contraceptives. The good news! [editorial]
Author: Skouby SO
Source: European Journal of Contraception and Reproductive Health Care. 2008 Dec;13(4):327-9.
Abstract: COCs have become pivotal in contemporary reproductive health by virtue of their ability to prevent pregnancy. The strong message about ovarian cancer prevention led to the publication of an outstanding and enthusiastic Editorial in The Lancet which extended the evidence from this large systematic review to individual women, by suggesting that the benefits of COCs be made more widely available via over-the-counter (OTC) access. We welcome this positive public-health message, although widespread OTC access may need further evaluation in relation to the optimal individual choice of hormonal contraception. Women are confronted with much adverse publicity about the risks of the pill. Little is said in the lay press about the health benefits. The good news is that its associated risk of cervical cancer can be prevented, that it reduces the risk of both ovarian and endometrial cancer even for many years after discontinuation of its use, and that the RCGP study estimated that the absolute rate of any cancer among ever-users was reduced by 10 to 45 per 100 000 woman-years. (excerpt)
Language: English
Keywords:
EUROPE | CRITIQUE | RECOMMENDATIONS | CLINICAL RESEARCH | WOMEN | CANCER | ORAL CONTRACEPTIVES, SIDE EFFECTS | ORAL CONTRACEPTIVES, COMBINED | CERVICAL CANCER | ENDOMETRIAL CANCER | OVARIAN CANCER | HPV | RISK FACTORS | DISEASE PREVENTION | Developed Countries | Research Methodology | Demographic Factors | Population | Neoplasms | Diseases | Contraceptive Safety | Safety | Public Health | Health | Oral Contraceptives | Contraceptive Methods | Contraception | Family Planning | Viral Diseases | Prevention and Control
Document Number: 331104

15.

Title: Hormone replacement therapy after treatment of endometrial cancer.
Author: Tangjitgamol S; Manusirivithaya S; Hanprasertpong J; Kavanagh JJ
Source: Gynecologic and Obstetric Investigation. 2008 Jan;65(1):35-38.
Abstract: Hormone replacement therapy (HRT) after endometrial cancer (EMC) treatment is an uncertain subject with limited exploration among gynecologic cancer research. Because estrogen is a well-recognized etiologic factor of EMC, most physicians are probably reluctant to provide a replacement therapy, or limit its use to only a selected group of patients. In order to give an overview on this subject, we searched the English-language literature to identify relevant studies or reports. We found that HRT did not appear to increase the recurrence or death rates in EMC. However, most information came from retrospective studies with selection bias, or from a small prospective non-randomized study. The only randomized controlled trial of the Gynecologic Oncology Group could also not provide a definite answer regarding its safety and recommendation. In conclusion, on the basis of the currently available studies, HRT after EMC treatment does not appear to have an adverse effect on EMC. Nevertheless, because of a limitation of data, the physician should thoroughly consider all possible benefits and theoretical risks of recurrence or mortality in each individual to provide the best of care for their patients. (author's)
Language: English
Keywords:
THAILAND | LITERATURE REVIEW | WOMEN | ENDOMETRIAL CANCER | TREATMENT | HORMONE REPLACEMENT THERAPY | ESTROGENS | RISK FACTORS | CARDIOVASCULAR EFFECTS | OSTEOPOROSIS | SAFETY | Asia, Southeastern | Asia | Developing Countries | Demographic Factors | Population | Cancer | Neoplasms | Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Hormones | Endocrine System | Physiology | Biology | Skeletal Effects | Public Health
Document Number: 323124

16.

