Reproductive Factors and Endometrial Cancer Risk Among Women

Curvilinear incidence models for parity in the entire fertility range for cancers of the breast, ovary, and endometrium: A follow-up of the Norwegian 1960 Census

The protective effect of parity has been demonstrated for cancer of the breast, ovary, and endometrium but no studies have estimated the effect of each subsequent birth in women with 10 or more children or grand-grand parity women, nor compared the linear relationship of the three cancers sites. Here, we aim to explore these relationships based on the Norwegian 1960 Census. The question of parity in present marriage was answered by 385,816 women born 1870-1915, a period with high fertility. Age at marriage has been validated as a proxy for age at first birth AFB. With high parity age at first birth will logically be restricted to early births giving structural zeros. Follow-up was based on linkages to national registers until the first of any of the three diagnoses, death, or age 90 before 31.12.2005. Included were 16,905 breast cancers, 3827 ovarian cancers, and 3834 endometrial cancers. Age- and period-specific incidence rates based on person-years, PY, were used in logit regression models. The percentage decrease for each additional child over the total parity range was for breast cancer 10.5% (95% CI; 9.6-11.4), ovarian cancer 13.2% (11.2-15.3), and endometrial cancer 10.9% (8.9-12.8), in a model without higher order terms. Adjustment for structural zeros reduced the effect of age at first birth to less than one additional child. To the best of our knowledge this is the first analysis of the curvilinear relationships for cancers of the breast, ovary, and endometrium throughout the extended fertility range.

Role of signaling pathways in endometrial cancer

Endometrial cancer (EC) is a prevalent gynecological malignancy with a complex molecular landscape, contributing to significant global morbidity and mortality. Dysregulated signaling pathways such as PI3K/AKT/mTOR and RAS/RAF/MEK drive EC progression by promoting uncontrolled cell proliferation, survival, angiogenesis, and metastasis. Mutations in genes like PTEN and PIK3CA further underpin tumor aggressiveness. Molecular alterations in these pathways not only serve as biomarkers for prognosis but also guide the formulation of targeted therapies, such as mTOR inhibitors and anti-angiogenic agents. While such therapies show promise, optimizing their efficacy and minimizing adverse effects requires further research. A comprehensive approach integrating early detection (e.g., addressing postmenopausal bleeding), preventive strategies (e.g., managing obesity), increasing diagnostic sensitivity (e.g., transvaginal ultrasound) and advanced molecularly tailored treatments (e.g., AI & ML) is critical to reducing the burden of this disease. By targeting key signaling pathways, leveraging AI-driven methodologies, and addressing treatment resistance, we can enhance patient outcomes, also mitigate the rising global impact of EC.

Reproductive and Hormonal Factors and Thyroid Cancer Risk: Pooled Analysis of Prospective Cohort Studies in the Asia Cohort Consortium

Given the female predominance of thyroid cancer, particularly in the reproductive age range, female sex hormones have been proposed as an etiology; however, previous epidemiological studies have shown conflicting results. We conducted a pooled analysis using individual data from nine prospective cohorts in the Asia Cohort Consortium to explore the association between 10 female reproductive and hormonal factors and thyroid cancer risk. Using Cox proportional hazards models, cohort-specific hazard ratios (HR) and 95% confidence intervals (CI) were estimated and then pooled using a random-effects model. Analyses were stratified by country, birth years, smoking status, and body mass index, and thyroid cancer risk based on age of diagnosis was also examined. Among 259,649 women followed up for a mean of 17.2 years, 1,353 incident thyroid cancer cases were identified, with 88% (n = 1,140) being papillary thyroid cancer. Older age at first delivery (≥26 vs. 21-25 years) was associated with increased thyroid cancer risk (P-trend = 0.003; HR = 1.16; 95% CI, 1.03-1.31), particularly when diagnosed later in life (≥55 vs. < 55 years; P-trend = 0.003; HR = 1.19; 95% CI, 1.02-1.39). Among younger birth cohorts, women with more number of deliveries showed an increased thyroid cancer risk [P-trend = 0.0001, HR = 2.40; 95% CI, 1.12-5.18 (≥5 vs. 1-2 children)], and there was no substantial trend in older cohorts. Distinct patterns were observed for the number of deliveries and thyroid cancer risk across countries, with a significant positive association for Korea [P-trend = 0.0008, HR = 1.89; 95% CI, 1.21-2.94 (≥5 vs. 1-2 children)] and nonsignificant inverse associations for China and Japan. Contextual and macrosocial changes in reproductive factors in Asian countries may influence thyroid cancer risk. Prevention Relevance: This analysis of prospective cohort studies across three Asian countries highlights that older age at first birth is linked to increased thyroid cancer risk. As women delay motherhood, understanding these trends is vital for public health strategies addressing reproductive factors influencing thyroid cancer risk in these populations.

Molecular and clinical insights into early-onset endometrial cancer

The global incidence of endometrial cancer is on the rise, marked by a notable surge in early-onset endometrial cancer (EOEC; age at diagnosis <50 years). By contrast to late-onset cases, EOEC displays distinct clinical, pathological, and molecular characteristics. The enhanced understanding of the disease's pathophysiology, enabling a more precise differentiation between low-risk and high-risk patients, could facilitate the establishment of risk-stratified treatments that preserve ovarian function and fertility in low-risk EOEC cases. In this review, we delve into the distinctive epidemiological, molecular, and clinical characteristics of EOEC, as well as early noninvasive screening and fertility preservation treatments.

Reproductive factors and risk of epithelial ovarian cancer: results from the Asia Cohort Consortium

BACKGROUND

There are scarce data on risk factors for epithelial ovarian cancer (EOC) in Asian populations. Our goal was to advance knowledge on reproductive -related risk factors for EOC in a large population of Asian women.

METHODS

This study used pooled individual data from baseline questionnaires in 11 prospective cohorts (baseline years, 1958-2015) in the Asia Cohort Consortium. A Cox proportional hazards regression model was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) adjusting for age, parity and cohort.

