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Chiarella SE, Buchheit KM, Foer D. Progestogen Hypersensitivity. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:3606-3613.e2. [PMID: 37579875 PMCID: PMC10841326 DOI: 10.1016/j.jaip.2023.07.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 07/19/2023] [Accepted: 07/27/2023] [Indexed: 08/16/2023]
Abstract
Progestogen hypersensitivity (PH) is a heterogeneous disease characterized by diverse cutaneous manifestations, bronchospasm, and/or anaphylaxis. Possible triggers include ovarian progesterone and exogenous progestogens. The timing of symptoms is critical to diagnose PH: during the luteal phase of the menstrual cycle for the endogenous form and after exposure to progestins for exogenous PH. Diagnostic modalities such as progesterone skin testing have low sensitivity and specificity for PH. When exogenous PH is suspected, the allergist should consider a progestogen challenge. Treatment strategies should be tailored for each patient, including symptom-directed therapies, ovulation suppression, and progesterone desensitization. Future studies should explore the mechanisms of PH, validation of diagnostic criteria, and standardization of treatment strategies.
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Affiliation(s)
| | - Kathleen M Buchheit
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - Dinah Foer
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
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Hoefgen HR, Benoit J, Chan S, Jayasinghe Y, Lustberg M, Pohl V, Saraf A, Schmidt D, Appiah LC. Female reproductive health in pediatric, adolescent, and young adult cancer survivors. Pediatr Blood Cancer 2023; 70 Suppl 5:e29170. [PMID: 37381166 DOI: 10.1002/pbc.29170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 05/02/2021] [Accepted: 05/11/2021] [Indexed: 06/30/2023]
Abstract
An estimated 500,000 cancer survivors of reproductive age in the United States will live to experience the long-term consequences of cancer treatment. Therefore, a focused aspect of cancer care has appropriately shifted to include quality of life in survivorship. Infertility is a late effect of therapy that affects 12% of female survivors of childhood cancer receiving any cancer treatment in large cohort studies and results in a 40% decreased likelihood of pregnancy in young adults of ages 18-39 years. Nonfertility gynecologic late effects such as hypoestrogenism, radiation-induced uterine and vaginal injury, genital graft-versus-host disease after hematopoietic stem cell transplant, and sexual dysfunction also significantly affect quality of life in survivorship but are underdiagnosed and require consideration. Several articles in the special edition "Reproductive Health in Adolescent and Young Adult Cancer Survivorship" address infertility, genital graft-versus-host disease, and psychosexual functioning in survivorship. This review article focuses on other adverse gynecologic outcomes of cancer therapies including hypogonadism and hormone replacement therapy, radiation-induced uterovaginal injury, vaccination and contraception, breast and cervical cancer screening, and pregnancy considerations in survivorship.
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Affiliation(s)
- Holly R Hoefgen
- Division of Pediatric and Adolescent Gynecology, Department of Obstet Gynecol, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Janie Benoit
- Gynecology & Reproductive Sciences, CHU Ste-Justine, University of Montreal, Montreal, Quebec, Canada
| | - Serena Chan
- Division of Pediatric and Adolescent Gynecology, Department of Obstetrics, Gynecology & Reproductive Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Yasmin Jayasinghe
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Parkville, Victoria, Australia
| | - Maryam Lustberg
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Victoria Pohl
- Center for Cancer and Blood Disorders, Connecticut Children's Medical Center, Hartford, Connecticut, USA
| | - Amanda Saraf
- Division Pediatric Hematology Oncology, Department of Pediatrics, Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana, USA
| | - Deb Schmidt
- MACC Fund Center for Cancer and Blood Disorders, Children's Hospital of Wisconsin, Milwaukee, Wisconsin, USA
| | - Leslie Coker Appiah
- Division of Pediatric and Adolescent Gynecology, Department of Obstet Gynecol, Children's Hospital Colorado, University of Colorado Denver, Denver, Colorado, USA
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Jo HB, Lee HJ, Kim SC, Joo JK, Suh DS, Kim KH. Evaluation of endometrial thickness in breast cancer patients with tamoxifen treatment - Difference between 2-dimensional ultrasonography and elastosonography. Taiwan J Obstet Gynecol 2023; 62:547-552. [PMID: 37407192 DOI: 10.1016/j.tjog.2023.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2023] [Indexed: 07/07/2023] Open
Abstract