Peer Reviewed

Title: Aggressive mixed type endometrial carcinoma in a young woman with rapid progression and fatal outcome.
Author: Taskin EA; Taskin S; Berker B; Erol E; Dunder I
Source: Archives of Gynecology and Obstetrics. 2008 Jan;277(1):71-73.
Abstract: Endometrial carcinoma in young ages is uncommon and tends to be a well differentiated endometrioid type and has an excellent prognosis. Nevertheless, in this report mixed type endometrial cancer including serous, clear cell and endometrioid components in a young patient with rapid progression and fatal outcome is presented. A 26-year-old virgin female was admitted with menometrohagia lasting for 9 months, leading to severe anemia. Transabdominal ultrasonography demonstrated 30 x 27 mm intramural mass consistent with leiomyoma in uterine corpus posterior. The patient did not permit any vaginal intervention including endometrial sampling, therefore laparotomy was decided. Mixed type endometrial carcinoma was diagnosed and she was treated with comprehensive surgery plus adjuvant chemotherapy. After 7 months of surgery she deceased. We suggest that persistent uterine bleeding associated with severe anemia should be evaluated for malignancy even in young women to avoid delay in diagnosis. Imaging studies especially magnetic resonance imaging may be helpful when endometrial sampling cannot be done. (author's)
Language: English
Keywords:
TURKEY | SUMMARY REPORT | CASE HISTORIES | ENDOMETRIAL CANCER | BLEEDING | ANEMIA | ULTRASONICS | LAPAROTOMY | HISTOLOGY | SURGERY | DRUGS | Europe, Southeastern | Europe | Developing Countries | Data Collection | Research Methodology | Cancer | Neoplasms | Diseases | Signs and Symptoms | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Treatment | Biology
Document Number: 322616

17.

Title: Prognostic factors in women 45 years of age or younger with endometrial cancer.
Author: Uharcek P; Mlyncek M; Ravinger J; Matejka M
Source: International Journal of Gynecological Cancer. 2008 Mar-Apr;18(2):209-386.
Abstract: The purpose of this study was to conduct a clinical and pathologic review of endometrial cancers diagnosed in women aged younger than 45 years to better identify the prognostic factors for this subgroup of women. We retrospectively evaluated the clinical history, treatment, and follow-up of patients with histologically confirmed endometrial cancer treated in Faculty Hospital Nitra, Slovakia from 1993 to 2003. Data were abstracted regarding tumor histology, grade, age, parity, stage, diabetes, use of oral contraceptives, body mass index (BMI), and survival. One hundred seventy-three patients with endometrioid histology were divided into two groups: younger group (age less than or equal to 45 years, n = 20) and older group (age greater than 45, n = 153). Patients with high-risk histology (clear cell or serous papillary) were excluded from the study. Twenty patients less than or equal to 45 years of age received treatment for endometrial cancer: stage I, 16 (80%); stage II, 2 (10%); stage III, 1 (5%); and stage IV, 1 (5%). Tumors were well differentiated in 12 (60%), moderately differentiated in 6 (30%), and poorly differentiated in 2 (10%). Age ranged from 28 to 45 years (mean 37), with mean BMI 35.8 plus or minus 9.4. At the end of study period, 17 (85%) were alive with no evidence of disease and 3 (15%) had died of recurrent disease. We conclude that patients less than or equal to 45 years of age have better survival compared to older patients. Deeper myometrial invasion was significantly associated with age greater than 45 years. Majority of young patients with endometrial cancer were obese and nulliparous. (author's)
Language: English
Keywords:
SLOVAKIA | LITERATURE REVIEW | RETROSPECTIVE STUDIES | WOMEN | MENSTRUAL CYCLE | ENDOMETRIAL CANCER | MYOMETRIAL EFFECTS | TREATMENT | AGE FACTORS | OBESITY | NULLIPARITY | Developing Countries | Europe, Central | Europe | Studies | Research Methodology | Demographic Factors | Population | Menstruation | Reproduction | Cancer | Neoplasms | Diseases | Myometrium | Uterus | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Population Characteristics | Body Weight | Parity | Fertility Measurements | Fertility | Population Dynamics
Document Number: 326852

18.