RESULTS

After a mean = 17.0 years (SD = 6.3) of follow-up, 674 incident invasive EOC cases were identified among 325,626 women. In multivariable adjusted models we observed an inverse association with parity (5+ children vs. 0, HR = 0.44, 95% CI = 0.28-0.68, Ptrend < 0.001), and a positive association with increasing menopausal age (55+ years vs. <45, HR = 1.77, 95% CI = 1.05-3.01, Ptrend = 0.02) for risk of all EOC.

CONCLUSIONS

In this large study of Asian women we identified an inverse association with parity and a positive association with higher menopausal age in relation to EOC risk. Further work is needed to understand EOC risk factors for rare histologic subtypes that occur more frequently in Asian populations.

The influence of menopause age on gynecologic cancer risk: a comprehensive analysis using NHANES data

Background

Menopause, a natural transition, affects women's health risks, including gynecologic cancers. Early menopause, linked to lower estrogen, may increase cancer susceptibility. This study analyzed NHANES data from 1999 to 2020 for 8,219 postmenopausal women to explore the relationship between menopausal age and gynecologic cancers. We used regression models and RCS models to assess the risk.

Methods

This study utilized data from the NHANES spanning 1999 to 2020, focusing on 8,219 postmenopausal women selected through stratified sampling. Variables including socioeconomic factors, health behaviors, nutritional status, and medical history were assessed in relation to participants' menopausal age and gynecologic cancer prevalence. We analyzed the relationship between menopausal age and gynecologic cancers (cervical, ovarian, and uterine) using multiple regression models. Additionally, we employed RCS models to evaluate nonlinear relationships between menopausal age and gynecologic cancer risk.

Results

Our findings indicate a significant inverse association between menopausal age and the risk of gynecologic cancers. After controlling for confounding factors such as age, race, BMI, and lifestyle variables, a later age at menopause was associated with a reduced risk of cervical, ovarian, and uterine cancers. The RCS model revealed a non-linear, low-L-shaped relationship, particularly highlighting increased cancer risks at younger menopausal ages. Subgroup analyses demonstrated consistent results across demographic and lifestyle factors, confirming the robustness of the observed associations.

Conclusion

This study reveals the link between menopausal age and gynecologic cancer prevalence. Early menopause is a significant risk factor for cervical, ovarian, and uterine cancers. Our findings support tailored cancer screening based on menopausal age, potentially improving preventive care for postmenopausal women.

Distribution and Related Influencing Factors of AMH Level in Family-Planning Women of Childbearing Age: A Cross-Sectional Study from Beijing, China

Purpose

This study aimed to analyze the distribution and factors influencing anti-Müllerian hormone (AMH) levels among family-planning women of childbearing age in Beijing, China.

Patients and Methods

We collected the data of 3,236 family-planning women of childbearing age who underwent pre-pregnancy examinations at Xicheng District Maternal and Child Health Hospital in Beijing between October 2021 and July 2024. Collected data included age, education level, ethnicity, height, weight, and systolic and diastolic blood pressure. We calculated the body mass index (BMI) of each participant. The collected blood test results included AMH, fasting blood glucose (FBG), thyroid-stimulating hormone (TSH), creatinine (Cr), and alanine aminotransferase, and hemoglobin levels and platelet count. A structured questionnaire was used to document the subjects' dietary and lifestyle habits, environmental factors, and emotional and mental stress statuses. The patients were divided into age groups (≥36 years versus ≤35 years) and factors compared between them. Two different factors influencing AMH level were analyzed using a logistics model.

Results

The AMH level decreased with age, with a median AMH of <2.0 ng/mL for subjects aged ≥36 years. Significant intergroup differences were noted in ethnicity, education level, FBG, creatinine level, BMI, diastolic blood pressure, hemoglobin level, smoking rate, and life-related stress level. A logistic regression analysis suggested that age was a negative factor affecting AMH level in both groups (P=0.000 and 0.002, respectively). Hemoglobin and educational levels were also important influential factors of AMH in patients aged ≤ 35 years but not in those aged ≥ 36 years.

Conclusion

AMH levels gradually decreased with age. Although nutritional status and educational level significantly impacted AMH levels among women ≤ 35 years of age, their effects decreased thereafter. Thus, 35 years of age is considered an important reproductive boundary for women of childbearing age.

Global burden and trends in pre- and post-menopausal gynecological cancer from 1990 to 2019, with projections to 2040: a cross-sectional study

BACKGROUND

The global burden and trends in gynecological cancer (GC) by menopausal status worldwide remain unclear.

METHODS

Data on the number of incident cases and deaths, as well as age-standardized rates (ASR) and risk factors for GC in pre- and post-menopausal women were obtained from the Global Burden of Disease (GBD) Study 2019. The estimated annual percent change was calculated to quantify the temporal trend of GC burden by menopausal status between 1990 and 2019. The Bayesian age-period-cohort model was used to predict the trends in age-standardized incidence and mortality rates for pre- and post-menopausal GC during 2020-2040.

RESULTS

In 2019, an estimated 400 146 pre-menopausal and 879 476 post-menopausal GC cases were newly diagnosed worldwide, with ~111 420 and 442 821 GC-related deaths occurring in each menopausal group, respectively. The majority of both pre- and post-menopausal GC cases in low-to-middle-SDI regions was due to cervical cancer. In high- and high-middle-SDI regions, pre-menopausal GC was primarily attributed to cervical cancer, while post-menopausal GC was mainly attributed to uterine cancer. Additionally, the contribution of uterine cancer to GC was higher among post-menopausal women than pre-menopausal women, across all SDI levels and geographical regions. ASIRs either remained stable or increased from 1990 to 2019 worldwide for both pre- and post-menopausal GC [an average change of 0.03% (95% CI -0.02 to 0.08) and 0.09% (0.05-0.13) per year, respectively]. However, the age-standardized mortality rates (ASMRs) declined by an annual average of 0.86% (95% CI -0.92 to -0.8) and 0.63% (95% CI -0.66 to -0.6) globally during the same period. The risk-attributable proportion of post-menopausal GC deaths was higher than that of pre-menopausal GC and increased with increasing SDI. The projections indicate an increasing trend in the burden of pre-menopausal GC from 2020 to 2040, while the burden of post-menopausal GC is expected to decline.

