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Orta OR, Terry KL, Missmer SA, Harris HR. Dairy and related nutrient intake and risk of uterine leiomyoma: a prospective cohort study. Hum Reprod 2021; 35:453-463. [PMID: 32086510 DOI: 10.1093/humrep/dez278] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 11/26/2019] [Indexed: 12/24/2022] Open
Abstract
STUDY QUESTION Is there an association between consumption of dairy foods and related nutrients and risk of uterine leiomyoma? SUMMARY ANSWER While dairy consumption was not consistently associated with uterine leiomyoma risk, intake of yogurt and calcium from foods may reduce risk of uterine leiomyoma. WHAT IS KNOWN ALREADY Two studies have examined the association between dairy intake and uterine leiomyoma risk with inconsistent results. Dairy foods have been inversely associated with inflammation and tumorigenesis, suggesting that vitamins and minerals concentrated in these dietary sources may influence uterine leiomyoma risk. STUDY DESIGN, SIZE, DURATION A prospective cohort study was carried out using data collected from 81 590 premenopausal women from 1991 to 2009 as part of the Nurses' Health Study II cohort. PARTICIPANTS/MATERIALS, SETTING, METHODS Diet was assessed with a validated food frequency questionnaire every 4 years. Cases were restricted to self-reported ultrasound or hysterectomy-confirmation uterine leiomyoma. Cox proportional hazards models were used to calculate hazard ratios (HRs) and 95% CI. MAIN RESULTS AND THE ROLE OF CHANCE Eight thousand one hundred and forty-two cases of ultrasound or hysterectomy-confirmed uterine leiomyoma were diagnosed over an 18-year period. When compared to participants who consumed two servings a week of total dairy foods, participants who consumed four or more servings had a borderline significant 8% reduced risk of uterine leiomyoma (HR = 0.92, 95% CI = 0.85, 1.00; ptrend = 0.19). When the association between specific dairy foods and uterine leiomyoma was examined, the relation between dairy-food intake and uterine leiomyoma appeared to be driven primarily by yogurt consumption (HR for 2+ servings/day = 0.76; 95% CI = 0.55, 1.04 compared to <=4 servings/week; ptrend = 0.03); however, there was a small number of cases in the 2+ servings/day group (n = 39). Of the nutrients examined, the association was strongest for calcium from foods (HR fifth quintile = 0.92, 95% CI = 0.86, 0.99; ptrend = 0.04). LIMITATIONS, REASONS FOR CAUTION Some cases of uterine leiomyoma were likely misclassified, particularly those that were asymptomatic. It is possible that dairy product constituents reduce uterine leiomyoma symptomology rather than development, giving the appearance of a protective effect on leiomyoma development: no data on uterine leiomyoma symptomology were available. We did not have vitamin and mineral concentrations from actual blood levels. Similarly, there is the potential for misclassification of participants based on predicted 25(OH)D, and changes in vitamin D supplementation over time may have impacted prediction models for 25(OH)D. Further, some error in the self-reporting of dietary intake is expected. Given our prospective design, it is likely that these misclassifications were non-differential with respect to the outcome, likely biasing estimates toward the null. WIDER IMPLICATIONS OF THE FINDINGS While no clear association between overall dairy consumption and uterine leiomyoma risk was observed, our findings suggest that intake of yogurt and calcium from foods may reduce risk of uterine leiomyoma. STUDY FUNDING/COMPETING INTEREST(S) This work was supported by research grant HD081064 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development. The Nurses' Health Study II is supported by the Public Health Service grant UM1 CA176726 from the National Cancer Institute, NIH, U.S. Department of Health and Human Services. H.R.H. is supported by the National Cancer Institute, National Institutes of Health (K22 CA193860). There are no conflicts of interest to declare.
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Affiliation(s)
- O R Orta
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - K L Terry
- Obstetrics and Gynecology Epidemiology Center, Brigham and Women's Hospital, Boston, MA, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - S A Missmer
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Division of Adolescent and Young Adult Medicine, Department of Medicine, Boston Children's Hospital and Harvard Medical School, 333 Longwood Avenue, Boston, Massachusetts, USA.,Department of Obstetrics, Gynecology, and Reproductive Biology, College of Human Medicine, Michigan State University, 15 Michigan Street NE, Grand Rapids, Michigan, USA
| | - H R Harris
- Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Department of Epidemiology, University of Washington, Seattle, WA, USA
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Moridi I, Mamillapalli R, Kodaman PH, Habata S, Dang T, Taylor HS. CXCL12 Attracts Bone Marrow-Derived Cells to Uterine Leiomyomas. Reprod Sci 2020; 27:1724-1730. [PMID: 32020550 DOI: 10.1007/s43032-020-00166-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 01/23/2020] [Indexed: 01/02/2023]
Abstract
Uterine leiomyomas, also known as fibroids or myomas, are a common benign gynecologic tumor found in women of reproductive age. Though advances have been made in understanding leiomyomas, the etiology and pathogenesis of this disease are not fully characterized. Current evidence supports a role of putative human uterine stem/progenitor cells in the onset of uterine disease such as uterine myomas. In this study, we report that increased expression of CXCL12 in leiomyomas recruits bone marrow-derived cells (BMDCs) that may contribute to leiomyoma growth. Tissue was collected from leiomyomas or control myometrium from women with or without leiomyomas. qRT-PCR analysis showed increased expression of CXCL12 and decreased CXCR4 expression in the leiomyoma and myometrium of women with leiomyoma compared with normal myometrium. Increased CXCL12 protein secretion from cultured myoma cells was confirmed by ELISA. Further, we found that BMDCs migration was increased toward leiomyoma conditioned medium compared with conditioned medium from normal myometrium. CXCR4 antagonist AMD3100 completely blocked this migration. Engraftment of BMDCs significantly increased in myoma of mouse uteri treated with CXCL12 compared with placebo. We conclude that CXCL12 may play a role in leiomyomas growth by attracting bone marrow-derived cells to leiomyoma. Therefore, CXCL12 and its receptors are novel targets for leiomyoma therapy.