Title: The effectiveness of a levonorgestrel-releasing intrauterine system (LNG-IUS) in the treatment of endometrial hyperplasia--a long-term follow-up study.
Author: Varma R; Soneja H; Bhatia K; Ganesan R; Rollason T; Clark TJ; Gupta JK
Source: European Journal of Obstetrics, Gynecology, and Reproductive Biology. 2008 Aug;139(2):169-75.
Abstract: OBJECTIVES: Medical treatment of non-atypical endometrial hyperplasia with oral progestogens has limited efficacy and poor compliance. A levonorgestrel-releasing intrauterine system (LNG-IUS) has been shown to successfully treat hyperplasia in small-sized studies. Our aim was to examine the effectiveness of LNG-IUS in a larger study with long-term follow up. STUDY DESIGN: Prospective observational study of 105 women diagnosed with endometrial hyperplasia and treated with LNG-IUS between 1999 and 2004 at a University Teaching hospital. Baseline characteristics and outpatient endometrial Pipelle sampling were undertaken at 3 and 6 months post LNG-IUS insertion and 6-monthly intervals thereafter in all cases. Outcome included histological data derived from both Pipelle and uterine histologies at 1 and 2 years LNG-IUS therapy. RESULTS: LNG-IUS achieved endometrial regression in 90% (94/105) of cases by 2 years, with a significant proportion (96%, 90/94) achieving this within 1 year. Regression occurred in 88/96 (92%) of non-atypical and 6/9 (67%) of atypical hyperplasias, and in all 22 cases of endometrial hyperplasia associated with HRT. Regression rates did not differ between histological types of hyperplasia. Twenty-three women (22%) underwent hysterectomy of which 13 were indicated and 10 were performed at patient request despite regressed endometrium. Two cases of cancer (one uterine and one ovarian) were identified. CONCLUSION: LNG-IUS is highly effective in treating endometrial hyperplasia. Beneficial effects are observed by the majority within 1 year. Treatment can be reliably monitored through regular 6-montly outpatient endometrial Pipelle surveillance. LNG-IUS treatment of non-atypical hyperplasias is likely to reduce the number of hysterectomies performed in this subgroup.
Language: English
Keywords:
UNITED KINGDOM | RESEARCH REPORT | PROSPECTIVE STUDIES | WOMEN | CLIENTS | ENDOMETRIAL CANCER | LEVONORGESTREL | IUD | TREATMENT | PREVENTION AND CONTROL | Developed Countries | Europe, Western | Europe | Studies | Research Methodology | Demographic Factors | Population | Program Activities | Programs | Organization and Administration | Cancer | Neoplasms | Diseases | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Contraception | Family Planning | Contraceptive Methods | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 328653

19.

Title: [Dermatofibrosarcoma protuberans in inguinal region: a case report] Dermatofibrosarcoma protuberans em regiao inguinal: relato de caso.
Author: Aoki T; Campaner AB; Ribeiro PA; Auge AP; Muller H
Source: Revista Brasileira de Ginecologia e Obstetricia. 2007 Mar;29(3):153-157.
Abstract: Dermatofi brosarcoma protuberans (DFSP) is a rare malignant neoplasia in gynecology, with probability of recurrence and low possibilities of metastasis. A 34-year-old patient after endometriosis treatment presented pain in the left inguinal region. She reported sensation of gradual increase in a solid nodule, painless at palpation, with difficult mobilization. Exeresis was proceeded with diagnostic hypothesis of endometriosis. Microscopy revealed a mesenchymal neoplasia characterized by proliferation of monomorphic fusiform cells and storiform aspect characterizing the DFSP. DFSP must be remembered in the differential diagnosis of the affections of the inguinal region in gynecology because it represents a malignant neoplasia, although it's rare.
Language: Portuguese
Keywords:
RESEARCH REPORT | CLINICAL RESEARCH | CASE STUDIES | WOMEN | CANCER | DERMATOLOGICAL EFFECTS | ENDOMETRIAL CANCER | ENDOMETRIOSIS | Research Methodology | Studies | Demographic Factors | Population | Neoplasms | Diseases | Physiology | Biology
Document Number: 324609

21.