CONCLUSIONS

GC continues to be a significant public health concern worldwide, with notable regional and demographic disparities in the burden based on menopausal status. Policymakers and healthcare providers must be proactively aware of these evolving trends and tailor age-appropriate and region-specific screening strategies, as well as allocate resources accordingly.

Understanding risk factors for endometrial cancer in young women

BACKGROUND

The American Cancer Society recommends physicians inform average-risk women about endometrial cancer risk on reaching menopause, but new diagnoses are rising fastest in women aged younger than 50 years. Educating these younger women about endometrial cancer risks requires knowledge of risk factors. However, endometrial cancer in young women is rare and challenging to study in single study populations.

METHODS

We included 13 846 incident endometrial cancer patients (1639 aged younger than 50 years) and 30 569 matched control individuals from the Epidemiology of Endometrial Cancer Consortium. We used generalized linear models to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for 6 risk factors and endometrial cancer risk. We created a risk score to evaluate the combined associations and population attributable fractions for these factors.

RESULTS

In younger and older women, we observed positive associations with body mass index and diabetes and inverse associations with age at menarche, oral contraceptive use, and parity. Current smoking was associated with reduced risk only in women aged 50 years and older (Phet < .01). Body mass index was the strongest risk factor (OR≥35 vs<25 kg/m2 = 5.57, 95% CI = 4.33 to 7.16, for ages younger than 50 years; OR≥35 vs<25 kg/m2 = 4.68, 95% CI = 4.30 to 5.09, for ages 50 years and older; Phet = .14). Possessing at least 4 risk factors was associated with approximately ninefold increased risk in women aged younger than 50 years and approximately fourfold increased risk in women aged 50 years and older (Phet < .01). Together, 59.1% of endometrial cancer in women aged younger than 50 years and 55.6% in women aged 50 years and older were attributable to these factors.

CONCLUSIONS

Our data confirm younger and older women share common endometrial cancer risk factors. Early educational efforts centered on these factors may help mitigate the rising endometrial cancer burden in young women.

Is Insulin Resistance a High-Risk Factor for Postmenopausal Endometrial Cancer: Insights from the Triglyceride Glucose (TyG) Index and the Metabolic Score for Insulin Resistance (METS-IR)

Purpose

To evaluate the insulin resistance in patients with menopause who were newly diagnosed with endometrial cancer and its association with disease development.

Methods

The study included 356 patients with menopause who underwent hysteroscopy at Beijing Obstetrics and Gynecology Hospital between September 2013 and July 2018. Data on age, height, weight, menarche and menopausal age, pregnancies, births, and family history of tumors, hypertension, and diabetes were collected. Blood tests provided fasting blood glucose, triglycerides, total cholesterol, high-density lipoprotein, and low-density lipoprotein levels. Pathological testing determined whether patients had endometrial cancer or precancerous lesions. Differences in influencing factors between patients with endometrial cancer or precancerous lesions and those with normal or benign conditions were analyzed using univariate analysis. Quartile grouping of the Metabolic Score for Insulin Resistance (METS-IR) and Triglyceride-Glucose (TyG) index were applied to examine the impact of different insulin resistance on the development of endometrial cancer or precancerous lesions.

Results

Univariate analysis revealed that the proportion of patients with hypertension and diabetes was significantly higher among those with endometrial cancer and precancerous lesions. METS-IR and TyG levels were significantly increased in patients with endometrial cancer and precancerous lesions. The quartile grouping results of METS-IR and TyG suggested that age, BMI, FBG, TG, hypertension, and diabetes prevalence rates increased with an increase in METS-IR or TyG, whereas lipid indicators were negatively correlated and unstable Logistic regression suggested that none of the above influencing factors and METS-IR or TyG were related to the pathological results of the patients.

Conclusion

Patients with endometrial or precancerous lesions showed evidence of insulin resistance compared to others, though this was not directly associated with disease presence. This study provides relevant information for preventing of endometrial cancer in the future. Larger studies are needed to evaluate the role of METS-IR and TyG in endometrial cancer prevention.

HNF1B polymorphisms and endometrial cancer risk: validation of identified loci and evaluation of novel variants

BACKGROUND

This study aimed to validate HNF1B single nucleotide polymorphisms (SNPs) associated with endometrial cancer risk in a Chinese Han population and explore novel SNPs. Our findings enhance the understanding of genetic components and are crucial for detection strategies and personalized medicine.

METHODS

We genotyped four HNF1B SNPs in 637 patients and 667 controls using Agena MassARRAY. Logistic regression calculated odds ratios (ORs) and 95% CI. Forest plots visualize stratified analyses. Multiple comparisons tested genetic loci-clinical indicator associations.

RESULTS

The study confirmed that rs4430796 (A>G) reduced endometrial cancer risk (OR = 0.83, 95% CI: 0.70-0.99, p = 0.041). Additionally, novel HNF1B mutations were associated with endometrial cancer risk: rs7405776 in individuals under the age of 55 (OR = 047, 95% CI: 0.25-0.91, p = 0.025) and nonsmokers (OR = 0.42, 95% CI: 0.23-0.75, p = 0.004), and rs11651755 in drinkers (OR = 0.39, 95% CI: 0.17-0.90, p = 0.027) and nonsmokers (OR = 0.43, 95% CI: 0.23-0.81, p = 0.009). The SNP rs4430796 was also associated with the CA125 level (p < 0.05).

CONCLUSION

HNF1B polymorphisms influence endometrial cancer risk in the Chinese Han population. Further studies are needed to explore the functional roles and clinical practicality of these SNPs.