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Affiliation(s)
- Irene Moridi
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA
| | - Ramanaiah Mamillapalli
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA.
| | - Pinar H Kodaman
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA
| | - Shutaro Habata
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA
| | - Tran Dang
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA
| | - Hugh S Taylor
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA
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EC313-a tissue selective SPRM reduces the growth and proliferation of uterine fibroids in a human uterine fibroid tissue xenograft model. Sci Rep 2019; 9:17279. [PMID: 31754172 PMCID: PMC6872653 DOI: 10.1038/s41598-019-53467-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 10/31/2019] [Indexed: 11/09/2022] Open
Abstract
Uterine fibroids (UFs) are associated with irregular or excessive uterine bleeding, pelvic pain or pressure, or infertility. Ovarian steroid hormones support the growth and maintenance of UFs. Ulipristal acetate (UPA) a selective progesterone receptor (PR) modulator (SPRM) reduce the size of UFs, inhibit ovulation and lead to amenorrhea. Recent liver toxicity concerns with UPA, diminished enthusiasm for its use and reinstate the critical need for a safe, efficacious SPRM to treat UFs. In the current study, we evaluated the efficacy of new SPRM, EC313, for the treatment for UFs using a NOD-SCID mouse model. EC313 treatment resulted in a dose-dependent reduction in the fibroid xenograft weight (p < 0.01). Estradiol (E2) induced proliferation was blocked significantly in EC313-treated xenograft fibroids (p < 0.0001). Uterine weight was reduced by EC313 treatment compared to UPA treatment. ER and PR were reduced in EC313-treated groups compared to controls (p < 0.001) and UPA treatments (p < 0.01). UF specific desmin and collagen were markedly reduced with EC313 treatment. The partial PR agonism and no signs of unopposed estrogenicity makes EC313 a candidate for the long-term treatment for UFs. Docking studies have provided a structure based explanation for the SPRM activity of EC313.
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Kogan EA, Zharkov NV, Askolskaya SI, Popov YV, Krot MA, Demura TA. [Growth mechanisms and morphological structural features of large uterine leiomyoma]. Arkh Patol 2018; 80:16-22. [PMID: 30335056 DOI: 10.17116/patol20188005116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To investigate the growth mechanisms of large uterine leiomyoma (LULM) on the basis of a clinical morphology examination, by providing immunohistochemical (IHC) characteristics of the expression of growth factors (transforming growth factor-beta (TGFβ) and platelet-derived endothelial cell growth factor (PD-ECGF)) and markers of stemness (CD117/c-kit, Connexin 43, Nestin) and proliferation (Ki-67). SUBJECT AND METHODS The investigators examined surgical specimens from 38 women diagnosed with simple uterine leiomyoma (ULM), who had been divided into two groups: 1) 21 patients with LULM (>6 cm in diameter) (a study group); 2) 17 patients with small ULM (<4 cm in diameter) (a comparison group). Each group was also divided into two age subgroups (younger (<45 years) and older (≥45 years) subgroups (1a (n=12), 1b (n=9), 2a (n=8) and 2b (n=9), respectively. Histological specimens were used to make IHC examination with antibodies against TGFβ, PD-ECGF, CD117/c-kit, Connexin 43, Nestin, and Ki-67. RESULTS The growth mechanisms of LULM of simple histological structure were found to be associated with the larger number of growth zones in the tumors, with their enhanced cellular proliferative activity, and with the appearance of cells with signs of stemness, which is combined with the preserved subsequent maturation of tumor cells and determines the benign nature of LULM. CONCLUSION There were differences in the molecular profile of LULM and small ULM, as well as LULM in perimenopausal and young women by the expression levels of Ki-67, TGFβ, PD-ECGF, CD117, and Connexin 43, which can be used for diagnosis, prediction, and development of targeted therapies.
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Affiliation(s)
- E A Kogan
- I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow, Russia
| | - N V Zharkov
- I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow, Russia
| | - S I Askolskaya
- Federal Research and Clinical Center for Special Medical Care and Medical Technologies, Federal Biomedical Agency of Russia, Moscow, Russia
| | - Yu V Popov
- Federal Research and Clinical Center for Special Medical Care and Medical Technologies, Federal Biomedical Agency of Russia, Moscow, Russia
| | - M A Krot
- I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow, Russia
| | - T A Demura
- I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow, Russia
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Abstract
Uterine leiomyomas (ULMs) are the most common benign tumors in premenopausal women associated with major tissue fibrosis. It has been suggested that inflammatory response is associated with the development of ULM. YKL-40 is a chitinase-like protein present in serum of healthy participants, and its levels are increased in several human inflammatory diseases. However, the association between YKL-40 and ULM has not been reported. The aim of this study was to identify whether serum YKL-40 levels correlate with ULM. Premenopausal women with ULM (n = 61) and leiomyoma-free control women (n = 45) were recruited for this study. Serum YKL-40 levels were analyzed by enzyme-linked immunosorbent assay. Correlations were assessed by Spearman rank correlation test. Receiver-operating characteristics (ROC) curve was used to define the optimal cutoff value for predicting ULM. We found that serum YKL-40 levels in patients with ULM were significantly higher than in healthy controls (P < .001). Positive correlation was also observed between serum YKL-40 levels and leiomyoma weight (r = .92; P < .001). Moreover, ROC curves yielded robust area under the curve value (0.94) accompanied by high sensitivity (82.0%) and specificity (91.1%) in distinguishing patients with ULM from healthy controls. These findings suggest that elevated serum YKL-40 levels are associated with the existence of ULM, and YKL-40 might be a potential adjunct biomarker for diagnosis of ULM.