Peer Reviewed

Title: Reproductive risk factors for endometrial cancer among Polish women.
Author: Brinton LA; Sakoda LC; Lissowska J; Sherman ME; Chatterjee N
Source: British Journal of Cancer. 2007 May 7;96(9):1450-1456.
Abstract: We conducted a population-based case-control study of reproductive factors in Warsaw and Looz�, Poland, in 551 incident endometrial cancer cases and 1925 controls. The reproductive variable most strongly related to risk was multiparity, with subjects with three or more births having a 70% lower risk than the nulliparous women. The reduced risk was particularly strong below 55 years of age. Subjects with older ages at a first birth were also at reduced risk even after adjustment for number of births. Ages at last birth or intervals since last birth were not strongly related to risk. Spontaneous abortions were unrelated to risk, but induced abortions were associated with slight risk increases (odds ratios = 1.28, 95% confidence intervals 0.8-2.1 for 3+ vs no abortions). The absence of effects on risk of later ages at, or short intervals since, a last birth fails to support the view that endometrial cancer is influenced by mechanical clearance of initiated cells. Alternative explanations for reproductive effects should be sought, including alterations in endogenous hormones. (author's)
Language: English
Keywords:
POLAND | RESEARCH REPORT | CONTROL GROUPS | ENDOMETRIAL CANCER | RISK FACTORS | ABORTION | BREASTFEEDING | PARITY | AGE FACTORS | BIRTH INTERVALS | INFERTILITY | Developing Countries | Europe, Central | Europe | Research Methodology | Cancer | Neoplasms | Diseases | Biology | Fertility Control, Postconception | Family Planning | Infant Nutrition | Nutrition | Health | Fertility Measurements | Fertility | Population Dynamics | Demographic Factors | Population | Population Characteristics | Reproduction
Document Number: 317514 Notification

22.

Peer Reviewed

Title: Neoplasia with use of intrauterine devices.
Author: Curtis KM; Marchbanks PA; Peterson HB
Source: Contraception. 2007 Jun;75(6 Suppl 1):S60-S69.
Abstract: One of the mechanisms by which intrauterine devices (IUDs) prevent pregnancy is the creation of a sterile inflammatory response in the endometrium. Additionally, hormone-releasing IUDs or intrauterine systems (IUSs) release progestins or progesterone into the uterus. Both of these mechanisms may affect users' risk for neoplasia. We searched the PubMed database for studies on IUD use and risk for neoplasia conducted between 1960 and September 2006 and published in all languages. We excluded case reports and case series. For the association between ever using an IUD and risk for endometrial cancer, we conducted a meta-analysis using a Bayesian random-effects model to account for between-study heterogeneity. We found no evidence of increased risk for neoplasia with IUD use. Nine case-control studies and one cohort study found reduced risks for endometrial cancer with having ever used an IUD (pooled adjusted odds ratio=0.6, 95% confidence interval=0.4-0.7). No trend in associations was observed with characteristics of IUD use, type of IUD and histologic type of cancer. Four case-control studies found no association between IUD use and risk for cervical cancer. One study found no increased incidence of breast cancer among levonorgestrel-releasing IUS users as compared with the general population in Finland. Finally, three studies found no association between IUD use and occurrence of hydatidiform moles or malignant sequelae. Use of an IUD does not appear to increase the risk for neoplasia. While nearly all studies found that IUD use was associated with a decreased risk for endometrial cancer, it remains unclear whether this association is causal. (author's)
Language: English
Keywords:
UNITED STATES OF AMERICA | LITERATURE REVIEW | WOMEN | IUD | RISK FACTORS | REPRODUCTIVE HEALTH | ENDOMETRIAL CANCER | CERVICAL CANCER | BREAST CANCER | North America | Americas | Developed Countries | Demographic Factors | Population | Contraceptive Methods | Contraception | Family Planning | Biology | Health | Cancer | Neoplasms | Diseases
Document Number: 316864

23.

Peer Reviewed

Title: [Hormone replacement therapy and endometrial cancer] Terapia de reposicao hormonal e o cancer do endometrio.
Author: de Araujo Junio NL; Athanazio DA
Source: Cadernos de Saude Publica. 2007 Nov;23(11):2613-2622.
Abstract: Hormone replacement therapy (HRT) has been used worldwide to relieve menopausal symptoms. The evolution in clinical knowledge of its risks has lagged persistently behind its application in clinical practice. In the 1970s, endometrial cancer incidence increased in developed countries, and exogenous estrogen therapy in postmenopausal women was the most important factor. In the 1980s and 90s, combined estrogen- progesterone therapy was prescribed on a large scale, based on its potential beneficial effects on the musculoskeletal and cardiovascular systems without increasing the risk of endometrial carcinoma. However, once again, recent reports argue against the safety of HRT, and the most important issues are now the increased risk of cardiovascular disease and total cancer in combined formulations. We conclude that the recently reported risks on combined HRT may have a significant public health impact, and that this treatment regimen should not be prescribed to protect postmenopausal women from endometrial carcinoma, since the risks outweigh the benefits. (author's)
Language: Portuguese
Keywords:
BRAZIL | GLOBAL | HISTORICAL REVIEW | MENOPAUSE | HORMONE REPLACEMENT THERAPY | ENDOMETRIAL CANCER | RISK FACTORS | WOMEN'S HEALTH | South America, Eastern | South America | Latin America | Americas | Developing Countries | Reproduction | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Cancer | Neoplasms | Diseases | Biology
Document Number: 324590

24.

