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Bassette E, Ducie JA. Endometrial Cancer in Reproductive-Aged Females: Etiology and Pathogenesis. Biomedicines 2024; 12:886. [PMID: 38672240 DOI: 10.3390/biomedicines12040886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 03/26/2024] [Accepted: 04/01/2024] [Indexed: 04/28/2024] Open
Abstract
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.
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Affiliation(s)
- Emma Bassette
- Department of Obstetrics and Gynecology, Creighton University School of Medicine, Omaha, NE 68178, USA
| | - Jennifer A Ducie
- Methodist Gynecology Oncology, Nebraska Methodist Hospital, Omaha, NE 68114, USA
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Abedi MS, Flink TS, Roca CP. A Rare Presentation of Multicanal Benign Paroxysmal Positional Vertigo in a Premenopausal Woman With Osteopenia: A Case Report. Cureus 2024; 16:e55421. [PMID: 38567227 PMCID: PMC10985560 DOI: 10.7759/cureus.55421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 03/03/2024] [Indexed: 04/04/2024] Open
Abstract
We report a case of non-traumatic, multicanal benign paroxysmal positional vertigo (BPPV) in a premenopausal, osteopenic 35-year-old female with corresponding low bone mineral density. Dix-Hallpike and supine roll tests confirmed unilateral posterior canal (PC) BPPV from 2012-2014, and later, a rare presentation of multicanal BPPV with specifically ipsilateral horizontal canals (HC) and anterior canals (AC) affected in 2015. Heel scans displayed T-scores within the osteopenia range in 2012 until levels normalized one year later. Despite treatment with indicated canalith repositioning treatments (CRTs), symptoms continued to persist. Complete resolution of symptoms occurred in 2016, which is most likely due to self-treatment with daily 5000 IU vitamin D in 2015. This case emphasizes the rare presentation of unilateral single-canal BPPV to multi-canal BPPV, along with the importance of vitamin D treatment in preventing the recurrence of symptoms.
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Affiliation(s)
- Maleeha S Abedi
- Medicine, Lake Erie College of Osteopathic Medicine, Bradenton, USA
| | - Tania S Flink
- Physiology, Lake Erie College of Osteopathic Medicine, Bradenton, USA
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Hyung J, Lee SB, Kim J, Kim HJ, Ko B, Lee JW, Son BH, Lee HJ, Gong G, Jeong H, Jeong JH, Kim JE, Ahn JH, Jung KH, Kim SB. 21-gene expression assay and clinical outcomes of premenopausal patients with hormone receptor-positive breast cancer. Int J Cancer 2024; 154:748-756. [PMID: 37718333 DOI: 10.1002/ijc.34728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 07/24/2023] [Accepted: 08/14/2023] [Indexed: 09/19/2023]
Abstract
The prognostic role of the recurrence score (RS) based on the 21-gene expression assay in premenopausal women is not well delineated, and we investigated the association of outcomes and the RS in premenopausal patients who had 21-gene expression assay at Asan Medical Center, Seoul, Korea, between June 2005 and July 2018. Invasive breast cancer-free survival (IBCFS) by STEEP version 2.0 was compared according to the RS and clinical risk factors. A total of 554 patients were included in our study and 116 patients (20.9%) had age <40 years, 238 patients (43.0%) had luminal B subtype (Ki67 ≥ 20%), and 83 patients (15.0%) had RS >25. All patients received adjuvant tamoxifen ± chemotherapy. Overall, patients with RS >25 showed trend toward worse IBCFS from multivariable analysis (adjusted HR 1.89 [95% CI: 0.95-3.73], P = .069). When comparing outcomes according to age and luminal subtypes, patients with luminal B subtype and age <40 years (n = 60) showed significantly worse outcomes compared to the others (luminal A or luminal B + age ≥40 years, n = 494; adjusted HR 2.95 [95% CI: 1.49-5.82], log-rank P < .001). Among patients with luminal B subtype and age <40 years, there was no significant association observed between IBCFS and the RS (log-rank P = .51). In conclusion, while RS >25 showed association with poor outcomes in premenopausal women, it may have less prognostic significance among those with luminal B subtype and age <40 years.
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Affiliation(s)
- Jaewon Hyung
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sae Byul Lee
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jisun Kim
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hee Jeong Kim
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - BeomSeok Ko
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jong Won Lee
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Byung-Ho Son
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hee Jin Lee
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gyungyub Gong
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyehyun Jeong
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Ho Jeong
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jeong Eun Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin-Hee Ahn
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyung Hae Jung
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung-Bae Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Stewart EA, Al-Hendy A, Lukes AS, Madueke-Laveaux OS, Zhu E, Proehl S, Schulmann T, Marsh EE. Relugolix combination therapy in Black/African American women with symptomatic uterine fibroids: LIBERTY Long-Term Extension study. Am J Obstet Gynecol 2024; 230:237.e1-237.e11. [PMID: 37863160 DOI: 10.1016/j.ajog.2023.10.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 10/05/2023] [Accepted: 10/16/2023] [Indexed: 10/22/2023]
Abstract
BACKGROUND In the LIBERTY Long-Term Extension study, once-daily relugolix combination therapy (40 mg relugolix, estradiol 1 mg, norethindrone acetate 0.5 mg) substantially improved uterine fibroid-associated heavy menstrual bleeding throughout the 52-week treatment period in the overall study population. OBJECTIVE Black or African American women typically experience a greater extent of disease and symptom burden of uterine fibroids vs other racial groups and have traditionally been underrepresented in clinical trials. This secondary analysis aimed to assess the efficacy and safety of relugolix combination therapy in the subgroup population of Black or African American women with uterine fibroids in the LIBERTY Long-Term Extension study. STUDY DESIGN Black or African American premenopausal women (aged 18-50 years) with uterine fibroids and heavy menstrual bleeding who completed the 24-week randomized, placebo-controlled, double-blind LIBERTY 1 (identifier: NCT03049735) or LIBERTY 2 (identifier: NCT03103087) trials were eligible to enroll in the 28-week LIBERTY Long-Term Extension study (identifier: NCT03412890), in which all women received once-daily, open-label relugolix combination therapy. The primary endpoint of this subanalysis was the proportion of Black or African American treatment responders: women who achieved a menstrual blood loss volume of <80 mL and at least a 50% reduction in menstrual blood loss volume from the pivotal study baseline to the last 35 days of treatment by pivotal study randomized treatment group. The secondary outcomes included rates of amenorrhea and changes in symptom burden and quality of life. RESULTS Overall, 241 of 477 women (50.5%) enrolled in the LIBERTY Long-Term Extension study self-identified as Black or African American. In Black or African American women receiving continuous relugolix combination therapy for up to 52 weeks, 58 of 70 women (82.9%; 95% confidence interval, 72.0%-90.8%) met the treatment responder criteria for reduction in heavy menstrual bleeding (primary endpoint). A substantial reduction in menstrual blood loss volume from the pivotal study baseline to week 52 was demonstrated (least squares mean percentage change: 85.0%); 64.3% of women achieved amenorrhea; 59.1% of women with anemia at the pivotal study baseline achieved a substantial improvement (>2 g/dL) in hemoglobin levels; and decreased symptom severity and distress because of uterine fibroid-associated symptoms and improvements in health-related quality of life through 52 weeks were demonstrated. The most frequently reported adverse events during the cumulative 52-week treatment period were hot flush (12.9%), headache (5.7%), and hypertension (5.7%). Bone mineral density was preserved through 52 weeks. CONCLUSION Once-daily relugolix combination therapy improved uterine fibroid-associated heavy menstrual bleeding in most Black or African American women who participated in the LIBERTY Long-Term Extension study. The safety and efficacy profile of relugolix combination therapy in Black or African American women was consistent with previously published results from the overall study population through 52 weeks. Findings from this subanalysis will assist shared decision-making by helping providers and Black or African American women understand the efficacy and safety of relugolix combination therapy as a pharmacologic option for the management of uterine fibroid-associated symptoms.
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Affiliation(s)
- Elizabeth A Stewart
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Mayo Clinic and Mayo Clinic Alix School of Medicine, Rochester, MN.
| | - Ayman Al-Hendy
- Department of Obstetrics and Gynecology, University of Illinois at Chicago, Chicago, IL
| | - Andrea S Lukes
- Carolina Women's Research and Wellness Center, Durham, NC
| | | | | | | | | | - Erica E Marsh
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, MI
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Lu C, Dharmalingam M, R MP, Y P G, Selvan C, Kalra P. Bone Mineral Density and Bone Turnover Marker in a Subclinical Thyrotoxic State in Young Premenopausal Women. Cureus 2024; 16:e52610. [PMID: 38374858 PMCID: PMC10875710 DOI: 10.7759/cureus.52610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND Subclinical thyrotoxicosis (SCH) is characterized by normal serum thyroid hormone levels and low thyrotropin levels. The impact of this condition on the skeletal system may vary depending on its cause, yet the relationship is not fully comprehended in premenopausal women. Studies are scarce about its effects on bone health in our population. OBJECTIVES This study aims to evaluate the bone mineral density (BMD) and bone turnover markers in premenopausal women with SCH and determine if any differences exist based on the condition's etiology. METHODS A cross-sectional study was conducted at Ramaiah Medical College involving 36 participants for one year and six months after approval from the Ethics Committee. The carboxy-terminal telopeptide of type I collagen in blood and BMD were measured at the lumbar vertebrae (L1-L4) and femoral neck by dual-energy x-ray absorptiometry (Hologic v 2.0, Hologic, Massachusetts, U.S.). Statistical analysis was done using IBM SPSS Statistics for Windows, Version 20 (Released 2011; IBM Corp., Armonk, New York, United States). Results: The mean age of the study population was 35.2 ± 7.2 years. The etiology was Graves' disease [n=11 (33.3%)], iatrogenic [n=14(38.8%)], toxic adenoma [n=6 (15.1%)], and multi-nodular goiter [n=5 (15.1%)]. The mean BMI was 23.5 ± 3.8 kg/m2, and the mean levels of corrected calcium, phosphorus, and 25 hydroxy-vitamin D were 9.12 ± 0.25 mg/dl, 2.95 ± 0.34 mg/dl, and 29.4 ± 6.4 ng/ml, respectively. The mean BMD at hip and spine was 0.81 ±0.16 g/cm2 and 0.92±0.08 g/cm2 respectively. The mean Z-score was (-0.02 ± 0.8) and (-0.92± 0.08) at the hip and spine. No significant difference was observed in the BMD at the hip (p = 0.14) or spine (p = 0.44) between the endogenous and exogenous subclinical thyrotoxic subgroups. At the same time, the carboxy-terminal telopeptide of type I collagen was significantly different between the two groups (p<0.05). CONCLUSION In our cross-sectional study of premenopausal women with SCH, BMD at the hip or spine as measured by dual-energy X-ray absorptiometry did not reveal any significant reduction. The subclinical thyrotoxic state may not have an adverse effect on bone health in premenopausal females with sufficient levels of serum 25-hydroxy-vitamin D in the short term.
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Affiliation(s)
- Chirag Lu
- Endocrinology and Diabetes, Ramaiah Medical College, Bengaluru, IND
| | - Mala Dharmalingam
- Endocrinology and Diabetes, Bangalore Endocrinology and Diabetes Research Centre, Bengaluru, IND
| | - Manjunath P R
- Endocrinology and Diabetes, Ramaiah Medical College, Bengaluru, IND
| | - Ganavi Y P
- Endocrinology and Diabetes, Ramaiah Medical College, Bengaluru, IND
| | - Chitra Selvan
- Endocrinology and Diabetes, Ramaiah Medical College, Bengaluru, IND
| | - Pramila Kalra
- Endocrinology and Diabetes, Ramaiah Medical College, Bengaluru, IND
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Scime NV, Brown HK, Metcalfe A, Simpson AN, Brennand EA. Bilateral salpingo-oophorectomy at the time of benign hysterectomy among females with disabilities: a population-based cross-sectional study. Am J Obstet Gynecol 2023; 229:658.e1-658.e17. [PMID: 37544349 DOI: 10.1016/j.ajog.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 07/31/2023] [Accepted: 08/01/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND Up to 40% of patients aged ≤55 years undergo concomitant bilateral salpingo-oophorectomy at the time of benign hysterectomy, with practice variation in bilateral salpingo-oophorectomy occurring along the lines of patient health and social factors. Disability is common in premenopausal women and is an important determinant of reproductive health more broadly; however, studies on bilateral salpingo-oophorectomy rates among women with disabilities are lacking. OBJECTIVE This study aimed to examine whether the use of concomitant bilateral salpingo-oophorectomy at the time of benign hysterectomy differs by preexisting disability status in adult females aged ≤55 years. STUDY DESIGN This population-based cross-sectional study used data from the 2016-2019 US National Inpatient Sample. Females undergoing inpatient hysterectomy for a benign gynecologic indication (n=74,315) were classified as having physical (6.1%), sensory (0.1%), intellectual or developmental (0.2%), or multiple (0.2%) disabilities and compared with those without a disability. Logistic regression was used to estimate risk ratios for differences in bilateral salpingo-oophorectomy rates by disability status, adjusted for patient and clinical factors. Models were stratified by potentially avoidable or potentially appropriate bilateral salpingo-oophorectomy based on the presence of clinical indications for ovarian removal and by age group. RESULTS Bilateral salpingo-oophorectomy at the time of benign hysterectomy occurred in 26.0% of females without a disability, with rates clearly elevated in those with a physical (33.2%; adjusted risk ratio, 1.10; 95% confidence interval, 1.05-1.14) or intellectual or developmental (31.1%; adjusted risk ratio, 1.32; 95% confidence interval, 1.02-1.64) disability, possibly elevated in those with multiple disabilities (38.2%; adjusted risk ratio, 1.20; 95% confidence interval, 0.94-1.45), and similar in those with a sensory disability (31.2%; adjusted risk ratio, 0.98; 95% confidence interval, 0.83-1.13). The results were similar but with lower statistical precision for potentially avoidable and potentially appropriate bilateral salpingo-oophorectomy, which occurred in 9.1% and 17.0% of females without a disability, respectively. The largest differences in bilateral salpingo-oophorectomy rates among women with any disability were observed in the perimenopausal 45- to 49-year age group. CONCLUSION Females with disabilities experienced elevated concomitant bilateral salpingo-oophorectomy rates at the time of benign hysterectomy, particularly those with an intellectual or developmental disability and those of perimenopausal age, although some estimates were imprecise. Equity-focused physician training in surgical counseling and research into the epidemiology and experiences of gynecologic conditions among females with a disability may be beneficial.
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Affiliation(s)
- Natalie V Scime
- Department of Health and Society, University of Toronto Scarborough, Toronto, Ontario, Canada
| | - Hilary K Brown
- Department of Health and Society, University of Toronto Scarborough, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Amy Metcalfe
- Department of Obstetrics and Gynaecology, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Andrea N Simpson
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital/Unity Health Toronto, Toronto, Ontario, Canada
| | - Erin A Brennand
- Department of Obstetrics and Gynaecology, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
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Singh P, Vyas S, Vallabh V, Nautiyal R, Srivastava A, Semwal J. A Study to Assess the Prevalence and Factors Affecting Menopausal Symptoms among Middle-Aged Females in the Garhwal Region of Uttarakhand. J Midlife Health 2023; 14:237-245. [PMID: 38504740 PMCID: PMC10946681 DOI: 10.4103/jmh.jmh_198_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 01/29/2023] [Accepted: 02/11/2023] [Indexed: 03/21/2024] Open
Abstract
Background Middle age is a link between adulthood and old age, which requires special attention. During middle age among females, changes like menopause occur, which is responsible for causing various physical, vasomotor, psychological, and social changes, which may affect overall well-being and positive mental health status. Hence, the present study has been planned to assess the prevalence of menopausal symptoms among middle-aged females. Materials and Methods The present study was a cross-sectional study carried out in rural and urban areas of district Dehradun among 400 females. A stratified systematic random sampling technique method was used. All the females fulfilling the inclusion criteria and aged 40-60 years were included in the study. The Menopause-Specific Quality of Life (MENQOL) questionnaire was used to assess the prevalence of menopausal symptoms. Results A total of 400 women were recruited in the study, 200 from rural and urban areas each. The mean age of the total study participants was 50.00 ± 0.32 years. Among 400 middle-aged women, 189 were premenopausal and 211 were postmenopausal. The frequencies of occurrence of menopausal symptoms were explored in 189 premenopausal and 211 postmenopausal women. The mean age of premenopausal women was 44.21 ± 2.35 and postmenopausal was 54.39 ± 4.21. Females experienced varying grades of MENQOL symptoms. Conclusions It was found that majority of the females' quality of life were found to be affected with different grades of menopausal symptoms. With increasing age, symptoms also increase and are significantly high among postmenopausal women.