The Role of the Endometrial Microbiota in Endometrial Cancer: A Systematic Review of the Literature

Background: Endometrial cancer is currently the sixth most frequent cancer in women, and scientific research is focusing on the search for particular features of the endometrium that may explain a further predisposition to the onset of endometrial cancer, aimed at improving knowledge of the pathogenetic factors of this disease. The aim of our review is to analyze in detail the results of the literature on the endometrial microbiota in patients with endometrial cancer and to investigate its role. Methods: We performed our research on the Pubmed, Web of Science, and Scopus databases. We searched up to December 2023 and considered manuscripts published from 2000. Only articles in English were included in the search. We excluded studies in which the endometrial microbiota were collected through the vagina or cervical canal. Results: We included in our review a total of five manuscripts at the end of the screening process, and the total number of patients involved was 190. Four studies considered only post-menopausal patients, while one study considered both pre- and post-menopausal patients. In all studies, the microbiota analysis was derived from a post-hysterectomy biopsy. From our review, it emerged that Bacteroidetes, Actinobacteria, Firmicutes, and Proteobacteria are the most represented bacteria in patients with endometrial cancer. These are both Gram-positive and Gram-negative, but predominantly anaerobic bacteria. Conclusions: The reduced microbial diversity and the presence of specific bacteria is often associated with endometrial cancer. Further work on larger population samples, and on healthy women and those affected by endometrial carcinoma, is needed to understand how the endometrial microbiota changes and influences the development of the tumor and whether intervening in the changes in the microbiota will have a therapeutic impact on endometrial carcinoma.

Endometriosis and uterine fibroids and risk of premature mortality: prospective cohort study

OBJECTIVE

To prospectively assess the effect of endometriosis and uterine fibroids on the long term risk of premature mortality (younger than 70 years).

DESIGN

Prospective cohort study SETTING: The Nurses' Health Study II, United States (1989-2019).

PARTICIPANTS

110 091 women aged 25-42 years in 1989 without a history of hysterectomy before endometriosis or fibroids diagnosis, cardiovascular diseases, or cancer.

MAIN OUTCOME MEASURES

Hazard ratios (estimated by Cox proportional hazards models) for total and cause specific premature mortality according to laparoscopically confirmed endometriosis or ultrasound or hysterectomy confirmed uterine fibroids reported in biennial questionnaires.

RESULTS

4356 premature deaths were recorded during 2 994 354 person years of follow-up (27.2 years per person), including 1459 from cancer, 304 from cardiovascular diseases, and 90 from respiratory diseases. The crude incidence of all cause premature mortality for women with and without laparoscopically confirmed endometriosis was 2.01 and 1.40 per 1000 person years, respectively. In age adjusted models, laparoscopically confirmed endometriosis was associated with a hazard ratio of 1.19 (95% confidence interval 1.09 to 1.30) for premature death; these models were strengthened after also adjusting for potential confounders including behavioral factors (1.31, 1.20 to 1.44). Cause specific mortality analyses showed that the association was largely driven by mortality from senility and ill-defined diseases (1.80, 1.19 to 2.73), non-malignant respiratory diseases (1.95, 1.11 to 3.41), diseases of the nervous system and sense organs (2.50, 1.40 to 4.44), and malignant neoplasm of gynecological organs (2.76, 1.79 to 4.26). Ultrasound or hysterectomy confirmed uterine fibroids were not associated with all cause premature mortality (1.03, 0.95 to 1.11), but were associated with a greater risk of mortality from malignant neoplasm of gynecological organs (2.32, 1.59 to 3.40) in cause specific mortality analyses. The risk of mortality caused by cardiovascular and respiratory diseases varied according to joint categories of endometriosis and uterine fibroids, with an increased risk of all cause premature mortality among women reporting both endometriosis and uterine fibroids.

CONCLUSION

Women with a history of endometriosis and uterine fibroids might have an increased long term risk of premature mortality extending beyond their reproductive lifespan. These conditions were also associated with an increased risk of death due to gynecological cancers. Endometriosis was associated with a greater risk of non-cancer mortality. These findings highlight the importance for primary care providers to consider these gynecological disorders in their assessment of women's health.

Body mass index and breast cancer risk in premenopausal and postmenopausal East Asian women: a pooled analysis of 13 cohort studies

BACKGROUND

It has been suggested that the association between body mass index and breast cancer risk differs between Asian women and Western women. We aimed to assess the associations between body mass index and breast cancer incidence in East Asian women.

METHODS

Pooled analyses were performed using individual participant data of 319,189 women from 13 cohort studies in Japan, Korea, and China. Participants' height and weight were obtained by measurement or self-reports at cohort baseline. Breast cancer was defined as code C50.0-C50.9 according to the International Classification. Using a Cox proportional hazards model, hazard ratios of breast cancer were estimated for each body mass index category, with the reference group set as the group with a body mass index of 21 to < 23 kg/m2. The hazard ratio for a 5 kg/m2 increase in body mass index was also calculated.

RESULTS

During a mean 16.6 years of follow-up, 4819 women developed breast cancer. Similar to Westerners, a steady increase in breast cancer risk with increasing body mass index was observed in postmenopausal women, but the slope of the risk increase appeared to slow at a body mass index of 26-28 kg/m2. In premenopausal women, the inverse association seen in Westerners was not observed. The risk of developing breast cancer after 50 years of age increased slightly with increasing body mass index, which was more pronounced in the older birth cohort. There was no significant association between body mass index and the risk of developing breast cancer before 50 years of age, but the risk estimates changed from positive to negative as the birth cohort got younger.

CONCLUSIONS

In East Asia, the role of body mass index in breast cancer in premenopausal women may be changing along with the increase in obesity and breast cancer. The increased risk of postmenopausal breast cancer with a higher body mass index was as robust as that of Western women.