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Affiliation(s)
- Wenping Guo
- Department of Gynecology and Obstetrics, Peking University International Hospital, Beijing, China
| | - Jing Wang
- Department of Gynecology and Obstetrics, Peking University International Hospital, Beijing, China
| | - Hongyi Wei
- Department of Gynecology and Obstetrics, Peking University International Hospital, Beijing, China
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Kayisli UA, Berkkanoglu M, Kizilay G, Senturk L, Arici A. Expression of Proliferative and Preapoptotic Molecules in Human Myometrium and Leiomyoma Throughout the Menstrual Cycle. Reprod Sci 2016; 14:678-86. [DOI: 10.1177/1933719107305866] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | | | | | | | - Aydin Arici
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology, & Reproductive Sciences,Yale University School of Medicine, New Haven, CT,
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LARGE UTERINE LEIOMYOMAS: PATHOGENETIC MECHANISMS OF GROWTH. КЛИНИЧЕСКАЯ ПРАКТИКА 2016. [DOI: 10.17816/clinpract7122-28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The pathogenesis of uterine fibroids remains controversial and raises many questions. The causes and mechanism of development of large leiomyoma are unknown. In the work the pathogenic mechanisms of large leiomyomas growth were estimated for different age groups.The research was based on studying of the expression of TGF-β, CD117, PD-ECGF, Ki67, connexin and nestin in postoperative material by comparing the clinical and morphological data. The most pronounced activity of growth areas, identified by molecular markers, was found in women over 45 years with LMMB-size, which requires the vigilance of cancer.
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Díaz-Delgado J, Fernández A, Edwards JF, Sierra E, Xuriach A, García-Álvarez N, Sacchini S, Groch KR, Andrada M, Arbelo M. Uterine Leiomyoma and Prolapse in a Live-stranded Atlantic Spotted Dolphin (Stenella frontalis). J Comp Pathol 2015; 153:58-63. [PMID: 25979681 DOI: 10.1016/j.jcpa.2015.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 04/02/2015] [Accepted: 04/06/2015] [Indexed: 11/29/2022]
Abstract
A uterine prolapse associated with a leiomyoma (fibroid) was observed in a live-stranded Atlantic spotted dolphin (Stenella frontalis). A 7 cm segment of the reproductive tract including the cervix, uterine neck and caudal uterine body had intussuscepted and prolapsed into the cranial vaginal vault. In the leading edge of the intussuscepted/prolapsed uterine wall was a 6 × 3 × 3.5 cm leiomyoma expanding the myometrium. The leiomyoma and prolapse were associated with necrotizing exposure endometritis. This is the first report of a uterine prolapse associated with a leiomyoma in a cetacean. This lesion was believed to be the underlying cause of the live stranding.
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Affiliation(s)
- J Díaz-Delgado
- Division of Histology and Animal Pathology, Institute for Animal Health, Veterinary School, University of Las Palmas de Gran Canaria, C/Transmontana 35413, Canary Islands, Spain.
| | - A Fernández
- Division of Histology and Animal Pathology, Institute for Animal Health, Veterinary School, University of Las Palmas de Gran Canaria, C/Transmontana 35413, Canary Islands, Spain
| | - J F Edwards
- Department of Veterinary Pathobiology, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, USA
| | - E Sierra
- Division of Histology and Animal Pathology, Institute for Animal Health, Veterinary School, University of Las Palmas de Gran Canaria, C/Transmontana 35413, Canary Islands, Spain
| | - A Xuriach
- Division of Histology and Animal Pathology, Institute for Animal Health, Veterinary School, University of Las Palmas de Gran Canaria, C/Transmontana 35413, Canary Islands, Spain
| | - N García-Álvarez
- Division of Histology and Animal Pathology, Institute for Animal Health, Veterinary School, University of Las Palmas de Gran Canaria, C/Transmontana 35413, Canary Islands, Spain
| | - S Sacchini
- Division of Histology and Animal Pathology, Institute for Animal Health, Veterinary School, University of Las Palmas de Gran Canaria, C/Transmontana 35413, Canary Islands, Spain
| | - K R Groch
- Labouratório de Patologia Comparada de Animais Selvagens, Faculdade de Medicina Veterinária e Zootecnia, Universidade de São Paulo, Av. Orlando Marques de Paiva 87, São Paulo, Brazil
| | - M Andrada
- Division of Histology and Animal Pathology, Institute for Animal Health, Veterinary School, University of Las Palmas de Gran Canaria, C/Transmontana 35413, Canary Islands, Spain
| | - M Arbelo
- Division of Histology and Animal Pathology, Institute for Animal Health, Veterinary School, University of Las Palmas de Gran Canaria, C/Transmontana 35413, Canary Islands, Spain
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Is myomectomy in women aged 45 years and older an effective option? Eur J Obstet Gynecol Reprod Biol 2014; 177:57-60. [PMID: 24768231 DOI: 10.1016/j.ejogrb.2014.04.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 04/02/2014] [Accepted: 04/08/2014] [Indexed: 12/30/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the recurrence and reoperation rate after myomectomy in women aged 45 years and older, who want to preserve their uterus. STUDY DESIGN We performed a retrospective review of women aged ≥45 years that underwent myomectomy between January 2000 and December 2010. The inclusion criteria were premenopausal status, myomectomy through abdominal or laparoscopic surgery, and at least 12 months interval from surgery. The clinical outcomes, including symptomatic change, recurrence of myoma on transvaginal ultrasonography (TVS), and reoperation data were collected and analyzed. RESULTS A total 92 patients were included in this study. The median age of the patient was 47 years (range 45-53 years), and the median follow-up duration was 30.5 months (range 12-95 months). On follow-up TVS, the recurrence of myoma was detected in 20 of 82 (24.4%) patients. Ten (10.9%) patients were not subjected to follow-up TVS. However, during their pelvic examination, the uterus was normal size, and all the 10 patients experienced symptomatic improvement and none of them needed additional surgical management. Using the Kaplan-Meier method, the cumulative recurrence rate at 36 months after myomectomy was calculated as 17.1%. Three patients underwent hysterectomy during the follow-up periods, and only one underwent hysterectomy due to myoma. The overall reoperation rate after myomectomy in this age group was 3.3%, and the reoperation for myoma rate was only 1.1%. CONCLUSION Considering the natural regression of myoma after menopause, myomectomy might be an effective option for women aged 45 years and older, who want to preserve their uterus.