Title: [Prevalence of endometrial injury in asymptomatic obese women] Prevalencia de lesoes endometriais em mulheres obesas assintomaticas.
Author: Gouveia DA; Bahamondes L; Aldrighi JM; Tamanaha S; Ribeiro AL
Source: Revista da Associacao Medica Brasileira. 2007 Jul-Aug;53(4):344-348.
Abstract: OBJECTIVE. Obesity represents the most important risk factor for endometrial pathology. This study aimed to evaluate the prevalence of endometrial injuries, such as polyps, hyperplasia and endometrial cancer in asymptomatic obese women, as well as to recognize the associated risk factors . METHODS. A cross-sectional study was conducted between December 2004 and February 2006. Ninety-four obese (body mass index >or= 30 kg/m�) women were evaluated, divided in two groups of 47 participants each: pre-menopausal and postmenopausal women. Clinical characteristics, physical exams (anthropometric and gynecological), blood count and endometrial assessment by vaginal ultrasonography, biopsy, and hysteroscopy (only for confirmed endometrial pathology), were the variables appraised. RESULTS. In pre-menopausal women, 12.8% of cases had endometrial pathology statistically associated to age, hypertension, hypercholesterolemia and LDL-c increase. In the post-menopausal women, 40.4% of cases had a pathology identified as statistically associated with hypertension, LDL-c and estrone increase. Two cases of endometrial cancer were identified, one in each group. CONCLUSIONS. The increased incidence of obesity over recent years has increased risk factors of endometrial cancer. In premenopausal women only a small number of cases with endometrial alterations was observed. Therefore, it is suggested that greater attention be given to those over 40 years of age, associated with hypertension and/or higher LDL-c . The menopausal status increases risk of endometrial injury, and when associated with hypertension, LDL-c and/or estrone increase, women become candidates to biopsy aiming for an early diagnosis of cancer, a decisive factor for a favorable prognosis.
Language: Portuguese
Keywords:
UNITED STATES OF AMERICA | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS | WOMEN | OBESITY | RISK FACTORS | ENDOMETRIAL EFFECTS | ENDOMETRIAL CANCER | HYPERTENSION | Developed Countries | North America | Americas | Research Methodology | Demographic Factors | Population | Body Weight | Physiology | Biology | Endometrium | Uterus | Genitalia, Female | Genitalia | Urogenital System | Cancer | Neoplasms | Diseases | Vascular Diseases
Document Number: 324932

26.

Title: Improving the existing diagnostic strategy by accounting for characteristics of the women in the diagnostic work up for postmenopausal bleeding [letter]
Author: Mahajan NN; Mahajan K
Source: BJOG: An International Journal of Obstetrics and Gynaecology. 2007 May;114(5):650.
Abstract: We read with interest the article of Opmeer et al. on improving the existing diagnostic strategy for postmenopausal bleeding (PMB) by accounting for characteristics of the women. However, certain issues need to be clarified. Abnormal endometrial sonographic textures such as inhomogeneous echotexture or obvious invasion of the underlying myometrium are consistent with malignancy detected by transvaginal sonography (TVS). A meta-analysis confirmed the utility of TVS as a means to exclude endometrial carcinoma. Could the authors kindly comment on the incidence of abnormal endometrial sonographic texture in their population? We agree that the main objective in the diagnostic workup of women with PMB is to detect or rule out endometrial cancer, but neither there was mention of cervical cancer in the article by Opmeer et al. nor did they exclude women with cervical cancer. Although cervical cancer is relatively uncommon in developed countries, it is the third most common form of cancer in women worldwide and the leading cancer of women in sub-Saharan Africa, central and South America, and South-East Asia. In the study by Ergete and Tesfaye, the most common cause of PMB was cervical carcinoma, which accounted for 51.6% cases, which correlates with reports from other developing countries. We therefore suggest that the PMB diagnostic workup should include cytological screening or visual inspection with acetic acid with endocervical sampling in addition to TVS and/ or endometrial biopsy, especially in developing countries. (full text)
Language: English
Keywords:
INDIA | DEVELOPING COUNTRIES | CRITIQUE | WOMEN | ULTRASONICS | SCREENING | MENOPAUSE | BLEEDING | ENDOMETRIAL CANCER | EXAMINATIONS AND DIAGNOSES | PERFORMANCE IMPROVEMENT | Asia, Southern | Asia | Demographic Factors | Population | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Reproduction | Signs and Symptoms | Diseases | Cancer | Neoplasms | Management | Organization and Administration
Document Number: 315397