Endometrial Atypical Hyperplasia and Risk of Endometrial Cancer

Endometrial atypical hyperplasia (EAH) is a premalignant condition with a substantial risk of progression to endometrial cancer (EC), with the endometrioid subtype being the most common. EAH is characterized by abnormal endometrial gland proliferation and cellular atypia, often resulting from prolonged unopposed estrogen exposure. This review aims to explore the clinical significance of EAH, its risk of progression to EC, and the current approaches to management. The risk of EAH progressing to EC ranges from 20 to 50%, influenced by factors such as histopathology and genetic mutations including PTEN and KRAS. Key risk factors include obesity, polycystic ovary syndrome, and postmenopausal status. Abnormal uterine bleeding is a hallmark symptom of EAH and early-stage EC, necessitating diagnostic evaluation through endometrial biopsy and transvaginal ultrasonography. Therapeutic management strategies depend on patient risk and fertility considerations. Hormonal therapy, particularly progestins, is the mainstay for fertility preservation, while hysterectomy is preferred for higher-risk patients. Regular monitoring with biopsies is essential for those undergoing conservative treatment. Recent advancements in the management of EAH and EC have shifted towards incorporation of molecular diagnostics and targeted therapies, enabling better risk stratification and individualized care. Biomarkers and minimally invasive surgical techniques are emerging as promising approaches in improving outcomes for women with EAH. This review underscores the importance of early diagnosis and personalized management in preventing the progression of EAH to EC, highlighting current clinical practices and potential future developments in this field.

Association of coexposure to perfluoroalkyl and polyfluoroalkyl compounds and heavy metals with pregnancy loss and reproductive lifespan: The mediating role of cholesterol

Previous studies have demonstrated the toxic effects of per- and polyfluoroalkyl substances (PFASs) and heavy metals on the reproductive system. However, the interactions and combined effects of these substances remain unexplored. This study utilizes data from the National Health and Nutrition Examination Survey to investigate the associations between coexposure to four types of PFASs, lead (Pb), mercury (Hg) and self-reported pregnancy loss and reproductive lifespan in females. Genes associated with these substances and abortion were identified via the Comparative Toxicogenomics Database. The results revealed that Ln-PFOA (IRR=1.88, 95 % CI=1.42-2.50, Ln--: log transformed), Ln-PFOS (IRR=1.58, 95 % CI=1.12-2.22), Ln-PFHxS (IRR=1.99, 95 % CI=1.57-2.52), and Ln-Hg (IRR=1.92, 95 % CI=1.41-2.43) were positively associated with the risk of pregnancy loss. Ln-PFOA (β=1.27, 95 % CI=0.28-2.27), Ln-PFOS (β=1.01, 95 % CI=0.39-1.63), Ln-PFHxS (β=0.71, 95 % CI=0.12-1.63), Ln-PFNA (β=1.15, 95 % CI=0.23-2.08), Ln-Pb (β=3.87, 95 % CI=2.58-5.15), and Ln-Hg (β=1.01, 95 % CI=0.39-1.64) exposures were positively associated with reproductive lifespan. The mixed and overall effects of coexposure to PFASs and heavy metals were positively correlated with the risk of pregnancy loss and reproductive lifespan. Cholesterol partially mediated the association with the risk of pregnancy loss, whereas delay in menopause fully mediated the association with reproductive lifespan. Significant additive interactions were observed between PFOA and Pb and between PFOS, PFHxS, PFNA and Hg at high levels of coexposure. Thirty-nine overlapping genes associated with abortion were identified for these substances, and further analyses revealed that these genes significantly interact and may contribute to abortion through oxidative stress.

A look into the cancer continuum for the development of a physical activity intervention: qualitative investigation of the physical activity experiences and preferences of female cancer survivors

PURPOSE

Clinical guidelines recommend cancer survivors (i.e., people with a cancer diagnosis) engage in regular physical activity (PA) during and post treatment, yet most do not. Additionally, PA promotion for cancer survivors has primarily focused on post treatment, calling for an understanding of PA promotion during treatment. This study explores the PA experiences and preferences of both in-treatment and post-treatment breast and gynecologic cancer survivors (BGCS) to inform the design of a PA intervention.

METHODS

Semi-structured interviews were conducted with postmenopausal women aged ≥ 50 years, diagnosed with breast or gynecological cancer (stages 1-3), who were undergoing, or recently completed (12 to 24 months) chemotherapy and/or primary treatment. Interviews were audio-recorded and transcribed verbatim. Thematic analysis was used to explore themes.

RESULTS

Participants (N = 26; Mage: 63.9 years) had a breast (92.3%) and gynecologic (7.7%) cancer diagnosis and 46.2% (n = 12) were in treatment whereas 53.8% (n = 14) were post treatment. BGCS experienced several side effects of cancer treatment and both groups felt PA was an important goal. In-treatment BGCS focused on managing side effects (e.g., fatigue) and recognized energy fluctuated around treatments, making those periods less ideal for PA. In-treatment BGCS strongly endorsed a flexible, at-home intervention. Post-treatment BGCS emphasized recovery and relapse prevention, also favoring at-home, flexible interventions but showing greater interest towards support groups to aid with their recovery journey. Preferred activities included walking, dancing, and muscle-strengthening.

CONCLUSION

Findings highlight the unique challenges postmenopausal BGCS face in participating in PA, especially in-treatment, emphasizing the importance of a tailored PA intervention.

Association of endometrial cancer risk with hypertension- an updated meta-analysis of observational studies

Endometrial cancer is one of the most common gynaecological cancers in the developed countries. The aim of this study was to determine the impact of hypertension on endometrial cancer risk. Databases: PubMed, Embase and the Cochrane Library were searched from January 2000 to June 2024. We used DerSimonian-Laird random-effects model for analysis. Risk estimates were extracted by two authors and summarized using meta-analytic methods. A total of 26 observational studies with 207,502 endometrial cancer cases were included in the study. Overall meta-analysis demonstrates significant association between hypertension and endometrial cancer risk (RR = 1.37, 95% CI: 1.27-1.47, p < 0.001). Subgroup analysis of the risk of endometrial cancer shows statistically significant higher risk in patients with BMI ≥ 30 kg/m2, diabetics, women who had their first menstrual period at the age of 11 years or earlier, and who had never given birth. Findings of this comprehensive review and meta-analysis indicate that hypertension is associated with higher overall risk of endometrial cancer.