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Overt hypothyroidism is associated with the presence of uterine leiomyoma: a retrospective analysis. Eur J Obstet Gynecol Reprod Biol 2014; 177:19-22. [PMID: 24690197 DOI: 10.1016/j.ejogrb.2014.03.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 02/06/2014] [Accepted: 03/01/2014] [Indexed: 11/22/2022]
Abstract
OBJECTIVE A possible correlation between uterine leiomyoma and thyroid disease was reported decades ago. We aimed to evaluate the possible associations between the presence of uterine leiomyomas and (i) the presence of overt hypothyroidism, (ii) the level of anti-thyroid peroxidase antibodies (TPO-Ab) and thyroglobulin antibodies (TG-Ab), and (iii) thyroid stimulating hormone (TSH) levels. STUDY DESIGN In a retrospective study, all 215 sterile women who underwent reproductive surgery (hysteroscopy and laparoscopy/laparotomy) at our department from January 2007 to January 2011 were included. All leiomyomas suspected on gynecologic ultrasound were verified during surgery. As risk factors for uterine leiomyomas, thyroid parameters, age, African heritage, age at menarche, parity, and body mass index were included. RESULTS One or more uterine leiomyomas were found in 51 cases (23.7%). After multivariate analysis, three parameters remained significant, with African heritage the most important (odds ratio, OR, 27.80), followed by overt hypothyroidism (OR 3.10) and increasing age (OR 1.23). Larger leiomyomas were found in women with overt hypothyroidism than in those without overt hypothyroidism (median, 70 mm; range, 5-88 vs. median, 30 mm; range, 2-93, respectively; p=0.007). CONCLUSIONS Overt hypothyroidism, but not autoantibodies against the thyroid gland, was associated with the presence of uterine leiomyoma in our study.
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T-cadherin expression in uterine leiomyoma. Arch Gynecol Obstet 2013; 288:607-14. [PMID: 23463326 DOI: 10.1007/s00404-013-2732-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2012] [Accepted: 01/17/2013] [Indexed: 10/27/2022]
Abstract
OBJECTIVE T-cadherin is a tumor-suppressor with low expression in many malignant tumors, but with high expression in endothelial cells and so on. In this study we investigated whether T-cadherin was expressed and if together with bFGF play a role in the occurrence and development of uterine leiomyoma. METHOD Uterine leiomyoma, the adjacent normal myometrium, control normal myometrium without uterine leiomyoma and vascular features of myoma were collected. Immunohistochemistry, western blot and relative quantitative real time PCR were used to evaluate bFGF and T-cadherin on the three specimens. Data were statistically analysed. RESULTS T-cadherin was observed on the leiomyoma cellular layers but not in the endochylema, extracellular matrix and leiomyoma vascular endothelial cell, bFGF in the leiomyoma endochylema but not observed in the extracellular matrix and leiomyoma vascular endothelial cell. The protein and mRNA expression of bFGF and T-cadherin in uterine leiomyoma were significantly with higher expression than that in adjacent normal myometrium and control normal myometrium. In addition, T-cadherin correlated well with bFGF. There was relationship between T-cadherin and color Doppler flow imaging (CDFI). CONCLUSION bFGF and T-cadherin have high expressions in uterine leiomyoma, and T-cadherin is associated with CDFI, indicating that a cross talk between bFGF and T-cadherin plays an important role in the occurrence and development of uterine leiomyoma or even malignant tumors.