27.

Peer Reviewed

Title: Modern management of abnormal uterine bleeding -- the levonorgestrel intra-uterine system.
Author: Mansour D
Source: Best Practice and Research Clinical Obstetrics and Gynaecology. 2007 Dec;21(6):1007-1021.
Abstract: Since its launch, more than 9 million women worldwide have used the levonorgestrel intra-uterine system (IUS) for contraception, as a treatment for heavy menstrual bleeding and as the progestogen component of hormone-replacement therapy. For women in their reproductive years, the IUS has become one of the most acceptable medical treatments for menorrhagia, reducing referrals to specialists and decreasing the need for operative gynaecological surgery. This article will outline the development of the IUS, highlighting the most important recent areas of research covering its use to control menstrual blood loss and pain. (author's)
Language: English
Keywords:
UNITED KINGDOM | GLOBAL | HISTORICAL REVIEW | IUD, HORMONE RELEASING | CONTRACEPTIVE EFFECTIVENESS | CONTRACEPTIVE AGENTS, SIDE EFFECTS | MENORRHAGIA | ENDOMETRIOSIS | DYSMENORRHEA | ENDOMETRIAL CANCER | TREATMENT | Developed Countries | Europe, Western | Europe | IUD | Contraceptive Methods | Contraception | Family Planning | Contraceptive Agents | Menstruation Disorders | Diseases | Cancer | Neoplasms | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 314000

28.

Peer Reviewed

Title: Endometrial volume as predictor of malignancy in women with postmenopausal bleeding.
Author: Mansour GM; El-Lamie IK; El-Kady MA; El-Mekkawi SF; Laban M
Source: International Journal of Gynecology and Obstetrics. 2007 Dec;99(3):206-210.
Abstract: The objective was to assess endometrial volume as a predictor of endometrial malignancy in women with postmenopausal bleeding. Endometrial volume was measured by virtual organ computer-aided analysis in 170 women with postmenopausal bleeding, and histopathologic results of endometrial biopsies were obtained for all. A group of 100 women without postmenopausal bleeding was used for control. There were 90 cases of benign disease, 53 cases of atypia, and 27 cases of endometrial cancers in the study group. Whereas endometrial thickness was 9.61+or-5.12 mm (range, 5-20 mm) and endometrial volume was 3+or-1.1 mL (range, 1.8-5.4 mL) in women with atypia or cancer, they were 4.87+or-3.43mm (range, 2-8mm) and 1.52+or-0.82 (range, 0.6-2.2 mL), respectively, in women with benign disease. In the control group, endometrial volume was 1.15+or-0.14 mL (range, 0.6-1.3 mL). Volume was more sensitive than thickness for predicting malignancy, and a cutoff value of 1.35 mL was found to provide the best sensitivity. An endometrial volume of 1.35 mL or greater may predict malignancy in women with postmenopausal bleeding. (author's)
Language: English
Keywords:
EGYPT | RESEARCH REPORT | WOMEN | MENOPAUSE | ENDOMETRIAL EFFECTS | BLEEDING | ULTRASONICS | ENDOMETRIAL CANCER | NEOPLASMS, BENIGN | EVALUATION | Developing Countries | Africa, North | Africa | Demographic Factors | Population | Reproduction | Endometrium | Uterus | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Signs and Symptoms | Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Cancer | Neoplasms
Document Number: 322126

29.