OBJECTIVE This study aimed to confirm the clinical significance of elastographic endometrium measurement in comparison with conventional ultrasonography for tamoxifen users with breast cancer. MATERIALS AND METHODS In this retrospective analysis, 98 women receiving tamoxifen as postoperative breast cancer treatment were included. Patient medical charts were reviewed, and related medical, obstetric, and gynecological information and histories relevant to breast cancer were evaluated. Patient clinical imaging data included endometrial thickness measurements using both conventional ultrasonography and elastography, and the differences between these two modalities in delta values were statistically analyzed along with possible influencing factors. RESULTS Endometrial thickness measured using 2-dimensional ultrasonography had a mean value of 5.81 mm (standard deviation [SD] = 3.09), and elastosonography showed a mean value of 3.07 mm (SD = 1.62). A paired t-test was conducted and a significant difference between them was confirmed (P-value <0.001). Logistic regression analysis revealed that age and duration of tamoxifen treatment significantly influenced the degree of difference between endometrial thickness measurements. CONCLUSIONS Elastosonography may be a more successful and useful tool for measuring actual endometrial thickness than generalized 2-dimensional ultrasonography. In clinical cases with limited use of elastosonography and consequent inability for thorough evaluation of endometrial thickness, practitioners should exercise caution in deciding whether or not to adopt invasive diagnostic procedures, such as endometrial curettage, especially for young patients of reproductive age or those with prolonged treatment of breast cancer with tamoxifen.
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Affiliation(s)
- Hyun Been Jo
- Pusan National University Graduate School, Busan, South Korea
| | - Hyun Joo Lee
- Department of Obstetrics and Gynecology, Pusan National University School of Medicine, Pusan National University Hospital Medical Research Institute, Busan, South Korea
| | - Seung Chul Kim
- Department of Obstetrics and Gynecology, Pusan National University School of Medicine, Pusan National University Hospital Medical Research Institute, Busan, South Korea
| | - Jong Kil Joo
- Department of Obstetrics and Gynecology, Pusan National University School of Medicine, Pusan National University Hospital Medical Research Institute, Busan, South Korea.
| | - Dong Soo Suh
- Department of Obstetrics and Gynecology, Pusan National University School of Medicine, Pusan National University Hospital Medical Research Institute, Busan, South Korea
| | - Ki Hyung Kim
- Department of Obstetrics and Gynecology, Pusan National University School of Medicine, Pusan National University Hospital Medical Research Institute, Busan, South Korea
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Zhang J, Yu X, Zhang X, Chen S, Song Y, Xie L, Chen Y, Ouyang H. Whole-lesion apparent diffusion coefficient (ADC) histogram as a quantitative biomarker to preoperatively differentiate stage IA endometrial carcinoma from benign endometrial lesions. BMC Med Imaging 2022; 22:139. [PMID: 35941559 PMCID: PMC9358891 DOI: 10.1186/s12880-022-00864-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 07/29/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To assess the value of whole-lesion apparent diffusion coefficient (ADC) histogram analysis in differentiating stage IA endometrial carcinoma (EC) from benign endometrial lesions (BELs) and characterizing histopathologic features of stage IA EC preoperatively. METHODS One hundred and six BEL and 126 stage IA EC patients were retrospectively enrolled. Eighteen volumetric histogram parameters were extracted from the ADC map of each lesion. The Mann-Whitney U or Student's t-test was used to compare the differences between the two groups. Models based on clinical parameters and histogram features were established using multivariate logistic regression. Receiver operating characteristic (ROC) analysis and calibration curves were used to assess the models. RESULTS Stage IA EC showed lower ADC10th, ADC90th, ADCmin, ADCmax, ADCmean, ADCmedian, interquartile range, mean absolute deviation, robust mean absolute deviation (rMAD), root mean squared, energy, total energy, entropy, variance, and higher skewness, kurtosis and uniformity than BELs (all p < 0.05). ADCmedian yielded the highest area under the ROC curve (AUC) of 0.928 (95% confidence interval [CI] 0.895-0.960; cut-off value = 1.161 × 10-3 mm2/s) for differentiating stage IA EC from BELs. Moreover, multivariate analysis demonstrated that ADC-score (ADC10th + skewness + rMAD + total energy) was the only significant independent predictor (OR = 2.641, 95% CI 2.045-3.411; p < 0.001) for stage IA EC when considering clinical parameters. This ADC histogram model (ADC-score) achieved an AUC of 0.941 and a bias-corrected AUC of 0.937 after bootstrap resampling. The model performed well for both premenopausal (accuracy = 0.871) and postmenopausal (accuracy = 0.905) patients. Besides, ADCmin and ADC10th were significantly lower in Grade 3 than in Grade 1/2 stage IA EC (p = 0.022 and 0.047). At the same time, no correlation was found between ADC histogram parameters and the expression of Ki-67 in stage IA EC (all p > 0.05). CONCLUSIONS Whole-lesion ADC histogram analysis could serve as an imaging biomarker for differentiating stage IA EC from BELs and assisting in tumor grading of stage IA EC, thus facilitating personalized clinical management for premenopausal and postmenopausal patients.