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Affiliation(s)
- Pragya Singh
- Department of Community Medicine, RBBSU, Swami Rama Himalayan Institute, Dehradun, Uttarakhand, India
| | - Shaili Vyas
- Department of Community Medicine, Himalayan Institute of Medical Sciences, Swami Rama Himalayan Institute, Dehradun, Uttarakhand, India
| | - Vidisha Vallabh
- Department of Community Medicine, Himalayan Institute of Medical Sciences, Swami Rama Himalayan Institute, Dehradun, Uttarakhand, India
| | - Ruchira Nautiyal
- Department of Obstetrics and Gynaecology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan Institute, Dehradun, Uttarakhand, India
| | - Abhay Srivastava
- Department of Community Medicine, Himalayan Institute of Medical Sciences, Swami Rama Himalayan Institute, Dehradun, Uttarakhand, India
| | - Jayanti Semwal
- Department of Community Medicine, Himalayan Institute of Medical Sciences, Swami Rama Himalayan Institute, Dehradun, Uttarakhand, India
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Scioscia MF, Zanchetta MB. Recent Insights into Pregnancy and Lactation-Associated Osteoporosis (PLO). Int J Womens Health 2023; 15:1227-1238. [PMID: 37551335 PMCID: PMC10404404 DOI: 10.2147/ijwh.s366254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 07/11/2023] [Indexed: 08/09/2023] Open
Abstract
During pregnancy and lactation, female physiology adapts to fulfill the fetal and neonatal calcium and phosphorus requirements. The physiological changes that take place during these periods do not affect maternal skeleton resistance to fracture in most of the cases. However, there is a small percentage of women that do experience fragility fractures during these times of life. Pregnancy and lactation-associated osteoporosis (PLO) is an infrequent condition defined by the occurrence of non-traumatic fractures - most frequently vertebral - during the third trimester of gestation and/or the first months of postpartum. Its physiopathology has not yet been completely elucidated. Several authors have reported that risk factors for secondary osteoporosis might be present in up to 80% of the cases of PLO patients. According to recent studies, genetic factors might also play a relevant role in PLO. Given its rarity, the available literature on this condition is limited. Most of the published data consist on case reports and case series articles. There are not any randomized controlled trials regarding this disorder. Although there is consensus about discontinuation of lactation and calcium and vitamin D supplementation as the first steps in the treatment of these patients, there is still controversy regarding the long-term and/or pharmacological management of this condition. Recent data on the use of teriparatide in this population looks promising. In this review, we aimed to revise and summarize current knowledge about the physiopathology and management of PLO.
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Affiliation(s)
- Maria Florencia Scioscia
- Instituto de Diagnóstico e Investigaciones Metabólicas (IDIM), Universidad del Salvador, Buenos Aires, ZC 1012, Argentina
| | - Maria Belen Zanchetta
- Instituto de Diagnóstico e Investigaciones Metabólicas (IDIM), Universidad del Salvador, Buenos Aires, ZC 1012, Argentina
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Kang D, Cho J, Park S, Kim HJ, Kim SW, Lee JE, Yu J, Lee SK, Kim JY, Nam SJ, Park YH. Pretreatment endocrine symptoms and recurrence-free survival among young premenopausal patients with breast cancer: a prospective cohort study. Ther Adv Med Oncol 2023; 15:17588359231189421. [PMID: 37547446 PMCID: PMC10399274 DOI: 10.1177/17588359231189421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 07/05/2023] [Indexed: 08/08/2023] Open
Abstract
Background Pretreatment endocrine symptoms in premenopausal patients might be considered as a potential marker of poor prognosis. We conducted a cohort study to evaluate the association between endocrine symptoms prior to treatment and recurrence-free survival (RFS) among premenopausal patients with breast cancer aged ⩽40 years. Methods Data were obtained from a prospective cohort study (NCT03131089) conducted at the Samsung Medical Center from 2013 to 2021. We included patients aged ⩽40 years who had been diagnosed with breast cancer. The primary outcome measure was RFS. Endocrine symptoms were measured using the Functional Assessment of Cancer Therapy - Endocrine Symptoms (FACT-ES). We also calculated the hazard ratio (HR) for recurrence or all-cause mortality by comparing the tertiles of the FACT-ES score at diagnosis. Results Among the 977 participants, the mean (standard deviation) age was 35.3 (3.9) years. At diagnosis, 17.2% of the patients had at least one severe endocrine symptom. During 3512 person-years of follow-up, the high symptom group had a worse RFS than the low-symptom group [HR = 2.05; 95% confidence interval (CI) = 1.19-3.54]. In particular, hot flashes (HR = 5.59; 95% CI = 1.96-15.93) and breast sensitivity (HR = 1.82; 95% CI = 1.00-3.32) were associated with reduced RFS. Conclusion Close monitoring of pretreatment endocrine symptoms may be important in patients diagnosed with breast cancer at a young age.
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Affiliation(s)
- Danbee Kang
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea
- Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Juhee Cho
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea
- Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Seri Park
- Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, South Korea
| | - Hyo Jung Kim
- Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul, South Korea
| | - Seok Won Kim
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jeong Eon Lee
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jonghan Yu
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Se Kyung Lee
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Ji-Yeon Kim
- Division of Hematology and Oncology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Seok Jin Nam
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yeon Hee Park
- Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, South Korea
- Division of Hematology and Oncology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-gu, Seoul 06351, South Korea
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Jana A, Thomas J, Ghosh P. Expression of Oestrogen Receptor Alpha (ERα) in Oral Lichen Planus - A Precancerous Inflammatory Disease in Middle-Aged Females. Indian J Dermatol 2023; 68:405-409. [PMID: 37822373 PMCID: PMC10564195 DOI: 10.4103/ijd.ijd_122_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023] Open
Abstract
Background Oral lichen planus (OLP) is an autoimmune disease primarily affecting the middle-aged females. The present study aims to determine the relation of the oestrogen receptor alpha (ERα) with OLP pathogenesis, correlating it with the possible cause of its higher prevalence among females. Materials and Methods Clinically and histologically identified fifteen of each pre-menopausal and peri-menopausal OLP female patients were chosen for this study. The expression of ERα was analysed from the collected lesion tissue samples by using two-step semi-quantitative reverse transcriptase polymerase chain reaction (SqRT-PCR) and enzyme-linked immunosorbent assay (ELISA). Results mRNA and protein expression of ERα were significantly higher in both groups of OLP female patients when compared with the control. The perimenopausal OLP patients showed significantly elevated expression of ERα compared to premenopausal patients. Conclusion Higher expression of ERα in pre- and peri-menopausal females may be a causative factor for the higher prevalence of OLP among females.
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Affiliation(s)
- Abhishek Jana
- From the Department of Allied Health Sciences, Brainware University, Kolkata, West Bengal, India
| | - Jincy Thomas
- Department of Oral Medicine and Radiology, PMS College of Dental Sciences and Research, Trivandrum, Kerala, India
| | - Pratiti Ghosh
- Department of Physiology, West Bengal State University, Kolkata, West Bengal, India
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11
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Al Khamees M, Alqurain AA, Alsaleh AA, Alhashem YA, AlSaffar N, Alibrahim NN, Aljunibi FA, Alradwan Z, Almohammade N, AlAlwan B. Prevalence of Iron Deficiency and its Association With Breast Cancer in Premenopausal Compared to Postmenopausal Women in Al Ahsa, Saudi Arabia. Cancer Inform 2023; 22:11769351231172589. [PMID: 37223318 PMCID: PMC10201173 DOI: 10.1177/11769351231172589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 04/12/2023] [Indexed: 05/25/2023] Open
Abstract
Iron is an essential cofactor needed for normal functions of various enzymes and its depletion lead to increase DNA damage, genomic instability, deteriorate innate, adaptive immunity, and promote tumor development. It is also linked to tumorigenesis of breast cancer cells through enhancing mammary tumor growth and metastasis. There is insufficient data describing this association in Saudi Arabia. This study aims to determine the prevalence of iron deficiency and its association with breast cancer among premenopausal and postmenopausal women referred for breast cancer screening center in Al Ahsa, Eastern Province of Saudi Arabia. Age, hemoglobin level, iron level, history of anemia, or iron deficiency were collected from patients' medical records. The included participants were grouped based on their age into premenopausal (<50 years) or postmenopausal (⩾50 years). The definition of low Hb implemented (Hb below 12 g/dL) and low total serum Iron levels (below 8 μmol/L). Logistic regression test was used to compute the association between having a positive cancer screening test (radiological or histocytological) and participant's lab results. The results are presented as odds ratios and 95% confidence intervals. Thrree hundred fifty-seven women were included, 77% (n = 274) of them were premenopausal. This group cases had more history of iron deficiency (149 [60%] vs 25 (30%), P = .001) compared to those in the postmenopausal group. The risk of having a positive radiological cancer screening test was associated with age (OR = 1.04, 95% CI 1.02-1.06), but negatively was associated with iron level (OR = 0.9, 95% CI 0.86-0.97) among the entire cohort. This study is the first to propose an association between iron deficiency and breast cancer among Saudi young females. This could suggest iron level as a new risk factor that may be used by clinicians to assess breast cancer risk.
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Affiliation(s)
- Mohammad Al Khamees
- Clinical Laboratory Department, King
Fahad Hospital Hoffuf, Hoffuf, Saudi Arabia
| | - Aymen A Alqurain
- Department of Pharmacy, Mohammed
Al-Mana College for Medical Sciences, Dammam, Saudi Arabia
| | - Abdulmonem A Alsaleh
- Medical Laboratory Science Department,
Mohammed Al-Mana College for Medical Sciences, Dammam, Saudi Arabia
| | - Yousef A Alhashem
- Medical Laboratory Science Department,
Mohammed Al-Mana College for Medical Sciences, Dammam, Saudi Arabia
| | - Nida AlSaffar
- Medical Laboratory Science Department,
Mohammed Al-Mana College for Medical Sciences, Dammam, Saudi Arabia
| | - Noura N Alibrahim
- Medical Laboratory Science Department,
Mohammed Al-Mana College for Medical Sciences, Dammam, Saudi Arabia
| | - Fardus A Aljunibi
- Medical Laboratory Science Department,
Mohammed Al-Mana College for Medical Sciences, Dammam, Saudi Arabia
| | - Zaheda Alradwan
- Medical Laboratory Science Department,
Mohammed Al-Mana College for Medical Sciences, Dammam, Saudi Arabia
| | - Nesreen Almohammade
- Foundation Year Department, Mohammed
Al-Mana College for Medical Sciences, Dammam, Saudi Arabia
| | - Bader AlAlwan
- Medical Laboratory Science Department,
Mohammed Al-Mana College for Medical Sciences, Dammam, Saudi Arabia
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12
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Johnson JE, Daley D, Tarta C, Stanciu PI. Risk of endometrial cancer in patients with polycystic ovarian syndrome: A meta‑analysis. Oncol Lett 2023; 25:168. [PMID: 36960190 PMCID: PMC10028221 DOI: 10.3892/ol.2023.13754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 11/30/2022] [Indexed: 03/25/2023] Open
Abstract
While existing literature suggests an association between polycystic ovarian syndrome (PCOS) and endometrial cancer, the sparsity and inconsistency of current evidence indicates a lack of clarity regarding the exact strength of this association. It also remains uncertain whether the degree of risk of disease is affected by confounding factors, such as age and body mass index (BMI). The present meta-analysis is aimed to quantify the risk of endometrial cancer in female subjects with PCOS compared to those without PCOS. PubMed, MEDLINE, EMBASE, Scopus and Cochrane were searched from inception to October 31, 2022, to identify peer-reviewed case-control, cohort and cross-sectional studies that assessed the association between endometrial cancer and PCOS and contained original data. Two researchers independently extracted data and performed quality assessment using the Newcastle-Ottawa criteria. Pooled odds ratios (ORs) were calculated using the random-effect model and inverse variance. The degree of heterogeneity was assessed using I2 statistics. A total of 10 relevant studies were identified and included in the meta-analysis (comprising 12,248 female patients with PCOS and 54,120 controls). Females with PCOS had a significantly increased odds of developing endometrial cancer as compared to those without PCOS [OR, 4.07; 95% confidence interval (CI), 2.13-7.78; P<0.0001]. When postmenopausal subjects (age, >54 years) were excluded from the meta-analysis, the odds increased further (OR, 5.14; 95% CI, 3.22-8.21; P<0.00001). Patients with PCOS are up to 5 times more likely to develop endometrial cancer compared to those without PCOS. Larger, prospective studies that are well-controlled for confounding factors, such as BMI, are required.
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Affiliation(s)
- Jean-Ellen Johnson
- Gynaecological Oncology Department, Watford General Hospital, West Hertfordshire Teaching Hospitals NHS Trust, Watford, West Hertfordshire, WD18 0HB, UK
| | - Diandra Daley
- Gynaecological Oncology Department, Watford General Hospital, West Hertfordshire Teaching Hospitals NHS Trust, Watford, West Hertfordshire, WD18 0HB, UK
- Correspondence to: Dr Diandra Daley, Gynaecological Oncology Department, Watford General Hospital, West Hertfordshire Teaching Hospitals NHS Trust, Vicarage Road, Watford, West Hertfordshire, WD18 0HB, United Kingdom, E-mail:
| | - Cristi Tarta
- Department X, 2nd Surgical Clinic, ‘Victor Babes’ University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Paul I. Stanciu
- Gynaecological Oncology Department, Watford General Hospital, West Hertfordshire Teaching Hospitals NHS Trust, Watford, West Hertfordshire, WD18 0HB, UK
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13
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Zhu J, Tang Y, Lv C, Cong H, Liu J, Zhao S, Wang Y, Zhang K, Yu W, Cai Q, Ma R, Wang J. Hyperprolactinaemia is common in Chinese premenopausal women with breast diseases. Front Genet 2023; 14:1018668. [PMID: 36845388 PMCID: PMC9950106 DOI: 10.3389/fgene.2023.1018668] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 01/31/2023] [Indexed: 02/12/2023] Open
Abstract
Purpose: Hyperprolactinaemia has been proposed to play a role in breast lesions pathophysiology. Thus far, controversial results have been reported for the relationship between hyperprolactinaemia and breast lesions. Moreover, the prevalence of hyperprolactinaemia in a population with breast lesions is scarcely reported. We aimed to investigate the prevalence of hyperprolactinaemia in Chinese premenopausal women with breast diseases, and explore the associations between hyperprolactinaemia with different clinical characteristics. Methods: This was a retrospective cross-sectional study performed in the department of breast surgery of Qilu hospital of Shandong University. Overall, 1,461 female patients who underwent the serum prolactin (PRL) level assay before breast surgery from January 2019 to December 2020 were included. Patients were divided into two groups: before and after menopause. Data were analyzed using SPSS 18.0 software. Results: The results showed an elevated PRL level in 376 of the 1,461 female patients with breast lesions (25.74%). Furthermore, the proportion of hyperprolactinemia among premenopausal patients with breast disease (35.75%, 340/951) was significantly higher than among postmenopausal patients with breast disease (7.06%, 36/510). In premenopausal patients, the proportion of patients with hyperprolactinaemia and the mean serum PRL level were significantly higher in those diagnosed with fibroepithelial tumours (FETs) and in younger patients (aged < 35 years) than in those with non-neoplastic lesions and in those aged ≥ 35 years (both p < 0.05). Especially, the prolactin level exhibited steady ascending tendency for positive correlation with FET. Conclusion: Hyperprolactinaemia is prevalent in Chinese premenopausal patients with breast diseases, especially in those with FETs, which implies a potential association, to some extent, between the PRL levels in various breast diseases.