Association between parity and female mortality: the mediative role of depressive symptoms

STUDY QUESTION

Is parity associated with all-cause and cause-specific mortality among women in a nationally representative cohort of the US population, and does depression mediate this association?

SUMMARY ANSWER

Nulliparous women have a higher risk of all-cause and cause-specific mortality, with depression partially mediating the relationship between parity and women's all-cause and cause-specific mortality.

WHAT IS KNOWN ALREADY

Parity, a significant state in reproductive life, has enduring implications for women's health. There is also a complex relationship between depression, a prevalent mental and emotional disorder, and female fertility. Previous studies have elucidated the relationships between parity and depression, both of which are associated with mortality. However, findings from studies examining parity and women's mortality have been inconsistent. Moreover, few studies have investigated whether the effect of parity on mortality is mediated by depression.

STUDY DESIGN, SIZE, DURATION

We conducted a cross-sectional study using data from seven cycles of the National Health and Nutrition Examination Survey (NHANES) spanning 2005-2018.

PARTICIPANTS/MATERIALS, SETTING, METHODS

The study cohort comprised adult women with available parity and survival follow-up data. Parity data were self-reported and sourced from the Reproductive Health Questionnaire. Depression scores were derived from the Patient Health Questionnaire 9, and cause-specific deaths were identified using the International Statistical Classification of Diseases, 10th Revision (ICD-10). Weighted multivariable Cox regression was applied to analyze the association between parity, depression, and mortality. Weighted linear regression was performed to examine the relationship between parity and depression. Mediation analyses were employed to determine whether and to what extent depression mediated the effect of parity on mortality.

MAIN RESULTS AND THE ROLE OF CHANCE

Our study ultimately encompassed 16 962 American women. Following multivariable adjustment, compared to nulliparous women, those with one to three live births exhibited a 17% and 33% reduction in all-cause and cancer mortality, respectively (all-cause mortality: HR = 0.83, 95% CI = 0.69-0.99, P = 0.040; cancer mortality: HR = 0.67, 95% CI = 0.45-0.99, P = 0.045). Women with more than four live births demonstrated lower all-cause mortality and mortality from other (not cancer or cardiovascular disease) diseases (all-cause mortality: HR = 0.73, 95% CI = 0.58-0.93, P = 0.011; other diseases mortality: HR = 0.66, 95% CI = 0.47-0.91, P = 0.013). No correlation was detected between parity and the risk of cardiovascular disease mortality among women. Furthermore, depression was found to partially mediate the impact of parity on all-cause mortality and mortality from other diseases in women.

LIMITATIONS, REASONS FOR CAUTION

Firstly, a single index of parity was used as an exposure factor, and other reproductive factors such as birth spacing, age at first birth, and mode of delivery were not taken into account. Secondly, despite accounting for important potentially confounders in our analysis, such as BMI, smoking status, and educational level, the influence of unmeasured confounders (e.g., social class, latent reproductive system diseases) on reproductive behavior or mortality cannot be dismissed. Thirdly, women's vulnerability to depression fluctuates across reproductive stages, and the effect of depression on female fertility varies over time. Due to data constraints, we were unable to obtain information on women's mental health status at different reproductive stages. Fourthly, due to the data accessibility limitations of NHANES, we were unable to specifically explore the relationship between parity and different specific types of cancer, a limitation that may obscure potential correlations. Additionally, despite our efforts to control for various confounding factors in subgroup analyses, the smaller sample sizes in some subgroups may limit the statistical power, affecting the ability to detect effects. Finally, studies exploring the association between parity and depression are cross-sectional designs, making it difficult to infer causality. These results should be interpreted with caution, and further research is warranted to corroborate our findings.

WIDER IMPLICATIONS OF THE FINDINGS

Our study underscores the elevated risk of all-cause and cause-specific mortality in nulliparous women and reveals that depression partially mediates the negative correlation between parity and women's all-cause mortality and mortality from other diseases. These results should be interpreted with caution, and further investigation is needed to support our findings.

STUDY FUNDING/COMPETING INTEREST(S)

This work was supported by the National Key Research and Development Program of China (2023YFC2705700), the Key Research & Developmental Program of Hubei Province (2022BCA042), and the Interdisciplinary Innovative Talents Foundation from Renmin Hospital of Wuhan University (JCRCWL-2022-001). The authors declare that they have no conflict of interest.

TRIAL REGISTRATION NUMBER

N/A.

A Retrospective Study on the Expression of E-Cadherin in Endometrial Carcinoma

E-cadherin is a cell adhesion molecule crucial for maintaining cellular integrity and survival. E-cadherin is the focus of this study, which aims to evaluate its immunohistochemical staining patterns in endometrial carcinoma (EC). Material and methods In this retrospective study, 25 formalin-fixed, paraffin-embedded tissue blocks of EC were retrieved from the Department of Pathology at Saveetha Medical College. These samples, collected between September 2020 and May 2023, were identified using unique histopathology numbers. Results The analysis revealed that E-cadherin expression decreased as the endometrial tissue progressed from normal to carcinoma. This reduction was more pronounced in cancers with greater depth of invasion and in more advanced stages compared to those with less invasive depth and earlier stages. Additionally, E-cadherin expression was higher in grade 1 tumors but became heterogeneous or negative in grade 3 tumors. Conclusion The downregulation of E-cadherin is likely due to disruptions in the cadherin-catenin complex, which is linked to the potential for local and distant metastasis in cancer. This study underscores the significance of cell adhesion molecule expression in predicting the prognosis of EC.

Prognostic factors and survival of endometrial cancer: An 11-year retrospective cohort study in southern Taiwan

OBJECTIVE

Endometrial cancer (EC) is the most common gynecological malignancy in high-income countries. In Taiwan, the incidence of EC increased from 1.69 in 1980 to 11.36 per 100,000 women/year in 2010. Therefore, we aimed to study the prognostic factors and survival of patients with EC in southern Taiwan.