Title: Is ultraviolet B irradiance inversely associated with incidence rates of endometrial cancer: An ecological study of 107 countries.
Author: Mohr SB; Garland CF; Gorham ED; Grant WB; Garland FC
Source: Preventive Medicine. 2007 Nov;45(5):327-331.
Abstract: The purpose of this study was to perform an ecological analysis of the relationship between low levels of ultraviolet B (UVB) irradiance and age-standardized incidence rates of endometrial cancer by country, controlling for known confounders. The contributions of UVB irradiance, cloud cover, intake of energy from animal sources, proportion of population overweight, skin pigmentation, per capita cigarette consumption, per capita health expenditure, and total fertility rates, to age-standardized incidence rates of endometrial cancer in 107 countries were assessed using multiple regression. Incidence rates were higher at higher latitudes (R2=0.47, p<0.01). According to multiple regression, UVB irradiance adjusted for cloud cover was negatively associated with incidence rates (p=0.02), while proportion of population overweight (p=0.004), intake of energy from animal sources (p=0.01) and per capita health expenditure (p<0.0001) were positively associated with incidence rates (overall R2=0.73, p<0.0001). An association was found between low UVB irradiance, high intake of energy from animal sources, per capita health expenditure, proportion of population overweight, and incidence rates. (author's)
Language: English
Keywords:
UNITED STATES OF AMERICA | GLOBAL | RESEARCH REPORT | INCIDENCE | EPIDEMIOLOGY | DIET | VITAMIN D | NEOPLASMS | ENDOMETRIAL CANCER | BODY WEIGHT | Developed Countries | North America | Americas | Measurement | Research Methodology | Public Health | Health | Nutrition | Vitamins and Minerals | Physiology | Biology | Diseases | Cancer
Document Number: 322086

30.

Title: Improving the existing diagnostic strategy by accounting for characteristics of the women in the diagnostic work up for postmenopausal bleeding. Author's reply [letter]
Author: Opmeer BC; van Doorn HC; Heintz AP; Burger CW; Bossuyt PM
Source: BJOG: An International Journal of Obstetrics and Gynaecology. 2007 May;114(5):650-651.
Abstract: Thank you for providing the opportunity to respond to the letter of Dr NMahajan and Dr K Mahajan. The authors suggest that abnormal sonographic textures may have additional diagnostic value for the diagnosis of endometrial carcinoma. In our study, we have no data available concerning the homogeneity of echotexture, so we could not evaluate whether this would have further improved the diagnostic accuracy of the models. Thereby, our aim was to evaluate models based on information that is more or less commonly and reliably assessed in gynaecological practice. With respect to assessing sonographic textures of the endometrium, we suspect that this is not always systematically documented, and (consequently) inter-observer reliability may be an issue when designing such a study. The other comment by these authors concerns the difference in prevalence rates of cervical cancer between developing and developed countries, and they suggest that the workup for postmenopausal bleeding should include cytologicalscreening of the endocervix. In the Netherlands (and probably many other western countries), a population-wide programme for cervical cancer screening periodically offers a cervical smear to all women aged 30 years and older. Consequently, only few cases of cervical cancer remain undetected, and only a limited number will be encountered in gynaecological practice as the cause of postmenopausal bleeding (<1% in our sample). Thereby, in line with the guidelines, a cervical smear is obtained when women present with postmenopausal bleeding in a primary care visit. Consequently, those cases are identified early in the workup and are therefore not so relevant for the probabilistic approach in our article. We can agree with the authors, however, that this difference becomes pertinent when generalising our findings to regions with different healthcare systems (i.e. screening programmes and/or guidelines for postmenopausal bleeding) and/or when combining data from different regions, e.g. in systematic reviews or individual patient data meta-analysis. Strictly, applicability of our findings to the clinical practice of the authors should be assessed empirically. However, as in our study, women with cervical cancer were generally detected before it could cause postmenopausal bleeding, the findings may hold true for women in whom cervical cancer was ruled out as cause of postmenopausal bleeding. (full text)
Language: English
Keywords:
INDIA | DEVELOPING COUNTRIES | CRITIQUE | RESEARCH METHODOLOGY | SCREENING | ENDOMETRIAL CANCER | CERVICAL CANCER | ULTRASONICS | Asia, Southern | Asia | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Cancer | Neoplasms | Diseases
Document Number: 315398


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