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Affiliation(s)
- Jieying Zhang
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Xiaoduo Yu
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
| | - Xiaomiao Zhang
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Shuang Chen
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Yan Song
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Lizhi Xie
- MR Research China, GE Healthcare, Beijing, 100176, China
| | - Yan Chen
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Han Ouyang
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
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Gynecological Management of the Breast Cancer Survivor. Best Pract Res Clin Obstet Gynaecol 2022; 82:69-80. [DOI: 10.1016/j.bpobgyn.2022.01.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 01/31/2022] [Accepted: 01/31/2022] [Indexed: 12/30/2022]
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Abd-Alhussain GK, Alatrakji MQYMA, Saleh WA, Fawzi HA, Mahmood AS. Effects of tamoxifen on the reproductive system of female breast cancer patients: an ultrasound-based cohort study. F1000Res 2020; 9:102. [DOI: 10.12688/f1000research.21481.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/02/2023] Open
Abstract
Background: Tamoxifen (TMX) is regarded as standard treatment for breast cancer (BC) patients. In recent years, several studies have reported gynecological side effects and due to TMX's estrogenic effects. Here, we evaluate the side effects of TMX on the endometrium and ovaries of female BC patients. Methods: This was an ultrasound-based cohort study conducted in three oncology centers in Baghdad, Iraq. A total of 255 female patients were included, 140 premenopausal (PreM) and 115 postmenopausal (PostM), with estrogen receptor (ER)-positive BC using TMX adjuvant hormonal treatment for at least three months after surgery and adjuvant chemo/radiotherapy. Ultrasound (US) on the endometrium and ovaries of the women following BC surgery/chemotherapy (baseline) and at 3, 6, 12, and 24 months following was performed. Data collected included age, menopausal status, co-morbid chronic illness and medications, including duration of TMX treatment. Results: Presence of ovarian cyst was significantly higher in the PreM compared to PostM women, while there were no significant differences for other gynecological findings. At baseline, endometrial thickness (ET) was significantly higher in the PreM compared to the PostM women. In both groups, women with increased ET became more frequent from baseline to 3 months, from 3 to 6 months, from 6 to 12 months, and from 12 to 24 months. At all time periods, women with increased ET was significantly higher in the PostM compared PreM women, resulting in a risk of ET increase by 6 folds (ranging from 3 – 11 folds) in PostM compared to PreM women. Conclusions: Longer duration of TMX is associated with increased ET. Duration of TMX did not appear to increase the risk of various gynecological outcomes, for example endometrial cancer rate was low. Finally, there was an increase in ET, which appeared to be six-folds higher in PostM compared to PreM women.