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Islam MS, Protic O, Giannubilo SR, Toti P, Tranquilli AL, Petraglia F, Castellucci M, Ciarmela P. Uterine leiomyoma: available medical treatments and new possible therapeutic options. J Clin Endocrinol Metab 2013; 98:921-34. [PMID: 23393173 DOI: 10.1210/jc.2012-3237] [Citation(s) in RCA: 124] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
CONTEXT Uterine leiomyomas (fibroids or myomas) are benign tumors of the uterus and are clinically apparent in up to 25% of reproductive-age women. Heavy or abnormal uterine bleeding, pelvic pain or pressure, infertility, and recurrent pregnancy loss are generally associated with leiomyoma. Although surgical and radiological therapies are frequently used for the management of this tumor, medical therapies are considered the first-line treatment of leiomyoma. EVIDENCE ACQUISITION AND SYNTHESIS A review was conducted of electronic and print data comprising both original and review articles on pathophysiology and medical treatments of uterine leiomyoma retrieved from the PubMed or Google Scholar database up to June 2012. These resources were integrated with the authors' knowledge of the field. CONCLUSION To date, several pathogenetic factors such as genetic factors, epigenetic factors, estrogens, progesterone, growth factors, cytokines, chemokines, and extracellular matrix components have been implicated in leiomyoma development and growth. On the basis of current hypotheses, several medical therapies have been investigated. GnRH agonist has been approved by US Food and Drug Administration for reducing fibroid volume and related symptoms. In addition, the FDA also approved an intrauterine device, levonorgestrel-releasing intrauterine system (Mirena), for additional use to treat heavy menstrual bleeding in intrauterine device users only. Currently, mifepristone, asoprisnil, ulipristal acetate, and epigallocatechin gallate have been shown to be effective for fibroid regression and symptomatic improvement which are all in clinical trial. In addition, some synthetic and natural compounds as well as growth factor inhibitors are now under laboratory investigation, and they could serve as future therapeutic options.
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Affiliation(s)
- Md Soriful Islam
- Department of Experimental and Clinical Medicine, Faculty of Medicine, Polytechnic University of Marche, via Tronto 10/a, 60020 Ancona, Italy
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Are uterine leiomyoma a consequence of a chronically inflammatory immune system? Med Hypotheses 2012; 79:226-31. [PMID: 22608860 DOI: 10.1016/j.mehy.2012.04.046] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Revised: 03/27/2012] [Accepted: 04/27/2012] [Indexed: 11/21/2022]
Abstract
The cumulative incidence of uterine leiomyoma at age 50 is ≈ 70% in White women and >80% in Black women. Although risk factor research is limited, increasing age, and being premenopausal, nulliparous or Black are risk factors for leiomyomas. Black women tend to have larger leiomyomas and be younger at diagnosis. Surprisingly little is known about the etiology or pathogenesis of uterine leiomyomas. Women with diagnosed uterine leiomyomas have higher healthcare costs - more than 2.5 times that of women without a diagnosis. In the United States, leiomyomas are the leading indication for hysterectomy. The proposed hypothesis is that leiomyomas are caused in part by a systemic immune milieu that is chronically inflammatory - one that predominates in T helper 17 (Th17) cytokines. Inflammation can be problematic if it is not well regulated. Should an inflammatory imbalance be demonstrated to be associated with leiomyoma development and growth, this would provide an avenue for development of preventative treatments (e.g., focus on anti-inflammatory pathways), which would substantially reduce the morbidity costs of these tumors and reduce a known health disparity.
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Horak P, Mara M, Dundr P, Kubinova K, Kuzel D, Hudecek R, Chmel R. Effect of a selective progesterone receptor modulator on induction of apoptosis in uterine fibroids in vivo. Int J Endocrinol 2012; 2012:436174. [PMID: 22844281 PMCID: PMC3403220 DOI: 10.1155/2012/436174] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Revised: 05/18/2012] [Accepted: 05/18/2012] [Indexed: 11/18/2022] Open
Abstract
Aim. To determine if hormonal treatment induces apoptosis in uterine fibroids. Methods. Immunohistochemical examination of fibroid tissue, using avidin-biotin complex and cleaved caspase-3 antibody for detecting apoptosis, was performed in premenopausal women who underwent 12-week treatment with oral SPRM (6 patients with 5 mg and 5 patients with 10 mg of ulipristal acetate per day) or gonadoliberin agonist (GnRHa, 17 patients) and subsequent myomectomy or hysterectomy for symptomatic uterine fibroids. Ten patients with no presurgical hormonal treatment were used as controls. Results. Apoptosis was present in a significantly higher proportion of patients treated with ulipristal acetate compared to GnRHa (P = 0.01) and to patients with no hormonal treatment (P = 0.01). In contrast to an AI of 158.9 in SPRM patients, the mean AI was 27.5 and 2.0 in GnRHa and control groups, respectively. No statistical difference in the AI was observed between the two groups of patients treated with ulipristal acetate (5 mg or 10 mg). Conclusion. Treatment with ulipristal acetate induces apoptosis in uterine fibroid cells. This effect of SPRM may contribute to their positive clinical effect on uterine fibroids.