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Affiliation(s)
- Jiang Zhu
- Department of Breast Surgery, General Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Yuyi Tang
- Department of Breast Surgery, General Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China,Department of General practice, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, China
| | - Cuixia Lv
- Shandong Center of Disease Control and Prevention, Jinan, Shandong, China
| | - Han Cong
- Department of Breast Surgery, General Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Jie Liu
- Department of Breast Surgery, General Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Song Zhao
- Department of Breast Surgery, General Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Yawen Wang
- Department of Breast Surgery, General Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Kai Zhang
- Department of Breast Surgery, General Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Wenbin Yu
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Qian Cai
- Department of Geriatric Medicine, Qilu Hospital of Shandong University, Jinan, Shandong, China,Key Laboratory of Cardiovascular Proteomics of Shandong Province, Qilu Hospital of Shandong University, Jinan, Shandong, China,*Correspondence: Qian Cai, ; Rong Ma,
| | - Rong Ma
- Department of Breast Surgery, General Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China,*Correspondence: Qian Cai, ; Rong Ma,
| | - Jianli Wang
- Department of Gynaecology and Obstetrics, Qilu Hospital of Shandong University, Jinan, Shandong, China
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14
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Paluch-Shimon S, Neven P, Huober J, Cicin I, Goetz MP, Shimizu C, Huang CS, Lueck HJ, Beith J, Tokunaga E, Contreras JR, de Sant’Ana RO, Wei R, Shahir A, Nabinger SC, Forrester T, Johnston SRD, Harbeck N. Efficacy and safety results by menopausal status in monarchE: adjuvant abemaciclib combined with endocrine therapy in patients with HR+, HER2-, node-positive, high-risk early breast cancer. Ther Adv Med Oncol 2023; 15:17588359231151840. [PMID: 36756142 PMCID: PMC9900651 DOI: 10.1177/17588359231151840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 01/04/2023] [Indexed: 02/05/2023] Open
Abstract
Background Abemaciclib is the first and only cyclin-dependent kinases 4 and 6 inhibitor approved for adjuvant treatment of hormone receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2-), node-positive, and high-risk early breast cancer (EBC), with indications varying by geography. Premenopausal patients with HR+, HER2- tumors may have different tumor biology and treatment response compared to postmenopausal patients. Objectives We describe the efficacy and safety of abemaciclib plus endocrine therapy (ET) for the large subgroup of premenopausal patients with HR+, HER2- EBC in monarchE. Design Randomized patients (1:1) received adjuvant ET with or without abemaciclib for 2 years plus at least 3 additional years of ET as clinically indicated. Methods Patients were stratified by menopausal status (premenopausal versus postmenopausal) at diagnosis. Standard ET (tamoxifen or aromatase inhibitor) with or without gonadotropin-releasing hormone agonist was determined by physician's choice. Invasive disease-free survival (IDFS) and distant relapse-free survival (DRFS) by menopausal status were assessed at data cutoff on 1 April 2021 (median follow-up of 27 months). Results Among randomized patients, 2451 (43.5%) were premenopausal and 3181 (56.4%) were postmenopausal. The choice of ET for premenopausal patients varied considerably between countries. Treatment benefit was consistent across menopausal status, with a numerically greater effect size in premenopausal patients. For premenopausal patients, abemaciclib with ET resulted in a 42.2% and 40.3% reduction in the risk of developing IDFS and DRFS events, respectively. Absolute improvement at 3 years was 5.7% for IDFS and 4.4% for DRFS rates. Safety profile for premenopausal patients was consistent with the overall safety population. Conclusion Abemaciclib with ET demonstrated clinically meaningful treatment benefit for IDFS and DRFS versus ET alone regardless of menopausal status and first ET, with a numerically greater benefit in the premenopausal compared to the postmenopausal population. Safety data in premenopausal patients are consistent with the overall safety profile of abemaciclib.
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Affiliation(s)
| | - Patrick Neven
- Universitaire Ziekenhuizen Leuven - Campus
Gasthuisberg, Leuven, Belgium
| | - Jens Huober
- Breast Center, University of Ulm, Ulm,
Germany
| | - Irfan Cicin
- Trakya University Faculty of Medicine, Edirne,
Turkey
| | | | - Chikako Shimizu
- National Center for Global Health and Medicine,
Tokyo, Japan
| | - Chiun-Sheng Huang
- National Taiwan University Hospital,
Taipei,National Taiwan University College of Medicine,
Taipei
| | | | - Jane Beith
- Chris O’Brien Lifehouse, Camperdown, NSW,
Australia
| | - Eriko Tokunaga
- Department of Breast Oncology, National
Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | | | - Rosane Oliveira de Sant’Ana
- Division of Clinical Oncology, Instituto do
Câncer do Ceará, Fortaleza, Brazil,Universidade de Fortaleza, Fortaleza,
Brazil
| | - Ran Wei
- Eli Lilly and Company, Indianapolis, IN,
USA
| | | | | | | | | | - Nadia Harbeck
- Breast Center, Department of Gynecology and
Obstetrics and Comprehensive Cancer Center Munich, LMU University Hospital,
Munich, Germany
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15
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Ozaki Y, Masuda J, Kataoka A, Kogawa T, Abe T, Morizono H, Inagaki L, Hara F, Takano T, Ueno T, Ohno S. The impact of obesity and endocrine therapy on the prognosis of premenopausal women with hormone receptor-positive breast cancer: A single-institute retrospective study. Cancer Rep (Hoboken) 2023; 6:e1695. [PMID: 36806718 PMCID: PMC9940008 DOI: 10.1002/cnr2.1695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 07/12/2022] [Accepted: 07/27/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Higher body mass index (BMI) is associated with worse prognosis in pre- and postmenopausal patients with breast cancer (BC). However, there is insufficient evidence regarding the optimal adjuvant endocrine therapy for obese premenopausal women with hormone receptor (HR)-positive BC. AIM To evaluate the impact of obesity and adjuvant endocrine therapy on prognosis in premenopausal patients with BC. METHODS AND RESULTS We retrospectively reviewed the medical record of premenopausal women who received curative surgery for clinical stage I-III HR-positive BC from 2007 to 2017. Patients were classified into five groups according to BMI: underweight (UW), normal weight (NW), obese 1 degree (OB1), obese 2 degree (OB2), and obese 3 degree (OB3) categories. The primary analysis was a comparison of BC-specific survival (BCSS) according to BMI (UW/NW vs. OB1-3) and adjuvant endocrine therapy (with or without ovarian function suppression [OFS]). Of 13 021 patients, the data of 3380 patients were analyzed. BCSS in OB1-3 patients was significantly worse than that in patients with UW/NW (hazard ratio [HR] 2.37; 95% confidence interval [CI], 1.40-4.02: p = .0009). In OB1-3 patients who received tamoxifen (TAM), BCSS was significantly worse than that in UW/NW patients (p = .0086); however, a significant difference was not shown in patients who received TAM and OFS (p = .0921). CONCLUSION High BMI was associated with worse prognosis in premenopausal patients with HR-positive BC who received adjuvant TAM. The role of OFS as adjuvant endocrine therapy remains unclear, and further studies are required to explore the adequate management of obese premenopausal patients.
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Affiliation(s)
- Yukinori Ozaki
- Breast Oncology CenterThe Cancer Institute Hospital of JFCRTokyoJapan
| | - Jun Masuda
- Breast Oncology CenterThe Cancer Institute Hospital of JFCRTokyoJapan
| | - Akemi Kataoka
- Breast Oncology CenterThe Cancer Institute Hospital of JFCRTokyoJapan
| | - Takahiro Kogawa
- Division of Early Clinical Development for Cancer, Advanced Medical Development CenterThe Cancer Institute Hospital of JFCRTokyoJapan
| | - Tomomi Abe
- Breast Oncology CenterThe Cancer Institute Hospital of JFCRTokyoJapan
| | - Hidetomo Morizono
- Breast Oncology CenterThe Cancer Institute Hospital of JFCRTokyoJapan
| | - Lina Inagaki
- Breast Oncology CenterThe Cancer Institute Hospital of JFCRTokyoJapan
| | - Fumikata Hara
- Breast Oncology CenterThe Cancer Institute Hospital of JFCRTokyoJapan
| | - Toshimi Takano
- Breast Oncology CenterThe Cancer Institute Hospital of JFCRTokyoJapan
| | - Takayuki Ueno
- Breast Oncology CenterThe Cancer Institute Hospital of JFCRTokyoJapan
| | - Shinji Ohno
- Breast Oncology CenterThe Cancer Institute Hospital of JFCRTokyoJapan
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Kalam F, Akasheh RT, Cienfuegos S, Ankireddy A, Gabel K, Ezpeleta M, Lin S, Tamatam CM, Reddy SP, Spring B, Khan SA, Varady KA. Effect of time-restricted eating on sex hormone levels in premenopausal and postmenopausal females. Obesity (Silver Spring) 2023; 31 Suppl 1:57-62. [PMID: 36203273 PMCID: PMC9877115 DOI: 10.1002/oby.23562] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/26/2022] [Accepted: 08/02/2022] [Indexed: 01/29/2023]
Abstract
OBJECTIVE Concerns have been raised regarding the impact of time-restricted eating (TRE) on sex hormones in females. This study examined how TRE affects sex steroids in premenopausal and postmenopausal females. METHODS This is a secondary analysis of an 8-week TRE study (4- to 6-hour eating window) conducted in adults with obesity. Men and perimenopausal females were excluded. Females were classified into two groups based on menstrual status: premenopausal (n = 12) or postmenopausal (n = 11). RESULTS After 8 weeks, body weight decreased in premenopausal females (-3% ± 2%) and postmenopausal females (-4% ± 2%) (main effect of time, p < 0.001), with no difference between groups (no group × time interaction). Circulating levels of testosterone, androstenedione, and sex hormone binding globulin (SHBG) did not change in either group (no group × time interaction). Dehydroepiandrosterone (DHEA) concentrations decreased (p < 0.05) in premenopausal (-14% ± 32%) and postmenopausal females (-13% ± 34%; main effect of time, p = 0.03), with no difference between groups. Estradiol, estrone, and progesterone were measured only in postmenopausal females, and they remained unchanged. CONCLUSIONS In premenopausal females, androgens and SHBG remained unchanged during TRE, whereas DHEA decreased. In postmenopausal females, estrogens, progesterone, androgens, and SHBG did not change, but DHEA was reduced.
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Affiliation(s)
- Faiza Kalam
- Department of Preventive Medicine, Northwestern University, Chicago, Illinois, USA
| | - Rand T Akasheh
- Department of Nutrition and Dietetics, American University of Madaba, Madaba, Jordan
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Sofia Cienfuegos
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Aparna Ankireddy
- Department of Pediatrics, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Kelsey Gabel
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Mark Ezpeleta
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Shuhao Lin
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Chandra M Tamatam
- Department of Pediatrics, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Sekhar P Reddy
- Department of Pediatrics, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Bonnie Spring
- Department of Preventive Medicine, Northwestern University, Chicago, Illinois, USA
| | - Seema A Khan
- Department of Preventive Medicine, Northwestern University, Chicago, Illinois, USA
| | - Krista A Varady
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, Illinois, USA
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Hermansyah D, Al Anas M, Yaznil MR, Lubis AT, Alianto R. Tamoxifen-associated Endometrial Cancer after Treatment in Young Premenopausal Women with Breast Cancer: A Case Report. Acta Inform Med 2023; 32:85-87. [PMID: 38585594 PMCID: PMC10997177 DOI: 10.5455/aim.2024.32.85-87] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 12/19/2023] [Indexed: 04/09/2024] Open
Abstract
Background Tamoxifen has been successfully administered as adjunctive therapy for breast cancer. However, the effect of tamoxifen as an estrogen agonist and antagonist can cause pathological changes in the uterus. The agonist effect may stimulate endometrial proliferation leading to endometrial polyps, hyperplasia, and, rarely, endometrial cancer. Objective We present the case of tamoxifen-treated breast cancer case to better understand one of the most serious consequences, endometrial cancer. Case presentation A 37-year-old woman came to our centre with complaints of abnormal vaginal bleeding. She has diagnosed with grade I infiltrative ductal carcinoma in 2018, with primary complaints of right breast mass and axillary lymphadenopathy. During this period, adjuvant chemotherapy was given tamoxifen 20 mg once daily. There were no complaints or relapses at a six-month follow-up over three years. In the fourth year, the patient complained of vaginal bleeding. A vaginal biopsy was performed, and the results showed low-grade endometrioid-type endometrial carcinoma. Total hysterectomy and bilateral salpingo-oophorectomy were performed with the resultant mass of up to half of the myometrial lining with metastatic negative parallax lymph nodes. Conclusion Following tamoxifen therapy, endometrial cancer is more likely to occur in patients. Patients who experience irregular vaginal hemorrhage should have hysteroscopy or uterine ultrasound performed, and if the cause is unknown, a biopsy should be performed.
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Affiliation(s)
- Dedy Hermansyah
- Division of Surgical Oncology, Department of Surgery, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
| | - Muhammad Al Anas
- Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
| | - Muhammad Rizki Yaznil
- Division of Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
| | | | - Ricky Alianto
- Department of Surgical Pathology, Columbia Asia General Hospital Medan, Medan, Indonesia
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Jacobs F, Gaudio M, Benvenuti C, De Sanctis R, Santoro A, Zambelli A. Controversies and Opportunities in the Clinical Daily Use of the 21-Gene Assay for Prognostication and Prediction of Chemotherapy Benefit in HR+/HER2- Early Breast Cancer. Cancers (Basel) 2022; 15. [PMID: 36612144 DOI: 10.3390/cancers15010148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/20/2022] [Accepted: 12/23/2022] [Indexed: 12/28/2022] Open
Abstract
Several multigene assays have been developed to help clinicians in defining adjuvant treatment for patients with hormone-receptor-positive (HR+), human epidermal growth factor receptor-2 (HER2)-negative early breast cancer. Despite the 21-gene assay having been available for decades, it has only recently been included in the healthcare systems of several countries. Clinical optimisation of the test remains of critical interest to achieve a greater impact of genomic information in HR+/HER2- early breast cancer. Although current guidelines recommend the use of the 21-gene assay in early breast cancer at intermediate risk of relapse, the implication of the Recurrence Score (RS) in some grey areas still remains uncertain. Our aim is to critically discuss the role of RS in peculiar circumstances. In particular, we focus on the complex integration of genomic data with clinicopathological factors; the potential clinical impact of RS in node-positive premenopausal women and in the neoadjuvant setting; the significance of RS in special histologies and in male patients; and the management and time-optimisation of test ordering. In the absence of robust evidence in these areas, we provide perspectives for improving the use of the 21-gene assay in the decision-making process and guide adjuvant treatment decisions even in challenging cases.
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Vičič V, Kukec A, Kugler S, Geršak K, Osredkar J, Pandel Mikuš R. Assessment of Vitamin D Status in Slovenian Premenopausal and Postmenopausal Women, Using Total, Free, and Bioavailable 25-Hydroxyvitamin D (25(OH)D). Nutrients 2022; 14. [PMID: 36558509 DOI: 10.3390/nu14245349] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/09/2022] [Accepted: 12/11/2022] [Indexed: 12/24/2022] Open
Abstract
The objective of our study was to evaluate vitamin D status and its predictors in Slovenian premenopausal and postmenopausal women. A cross-sectional study was carried out between 1 March 2021 and 31 May 2021. A total of 319 healthy women from the Central Slovenian region aged between 44 and 65 were recruited; 176 were included in the final analysis. The vitamin D status was determined by measuring the total 25-Hydroxycholecalciferol (25(OH)D) concentration, vitamin D binding protein (DBP), and albumin and calculating the bioavailable 25(OH)D and free 25(OH)D. For the calculation of bioavailable and free 25(OH)D, we developed a new online calculator. The Endocrine Society’s thresholds for vitamin D deficiency and insufficiency were used; 29.0% of premenopausal and 24.4% of postmenopausal subjects were found to be vitamin D deficient (total 25(OH)D < 50 nmol/L); 76.8% of the premenopausal and 61.7% of postmenopausal subjects were found to have insufficient levels (total 25(OH)D < 75 nmol/L). Premenopausal women had 11.8% lower total 25(OH)D, 32.2% lower bioavailable 25(OH)D, and 25.2% higher DBP than postmenopausal women. The most important predictors of vitamin D status were vitamin D supplementation and time spent in the sun. Contrary to similar studies, the vitamin D status in Slovenian postmenopausal women was significantly better than in premenopausal women. In postmenopausal women, the measurement of free or bioavailable 25(OH)D instead of the total 25(OH)D could be advantageous.