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Palacios J, Yildiz A, Young AH, Taylor MJ. Tamoxifen for bipolar disorder: Systematic review and meta-analysis. J Psychopharmacol 2019; 33:177-184. [PMID: 30741085 DOI: 10.1177/0269881118822167] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Tamoxifen is an oral medication that has been proposed as a potential treatment for bipolar disorder. Tamoxifen acts to inhibit the intracellular action of protein kinase C, which is also an action of well-established treatments such as lithium and valproate. Here we aimed to identify randomised controlled trials (RCTs) of tamoxifen in the treatment of bipolar disorder and synthesise their results using meta-analysis. METHODS RCTs were identified by searching of electronic databases and from discussion with experts in the field. Data were extracted, and meta-analyses performed in R. RESULTS Five placebo-controlled RCTs of tamoxifen in the treatment of acute mania were identified. There were no trials in the treatment of episodes of bipolar depression, or for relapse prevention. The studies of mania treatment were of between three and six weeks duration. Tamoxifen was studied either as monotherapy (two trials) or as augmentation of lithium or valproate (three trials). Change in mania scale scores favoured tamoxifen over placebo: SMD -2.14 (95% CI -3.39 to -0.89; 4 trials), as did endpoint mania scale scores SMD 1.23 (95% CI 0.60-1.87; 5 trials). Response rates were also higher: RR 4.35 (1.99-9.50; 4 trials). Acceptability was similar to placebo: RR 1.03 (0.94-1.13; 5 trials). CONCLUSIONS Tamoxifen appears to be a promising potential treatment for episodes of mania. Future studies could investigate its effects as an adjunct to dopamine antagonists for improved anti-manic efficacy, and establish its longer term effects on mood, particularly depression and relapse.
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Affiliation(s)
- Jorge Palacios
- 1 Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Ayşegül Yildiz
- 2 Department of Psychiatry, Dokuz Eylül University, Izmir, Turkey
| | - Allan H Young
- 1 Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Matthew J Taylor
- 1 Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,3 Department of Psychiatry, University of Oxford, Oxford, UK
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Kojima N, Yamasaki Y, Koh H, Miyashita M, Morita H. Long-Acting Luteinizing Hormone-Releasing Hormone Agonist for Ovarian Hyperstimulation Induced by Tamoxifen for Breast Cancer. Case Rep Obstet Gynecol 2018; 2018:4931852. [PMID: 29607235 PMCID: PMC5827888 DOI: 10.1155/2018/4931852] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 12/26/2017] [Accepted: 12/27/2017] [Indexed: 01/13/2023] Open
Abstract
Tamoxifen treatment for breast cancer may induce ovarian cysts and supraphysiological levels of serum estrogen. We report successful management with luteinizing hormone-releasing hormone (LHRH) agonist of ovarian hyperstimulation induced by tamoxifen. A 49-year-old woman was operated on for invasive ductal carcinoma of the right breast. She received breast irradiation and adjuvant tamoxifen therapy. After 2 years, she had a cystic ovarian mass, and her serum concentration of estradiol was 1280 pg/mL. She was treated with an injection of 11.25 mg leuprolide acetate, a long-acting LHRH agonist, without abandoning tamoxifen therapy. The levels of estradiol decreased to <10 pg/mL and the cystic mass disappeared 2 months later. Three-month depot treatment with LHRH agonists can be useful for patients receiving tamoxifen for breast cancer who have ovarian cysts and supraphysiological levels of estrogen.
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Affiliation(s)
- Nobue Kojima
- Department of Obstetrics and Gynecology, Rokko Island Konan Hospital, Kobe, Japan
| | - Yui Yamasaki
- Department of Obstetrics and Gynecology, Rokko Island Konan Hospital, Kobe, Japan
| | - Houu Koh
- Department of Obstetrics and Gynecology, Rokko Island Konan Hospital, Kobe, Japan
| | | | - Hiroki Morita
- Department of Obstetrics and Gynecology, Rokko Island Konan Hospital, Kobe, Japan
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Endometrial polyp surveillance in premenopausal breast cancer patients using tamoxifen. Obstet Gynecol Sci 2017; 60:26-31. [PMID: 28217668 PMCID: PMC5313360 DOI: 10.5468/ogs.2017.60.1.26] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 07/11/2016] [Accepted: 08/03/2016] [Indexed: 11/10/2022] Open