MATERIALS AND METHODS

This study included patients with EC who underwent hysterectomy-based surgery at our hospital between 2010 and 2020. The primary outcome was 5-year progression-free survival (PFS) and overall survival (OS) of patients diagnosed with EC. The secondary outcome was the prognostic factors associated with 5-year PFS and OS in patients with EC. We used the chi-square test to assess categorical variables and the independent t-test to assess continuous variables. The Kaplan-Meier method was used to estimate survival outcomes. Cox regression analysis was conducted to examine the factors associated with PFS and OS.

RESULTS

A total of 133 patients were enrolled in this study. The mean age of the patients was 56.5 ± 10.71 years. The mean body mass index was 26.4 ± 5.21 kg/m2. The 5-year PFS and OS were 90.3% and 94.53%, respectively. In terms of PFS, endometrioid histology was linked to more favorable outcomes (hazard ratio [HR] = 0.02, 95% confidence interval [CI]:0.001-0.59), while lymph-vascular space invasion (LVSI) was associated with adverse results (HR = 9.11, 95% CI: 1.07-77.44). Initial analyses revealed no significant correlations between OS and various factors, including age, BMI, parity, DM, hypertension, age at last birth, and tumor grade. However, univariate analysis found grade 3 tumor differentiation, LVSI, and lymph node invasion associated with poorer OS. Laparoscopy was associated with better OS. Nevertheless, subsequent multivariate analysis did not reveal any factor significantly associated with OS. Most patients with EC (76.69%) underwent laparoscopic surgery.

CONCLUSION

In conclusion, endometrioid histology was linked to more favorable PFS, while LVSI was related to adverse PFS. Our study did not identify any factors associated with OS. Two-thirds of the patients underwent minimally invasive surgery.

Endometriosis and endometrial cancer: A propensity score-adjusted real-world data study

Endometriosis is a benign condition characterized by the presence of ectopic endometrial tissue. Our study investigated the effect of endometriosis on the risk of endometrial cancer (EC) and the prognosis of endometriosis-associated EC. In our study, 197,196 patients with endometriosis and without a previous diagnosis of EC were compared with 6,455,556 females encountering health services for examinations, with body mass index (BMI) data, and without endometriosis or EC. A propensity score generated 197,141 matched pairs. In the endometriosis cohort, 875 cases of EC were seen, whereas 558 were in the control group: the hazard ratio (HR) was 1.56 (95% CI 1.40-1.73, p < 0.001). Women with endometriosis were more likely to develop invasive endometrioid (p = 0.005) and clear cell (p < 0.001) EC. There was no difference in overall survival between endometriosis-associated EC and EC without endometriosis. Our epidemiological findings were consistent with the evidence of an association between endometriosis and EC.

Incidence, risk factors, and a prognostic nomogram for distant metastasis in endometrial cancer: A SEER-based study

OBJECTIVE

To evaluate the metastatic pattern, identify the risk factors, and establish a nomogram for predicting prognosis of endometrial cancer (EC) with distant metastasis.

METHODS

A retrospective cohort study of women diagnosed with EC was conducted according to the Surveillance, Epidemiology, and End Results (SEER) database during 2010-2017. Multivariate logistic analysis and Cox analysis were performed to identify the risk factors in promoting distant metastasis and predictors associated with overall survival (OS) in this particular subpopulation. A nomogram was then constructed and validated by the concordance index (C-index), the area under the receiver operating characteristic curve (AUC), calibration plots, and decision curve analysis.

RESULTS

A total of 2799 cases of distant metastasis in EC patients were identified, with an overall incidence rate of 3.74% from 2010 to 2017. Black race, unmarried status, non-endometrioid histologic types, and grade IV were significant risk factors for distant metastasis in EC patients. Meanwhile, race, histology, grade, metastasis status, surgery, lymphadenectomy, and chemotherapy were identified as independent prognostic factors for OS. A nomogram to predict 1-, 3-, and 5-year OS was established, and presented favorable accuracy and clinical applicability. Patients were further divided into high- and low-risk groups according to the model.

CONCLUSION

The nomogram was developed as a highly accurate, individualized tool to better predict the prognosis of EC patients with distant metastasis, which would help clinicians to identify high-risk patients, and adjust and tailor their treatment strategies.

The risk of breast cancer and gynecologic malignancies after ovarian stimulation: Meta-analysis of cohort study

The effects of ovarian stimulation on breast and gynecological tumor incidence remain controversial. Therefore, the aim of this meta-analysis was to study the risk of cancer in ovarian stimulation. Of the 22713 studies initially identified, 28 were eligible for inclusion. The results revealed that the impact of ovarian cancer (RR = 1.33, [1.05; 1.69]) and cervical cancer (RR = 0.67, [0.46; 0.97]) is significant among the overall effects. In subgroup analysis, in the nulliparous population (RR = 0.81 [0.68; 0.96]) was the protective factor for the breast cancer. In the Caucasians subgroup (RR = 1.45, [1.12; 1.88]), the ovarian cancer incidence was statistically significant. In the Asian subgroup (RR = 1.51, [1.00; 2.28]), the endometrial cancer incidence was statistically significant. In the subgroup of Asians (RR = 0.55 [0.44; 0.68]) and the multiparous population (RR = 0.31, [0.21; 0.46]), them can be the statistically protective factor for the cervical cancer.

Endometrial Cancer in Reproductive-Aged Females: Etiology and Pathogenesis

Endometrial cancer is the most common gynecologic malignancy in developed countries, and the incidence is rising in premenopausal females. Type I EC is more common than Type II EC (80% vs. 20%) and is associated with a hyperestrogenic state. Estrogen unopposed by progesterone is considered to be the main driving factor in the pathogenesis of EC. Studies show that BMI > 30 kg/m2, prolonged duration of menses, nulliparity, presence of polycystic ovarian syndrome, and Lynch syndrome are the most common causes of EC in premenopausal women. Currently, there are no guidelines established to indicate premenopausal patients who should be screened. This review aims to synthesize current data on the etiology, risk factors, presentation, evaluation, and prognosis of endometrial cancer in this population.