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Tan NL, Lee SW, Zaloumis S, Lamb KE, Dawson D, Teede HJ, Myles PS. Association of menstrual cycle and postoperative quality of recovery in premenopausal women: a prospective cohort study. BJA Open 2022; 4:100102. [PMID: 37588793 PMCID: PMC10430848 DOI: 10.1016/j.bjao.2022.100102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 10/06/2022] [Indexed: 08/18/2023]
Abstract
Background Women have poorer quality of postoperative recovery from general anaesthesia than men. This persists for at least 3 days postoperatively, and is more pronounced in premenopausal women. Studies of menstrual cycle effects on pain or postoperative nausea and vomiting report conflicting results. Our aim was to determine whether menstrual cycle phase is associated with quality of recovery after surgery in premenopausal women. Methods Eligible women aged 18-45 yr undergoing wisdom teeth extraction or laparoscopic cholecystectomy under general anaesthesia with volatile agents were recruited from Epworth HealthCare Richmond in Melbourne, Australia from 2019 to 2021. Menstrual history and progesterone levels were used to determine cycle phase (luteal or non-luteal). Linear mixed and generalised linear regression models were fitted to examine differences in Quality of Recovery-15 (QoR-15) score on postoperative days 1 (primary outcome) and 3, and secondary outcomes (pain, analgesic effectiveness, postoperative nausea and vomiting, prolonged hospital admission), between groups, adjusting for confounders. Results A total of 177 women were recruited (74 luteal, 103 non-luteal). Six (3%) underwent laparoscopic cholecystectomy. Estimated mean differences (95% confidence interval; P-value) in adjusted QoR-15 scores between luteal and non-luteal groups were -0.05 (-5.86 to 5.76; P=0.986) and 1.40 (-4.41 to 7.21; P=0.636) on postoperative days 1 and 3, respectively. Secondary outcomes were not different between groups. Conclusions There was no significant difference in postoperative QoR-15 score or other outcomes between women in the luteal and non-luteal phases of their cycle. Women can be reassured that cycle phase does not impact postoperative quality of recovery when undergoing minor surgery under general anaesthesia. Clinical trial registration ACTRN12618000240246.
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Affiliation(s)
- Nicole L.T. Tan
- Critical Care Institute, Epworth HealthCare, Melbourne, Australia
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Australia
| | - Sze Wey Lee
- Women's and Children's Clinical Institute, Epworth HealthCare, Melbourne, Australia
| | - Sophie Zaloumis
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Australia
| | - Karen E. Lamb
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Australia
| | - Dianne Dawson
- Research Governance Unit, Epworth HealthCare, Melbourne, Australia
| | - Helena J. Teede
- Monash Centre for Health Research and Implementation, Monash University, Melbourne, Australia
| | - Paul S. Myles
- Department of Anaesthesiology and Perioperative Medicine, Alfred Hospital and Monash University, Melbourne, Australia
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21
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Shahraki SK, Emadi SF, Salarfard M, Chenari Z, Tadayyonfar F, Alikamali M. Effect of vitamin D supplementation on the severity of stress urinary incontinence in premenopausal women with vitamin D insufficiency: a randomized controlled clinical trial. BMC Womens Health 2022; 22:431. [PMCID: PMC9636788 DOI: 10.1186/s12905-022-02024-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 10/25/2022] [Indexed: 11/06/2022] Open
Abstract
Background Urinary incontinence, especially stress urinary incontinence (SUI), is one of the problems experienced by premenopausal women. Given the role of vitamin D in enhancing muscle strength and function, this study explored the effect of vitamin D3 supplementation on SUI in premenopausal women. Methods A randomized controlled trial was performed with 60 premenopausal women referring to Kerman gynecological clinic in 2020 and 2021. Eligible women received a 5000-unit vitamin D supplement or placebo weekly for 3 months. The International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-SF) was utilized to assess SUI severity before and after the intervention. The t-test, Chi-square test, and repeated measures ANOVA were carried out in SPSS software (version 22) to analyze the data. P-values smaller than 0.05 were considered significant. Results Before the intervention, there was no significant difference between the intervention and control groups in SUI severity (P = 0.652) and the impact of SUI severity on premenopausal women’s lives (P = 0.804). In contrast, after 8-12 weeks of vitamin D supplementation, these scores decreased significantly in the intervention group relative to the control group (P < 0.001). In addition, after vitamin D supplementation, the number of SUI and urinary leakage symptoms decreased in the intervention group (P < 0.001). Conclusion Vitamin D supplementation improves SUI in premenopausal women. Trial registration This trial was registered with the Iranian Registry of Clinical Trials; https://fa.irct.ir/trial/53474 (IRCT20190724044318N2) on 11/02/2021.
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Affiliation(s)
- Sedigheh Khodabandeh Shahraki
- grid.412105.30000 0001 2092 9755Department of Community Health Nursing, Razi Faculty of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran
| | - Seyedeh Fatemeh Emadi
- grid.411230.50000 0000 9296 6873Department of Midwifery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mahla Salarfard
- grid.411583.a0000 0001 2198 6209PhD student in Reproductive Health, Faculty of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Zahra Chenari
- grid.411230.50000 0000 9296 6873Department of Midwifery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Faezeh Tadayyonfar
- grid.412266.50000 0001 1781 3962Department of Reproductive Health, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Maryam Alikamali
- grid.412105.30000 0001 2092 9755Student Research Committee, Kerman University of Medical Sciences, Kerman, Iran
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Garzia NA, Cushing-Haugen K, Chiu YH, Sandoval-Insausti H, Chavarro JE, Missmer SA, Harris HR. Pesticide residue intake from fruit and vegetable consumption and risk of laparoscopically confirmed endometriosis. F S Sci 2022; 3:376-382. [PMID: 35598776 PMCID: PMC9669096 DOI: 10.1016/j.xfss.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 05/11/2022] [Accepted: 05/13/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To examine the association between the intake of fruits and vegetables with high- vs. low-pesticide residue burden and diagnosis of laparoscopically confirmed endometriosis. The etiology of endometriosis is not well understood, but dietary factors may influence the risk. Pesticides may act as endocrine disruptors, and the intake of pesticide-contaminated food is a common exposure pathway. DESIGN Prospective cohort study. Hazard ratios and 95% confidence intervals were calculated using multivariable Cox proportional hazard models to evaluate the intake of fruits and vegetables with high- and low-pesticide residues in relation to the diagnosis of laparoscopically confirmed endometriosis. SETTING Not applicable. PATIENT(S) Premenopausal US women (N = 52,053) of the Nurses' Health Study II, aged 34-53 years at study baseline (1999), were followed until 2013. The diet was assessed every 4 years using a validated food frequency questionnaire. A previously developed and validated pesticide residue burden score (PRBS), on the basis of the US Department of Agriculture Pesticide Data Program, was used to assign fruits and vegetables to pesticide residue groups (high/low). INTERVENTION(S) Not applicable. MAIN OUTCOME MEASURE(S) Cases of laparoscopically confirmed endometriosis were identified from self-reports to validated questionnaires. RESULT(S) During 14 years of follow-up, 956 incidences of laparoscopically confirmed endometriosis were reported. No association was observed between the intake of high- or low-PRBS fruit and vegetable intake and endometriosis (hazard ratio for 5th vs. 1st quintile: high-PRBS intake = 0.94, 95% confidence interval = 0.73-1.23; low-PRBS intake = 1.07, 95% confidence interval = 0.82-1.40). No associations were observed for high- or low-PRBS fruit and vegetable intake by fertility status. CONCLUSION(S) No clear associations were observed between high- or low-PRBS fruit and vegetable intake and endometriosis risk among premenopausal women. To our knowledge, this is the first study to evaluate the association between dietary pesticide residue intake and endometriosis. Further research is needed, particularly to evaluate this association among a younger population of women (adolescence or early adulthood) and assess the dietary exposure to specific pesticides or chemical families.
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Affiliation(s)
- Nichole A Garzia
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington.
| | - Kara Cushing-Haugen
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Yu-Han Chiu
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | | | - Jorge E Chavarro
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Stacey A Missmer
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Obstetrics, Gynecology and Reproductive Biology, College of Human Medicine, Michigan State University, Grand Rapids, Michigan; Division of Adolescent and Young Adult Medicine, Department of Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Holly R Harris
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington
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Abdol Manap N, Ng BK, Phon SE, Abdul Karim AK, Lim PS, Fadhil M. Endometrial Cancer in Pre-Menopausal Women and Younger: Risk Factors and Outcome. Int J Environ Res Public Health 2022; 19:9059. [PMID: 35897440 DOI: 10.3390/ijerph19159059] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 07/20/2022] [Accepted: 07/22/2022] [Indexed: 12/04/2022]
Abstract
Endometrial cancer is the sixth most common malignancy in women, and it is known to be a disease among postmenopausal women, but there is rising in the number of endometrial cancers among premenopausal women. This study aims to determine the clinical characteristic, risk factors, outcomes, and survival in pre and postmenopausal women with endometrial cancer in Malaysia. A retrospective study was conducted in Hospital Melaka that involved all women who were diagnosed with endometrial cancer in Hospital Melaka from January 2002 until July 2020. All subjects’ histopathological examination result was confirmed, and their clinical data were extracted and transferred into a standardized data checklist and analysed. A total number of 392 cases was obtained from the Annual Cancer Registry Hospital Melaka. However, only 281 cases were studied, including 44.8% premenopausal and 55.2% postmenopausal women. In the premenopausal group, there were higher incidence of obesity (30.8 + 8.6 vs. 28.9 + 7.1), younger age at menarche (12.7 + 1.5 vs. 13.3 + 1.6), lesser parity (1.47 vs. 3.26), and a higher number of nulliparous women (46.8% vs. 19.4%) as compared to postmenopausal group. The premenopausal group tends to be presented with a well-differentiated grading of tumour (52.4%) and a higher incidence of having concomitant endometrial hyperplasia (41.3%). The mean survival among the premenopausal group (200.3 + 7.9 months) is higher compared to postmenopausal group (153.9 + 6.5 months). These findings correlate with good survival and prognosis among the premenopausal group compared to the postmenopausal group.
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Arboleda B, Bartsch R, de Azambuja E, Hamilton E, Harbeck N, Klemp J, Knauer M, Kuemmel S, Mahtani R, Schwartzberg L, Villarreal-Garza C, Wolff A. Ovarian Function Suppression: A Deeper Consideration of the Role in Early Breast Cancer and its Potential Impact on Patient Outcomes: A Consensus Statement from an International Expert Panel. Oncologist 2022; 27:722-731. [PMID: 35704278 PMCID: PMC9438910 DOI: 10.1093/oncolo/oyac101] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 04/26/2022] [Indexed: 01/07/2023] Open
Abstract
It has been suggested that the benefit of adjuvant chemotherapy (CT) in premenopausal women with hormone receptor-positive (HR+), human epidermal growth factor receptor 2 negative (HER2-) early breast cancer may be related, at least in part, to CT-induced ovarian function suppression (OFS) in this subgroup of patients. Although this hypothesis has not been directly tested in large randomized clinical trials, the observations from prospective studies have been remarkably consistent in showing a late benefit of CT among the subgroup of patients who benefit (ie, women who were close to menopause). The hypothesis has important clinical implications, as it may be possible to spare the associated adverse effects of adjuvant CT in a select group of women with early breast cancer, in favor of optimizing OFS and endocrine therapy (ET), without compromising clinical outcomes. Such an approach has the added benefit of preserving the key quality of life outcomes in premenopausal women, particularly by preventing the irreversible loss of ovarian function that may result from CT use. For this reason, we convened an international panel of clinical experts in breast cancer treatment to discuss the key aspects of the available data in this area, as well as the potential clinical implications for patients. This article summarizes the results of these discussions and presents the consensus opinion of the panel regarding optimizing the use of OFS for premenopausal women with HR+, HER2- early breast cancer.
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Affiliation(s)
- Bolivar Arboleda
- Puerto Rican Society of Mastology, HIMA San Pablo Oncology Hospital, Caguas, Puerto Rico
| | - Rupert Bartsch
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | | | - Erika Hamilton
- Breast and Gynecologic Research Program, Sarah Cannon Research Institute, Tennessee Oncology PLLC, Nashville, TN, USA
| | - Nadia Harbeck
- LMU Munich, University Hospital, Department of Obstetrics and Gynecology, Breast Center and Comprehensive Cancer Center (CCLMU), Munich, Germany
| | - Jennifer Klemp
- University of Kansas Cancer Center, Kansas City, KS, USA
| | - Michael Knauer
- Department of Pathology and Laboratory Medicine, Western University and London Health Sciences Centre, London, ON, Canada
| | - Sherko Kuemmel
- Department of Gynecology with Breast Center, Charité-Universitätsmedizin Berlin, Germany
| | | | | | - Cynthia Villarreal-Garza
- Breast Cancer Center, Hospital Zambrano Hellion, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico
| | - Antonio Wolff
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
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25
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Wang Y, Li Y, Liang J, Zhang N, Yang Q. Chemotherapy-Induced Amenorrhea and Its Prognostic Significance in Premenopausal Women With Breast Cancer: An Updated Meta-Analysis. Front Oncol 2022; 12:859974. [PMID: 35463307 PMCID: PMC9022106 DOI: 10.3389/fonc.2022.859974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 03/04/2022] [Indexed: 11/13/2022] Open
Abstract
Objective Chemotherapy-induced amenorrhea (CIA) is one of the most common side effects in premenopausal patients with breast cancer, and several factors may contribute to the incidence of CIA. In this meta-analysis, we aimed to summarize clinical risk factors associated with CIA incidence and to evaluate their prognostic effects in patients with breast cancer. Methods Three electronic databases (Cochrane Library, EMBASE, and MEDLINE) were systematically searched for articles published up to October 2021. The articles included clinical trials that evaluated risk factors associated with CIA and their prognostic value in treatment. For the meta-analysis, pooled odds ratio estimates (ORs) and 95% confidence intervals (CIs) were calculated using the inverse variance-weighted approach, in addition to publication bias and the chi-square test. Results A total of 68 studies involving 26,585 patients with breast cancer were included in this meta-analysis, and 16,927 patients developed CIA. From the 68 studies, 7 risk factors were included such as age group, hormone receptor (HR) status, estrogen receptor (ER) status, progesterone receptor (PR) status, tamoxifen administration, chemotherapeutic regimen, and tumor stage. Based on our results, patients with age of ≤40, HR-negative status, ER-negative status, PR-negative status, no use of tamoxifen, and use of anthracycline-based regimen (A) compared with anthracycline-taxane-based regimen (A+T) were associated with less incidence of CIA in patients with breast cancer. Moreover, CIA was associated with favorable disease-free survival (OR = 0.595, 95% CI = 0.537 to 0.658, p < 0.001) and overall survival (OR = 0.547, 95% CI = 0.454–0.660, p < 0.001) in premenopausal patients with breast cancer. Conclusion Age, HR status, ER status, PR status, tamoxifen administration, and chemotherapeutic regimen can be considered independent factors to predict the occurrence of CIA. CIA is a favorable prognostic factor in premenopausal patients with breast cancer. CIA should be a trade-off in the clinical management of premenopausal patients with breast cancer, and further large cohort studies are necessary to confirm these results.