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Affiliation(s)
- Petr Horak
- Department of Obstetrics and Gynaecology, First Faculty of Medicine, Charles University in Prague, Apolinarska 18, 128 00 Prague, Czech Republic
| | - Michal Mara
- Department of Obstetrics and Gynaecology, First Faculty of Medicine, Charles University in Prague, Apolinarska 18, 128 00 Prague, Czech Republic
| | - Pavel Dundr
- Institute of Pathology, First Faculty of Medicine, Charles University in Prague, 128 00 Prague, Czech Republic
| | - Kristyna Kubinova
- Department of Obstetrics and Gynaecology, First Faculty of Medicine, Charles University in Prague, Apolinarska 18, 128 00 Prague, Czech Republic
- *Kristyna Kubinova:
| | - David Kuzel
- Department of Obstetrics and Gynaecology, First Faculty of Medicine, Charles University in Prague, Apolinarska 18, 128 00 Prague, Czech Republic
| | - Robert Hudecek
- Department of Obstetrics and Gynaecology, University Hospital Brno, 625 00 Brno, Czech Republic
| | - Roman Chmel
- Department of Obstetrics and Gynaecology, Second Faculty of Medicine, Charles University in Prague, 150 06 Prague, Czech Republic
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Wise LA, Radin RG, Palmer JR, Kumanyika SK, Boggs DA, Rosenberg L. Intake of fruit, vegetables, and carotenoids in relation to risk of uterine leiomyomata. Am J Clin Nutr 2011; 94:1620-31. [PMID: 22071705 PMCID: PMC3252555 DOI: 10.3945/ajcn.111.016600] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2011] [Accepted: 09/19/2011] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND US black women have higher rates of uterine leiomyomata (UL) and lower intakes of fruit and vegetables than do white women. Whether fruit and vegetable intake is associated with UL in black women has not been studied. OBJECTIVE We assessed the association of dietary intake of fruit, vegetables, carotenoids, folate, fiber, and vitamins A, C, and E with UL in the Black Women's Health Study. DESIGN In this prospective cohort study, we followed 22,583 premenopausal women for incident UL (1997-2009). Diet was estimated by using food-frequency questionnaires in 1995 and 2001. Cox regression was used to derive incidence rate ratios (IRRs) and 95% CIs for the association between each dietary variable (in quintiles) and UL. RESULTS There were 6627 incident cases of UL diagnosed by ultrasonography (n = 4346) or surgery (n = 2281). Fruit and vegetable intake was inversely associated with UL (≥4 compared with <1 serving/d; IRR: 0.90; 95% CI: 0.82, 0.98; P-trend = 0.03). The association was stronger for fruit (≥2 servings/d compared with <2 servings/wk; IRR: 0.89; 95% CI: 0.81, 0.98; P-trend = 0.07) than for vegetables (≥2 servings/d compared with <4 servings/wk: IRR: 0.97; 95% CI: 0.89, 1.05; P-trend = 0.51). Citrus fruit intake was inversely associated with UL (≥3 servings/wk compared with <1 serving/mo: IRR: 0.92; 95% CI: 0.86, 1.00; P-trend = 0.01). The inverse association for dietary vitamin A (upper compared with lower quintiles: IRR: 0.89; 95% CI: 0.83, 0.97; P-trend = 0.01) appeared to be driven by preformed vitamin A (animal sources), not provitamin A (fruit and vegetable sources). UL was not materially associated with dietary intake of vitamins C and E, folate, fiber, or any of the carotenoids, including lycopene. CONCLUSION These data suggest a reduced risk of UL among women with a greater dietary intake of fruit and preformed vitamin A.
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Affiliation(s)
- Lauren A Wise
- Slone Epidemiology Center at Boston University, MA 02215, USA.
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Nasiadek M, Swiatkowska E, Nowinska A, Krawczyk T, Wilczynski JR, Sapota A. The effect of cadmium on steroid hormones and their receptors in women with uterine myomas. ARCHIVES OF ENVIRONMENTAL CONTAMINATION AND TOXICOLOGY 2011; 60:734-741. [PMID: 20711721 DOI: 10.1007/s00244-010-9580-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2009] [Accepted: 07/19/2010] [Indexed: 05/29/2023]
Abstract
Cadmium (Cd) is one of the environmental metalloestrogens, and its role in uterine tissues has not yet been fully elucidated. The aim of the study was to investigate estrogenic properties of Cd in uterine tissues by analyzing the expression of estrogen receptor (ER) and progesterone receptor (PR) as well as estrogen and progesterone levels in serum and Cd concentrations in blood and tissues. The samples of tissues (leiomyoma and surrounding myometrium) collected intrasurgically and blood samples drawn from 53 women (age 39 to 52 years) with uterine myomas were thoroughly analyzed. In the study group, blood Cd concentration ranged from 0.33 to 3.5 μg/L. Cd concentration in leiomyoma tissues was twice as low [corrected] as that in surrounding myometrium (0.047 and 0.075 μg Cd/g [corrected] wet tissue, respectively), albeit the difference was not statistically significant. Cd concentrations in blood significantly correlated with Cd concentrations in tissues (leiomyoma and surrounding myometrium). The measurement of ER expression showed no difference between leiomyoma tissues and surrounding myometrium. The statistical analysis showed a significant correlation between ER expression and Cd concentration in both tissues under study. An additional statistical analysis (path analysis) demonstrated the correlation of uterine tissue levels of Cd and ER expression. However, there was no association between ER expression in both tissues and E(2) level in serum. Our results suggest a metalloestrogenic effect of Cd by way of ER stimulation in the uterus.
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Affiliation(s)
- Marzenna Nasiadek
- Department of Toxicology, Faculty of Pharmacy, Medical University, 90-151 Lodz, Poland.
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Chegini N. Proinflammatory and profibrotic mediators: principal effectors of leiomyoma development as a fibrotic disorder. Semin Reprod Med 2010; 28:180-203. [PMID: 20414842 DOI: 10.1055/s-0030-1251476] [Citation(s) in RCA: 105] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Leiomyomas are believed to derive from the transformation of myometrial smooth muscle cells/connective tissue fibroblasts. Although the identity of the molecule(s) that initiate such cellular transformation and orchestrate subsequent growth is still unknown, conventional evidence indicates that ovarian steroids are essential for leiomyoma growth. Ovarian steroid action in their target cell/tissue is mediated in part through local expression of various growth factors, cytokines, and chemokines. These autocrine/paracrine molecules with proinflammatory and profibrotic activities serve as major contributing factors in regulating cellular transformation, cell growth and apoptosis, angiogenesis, cellular hypertrophy, and excess tissue turnover, events central to leiomyoma growth. This review addresses the key regulatory functions of proinflammatory and profibrotic mediators and their molecular mechanisms, downstream signaling that regulates cellular events that result in transformation, and commitments of specific cells into forming a cellular environment with a possible role in development and subsequent growth of leiomyomas.