Analysis of Characteristics of Endometrial Carcinoma in Peri- and Postmenopausal Women with Abnormal Uterine Bleeding

Objective

To analyze the menstrual characteristics of endometrial carcinoma and investigate whether abnormal uterine bleeding in the perimenopausal period differs from postmenopausal bleeding.

Methods

We conducted a retrospective analysis of 928 cases of endometrial carcinoma in patients admitted from January 2016 to December 2022. We gathered fundamental clinical data and analyzed distinct clinical risk factors between the perimenopausal and postmenopausal groups. Furthermore, we computed the statistical variances in menarche, regular menstrual cycles, and the duration of abnormal uterine bleeding.

Results

Perimenopausal patients with endometrial carcinoma exhibit similar factors to postmenopausal patients, especially if they have a history of menstrual cycles lasting more than 30 years, hypertension, abnormal uterine bleeding for over 1 year, and a high risk of endometrial carcinoma. Early intervention for abnormal uterine bleeding during the perimenopausal stage can prevent up to 80% of women from developing endometrial carcinoma.

Conclusion

Perimenopause women experiencing abnormal uterine bleeding should be mindful of the risk of endometrial carcinoma, as this awareness can substantially decrease the occurrence of the disease.

Evaluation of pre-therapeutic imaging work-up in the staging of endometrial cancer: Interest in a systematic second opinion in a cancer center

RATIONALE AND OBJECTIVES

To evaluate the interest of a systematic second opinion in quality assessment and FIGO staging in the pretherapeutic imaging work-up.

MATERIALS AND METHODS

A retrospective observational study was conducted on 156 patients who underwent surgery for endometrioid cancer in our institution. 42 % had their initial MRI scans performed in expert centers (University Hospital and Cancer center) and 58 % in non-expert centers. Quality assessment, concordances between initial reports, and second opinions by a junior and a senior ICL radiologist versus histopathological data were analyzed.

RESULTS

MRI scans performed in expert centers were more complete and more likely to be rated as higher quality. The overall accuracy of T staging from initial reports vs gold standard was 0.59 (95 % CI, 0.46-0.71) in expert centers and 0.49 (95 % CI, 0.38-0.60) in non-expert centers. The overall accuracy and Kappa of a second opinion for FIGO 2009 staging from expert center and non-expert center examinations were 0.61 (95 % CI, 0.48-0.72) vs 0.50 (95 % CI, 0.39-0.60) and 0.37 vs 0.27 for junior reader and 0.62 (95 % CI, 0.49-0.74) vs 0.48 (95 % CI, 0.37-0.58) and 0.39 vs 0.24 for senior reader, respectively. There was also a significant lower confidence level of the junior radiologist in MRI FIGO staging for non-expert center examinations (p 0.003).

CONCLUSION

Accuracy in the FIGO 2009 staging and quality assessment are higher for MR examinations performed from expert centers than in non-expert centers. A systematic second opinion by radiologists in expert centers should be proposed before pre-treatment multidisciplinary consultation.

Differential patterns of reproductive and lifestyle risk factors for breast cancer according to birth cohorts among women in China, Japan and Korea

BACKGROUND

The birth cohort effect has been suggested to influence the rate of breast cancer incidence and the trends of associated reproductive and lifestyle factors. We conducted a cohort study to determine whether a differential pattern of associations exists between certain factors and breast cancer risk based on birth cohorts.

METHODS

This was a cohort study using pooled data from 12 cohort studies. We analysed associations between reproductive (menarche age, menopause age, parity and age at first delivery) and lifestyle (smoking and alcohol consumption) factors and breast cancer risk. We obtained hazard ratios (HRs) with 95% confidence intervals (CIs) using the Cox proportional hazard regression analysis on the 1920s, 1930s, 1940s and 1950s birth cohorts.

RESULTS

Parity was found to lower the risk of breast cancer in the older but not in the younger birth cohort, whereas lifestyle factors showed associations with breast cancer risk only among the participants born in the 1950s. In the younger birth cohort group, the effect size was lower for parous women compared to the other cohort groups (HR [95% CI] 0.86 [0.66-1.13] compared to 0.60 [0.49-0.73], 0.46 [0.38-0.56] and 0.62 [0.51-0.77]). Meanwhile, a higher effect size was found for smoking (1.45 [1.14-1.84] compared to 1.25 [0.99-1.58], 1.06 [0.85-1.32] and 0.86 [0.69-1.08]) and alcohol consumption (1.22 [1.01-1.48] compared to 1.10 [0.90-1.33], 1.15 [0.96-1.38], and 1.07 [0.91-1.26]).

CONCLUSION

We observed different associations of parity, smoking and alcohol consumption with breast cancer risk across various birth cohorts.

The role of kaempferol in gynaecological malignancies: progress and perspectives

Kaempferol, a flavonoid derived from various herbs such as cocoyam, propolis, and grapefruit, has garnered interest due to its numerous pharmacological benefits, including anti-inflammatory, antioxidant, and anti-diabetic properties. Kaempferol has been shown to possess notable anti-tumour bioactivity, indicating potential for treating gynaecological malignancies. To date, numerous studies have demonstrated the potential of kaempferol to induce tumour cell apoptosis, inhibit proliferation, and prevent metastasis and invasion in several gynaecological malignancies, including breast, ovarian and endometrial cancers. However, there is currently insufficient research investigating the efficacy of kaempferol for the treatment of gynaecological malignancies, and a lack of systematic review of its mechanism of action. Therefore, this review is founded on a literature analysis of the anticancer effects of kaempferol on gynaecological malignancies. The goal is to provide valuable reference material for scientific researchers and medical practitioners.