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Affiliation(s)
- Yifei Wang
- Department of Breast Surgery, General Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Yaming Li
- Department of Breast Surgery, General Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Jingshu Liang
- Department of Breast Surgery, General Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Nan Zhang
- Breast Cancer Center, Jinan Central Hospital, Shandong First Medical University, Jinan, China
| | - Qifeng Yang
- Department of Breast Surgery, General Surgery, Qilu Hospital of Shandong University, Jinan, China.,Pathology Tissue Bank, Qilu Hospital of Shandong University, Jinan, China.,Research Institute of Breast Cancer, Shandong University, Jinan, China
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Simon JA, Athavale A, Ravindranath R, Hadker N, Sadiq A, Lim-Watson M, Williams L, Krop J. Assessing the Burden of Illness Associated with Acquired Generalized Hypoactive Sexual Desire Disorder. J Womens Health (Larchmt) 2022; 31:715-725. [PMID: 35475708 PMCID: PMC9133974 DOI: 10.1089/jwh.2021.0255] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Hypoactive sexual desire disorder (HSDD), which affects ∼10% of women in the United States, is defined as the persistent or recurrent deficiency/absence of sexual desire accompanied by personal distress. Although HSDD impacts patient quality of life and interpersonal relationships, the disorder often goes unaddressed or untreated. Recent studies of the burden of illness in women with HSDD, especially premenopausal women, are limited. Materials and Methods: A 45-minute web-based survey was designed to investigate the experience of women seeking treatment for HSDD and the impact of this disorder on several psychosocial aspects of women's lives. Women were recruited from an online panel of patients who participated in research studies for compensation. Validated questionnaires assessed sexual function (Female Sexual Function Index) and health-related quality of life (12-Item Short Form Survey [SF-12]), including mental and physical component scores. Results: A total of 530 women, aged ≥18 years, diagnosed with acquired generalized HSDD were included in the study. Premenopausal women indicated greater overall HSDD symptom burden compared with postmenopausal women. Patients with HSDD reported lower SF-12 scores compared with the general population. A multivariable regression analysis demonstrated that psychosocial factors influencing the burden of HSDD, including interference with their relationship with their partner (β = −0.18; p < 0.005), mental and emotional well-being (β = −0.23; p < 0.005), and household and personal activities (β = −0.23; p = 0.02), negatively affected SF-12 mental component scores. Conclusions: HSDD symptom burden was found to be negatively and statistically significantly associated with patients' mental health; the impact was greater among premenopausal women compared with postmenopausal women.
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Affiliation(s)
- James A Simon
- Department of Obstetrics and Gynecology, George Washington University and IntimMedicine™ Specialists, Washington, District of Columbia, USA
| | | | | | | | - Amama Sadiq
- AMAG Pharmaceuticals, Inc., Waltham, Massachusetts, USA
| | | | | | - Julie Krop
- AMAG Pharmaceuticals, Inc., Waltham, Massachusetts, USA
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Kajale N, Khadilkar A, Shah N, Padidela R, Mughal Z, Chiplonkar S, Ekbote V, Khadilkar V. Impact of Adolescent Pregnancy on Bone Density in Underprivileged Pre-Menopausal Indian Women. J Clin Densitom 2022; 25:178-188. [PMID: 34911660 DOI: 10.1016/j.jocd.2021.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 09/29/2021] [Accepted: 11/08/2021] [Indexed: 10/19/2022]
Abstract
High prevalence (31.5%) of adolescent pregnancies (AP) have been reported in India. Reports suggest that pregnancy during adolescence may have deleterious effects on peak bone mass. Very few studies have described the long-term effects of a history of AP on bone mass. The objective of this study was to compare bone mineral density (BMD) and bone geometry of premenopausal women with first childbirth during adolescence (i.e., before age of 19 years) or after 20 years. A cross-sectional study was conducted in 242 women (age 28.0-54.5 years) from Pune, India (November, 2015 to November, 2017). Women were divided into 2-groups: Group-1: women-who had 1st-pregnancy and childbirth before 19 years of age (AP n = 131) and Group-2: women-who had 1st pregnancy after 20 years of age (non-AP n = 111). Demographic data, anthropometric measurements, and biochemical tests were performed using standard protocols. Physical activity and nutrient intakes were recorded using validated questionnaires. Areal BMD and bone geometry were measured using Dual-Energy-Absorptiometry-DXA (Lunar-iDXA, GE Healthcare) and peripheral-quantitative-computed-tomography-pQCT (XCT2000, Stratec Inc.). Mean age of the study group was 37 ± 4.6 years; in women from group-1 mean age at first delivery was 16.9 ± 1.6 years as against 22.6 ± 3.1 years in group-2. Both groups were similar in body mass index and socioeconomic status. pQCT measured radial diaphyseal cortical thickness (1.97 ± 0.3 mm vs 1.88 ± 0.3 mm resp., p = 0.016, periosteal circumference (38.0 ± 3.6 mm vs 36.7 ± 2.5 mm, resp. p = 0.016), total bone area (114.3 ± 24.8 mm2 vs 108.7 ± 14.7 mm2 resp. p = 0.026) and stress-strain index (SSI = 217 ± 75 vs 201 ± 40 mm3 resp. p = 0.042) were significantly higher in group-1 than group-2. After adjusting for anthropometric and lifestyle parameters, pQCT measured cortical thickness (1.98 ± 0.03 mm in group-1, 1.87 ± 0.03 mm group-2, p = 0.01, mean ± SE) and iDXA derived aBMD at forearm were still significantly higher (0.599 ± 0.006 g/cm3 vs 0.580 ± 0.006 g/cm3, p = 0.023) in Group-1. Our data suggest that women with a history of adolescent pregnancy had better bone geometry and higher aBMD at radius in later years. We speculate that early exposure to pregnancy resulted in higher aBMD at the radius and induced changes at radial diaphysis with bones becoming thicker and wider among these women.
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Affiliation(s)
- Neha Kajale
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India
| | - Anuradha Khadilkar
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India.
| | - Nikhil Shah
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India; Department of Pediatrics, Cloudnine Hospital, Malad, Mumbai
| | - Raja Padidela
- Department of Paediatric Endocrinology, Royal Manchester Children's Hospital, Manchester University, Manchester
| | - Zulf Mughal
- Department of Paediatric Endocrinology, Royal Manchester Children's Hospital, Manchester University, Manchester
| | - Shashi Chiplonkar
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India
| | - Veena Ekbote
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India
| | - Vaman Khadilkar
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India
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Eagan LE, Chesney CA, Mascone SE, Ranadive SM. Arterial stiffness and blood pressure are similar in naturally menstruating and oral contraceptive pill using women during the higher-hormone phases. Exp Physiol 2022; 107:374-382. [PMID: 35199392 DOI: 10.1113/ep090151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 02/14/2022] [Indexed: 11/08/2022]
Abstract
NEW FINDINGS What is the central question of this study? Are there differences in blood pressure, arterial stiffness and indices of pressure waveforms between young oral contraceptive pill using and naturally menstruating women during lower and higher hormone phases of their cycles? What is the main finding and its importance? Blood pressure, arterial stiffness and indices of pressure waveforms are influenced similarly by exogenous and endogenous hormones. However, lower levels of exogenous hormones moderately increase blood pressure among OCP. ABSTRACT Elevations in blood pressure (BP) are understood as having a bidirectional relationship with stiffening of central and peripheral arteries. Arterial stiffness is mitigated by oestrogen, which aides in arterial vasorelaxation. To evaluate whether BP, stiffness, and pressure waveforms were different between young healthy naturally menstruating (non-OCP) and oral contraceptive pill using women (OCP), we measured brachial and aortic BPs, carotid-to-femoral pulse wave velocity (cfPWV), carotid β-stiffness, elastic-modulus, central augmentation index (AIx and AIx75), and forward and backward pressure waveforms (Pf and Pb) in 22 women (22 (1) yr, OCP: n = 12). To assess phasic differences, women were studied during the early follicular (EF; ≤5 days of menstruation onset) and early luteal (EL; 4 (2) days post-ovulation) phases of non-OCP and compared to the placebo pill (PP; ≤5 days of onset) and active pill (AP; ≤5 days of highest-dose AP) phases of OCP. During the lower hormone phases, OCP have significantly higher brachial SBP (119.3 (8.3) vs. 110.2 (8.3) mmHg, P = 0.02) and aortic SBP (104.10 (7.44) vs. 96.80 (6.39) mmHg, P = 0.03) as compared to non-OCP; however, during the higher hormone phases, there are no differences in measures of brachial or aortic BP, arterial stiffness, or indices of BP waveforms between OCP and non-OCP (P≥0.05). In conclusion, exogenous and endogenous hormones have similar influences on BP and arterial stiffness; however, lower levels of exogenous hormones augment both central and peripheral BPs. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Lauren E Eagan
- Department of Kinesiology, School of Public Health, University of Maryland, College Park, MD, USA
| | - Catalina A Chesney
- Department of Kinesiology, School of Public Health, University of Maryland, College Park, MD, USA
| | - Sara E Mascone
- Department of Kinesiology, School of Public Health, University of Maryland, College Park, MD, USA
| | - Sushant M Ranadive
- Department of Kinesiology, School of Public Health, University of Maryland, College Park, MD, USA
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Clayton AH, Kingsberg SA, Portman D, Sadiq A, Krop J, Jordan R, Lucas J, Simon JA. Safety Profile of Bremelanotide Across the Clinical Development Program. J Womens Health (Larchmt) 2022; 31:171-182. [PMID: 35147466 DOI: 10.1089/jwh.2021.0191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Bremelanotide, a melanocortin receptor agonist, is Food and Drug Administration (FDA)-approved for the treatment of premenopausal women with acquired, generalized hypoactive sexual desire disorder. Methods: Review of bremelanotide's safety profile from the clinical development program (phases 1 through 3). Results: The clinical development program comprised 3500 subjects in 43 completed studies. In the phase 3 studies, subjects took bremelanotide for up to 18 months. The most common adverse events (AEs) were nausea (40.0% vs. 1.3%), flushing (20.3% vs. 1.3%), headache (11.3% vs. 1.9%), and injection site reactions (5.4 vs. 0.5), bremelanotide versus placebo groups, respectively, in the integrated double-blind portion of the phase 3 studies (N = 1247). Nausea was the most common reason for bremelanotide discontinuation. There were no deaths; a few subjects experienced serious AEs. Focal hyperpigmentation was rare when bremelanotide was dosed in accordance with label recommendations, but it occurred in more than one-third of subjects following up to 16 consecutive daily dosings. Small and transient but statistically significant blood pressure increases were observed during ambulatory blood pressure monitoring. Most drug-drug interactions were not clinically significant, except for interactions that lowered plasma concentrations of indomethacin and naltrexone. In the double-blind portion of the integrated phase 3 studies, 70% of the bremelanotide group proceeded to the open-label phase of the studies versus 87% of those on placebo. Conclusions: The AEs associated with bremelanotide are mostly mild to moderate. Although not deemed clinically important, bremelanotide should be used with caution in patients at risk of cardiovascular disease, and blood pressure should be well controlled during treatment. Clinical Trial Registration number: NCT02333071 [Study 301] and NCT02338960 [Study 302].
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Affiliation(s)
- Anita H Clayton
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, Virginia, USA
| | - Sheryl A Kingsberg
- Department of Reproductive Biology and Department of Psychiatry, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | | | - Amama Sadiq
- AMAG Pharmaceuticals, Inc., Waltham, Massachusetts, USA
| | - Julie Krop
- AMAG Pharmaceuticals, Inc., Waltham, Massachusetts, USA
| | - Robert Jordan
- Palatin Technologies, Inc., Cranbury, New Jersey, USA
| | - Johna Lucas
- Palatin Technologies, Inc., Cranbury, New Jersey, USA
| | - James A Simon
- George Washington University and IntimMedicine™ Specialists, Washington, District of Columbia, USA
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Linnane S, Quinn A, Riordan A, Dowling M. Women's fertility decision-making with a diagnosis of breast cancer: A qualitative evidence synthesis. Int J Nurs Pract 2022; 28:e13036. [PMID: 35088478 DOI: 10.1111/ijn.13036] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 04/18/2021] [Accepted: 12/19/2021] [Indexed: 11/30/2022]
Abstract
AIM To synthesize qualitative evidence of premenopausal women's experiences of fertility decision-making with a diagnosis of breast cancer. BACKGROUND Breast cancer is increasingly more common in premenopausal women who may have not yet considered starting a family or have completed their families. DESIGN Qualitative evidence synthesis guided by Thomas and Harden's three-stage approach to thematic analysis. DATA SOURCES Twelve electronic databases were searched: CINAHL, Embase, Pubmed, Proquest, PsychINFO, Lenus, Scopus, Web of Science, Rian.ie, Medline, EThOS e-theses online and DART Europe. No year limit was set. REVIEW METHODS The 'Enhancing transparency in reporting the synthesis of qualitative research guidelines' (ENTREQ) statement was followed. RESULTS Fifteen qualitative studies were included in the synthesis. Seven review findings under four major themes were identified: (1) first comes survival, (2) making decisions 'under the gun', (3) health-care professionals should not make assumptions and (4) we want accurate, detailed information and we want it early. High confidence in six of the review findings was agreed. CONCLUSION Most women experienced rushed fertility preservation decision-making at a time when they also faced cancer treatment decisions. Women want detailed, clear information on fertility preservation early after their diagnosis.
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Affiliation(s)
- Sharon Linnane
- Public Health Nurse, Mervue Health Centre, Galway, Ireland
| | - Aoife Quinn
- Clinical Nurse Specialist (Oncology), Galway University Hospitals, Galway, Ireland
| | - Anne Riordan
- National Health Library and Knowledge Service, Merlin Park University Hospital, Galway, Ireland
| | - Maura Dowling
- School of Nursing and Midwifery, National University of Ireland, Galway, Ireland
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Villarreal-Garza C, Ferrigno AS, Aranda-Gutierrez A, Frankel PH, Ruel NH, Fonseca A, Narod S, Chavarri-Guerra Y, Sifuentes E, Magallanes-Hoyos MC, Herzog J, Castillo D, Alvarez-Gomez RM, Mohar-Betancourt A, Weitzel JN. Influence of germline BRCA genotype on the survival of patients with triple-negative breast cancer. Cancer Res Commun 2021; 1:140-147. [PMID: 35875314 PMCID: PMC9307147 DOI: 10.1158/2767-9764.crc-21-0099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
The presence of BRCA pathogenic variants (PVs) in triple-negative breast cancer (TNBC) is associated with a distinctive genomic profile that makes the tumor particularly susceptible to DNA-damaging treatments. However, patients with BRCA PVs can develop treatment resistance through the appearance of reversion mutations and restored BRCA expression. As copy-number variants (CNV) could be less susceptible to reversion mutations than point mutations, we hypothesize that carriers of BRCA CNVs may have improved survival after treatment compared to carriers of other BRCA PVs or BRCA wild-type. Women diagnosed with stage I-III TNBC at ≤50 years at a cancer center in Mexico City were screened for BRCA PVs using a recurrent PV assay (HISPANEL; 77% sensitivity). The recurrence-free (RFS) and overall survival (OS) were compared according to mutational status. Among 180 women, 17 (9%) were carriers of BRCA1 ex9-12del CNV and 26 (14%) of other BRCA PVs. RFS at ten years for the whole cohort was 79.2% (95% CI 72.3-84.6%), with no significant differences according to mutational status. 10-year OS for the entire cohort was 85.3% (95%CI: 78.7-90.0%), with BRCA CNV carriers demonstrating numerically superior OS rates other PV carriers and non-carriers (100% vs. 78.6% and 84.7%; log-rank p=0.037 and p=0.051, respectively). This study suggests that BRCA1 ex9-12del CNV carriers with TNBC may have a better OS, and supports the hypothesis that the genotype of BRCA PVs may influence survival by limiting treatment resistance mediated by reversion mutations among CNV carriers.