Abstract
Objective To describe the endometrial pathologic lesions in premenopausal breast cancer patients with a history of tamoxifen (TMX) use. Methods We retrospectively reviewed the medical records of 120 premenopausal breast cancer patients with a history of TMX use that had undergone a gynecological examination. Results Among 120 patients, 44.2% (n=53) were asymptomatic with an endometrial thickness ≥5 mm, as assessed by transvaginal ultrasonography. Of the patients that reported abnormal uterine bleeding, 5% (n=6) had an endometrial thickness <5 mm and 20% (n=24) had an endometrial thickness ≥5 mm by transvaginal ultrasonography. The final group of patients were asymptomatic, but showed an abnormal endometrial lesion, such as an endometrial polyp, by transvaginal ultrasonography (30.8%, n=37). Of the 56 benign lesions that were histologically reviewed, 50 (41.7%) were endometrial polyps, 3 (2.5%) were submucosal myomas, 2 (1.7%) were endometrial hyperplasias, and 1 (0.8%) was chronic endometritis. There were 64 (53.3%) other non-pathologic conditions, including secreting, proliferative, and atrophic endometrium, or in some cases, there was insufficient material for diagnosis. In our data, only one case was reported as a complex hyperplasia without atypia arising from an endometrial polyp, and one patient was diagnosed with endometrioid adenocarcinoma. Conclusion For premenopausal breast cancer patients with a history of TMX use, the majority of the patients were asymptomatic, and endometrial polyps were the most common endometrial pathology observed. Therefore, we believe that endometrial assessment before starting TMX treatment, and regular endometrial screening throughout TMX treatment, are reasonable suggestions for premenopausal breast cancer patients.
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Fabian CJ, Kimler BF, Zalles CM, Phillips TA, Metheny T, Petroff BK, Havighurst TC, Kim K, Bailey HH, Heckman-Stoddard BM. Clinical Trial of Acolbifene in Premenopausal Women at High Risk for Breast Cancer. Cancer Prev Res (Phila) 2015; 8:1146-55. [PMID: 26391916 DOI: 10.1158/1940-6207.capr-15-0109] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 09/07/2015] [Indexed: 12/31/2022]
Abstract
The purpose of this study was to assess the feasibility of using the selective estrogen receptor modulator (SERM) acolbifene as a breast cancer prevention agent in premenopausal women. To do so, we assessed change in proliferation in benign breast tissue sampled by random periareolar fine-needle aspiration (RPFNA) as a primary endpoint, along with changes in other risk biomarkers and objective and subjective side effects as secondary endpoints. Twenty-five women with cytologic hyperplasia ± atypia and ≥2% of breast epithelial cells staining positive for Ki-67, received 20 mg acolbifene daily for 6-8 months, and then had benign breast tissue and blood risk biomarkers reassessed. Ki-67 decreased from a median of 4.6% [interquartile range (IQR), 3.1%-8.5%] at baseline to 1.4% (IQR, 0.6%-3.5%) after acolbifene (P < 0.001; Wilcoxon signed-rank test), despite increases in bioavailable estradiol. There were also significant decreases in expression (RT-qPCR) of estrogen-inducible genes that code for pS2, ERα, and progesterone receptor (P ≤ 0.026). There was no significant change in serum IGF1, IGFBP3, IGF1:IGFBP3 ratio, or mammographic breast density. Subjective side effects were minimal with no significant increase in hot flashes, muscle cramps, arthralgias, or fatigue. Objective measures showed a clinically insignificant decrease in lumbar spine bone density (DEXA) and an increase in ovarian cysts but no change in endometrial thickness (sonography). In summary, acolbifene was associated with favorable changes in benign breast epithelial cell proliferation and estrogen-inducible gene expression but minimal side effects, suggesting a phase IIB placebo-controlled trial evaluating it further for breast cancer prevention.
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Affiliation(s)
- Carol J Fabian
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Bruce F Kimler
- Department of Radiation Oncology, University of Kansas Medical Center, Kansas City, Kansas.