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Affiliation(s)
- Nasser Chegini
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Florida, Gainesville, Florida 32610, USA.
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Xu Q, Qiu L, Zhu L, Luo L, Xu C. Levonorgestrel inhibits proliferation and induces apoptosis in uterine leiomyoma cells. Contraception 2010; 82:301-8. [PMID: 20705162 DOI: 10.1016/j.contraception.2010.03.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2008] [Revised: 02/26/2010] [Accepted: 03/02/2010] [Indexed: 11/18/2022]
Abstract
BACKGROUND The levonorgestrel intrauterine system (LNG-IUS) is a widely recognized intrauterine anti-fertility system, which can alleviate symptoms of uterine leiomyoma. This study aims to evaluate leimyoma cell growth inhibition induced by high concentrations of LNG. STUDY DESIGN After treatment with LNG, the growth rate of the cultured primary uterine leiomyoma cells was studied with methyl thiazolyl tetrazolium (MTT) assay. Cell apoptosis rate was determined by morphological changes and flow cytometry. Reverse transcription polymerase chain reaction (RT-PCR) and Western blotting were performed to measure the differential mRNA and protein expression levels. RESULTS The proliferation rate of uterine leiomyoma cells was suppressed after treatment with LNG at a minimum concentration of 10 mcg/mL. The inhibitive effect was positively correlated with the LNG concentration and with the incubation time. Flow cytometry showed that the apoptosis rate was increased with the LNG concentration. The mRNA levels of IGF-1, Bcl-2 and survivin were down-regulated significantly after treatment with 10 mcg/mL LNG. Western blot analysis confirmed that the expression of Bcl-2 and survivin was decreased significantly, and the p38 phosphorylation level was increased and caspase 3 was activated remarkably 72 h after treatment with 10 and 20 mcg/mL LNG. CONCLUSIONS This study demonstrated that LNG may suppress the proliferation and induce apoptosis of the uterine leiomyoma cells.
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Affiliation(s)
- Qing Xu
- Department of Obstetrics and Gynecology, Nanjing Maternity and Child Health Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
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Abstract
The seminal article by Douglas Hanahan and Robert Weinberg on the hallmarks of cancer is 10 years old this year and its contribution to how we see cancer has been substantial. But, in embracing this view, have we lost sight of what makes cancer cancer?
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Affiliation(s)
- Yuri Lazebnik
- Cold Spring Harbor Laboratory, Cold Spring Harbor, NY 11724, New York, USA.
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21
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Wise LA, Radin RG, Palmer JR, Kumanyika SK, Rosenberg L. A prospective study of dairy intake and risk of uterine leiomyomata. Am J Epidemiol 2010; 171:221-32. [PMID: 19955473 DOI: 10.1093/aje/kwp355] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Rates of uterine leiomyomata are 2-3 times higher among black women than white women. Dietary factors that differ in prevalence between these populations that could contribute to the disparity include dairy intake. During 1997-2007, the authors followed 22,120 premenopausal US Black Women's Health Study participants to assess dairy intake in relation to uterine leiomyomata risk. Because soy may be substituted for dairy, the effect of soy intake was also evaluated. Diet was estimated by using food frequency questionnaires in 1995 and 2001. Incidence rate ratios and 95% confidence intervals were estimated with Cox regression. There were 5,871 incident cases of uterine leiomyomata diagnosed by ultrasound (n = 3,964) or surgery (n = 1,907). Multivariable incidence rate ratios comparing 1, 2, 3, and > or =4 servings/day with <1 serving/day of total dairy were 0.94 (95% confidence interval (CI): 0.88, 1.00), 0.87 (95% CI: 0.78, 0.98), 0.84 (95% CI: 0.70, 1.01), and 0.70 (95% CI: 0.58, 0.86), respectively (P-trend <0.001). Incidence rate ratios comparing the highest (> or =2 servings/day) with the lowest (<1 serving/week) intake categories were 0.81 (95% CI: 0.66, 0.99) for high-fat dairy, 0.80 (95% CI: 0.70, 0.91) for low-fat dairy, and 0.78 (95% CI: 0.68, 0.89) for milk. Soy intake was unrelated to uterine leiomyomata risk. This large prospective study of black women provides the first epidemiologic evidence of reduced uterine leiomyomata risk associated with dairy consumption.
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Affiliation(s)
- Lauren A Wise
- Slone Epidemiology Center, 1010 Commonwealth Avenue, Boston, MA 02215, USA.