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Affiliation(s)
- Cynthia Villarreal-Garza
- Breast Cancer Center, Hospital Zambrano Hellion TecSalud, Tecnologico de Monterrey, San Pedro Garza Garcia, Nuevo Leon, Mexico.,Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Ana S. Ferrigno
- Breast Cancer Center, Hospital Zambrano Hellion TecSalud, Tecnologico de Monterrey, San Pedro Garza Garcia, Nuevo Leon, Mexico
| | | | | | | | - Alan Fonseca
- Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Steven Narod
- Women's College Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Yanin Chavarri-Guerra
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | | | | | | | | | | | - Jeffrey N. Weitzel
- Latin American School of Oncology, Sierra Madre, California.,Corresponding Author: Jeffrey N. Weitzel, Latin American School of Oncology, 578 Acacia Street, Sierra Madre, CA 91024. Phone: 626-233-9713; E-mail:
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Kang YK, Wang X, Hu NL, Yue J, Si YR, Ju J, Gao SL, Yuan P. The Effects of Endocrine Therapies on Lipid Profiles in Chinese Young Women With Early Breast Cancer. Front Oncol 2021; 11:759595. [PMID: 34926260 PMCID: PMC8671131 DOI: 10.3389/fonc.2021.759595] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 11/02/2021] [Indexed: 12/04/2022] Open
Abstract
This study aimed to evaluate and compare the effects of various endocrine therapies on lipid profiles in young patients with breast cancer. A retrospective, single-center study was performed to investigate the effects of tamoxifen (TAM), tamoxifen plus ovarian function suppression (TAM+OFS), and aromatase inhibitors plus ovarian function suppression (AI+OFS) on lipid profiles during the 60 months of endocrine therapy in hormone receptor-positive patients aged <40 with early breast cancer. The primary endpoint was the cumulative incidence of lipid events, and the secondary endpoints were the changes in lipid profiles. A total of 230 young patients were included with the mean age of 35.7 years old. The patients in TAM group had significantly lower incidence of 5-year lipid events than those in TAM+OFS group (7.4% versus 21.3%; P=0.016) and AI+OFS group (7.4% versus 21.6%; P=0.009). The incidence of fatty liver was significantly higher in TAM+OFS group than TAM group (52.5%versus 30.9%; P=0.043). Lipid events were associated with younger age (odds ratio (OR)=0.865, 95% confidence interval (CI): 0.780-0960; P=0.006), higher baseline LDL-C (OR=14.959, 95% CI: 4.379-51.105; P<0.001), and use of OFS (OR=3.557, 95% CI: 1.151-10.989; P=0.027). Therefore, application of OFS, with younger age and higher baseline LDL-C, may increase the incidence of lipid events in premenopausal breast cancer. More care should be taken for lipid profiles during the endocrine therapy for young breast cancer patients.
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Affiliation(s)
| | | | | | | | | | | | | | - Peng Yuan
- Department of VIP Medical Services, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Kim S, Seo H, Rahim MDA, Lee S, Kim YS, Song HY. Changes in the Microbiome of Vaginal Fluid after Menopause in Korean Women. J Microbiol Biotechnol 2021; 31:1490-1500. [PMID: 34489372 PMCID: PMC9705842 DOI: 10.4014/jmb.2106.06022] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 08/12/2021] [Accepted: 09/01/2021] [Indexed: 12/15/2022]
Abstract
Various microorganisms reside in the human vagina; the vaginal microbiome is closely linked to both vaginal and general health, and for this reason, microbiome studies of the vagina are an area of research. In this study, we analyzed the vaginal microbiome of women before and after menopause to further increase our understanding of the vaginal microbiome and its contribution to general health. We did a 16s rRNA gene-based metagenomic analysis on the vaginal fluids of 11 premenopausal and 19 postmenopausal women in Korea. We confirmed that the taxonomic composition was significantly different between the two groups. In postmenopausal women, species richness was significantly decreased, but species diversity was significantly increased. In particular, among the taxonomic components corresponding to all taxon ranks of the vaginal microbiome, a reduction in Lactobacillus taxa after menopause contributed the most to the difference between the two groups. In addition, we confirmed through metabolic analysis that the lactic-acid concentration was also decreased in the vaginal fluid of women after menopause. Our findings on the correlation between menopause and the microbiome could help diagnose menopause and enhance the prevention and treatment diseases related to menopause.
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Affiliation(s)
- Sukyung Kim
- Probiotics Microbiome Convergence Center, Soonchunhyang University, Asan, Chungnam 31538, Republic of Korea
| | - Hoonhee Seo
- Probiotics Microbiome Convergence Center, Soonchunhyang University, Asan, Chungnam 31538, Republic of Korea
| | - MD Abdur Rahim
- Department of Microbiology and Immunology, School of Medicine, Soonchunhyang University, Cheonan, Chungnam 31151, Republic of Korea
| | - Saebim Lee
- Probiotics Microbiome Convergence Center, Soonchunhyang University, Asan, Chungnam 31538, Republic of Korea
| | - Yun-Sook Kim
- Department of Obstetrics and Gynecology, Soonchunhyang University Cheonan Hospital, Chungnam 31151, Republic of Korea,Corresponding authors Y.S. Kim E-mail:
| | - Ho-Yeon Song
- Probiotics Microbiome Convergence Center, Soonchunhyang University, Asan, Chungnam 31538, Republic of Korea,Department of Microbiology and Immunology, School of Medicine, Soonchunhyang University, Cheonan, Chungnam 31151, Republic of Korea,
H.Y. Song E-mail: ,
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Agrawal R, Ahmed H, Soorgani N, Naik L, Reddy S, Medabalmi M. Assessment of Periodontal Status in Pre- and Postmenopausal Women with Chronic Periodontitis: A Cross-Sectional Study. J Pharm Bioallied Sci 2021; 13:S997-S999. [PMID: 35017915 PMCID: PMC8686970 DOI: 10.4103/jpbs.jpbs_145_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 03/20/2021] [Accepted: 04/16/2021] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Periodontitis is inflammation of periodontium. Periodontal disease is associated with various risk factors among which female hormonal alterations such as menopause have been found to be connected with periodontal breakdown and osteoporosis in women. The aim of this study was to determine the periodontal status in pre- and postmenopausal females. MATERIALS AND METHODS In this study, 60 female patients were analyzed aged between 40 and 60 years. Group 1 (test) comprised 30 premenopausal women with/without chronic periodontitis and Group II (control) comprised 30 postmenopausal women with/without chronic periodontitis. After recording clinical parameters, the scores were provided using Orthopantomograph for each patient. Paired t-test was applied for intragroup comparison and independent sample t-test was applied for intergroup comparison. The value of P < 0.05 was considered statistically significant. RESULTS The mean plaque index, gingival index, calculus index, pocket probing depth, and clinical attachment loss scores in the premenopausal group were less as compared to postmenopausal group. Both the groups showed statistically significant differences with T=15.28 and P = 0.01. CONCLUSION Postmenopausal women are more susceptible to periodontitis. Hence, precaution and initial management of oral diseases should be the utmost priority in women's health. The effect of sex hormones can be reduced with regular dental examination, maintaining good oral hygiene, and hormonal replacement therapies.
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Affiliation(s)
- Richa Agrawal
- Department of Periodontics, Mansarovar Dental College, Bhopal, Madhya Pradesh, India
| | - Hina Ahmed
- Department of Periodontics, Mansarovar Dental College, Bhopal, Madhya Pradesh, India
| | - Neeharika Soorgani
- Department of Periodontics, Mansarovar Dental College, Bhopal, Madhya Pradesh, India,Address for correspondence: Dr. Neeharika Soorgani, Department of Periodontics, Mansarovar Dental College, Kolar Road, Bhopal - 462 042, Madhya Pradesh, India. E-mail:
| | - Laxman Naik
- Department of Periodontics, Mansarovar Dental College, Bhopal, Madhya Pradesh, India
| | - Shyamsunder Reddy
- Department of Periodontics, Mansarovar Dental College, Bhopal, Madhya Pradesh, India
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WRIGHT MA, DOLL KM, MYERS E, CARPENTER WR, GARTNER DR, ROBINSON WR. Changing trends in Black-White racial differences in surgical menopause: a population-based study. Am J Obstet Gynecol 2021; 225:502.e1-502.e13. [PMID: 34111405 PMCID: PMC9542172 DOI: 10.1016/j.ajog.2021.05.045] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 05/17/2021] [Accepted: 05/30/2021] [Indexed: 01/16/2023]
Abstract
BACKGROUND Bilateral oophorectomy before menopause, or surgical menopause, is associated with negative health outcomes, including an increased risk for stroke and other cardiovascular outcomes; however, surgical menopause also dramatically reduces ovarian cancer incidence and mortality rates. Because there are competing positive and negative sequelae associated with surgical menopause, clinical guidelines have not been definitive. Previous research indicates that White women have higher rates of surgical menopause than other racial groups. However, previous studies may have underestimated the rates of surgical menopause among Black women. Furthermore, clinical practice has changed dramatically in the past 15 years, and there are no population-based studies in which more recent data were used. Tracking actual racial differences among women with surgical menopause is important for ensuring equity in gynecologic care. OBJECTIVE This population-based surveillance study evaluated racial differences in the rates of surgical menopause in all inpatient and outpatient settings in a large, racially diverse US state with historically high rates of hysterectomy. STUDY DESIGN We evaluated all inpatient and outpatient surgeries in North Carolina from 2011 to 2014 for patients aged between 20 and 44 years. Surgical menopause was defined as a bilateral oophorectomy, with or without an accompanying hysterectomy, among North Carolina residents. International Classification of Diseases, Ninth Revision, and Current Procedural Terminology codes were used to identify inpatient and outpatient procedures, respectively, and diagnostic indications. We estimated age-, race-, and ethnicity-specific rates of surgical menopause using county-specific population estimates based on the 2010 United States census. We used Poisson regression with deviance-adjusted residuals to estimate the incidence rate ratios in the entire state population. We tested changes in surgery rates over time (reference year, 2011), differences by setting (reference, inpatient), and differences by race and ethnicity (reference, non-Hispanic White). We then described the surgery rates between non-Hispanic White and non-Hispanic Black patients. RESULTS Between 2011 and 2014, 11,502 surgical menopause procedures for benign indications were performed in North Carolina among reproductive-aged residents. Most (95%) of these surgeries occurred concomitant with a hysterectomy. Over the 4-year study period, there was a 39% reduction in inpatient surgeries (incidence rate ratio, 0.61) and a 100% increase in outpatient surgeries (incidence rate ratio, 2.0). Restricting the analysis to surgeries among non-Hispanic White and Black patients, the increase in outpatient surgeries was significantly higher among non-Hispanic Black women (P<.01) for year-race interaction (reference, 2011 and non-Hispanic White). The overall rates of bilateral oophorectomy for non-Hispanic Black women rose more quickly than for non-Hispanic White women (P<.01). In 2011, the rate of surgical menopause was greater among White women than among Black women (17.7 vs 13.2 per 10,000 women). By 2014, the racial trends were reversed (rate, 24.8 per 10,000 for non-Hispanic White women and 28.4 per 10,000 for non-Hispanic Black women). CONCLUSION Our findings suggest that the rates of surgical menopause increased in North Carolina in the early 2010s, especially among non-Hispanic Black women. By 2014, the rates of surgical menopause among non-Hispanic Black women had surpassed that of non-Hispanic White women. Given the long-term health consequences associated with surgical menopause, we propose potential drivers for the racially-patterned increases in the application of bilateral oophorectomy before the age of 45 years.
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Affiliation(s)
- Maya A. WRIGHT
- Department of Epidemiology, UNC Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina USA
| | - Kemi M. DOLL
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, Washington USA
| | - Evan MYERS
- Division of Reproductive Sciences, Department of Obstetrics & Gynecology, Duke University School of Medicine, Durham, North Carolina USA
| | - William R. CARPENTER
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina USA,Department of Health Policy and Management, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Danielle R. GARTNER
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, Michigan USA
| | - Whitney R. ROBINSON
- Department of Epidemiology, UNC Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina USA,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina USA,Carolina Population Center, University of North Carolina, Chapel Hill, North Carolina, USA
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Papakonstantinou E, Adonakis G. Management of pre-, peri-, and post-menopausal abnormal uterine bleeding: When to perform endometrial sampling? Int J Gynaecol Obstet 2021; 158:252-259. [PMID: 34669187 DOI: 10.1002/ijgo.13988] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 08/17/2021] [Accepted: 10/19/2021] [Indexed: 12/24/2022]
Abstract
Abnormal uterine bleeding (AUB) is defined as abnormal volume, duration, or frequency of menstrual period and is a common symptom in women of all ages (premenopausal, perimenopausal, and postmenopausal). The acronym PALM-COEIN, introduced by the International Federation of Gynecology and Obstetrics (FIGO), facilitates the evaluation and differential diagnosis of AUB, mostly in premenopausal women with AUB. Endometrial evaluation (including ultrasound or hysteroscopic imaging and tissue sampling) for subtle pathology is proposed in patients who are at high risk for endometrial cancer and in patients at low risk who present with AUB and who present poor correspondence in medical treatment. Many new diagnostic modalities are available in clinicians in order to help the assessment of women presenting with abnormalities in their menstrual pattern. The present study reviews the optimal management of women presenting with AUB, taking into consideration the actual need for invasive management in these women, who of them require it, and who can be diagnosed without histological verification. The importance of endometrial tissue sampling in women who present with AUB as well as the best timing for a clinician to conduct a biopsy are two axons analyzed below, according to the latest worldwide guidelines and major publications about this subject.
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Affiliation(s)
- Efthymia Papakonstantinou
- Department of Obstetrics-Gynecology, University Hospital, University of Patras School of Medicine, Patras, Greece
| | - Georgios Adonakis
- Department of Obstetrics-Gynecology, University Hospital, University of Patras School of Medicine, Patras, Greece
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Lu YS, Wong A, Kim HJ. Ovarian Function Suppression With Luteinizing Hormone-Releasing Hormone Agonists for the Treatment of Hormone Receptor-Positive Early Breast Cancer in Premenopausal Women. Front Oncol 2021; 11:700722. [PMID: 34595110 PMCID: PMC8477635 DOI: 10.3389/fonc.2021.700722] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 08/04/2021] [Indexed: 01/08/2023] Open
Abstract
Chemotherapy and endocrine therapies are mainstays of treatment for early and advanced hormone receptor-positive (HR+) breast cancer. In premenopausal women with HR+ tumors, the benefits of adding ovarian function suppression (OFS) to endocrine therapy have been debated. Consequently, for many years, tamoxifen monotherapy has been the standard of care for endocrine treatment in the adjuvant setting. Recent studies have, however, provided new evidence that, in some premenopausal patients, OFS in combination with tamoxifen or aromatase inhibitors (AIs) can significantly increase survival versus tamoxifen alone. Luteinizing hormone-releasing hormone agonists (LHRHa), including goserelin, triptorelin, and leuprorelin, achieve OFS through sustained suppression of the release of follicle-stimulating hormone and luteinizing hormone from the pituitary. In turn, this suppresses production and secretion of estradiol, an ovarian hormone that supports cancer cell growth, survival, and proliferation. In this review, we discuss the clinical evidence supporting the addition of LHRHa to adjuvant endocrine therapies, including tamoxifen and AIs, for premenopausal women with breast cancer. We also discuss the role of LHRHa use in combination with adjuvant chemotherapy to preserve ovarian function and fertility in young patients with breast cancer. Finally, we discuss important practical aspects of the use of LHRHa in breast cancer treatment, including side-effects, patient adherence to treatment, and the use of slow-release, long-acting drug formulations.