| | | | - Teresa A Phillips
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Trina Metheny
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Brian K Petroff
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Thomas C Havighurst
- Department of Biostatistics and Medical Informatics, University of Wisconsin Madison, Madison, Wisconsin
| | - KyungMann Kim
- Department of Biostatistics and Medical Informatics, University of Wisconsin Madison, Madison, Wisconsin
| | - Howard H Bailey
- University of Wisconsin Carbone Cancer Center, Madison, Wisconsin
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Lubián López DM, Orihuela López F, García-Berbel Molina L, Boza Novo P, Pozuelo Solís E, Menor Almagro D, Comino Delgado R. Endometrial polyps in obese asymptomatic pre and postmenopausal patients with breast cancer: Is screening necessary? Gynecol Oncol 2014; 133:56-62. [DOI: 10.1016/j.ygyno.2013.12.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Revised: 12/14/2013] [Accepted: 12/18/2013] [Indexed: 10/25/2022]
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Zelnak AB. Special considerations in early-stage breast cancer patients and survivors. Obstet Gynecol Clin North Am 2013; 40:573-82. [PMID: 24021258 DOI: 10.1016/j.ogc.2013.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Long-term outcomes for early-stage breast cancer have continued to improve, and more patients are becoming long-term survivors. In addition to patients' concern about risk of developing recurrent disease, they are also concerned about potential toxicities of treatment. Current guidelines for long-term follow-up are reviewed. Potential toxicities of tamoxifen and aromatase inhibitors are reviewed. Management of menopausal symptoms, cancer-related fatigue, and cognitive function is discussed.
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Affiliation(s)
- Amelia B Zelnak
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, 1365 Clifton Road Northeast, Atlanta, GA 30322, USA.
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Mourits MJ, Buijs C. Adjuvant endocrine therapy with tamoxifen: side-effects on the female genital tract are not always what they seem. Ann Oncol 2012; 23:2990. [PMID: 23091232 DOI: 10.1093/annonc/mds521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023] Open
Affiliation(s)
- M J Mourits
- Department of Gynecologic Oncology, University of Groningen, University Medical Center Groningen, Groningen.
| | - C Buijs
- Department of Obstetrics & Gynecology, Vie Curie Medical Center, Venlo, The Netherlands
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Pregnancy after treatment of breast cancer in young women does not adversely affect the prognosis. Breast 2011; 21:272-5. [PMID: 22018510 DOI: 10.1016/j.breast.2011.10.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Revised: 09/08/2011] [Accepted: 10/01/2011] [Indexed: 11/23/2022] Open
Abstract
We assessed whether pregnancy after breast cancer in patients younger than 36 years of age affects the prognosis. Of 115 women with breast cancer followed for a mean of 6 years, 18 became pregnant (median time between diagnosis and the first pregnancy 44.5 months). Voluntary interruption of pregnancy was decided by 8 (44.4%) women. Significant differences in prognostic factors between pregnant and non-pregnant women were not observed. Pregnant women showed a lower frequency of positive estrogen receptors (41%) than non-pregnant (64%) (P=0.06). At 5 years of follow-up, 100% of women in the pregnant group and 80% in the non-pregnant group were alive. The percentages of disease-free women were 94% and 64%, respectively (P=0.009). Breast cancer patients presented a high number of unwanted pregnancies. Pregnancy after breast cancer not only did not adversely affect prognosis of the neoplasm but also may have a protective effect.
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Bakkum-Gamez JN, Laughlin SK, Jensen JR, Akogyeram CO, Pruthi S. Challenges in the gynecologic care of premenopausal women with breast cancer. Mayo Clin Proc 2011; 86:229-40. [PMID: 21307388 PMCID: PMC3046944 DOI: 10.4065/mcp.2010.0794] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Premenopausal women with a new diagnosis of breast cancer are faced with many challenges. Providing health care for issues such as gynecologic comorbidities, reproductive health concerns, and vasomotor symptom control can be complicated because of the risks of hormone treatments and the adverse effects of adjuvant therapies. It is paramount that health care professionals understand and be knowledgeable about hormonal and nonhormonal treatments and their pharmacological parameters so they can offer appropriate care to women who have breast cancer, with the goal of improving quality of life. Articles for this review were identified by searching the PubMed database with no date limitations. The following search terms were used: abnormal uterine bleeding, physiologic sex steroids, endometrial ablation, hysteroscopic sterilization, fertility preservation in endometrial cancer, tranexamic acid and breast cancer, menorrhagia treatment and breast cancer, abnormal uterine bleeding and premenopausal breast cancer, levonorgestrel IUD and breast cancer, tamoxifen and gynecologic abnormalities, tamoxifen metabolism, hormones and breast cancer risk, contraception and breast cancer, pregnancy and breast cancer, and breast cancer and infertility treatment.
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