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Norian JM, Malik M, Parker CY, Joseph D, Leppert PC, Segars JH, Catherino WH. Transforming growth factor beta3 regulates the versican variants in the extracellular matrix-rich uterine leiomyomas. Reprod Sci 2009; 16:1153-64. [PMID: 19700613 DOI: 10.1177/1933719109343310] [Citation(s) in RCA: 116] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Uterine leiomyoma are common, benign tumors that are enriched in extracellular matrix. The tumors are characterized by a disoriented and loosely packed collagen fibril structure similar to other diseases with disrupted Transforming growth factor beta (TGF-beta) signaling. Here we characterized TGF-beta3 signaling and the expression patterns of the critical extracellular matrix component versican in leiomyoma and myometrial tissue and cell culture. We also demonstrate the regulation of the versican variants by TGF-beta3. Using leiomyoma and matched myometrium from 15 patients, messenger RNA (mRNA) from leiomyoma and myometrium was analyzed by semiquantitative real time reverse transcription-polymerase chain reaction (RT-PCR), while protein analysis was done by western blot. Transforming growth factor beta3 transcripts were increased 4-fold in leiomyoma versus matched myometrium. Phosphorylated-TGF-beta RII and phosphorylated-Smad 2/3 complex were greater in leiomyoma as documented by Western blot. The inhibitor Smad7 transcripts were decreased 0.44-fold. The glycosaminoglycan (GAG)-rich versican variants were elevated in leiomyoma versus myometrial tissue: specifically V0 (4.27 +/- 1.12) and V1 (2.01 +/- 0.27). Treatment of leiomyoma and myometrial cells with TGF-beta3 increased GAG-rich versican variant expression 7 to 12 fold. Neutralizing TGF-beta3 antibody decreased the expression of the GAG-rich versican variants 2 to 8 fold in leiomyoma cells. Taken together, the aberrant production of excessive and disorganized extracellular matrix that defines the leiomyoma phenotype involves the activation of the TGF-beta signaling pathway and excessive production of GAG-rich versican variants.
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Affiliation(s)
- John M Norian
- Department of Obstetrics and Gynecology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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Fleischer R, Weston GC, Vollenhoven BJ, Rogers PA. Pathophysiology of fibroid disease: angiogenesis and regulation of smooth muscle proliferation. Best Pract Res Clin Obstet Gynaecol 2008; 22:603-14. [DOI: 10.1016/j.bpobgyn.2008.01.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Di X, Yu L, Moore AB, Castro L, Zheng X, Hermon T, Dixon D. A low concentration of genistein induces estrogen receptor-alpha and insulin-like growth factor-I receptor interactions and proliferation in uterine leiomyoma cells. Hum Reprod 2008; 23:1873-83. [PMID: 18492705 DOI: 10.1093/humrep/den087] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Previously, we found that genistein at low concentrations stimulates the growth of human uterine leiomyoma (LM) cells, but not uterine smooth muscle (myometrial) cells (SMC). The aim of this study was to understand the molecular mechanism whereby genistein causes hyperproliferation of LM cells. METHODS The effects of genistein at 1 microg/ml on LM cells and SMC were evaluated using estrogen response element gene reporter, real-time RT-PCR, western blot, immunoprecipitation and cell proliferation assays. RESULTS Elevated estrogen receptor (ER) transactivation, increased mRNA expression of early estrogen-responsive genes, progesterone receptor and insulin-like growth factor-I (IGF-I), and decreased protein levels of ER-alpha (ER alpha) were found in genistein-treated LM cells, but not SMC. Additionally, extracellular regulated kinase (ERK), Src homology/collagen (Shc) and ER alpha were transiently activated, and interactions between ER alpha and IGF-I receptor (IGF-IR) were rapidly induced by genistein in LM cells. Using ER antagonist ICI 182,780 and MAPK/ERK kinase (MEK) inhibitor PD98059, we found that these early events were inhibited and the proliferative effect of genistein on LM cells was abrogated. CONCLUSIONS ER alpha is involved in the transient activation of ERK/mitogen activated protein kinase (MAPK) by genistein via its early association with IGF-IR, leading to hyper-responsiveness of LM cells and confirming that ER signaling is enhanced by activation of ERK/MAPK in LM cells.
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Affiliation(s)
- X Di
- Comparative Pathobiology Group, Cellular and Molecular Pathology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC 27709, USA
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Abstract
BACKGROUND The incidence of uterine leiomyomata (fibroids, myomas) is 2-3 times higher in black women than white women. Black women also report higher levels of racial discrimination. We evaluated the hypothesis that greater exposure to racism increases myoma risk in black women. METHODS Data were derived from the Black Women's Health Study, a prospective cohort study of US black women age 21-69 years in 1995. In 1997, women reported on "everyday" and "lifetime" experiences of racism. From 1997 through 2003, we followed 22,002 premenopausal women to assess the association between self-reported racism and risk of myomas. Incidence rate ratios (IRRs) and 95% confidence intervals (CIs) were estimated from Cox regression models. RESULTS During 107,127 person-years of follow-up, 3440 new cases of uterine myomas confirmed by ultrasound (n = 2774) or surgery (n = 666) were reported. All IRRs for "lifetime" and "everyday" experiences of racism were above 1.0. Using a summary variable that averaged the responses from 5 "everyday" racism items, multivariable IRRs comparing quartiles 2, 3, and 4 to quintile 1 (lowest) were 1.16 (95% CI = 1.04-1.29), 1.19 (1.06-1.32), and 1.27 (1.14-1.43), respectively. Multivariable IRRs comparing women who reported 1, 2, or 3 lifetime occurrences of major discrimination (ie, job, housing, or police) relative to those who reported none were 1.04 (0.96-1.13), 1.17 (1.07-1.28), and 1.24 (1.10-1.39), respectively. Results did not vary according to case definition (ultrasound vs. surgery) or health care utilization. Associations were weaker among foreign-born women and among women with higher coping skills. CONCLUSIONS Perceived racism was associated with an increased risk of uterine myomas in US-born black women.
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