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Affiliation(s)
- Yen-Shen Lu
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
| | - Andrea Wong
- Department of Haematology-Oncology, Cancer Science Institute, National University of Singapore, Singapore, Singapore
| | - Hee-Jeong Kim
- Department of Surgery, College of Medicine, Asan Medical Center, Seoul, South Korea
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Abdullatif VA, Sur RL, Eshaghian E, Gaura KA, Goldman B, Panchatsharam PK, Williams NJ, Abbott JE. Efficacy of Probiotics as Prophylaxis for Urinary Tract Infections in Premenopausal Women: A Systematic Review and Meta-Analysis. Cureus 2021; 13:e18843. [PMID: 34671514 PMCID: PMC8523083 DOI: 10.7759/cureus.18843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2021] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Although antibiotic therapy has been the mainstay of prophylaxis and treatment of urinary tract infections (UTIs), antibacterial resistance has led to increased incidence of infections and healthcare spending in both community-acquired and nosocomial UTIs. This has led to an active exploration of alternative remedies for both the prophylaxis and treatment of UTIs, especially in women with recurrent urinary tract infections. Probiotic supplementation is one novel intervention that has been studied as a prophylactic measure in patients with UTIs. The current systematic review and meta-analysis was conducted to evaluate the efficacy of probiotics for prophylaxis in UTIs in premenopausal women. METHODS Detailed search strategies for each electronic database were developed for PubMed, EMBASE, and Scopus to identify relevant literature published between 2001-2021. RevMan 5.3 statistical software was used to analyze data in studies. The random-effects model was used for pooling the data. The risk of bias and study quality were assessed using Cochrane Collaboration's tool for assessing risk of bias in included studies. The scope of focus for this review was premenopausal adult women with a history of one or more UTI. The intervention consisted of a probiotic regimen for which the goal was to enhance the defensive microflora of the urogenital tract. Studies comparing a probiotic regimen to a placebo regimen were included. These studies' primary outcome was the proportion of women with at least one symptomatic bacterial UTI in each group (i.e., UTI recurrence rate) in the 12-month period following probiotic intervention. This study extends the work of researchers who systematically investigated the scientific literature on probiotics in the prevention of urinary tract infections with a particular focus on premenopausal women. RESULTS After screening, three parallel-group randomized-controlled trials (RCTs) were included. We estimated the overall pooled data of these three studies with a total of 284 participants to have met the predefined inclusion criteria and were therefore included in this review. The results demonstrated that probiotics did not have a significant effect in the prophylaxis of UTIs. (Risk Ratio (RR): 0.59 confidence interval (CI): 0.26, 1.33), Heterogeneity: Chi² = 6.63, df = 2 (p = 0.04); I² =70%, Test for overall effect: Z = 1.27 (p = 0.20). Conclusions: Probiotics did not demonstrate a significant benefit in reducing UTI recurrence compared to placebo in premenopausal women. However, more conclusive data is needed to determine the effect that probiotics have on strengthening the urogenital microbial barrier against pathogenic bacteria and protecting against UTI recurrence.
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Affiliation(s)
| | - Roger L Sur
- Urology, UC San Diego Health, San Diego, USA
| | - Eli Eshaghian
- Research, Western University of Health Sciences, Pomona, USA
| | - Kellie A Gaura
- Research, Western University of Health Sciences, Pomona, USA
| | | | | | | | - Joel E Abbott
- Urology, Pacific West Urology, Las Vegas, USA
- Research, Western University of Health Sciences, Pomona, USA
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Kim S, Seo H, Rahim MA, Tajdozian H, Kim YS, Song HY. Characteristics of Vaginal Microbiome in Women with Pelvic Inflammatory Disease in Korea. Pol J Microbiol 2021; 70:345-357. [PMID: 34584529 PMCID: PMC8458998 DOI: 10.33073/pjm-2021-033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/11/2021] [Accepted: 07/14/2021] [Indexed: 01/03/2023] Open
Abstract
Human vaginal microorganisms play an important role in maintaining good health throughout the human life cycle. An imbalance in the vaginal microbiota is associated with an increased risk of pelvic inflammatory disease (PID). This study aimed to characterize and compare vaginal microbial profiles of premenopausal Korean women with and without PID. 74 Korean premenopausal female vaginal samples were obtained; 33 were from healthy women (a control group) and 41 from PID patients. Vaginal fluid samples were collected from the vaginal wall and posterior cervix and then analyzed by 16S ribosomal ribonucleic acid (rRNA) gene-based amplicon sequencing. Results showed a significant difference between the vaginal microbial communities of the two groups (Jensen-Shannon, p = 0.014; Bray-Curtis, p = 0.009; Generalized UniFrac, p = 0.007; UniFrac, p = 0.008). Lactobacillus accounted for the highest percentage (61.0%) of the control group but was significantly decreased (34.9%) in PID patients; this was the most significant difference among all bacterial communities (p = 0.028, LDA effect size = 5.129). In addition, in the PID patient group, species diversity significantly increased (Simpson, p = 0.07) as the proportion of various pathogens increased evenly, resulting in a polymicrobial infection. Similarly, lactate, which constituted the highest percentage of the organic acids in the control group, was significantly decreased in the PID patient group (p = 0.04). The present study's findings will help understand PID from the microbiome perspective and are expected to contribute to the development of more efficient PID diagnosis and treatment modalities.
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Affiliation(s)
- Sukyung Kim
- Probiotics Microbiome Convergence Center, Soonchunhyang University, Asan, South Korea
| | - Hoonhee Seo
- Probiotics Microbiome Convergence Center, Soonchunhyang University, Asan, South Korea
| | - Md Abdur Rahim
- Department of Microbiology and Immunology, School of Medicine, Soonchunhyang University, Cheonan, South Korea
| | - Hanieh Tajdozian
- Department of Microbiology and Immunology, School of Medicine, Soonchunhyang University, Cheonan, South Korea
| | - Yun-Sook Kim
- Department of Obstetrics and Gynecology, Soonchunhyang University Cheonan Hospital, Cheonan, South Korea
| | - Ho-Yeon Song
- Probiotics Microbiome Convergence Center, Soonchunhyang University, Asan, South Korea.,Department of Microbiology and Immunology, School of Medicine, Soonchunhyang University, Cheonan, South Korea
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Alhallak I, Wolter KG, Munoz AC, Simmen FA, Ward RJ, Petty SA, Li LX, Simmen RC. Breast adipose regulation of premenopausal breast epithelial phenotype involves interleukin 10. J Mol Endocrinol 2021; 67:173-188. [PMID: 34382943 PMCID: PMC8489570 DOI: 10.1530/jme-21-0100] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 08/12/2021] [Indexed: 11/08/2022]
Abstract
Epidemiological studies inversely associate BMI with breast cancer risk in premenopausal women, but the pathophysiological linkage remains ill-defined. Despite the documented relevance of the 'local' environment to breast cancer progression and the well-accepted differences in transcriptome and metabolic properties of anatomically distinct fat depots, specific breast adipose contributions to the proliferative potential of non-diseased breast glandular compartment are not fully understood. To address early breast cancer causation in the context of obesity status, we compared the cellular and molecular phenotypes of breast adipose and matched breast glandular tissue from premenopausal non-obese (mean BMI = 27 kg/m2) and obese (mean BMI = 44 kg/m2) women. Breast adipose from obese women showed higher expression levels of adipogenic, pro-inflammatory, and estrogen synthetic genes than from non-obese women. Obese breast glandular tissue displayed lower proliferation and inflammatory status and higher expression of anti-proliferative/pro-senescence biomarkers TP53 and p21 than from non-obese women. Transcript levels for T-cell receptor and co-receptors CD3 and CD4 were higher in breast adipose of obese cohorts, coincident with elevated adipose interleukin 10 (IL10) and FOXP3 gene expression. In human breast epithelial cell lines MCF10A and HMEC, recombinant human IL10 reduced cell viability and CCND1 transcript levels, increased those of TP53 and p21, and promoted (MCF10A) apoptosis. Our findings suggest that breast adipose-associated IL10 may mediate paracrine interactions between non-diseased breast adipose and breast glandular compartments and highlight how breast adipose may program the local inflammatory milieu, partly by recruiting FOXP3+ T regulatory cells, to influence premenopausal breast cancer risk.
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Affiliation(s)
- Iad Alhallak
- Department of Physiology & Cell Biology, University of Arkansas for Medical Sciences, Little Rock, AR 72205
| | - Keith G. Wolter
- Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR 72205
| | - Ana Castro Munoz
- Department of Physiology & Cell Biology, University of Arkansas for Medical Sciences, Little Rock, AR 72205
| | - Frank A. Simmen
- Department of Physiology & Cell Biology, University of Arkansas for Medical Sciences, Little Rock, AR 72205
- Department of The Winthrop P Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR 72205
| | | | - Stacy A. Petty
- Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR 72205
| | - Lin-Xi Li
- Department of Microbiology & Immunology, University of Arkansas for Medical Sciences, Little Rock, AR 72205
| | - Rosalia C.M. Simmen
- Department of Physiology & Cell Biology, University of Arkansas for Medical Sciences, Little Rock, AR 72205
- Department of The Winthrop P Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR 72205
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Jha S, Ahmed N, Sinha HH. Safety and efficacy of two repeated cycles of ulipristal acetate in the management of symptomatic uterine fibroid among Indian women. Prz Menopauzalny 2021; 20:127-132. [PMID: 34703413 PMCID: PMC8525252 DOI: 10.5114/pm.2021.109509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 06/22/2021] [Indexed: 12/03/2022]
Abstract
INTRODUCTION To evaluate the safety and efficacy along with the impact on uterine and fibroid vascular indices of 2 repeat 12-week courses of ulipristal acetate (UPA) among Indian women. MATERIAL AND METHODS Ninety-four premenopausal women aged 18-45 years with at least 1 symptomatic fibroid of size ranging from 1 cm to 10 cm were included in the study. All participants received 2 courses of 5 mg of UPA orally for 12 weeks starting from the 5th day of their menstrual cycle with a 2-menstrual-cycle break in between. The efficacy was measured in terms of time to amenorrhoea, percentage of women who achieved amenorrhoea for the last 35 consecutive days, reduction in uterine and fibroid volume, as well as its vascularity at the end of the first and second treatment cycle. RESULTS Eighty-six women completed the first treatment cycle whereas only 65 women completed the second treatment course. Seventy-nine per cent of women achieved amenorrhoea for 35 consecutive days during the first treatment cycle. Median time to amenorrhoea was 7 days and 5 days during the first and second treatment cycle, respectively. Percentage reduction of the mean fibroid volume was 32% and 52% after the first and second treatment cycle, respectively. We observed an increase in fibroid vascular indices (pulsatility index and resistive index) suggesting reduction in fibroid vascularity. Serum oestradiol remained at mid-follicular phase. No serious drug emergent side effect was noted. CONCLUSIONS Two interrupted repeat course of 5mg UPA is well tolerated efficient and safe in symptomatic fibroid among Indian women.
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Affiliation(s)
- Sangam Jha
- All India Institute of Medical Sciences, Patna, India
| | - Naaz Ahmed
- All India Institute of Medical Sciences, Patna, India
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Ni H, Kumbrink J, Mayr D, Seiler A, Hagemann F, Degenhardt T, Sagebiel S, Würstlein R, Kates R, Harbeck N, Eggersmann TK. Molecular Prognostic Factors for Distant Metastases in Premenopausal Patients with HR+/HER2- Early Breast Cancer. J Pers Med 2021; 11:835. [PMID: 34575612 DOI: 10.3390/jpm11090835] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 08/17/2021] [Accepted: 08/20/2021] [Indexed: 12/15/2022] Open
Abstract
Molecular factors that drive metastasis in premenopausal patients with hormone receptor positive (HR+), human epidermal growth factor receptor 2 negative (HER2−), early breast cancer (EBC) are largely unknown. To identify markers/signatures contributing to metastasis, we analyzed molecular changes in tumors from premenopausal patients who developed metastasis (M1) and who did not (M0). Ninety-seven premenopausal patients with HR+/HER2− EBC were included (M1, n = 48, median distant metastasis-free survival (DMFS): 54 (7–184) months; M0, n = 49, median follow-up: 149 (121–191) months). Gene expression profiling on tumor RNA (Breast Cancer 360TM panel, Nanostring) was performed, followed by comprehensive bioinformatic and statistical analyses. Significantly enhanced ROR (risk of recurrence) scores and reduced signature scores of PGR (progesterone receptor), claudin-low, and mammary stemness were determined in M1. These differences were significantly associated with shorter DMFS in univariate survival analyses. Gene set enrichment analysis showed an enriched mTORC1 pathway in M1. Moreover, a metastasis signature of 19 differentially expressed genes (DEGs) that were DMFS-related was defined. Multivariate analysis including the four signatures, 19 DEGs, pN, and pT status, identified LRP2, IBSP, and SCUBE2 as independent prognostic factors. We identified prognostic gene signatures and single-gene markers for distant metastasis in premenopausal HR+/HER2− EBC potentially applicable in future clinical practice.
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Vong S, Ronco AJ, Najafpour E, Aminololama-Shakeri S. Screening Breast MRI and the Science of Premenopausal Background Parenchymal Enhancement. J Breast Imaging 2021; 3:407-415. [PMID: 38424792 DOI: 10.1093/jbi/wbab045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Indexed: 03/02/2024]
Abstract
The significance of background parenchymal enhancement (BPE) on screening and diagnostic breast MRI continues to be elucidated. Background parenchymal enhancement was initially deemed probably benign and followed or thought of as an artifact degrading the accuracy of breast cancer detection on breast MRI examinations. Subsequent research has focused on understanding the role of BPE regarding screening breast MRI. Today, there is growing evidence that a myriad of factors affect BPE, which in turn may influence patient outcomes. Additionally, BPE could represent an important risk factor for the future development of breast cancer. This article aims to describe the most up-to-date research on BPE as it relates to screening breast MRI in premenopausal women.
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Affiliation(s)
- Stephen Vong
- University of California Davis, Department of Radiology, Sacramento, CA, USA
| | - Anthony J Ronco
- University of California Davis, Department of Radiology, Sacramento, CA, USA
| | - Elham Najafpour
- University of California Davis, Department of Radiology, Sacramento, CA, USA
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Geleta D, Kebede A, Bulcha G, Usman H, Hajibediru K, Kebede S, Dubale S, Degu G. Prevalence and Predictors of Contraceptive Use Among Women of Premenopausal Period in Ethiopia: A Retrospective Cross-Sectional Data Analysis. Open Access J Contracept 2021; 12:149-156. [PMID: 34349572 PMCID: PMC8326935 DOI: 10.2147/oajc.s318486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 07/13/2021] [Indexed: 11/23/2022] Open
Abstract
Background Contraceptive use is internationally endorsed as a human right and an indicator of the highest standard of sexual and reproductive health life. But reports from countries including Ethiopia showed a lower and capricious rate due to wider factors. Thus, the current study aimed to determine the prevalence and the predictors of contraceptive use among women of the premenopausal period. Methods A retrospective cross-sectional data analysis was performed from Ethiopian Demographic and Health survey 2019 in January 2021. A total of 3260 premenopausal women were included by stratified sampling, and data were analyzed using SPSS version 25 software. Data were initially analyzed descriptively, and tests were done for variable multicollinearity, and model goodness of fit and predictive capacity. Subsequently, bivariate and multivariable logistic regression analyses were performed successively for the crude and adjusted odds ratio, and finally declared variables with a p-value of <0.05 as predictors of contraceptive use. Results The study included 3260 women with an average age of 41.66 (standard deviation ±3.9) years. The overall prevalence of contraceptive use was reported 17% and explained to vary by women’s age, place of residence, education level, wealth index, and current working statuses. However, only the age, education, and wealth index of women have predicted a statistical significance with contraceptive use. Accordingly, an increase in women’s age was found to increase contraceptive use more likely by 89% [AOR=0.89 (95% CI: 0.87, 0.92)]. Similarly, primary [AOR = 1.53, (95% CI: 1.20, 195)], secondary [AOR = 2.57, (95% CI: 1.70)] or higher [AOR = 2.64, (95% CI: 1.67, 4.20)] level educated women were about twice more likely to use contraceptive methods than uneducated women. Finally, women in poorer [AOR = 3.11 (95% CI: 2.17, 4.46)], middle [AOR = 3.03 (95% CI: 2.09, 4, 37)], rich [AOR = 3.70, (95% CI: 2.58, 5.31)] or richest [AOR = 3.42, (95% CI: 2.39, 4, 88)] wealth index were more than 3 times more likely use contraceptive methods when compared to women of the poorest wealth index. Conclusion The prevalence of contraceptive use among premenopausal women in Ethiopia is low and utmost related to age, education level, and wealth index of women.
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Affiliation(s)
- Daniel Geleta
- Tropical & Infectious Diseases, Jimma University, Jimma, Oromia, Ethiopia
| | - Abebe Kebede
- Pharmaceutical science, Jimma University, Jimma, Oromia, Ethiopia
| | - Gebeyehu Bulcha
- Health Communication and Health Behavior, Jimma University, Oromia, Ethiopia
| | - Hyder Usman
- Pharmaceutical science, Jimma University, Jimma, Oromia, Ethiopia
| | | | - Selass Kebede
- Pharmaceutical science, Jimma University, Jimma, Oromia, Ethiopia
| | - Sileshi Dubale
- Pharmaceutical science, Jimma University, Jimma, Oromia, Ethiopia
| | - Getu Degu
- Epidemiology and Biostatistics, Bahir Dar University, Bahir Dar, Amhara, Ethiopia
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Atakpa EC, Brentnall AR, Astley S, Cuzick J, Evans DG, Warren RML, Howell A, Harvie M. The Relationship between Body Mass Index and Mammographic Density during a Premenopausal Weight Loss Intervention Study. Cancers (Basel) 2021; 13:3245. [PMID: 34209579 DOI: 10.3390/cancers13133245] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 06/17/2021] [Accepted: 06/18/2021] [Indexed: 11/17/2022] Open
Abstract
We evaluated the association between short-term change in body mass index (BMI) and breast density during a 1 year weight-loss intervention (Manchester, UK). We included 65 premenopausal women (35-45 years, ≥7 kg adult weight gain, family history of breast cancer). BMI and breast density (semi-automated area-based, automated volume-based) were measured at baseline, 1 year, and 2 years after study entry (1 year post intervention). Cross-sectional (between-women) and short-term change (within-women) associations between BMI and breast density were measured using repeated-measures correlation coefficients and multivariable linear mixed models. BMI was positively correlated with dense volume between-women (r = 0.41, 95%CI: 0.17, 0.61), but less so within-women (r = 0.08, 95%CI: -0.16, 0.28). There was little association with dense area (between-women r = -0.12, 95%CI: -0.38, 0.16; within-women r = 0.01, 95%CI: -0.24, 0.25). BMI and breast fat were positively correlated (volume: between r = 0.77, 95%CI: 0.69, 0.84, within r = 0.58, 95%CI: 0.36, 0.75; area: between r = 0.74, 95%CI: 0.63, 0.82, within r = 0.45, 95%CI: 0.23, 0.63). Multivariable models reported similar associations. Exploratory analysis suggested associations between BMI gain from 20 years and density measures (standard deviation change per +5 kg/m2 BMI: dense area: +0.61 (95%CI: 0.12, 1.09); fat volume: -0.31 (95%CI: -0.62, 0.00)). Short-term BMI change is likely to be positively associated with breast fat, but we found little association with dense tissue, although power was limited by small sample size.
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Choudhary M, Maximous M, Yang SJT, Chock B. Effect of Bisphosphonates on Fracture Incidence in Young Adults With Low Bone Density. Endocr Pract 2021; 27:977-982. [PMID: 34144211 DOI: 10.1016/j.eprac.2021.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 06/07/2021] [Accepted: 06/09/2021] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To assess the effect of bisphosphonates on fracture incidence in young adults over a 5-year follow-up period. METHODS Based on the Kaiser Permanente electronic health record, this retrospective study investigated patients aged 19 to 40 years with abnormal bone density (either any Z-score of ≤-2 standard deviation [SD] or any T-score of ≤-2.5 SD). The incidence and time to fracture between the control (patients with <6 months of bisphosphonate exposure) and treatment (patients with ≥6 months of bisphosphonate use within 4 years of their first dual energy x-ray absorptiometry scan) groups were compared. Comparisons were analyzed with Χ2 test for categorical variables and Wilcoxon rank sum test for continuous variables. RESULTS A total of 422 patients met the inclusion and exclusion criteria. Fractures occurred in 18 patients (5.0%) of the control group (n = 358) and 5 patients (7.8%) of the treatment group (n = 64; P = .37). T-scores were significantly lower in the treatment group (-2.53 ± 0.58 SD) than those in the control group (-2.30 ± 0.80 SD; P = .002) but did not correlate with fracture risk. No significant differences were found in total fracture incidence (hazard ratio = 1.54; 95% confidence interval, 0.26-6.26). Similarly, no correlation was noted between the length of bisphosphonate therapy and fracture incidence (odds ratio = 0.99; 95% confidence interval, 0.966-1.026). CONCLUSION In summary, we did not find a clear correlation of fracture incidence with the use of bisphosphonates in young adults. Further research into the pathophysiology, specific etiologies, and treatment options in this population is needed.
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Affiliation(s)
- Manita Choudhary
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Mina Maximous
- Department of Endocrinology, Kaiser Permanente San Bernardino County Service Area, San Bernardino, California
| | - Su-Jau T Yang
- Department of Research and Evaluation, Kaiser Permanente Pasadena, Pasadena, California
| | - Brandon Chock
- Department of Endocrinology, Kaiser Permanente San Bernardino County Service Area, San Bernardino, California.
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Wu ZY, Lee YJ, Kim H, Lee J, Chung IY, Kim J, Lee S, Son BH, Kim SB, Jeong JH, Gong G, Ahn SH, Ko B. Effectiveness of a 6-Month 22.5-mg Leuprolide Acetate Depot Formulation With Tamoxifen for Postoperative Premenopausal Estrogen Suppression in Hormone Receptor-Positive Breast Cancer. Front Oncol 2021; 11:665426. [PMID: 33996592 PMCID: PMC8113853 DOI: 10.3389/fonc.2021.665426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 03/30/2021] [Indexed: 11/15/2022] Open
Abstract
Background In patients with hormone receptor-positive (HR+)/premenopausal breast cancer, luteinizing hormone-releasing hormone analogs (LHRHas) are used as standard endocrine treatment. Based on previous clinical studies, 1-month formulations are recommended in most breast cancer treatment guidelines, but long-acting formulations facilitate reductions in side effects and patient discomfort caused by frequent administration. However, few efficacy studies have been conducted on 6-month formulations. Therefore, this study aimed to evaluate the efficacy of 6-month formulations of LHRHas. Methods This retrospective study was conducted from January 2018 to December 2019 and involved premenopausal patients with HR+ breast cancer administered 6-month LHRHas as adjuvant treatment after surgery, and those previously administered chemotherapy or other LHRHa types were excluded. Patients’ estradiol (E2) and follicle-stimulating hormone (FSH) levels were measured before surgery, and their E2 levels were also measured at 3, 6, 12, 18, and 24 months at periodic postsurgical examinations. Results A total of 228 patients were included, and the median patient age was 44 (range, 25–54) years. The mean serum E2 and FSH levels before surgery were 69.7 (range, 4–683) pg/mL and 7.3 (range, 0.4–88.9) mIU/mL, respectively, whereas the mean serum E2 level monitored at intervals during the 6-month LHRHa administration was 5.5 (range, 4.0–52) pg/mL. No women menstruated during the follow-up period after the LHRHas administration, and the E2 levels were less than 30 pg/mL in all patients except one. Conclusions The 6-month LHRHa formulation adequately suppressed ovarian function in premenopausal patients with HR+ breast cancer. This indicates that long-acting LHRHas can be effectively used for patient convenience and that there is high compliance with long-term use.
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Affiliation(s)
- Zhen-Yu Wu
- Department of Breast Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Young-Jin Lee
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Heejeong Kim
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jongwon Lee
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Il Yong Chung
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jisun Kim
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Saebyeol Lee
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Byung-Ho Son
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Sung-Bae Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jae Ho Jeong
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Gyungyub Gong
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Sei-Hyun Ahn
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - BeomSeok Ko
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Odhaib SA, Mohammed MJ, Hammadi SS. Do Gastrointestinal Symptoms Affect the Endoscopic Outcome in Anemic Premenopausal Women Due to Iron Deficiency: A Multicenter Study From Basrah-Iraq. Cureus 2021; 13:e14524. [PMID: 34007772 PMCID: PMC8121207 DOI: 10.7759/cureus.14524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The most common cause for iron deficiency anemia (IDA) in women before menopause is menstrual blood loss. The persistence of digestive symptoms despite iron supplementation is the only indication for gastrointestinal (GI) endoscopy in premenopausal women (PW) with IDA. We evaluated how the GI symptomatology manifestation affects the GI endoscopy diagnostic outcome in this cohort. MATERIALS AND METHODS This is an observational, multicenter retrospective evaluation of 245 PW admitted for GI endoscopic diagnosis for the etiology of IDA from 2006 to 2016. Baseline measurements included hemoglobin, iron status tests, and red blood corpuscle morphological evaluation. We evaluated the relationships of different endoscopic findings to the severity of IDA, different demographic characteristics, and hospitalization duration. RESULTS The mean age was 40±7 years. The duration of hospitalization was neither associated with age nor the IDA severity. The IDA was mild to moderate. More than 53% (n=131) had either a negative study or nonspecific inflammatory changes. Around 16% (n=39) had GI malignancies. There was a significant association between initial GI symptoms with endoscopic GI finding and GI malignancy diagnosis in particular. The relationship loses its power during further assessment by general univariate analysis. CONCLUSION A considerable percentage of anemic PW due to iron deficiency has an endoscopically-diagnosed pathology for IDA determined during GI endoscopy. The GI symptoms' phenotypes were unrelated to the endoscopically-diagnosed GI lesion location, even if they were malignant. Therefore, the determination of IDA severity must be thoroughly and individually determined.
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Affiliation(s)
- Samih A Odhaib
- Adult Endocrinology, Faiha Specialized Diabetes, Endocrine and Metabolism Center (FDEMC) College of Medicine, University of Basrah, Basrah, IRQ
| | - Miaad J Mohammed
- Diagnostic Radiology, Al-Refaee General Hospital, Thi-Qar Health Directorate, Thi-Qar, IRQ
| | - Saad S Hammadi
- Internal Medicine, College of Medicine, University of Basrah, Basrah, IRQ
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Dottino JA, Zhang Q, Loose DS, Fellman B, Melendez BD, Borthwick MS, McKenzie LJ, Yuan Y, Yang RK, Broaddus RR, Lu KH, Soliman PT, Yates MS. Endometrial biomarkers in premenopausal women with obesity: an at-risk cohort. Am J Obstet Gynecol 2021; 224:278.e1-278.e14. [PMID: 32835719 DOI: 10.1016/j.ajog.2020.08.053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 08/12/2020] [Accepted: 08/19/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Obesity is a well-known risk factor for endometrial cancer, but the mechanisms of obesity-related carcinogenesis are not well defined, particularly for premenopausal women. With the continuing obesity epidemic, increases in the incidence of endometrial cancer and a younger age of diagnosis are often attributed to a hyperestrogenic state created by hormone production in adipose tissue, but significant knowledge gaps remain. The balance of estrogen-responsive signals has not been defined in the endometrium of premenopausal women with obesity, where obesity may not create hyperestrogenism in the context of ovaries being the primary source of estrogen production. Obesity is associated with a state of low-grade, chronic inflammation that can promote tumorigenesis, and it is also known that hormonal changes alter the immune microenvironment of the endometrium. However, limited research has been conducted on endometrial immune-response changes in women who have an increased risk for cancer due to obesity. OBJECTIVE Endometrial estrogen-regulated biomarkers, previously shown to be dysregulated in endometrial cancer, were evaluated in a cohort of premenopausal women to determine if obesity is associated with differences in the biomarker expression levels, which might reflect an altered risk of developing cancer. The expression of a multiplexed panel of immune-related genes was also evaluated for expression differences related to obesity. STUDY DESIGN Premenopausal women with a body mass index of ≥30 kg/m2 (n=97) or a body mass index of ≤25 kg/m2 (n=33) were prospectively enrolled in this cross-sectional study, which included the assessment of serum metabolic markers and a timed endometrial biopsy for pathologic evaluation, hormone-regulated biomarker analysis, and immune response gene expression analysis. Medical and gynecologic histories were obtained. Endometrial gene expression markers were also compared across the body mass index groups in a previous cohort of premenopausal women with an inherited cancer risk (Lynch syndrome). RESULTS In addition to known systemic metabolic differences, histologically normal endometria from women with obesity showed a decrease in gene expression of progesterone receptor (P=.0027) and the estrogen-induced genes retinaldehyde dehydrogenase 2 (P=.008), insulin-like growth factor 1 (P=.016), and survivin (P=.042) when compared with women without obesity. The endometrial biomarkers insulin-like growth factor 1, survivin, and progesterone receptor remained statistically significant in multivariate linear regression models. In contrast, women with obesity and Lynch syndrome had an increased expression of insulin-like growth factor 1 (P=.017). There were no differences in endometrial proliferation, and limited endometrial immune differences were observed. CONCLUSION When comparing premenopausal women with and without obesity in the absence of endometrial pathology or an inherited cancer risk, the expression of the endometrial biomarkers does not reflect a local hyperestrogenic environment, but it instead reflects a decreased cancer risk profile that may be indicative of a compensated state. In describing premenopausal endometrial cancer risk, it may be insufficient to attribute a high-risk state to obesity alone; further studies are warranted to evaluate individualized biomarker profiles for differences in the hormone-responsive signals or immune response. In patients with Lynch syndrome, the endometrial biomarker profile suggests that obesity further increases the risk of developing cancer.
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Koochaki P, Revicki D, Wilson H, Pokrzywinski R, Jordan R, Lucas J, Williams LA, Sadiq A, Krop J. The Patient Experience of Premenopausal Women Treated with Bremelanotide for Hypoactive Sexual Desire Disorder: RECONNECT Exit Study Results. J Womens Health (Larchmt) 2021; 30:587-595. [PMID: 33538638 DOI: 10.1089/jwh.2020.8460] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Hypoactive sexual desire disorder (HSDD) has a significant negative impact on women's overall health and relationships with their partners. Primary analyses from the RECONNECT clinical trials demonstrated statistically significant and clinically meaningful improvements in sexual desire and related distress with bremelanotide relative to placebo in premenopausal women with HSDD. Exit surveys and patient interviews were conducted to evaluate the impact of HSDD and bremelanotide treatment from the patient's perspective. Materials and Methods: Upon completion of the double-blind study but before participation in the open-label extension, up to 250 participants were recruited to complete the quantitative exit survey (17 questions). A subset of up to 90 patients was invited to participate in the telephone interview (17 questions). Patients who volunteered to participate remained blinded to study drug until the survey and interviews were completed. Results: Quantitative exit surveys were completed by 242 RECONNECT participants; 80 of these women also completed qualitative telephone exit interviews. Participants who received bremelanotide described increased feelings of sexual desire, physical arousal, and improvements in overall quality of their sexual activities in their partner relationship. In comparison, women taking placebo reported benefits that did not include the physiological responses described by women receiving bremelanotide, such as positive experiences of seeking HSDD treatment and improved communication with their partner. Conclusions: Exit surveys and patient interviews support the primary findings from RECONNECT and provide quantitative and qualitative assessments of the impact of HSDD on patients' quality of life and the patients' perspectives on the impact of bremelanotide. Clinical trial numbers NCT02333071, NCT02338960.
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Affiliation(s)
| | | | | | | | - Robert Jordan
- Palatin Technologies, Inc., Cranbury, New Jersey, USA
| | - Johna Lucas
- Palatin Technologies, Inc., Cranbury, New Jersey, USA
| | | | - Amama Sadiq
- AMAG Pharmaceuticals, Inc., Waltham, Massachusetts, USA
| | - Julie Krop
- AMAG Pharmaceuticals, Inc., Waltham, Massachusetts, USA
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