Breast cancer and oral contraceptive use

The risk of breast cancer in relation to oral contraceptive use was evaluated in a case-control study of 1191 patients with breast cancer and 5026 control patients. For ever-use compared with never-use, the estimated relative risk of breast cancer was 1.0 (95% confidence interval 0.9-1.2). Use of oral contraceptives for five or more years was not associated with breast cancer, regardless of whether use had ended as much as 10 or more years previously, or more recently. Within categories of women whose baseline risk was elevated, including nulligravidae, premenopausal women, and those with benign breast disease or history of breast cancer in first-degree relatives, the relative risk estimates for five or more years of oral contraceptive use approximated 1.0. For any use before first pregnancy, the relative risk estimate was 1.3, and for use lasting three or more years it was 0.9. These data suggest that long-term oral contraceptive use does not increase the risk of breast cancer even after a latent interval in excess of one decade; nor do oral contraceptives appear to increase the risk within categories of women at relatively high baseline risk.     

Ovarian morphology during and after lynestrenol treatment around menopause

In this histological study, the inhibition of a continuous oral administration of lynestrenol 5 mg/day on the ovarian follicle and corpus luteum development was found to be extremely pronounced. Known estrogen — producing structures such as antral, mature follicles and corpora lutea were completely absent during treatment. Structures devoid of cystic function however, as persistent and cystic follicles and follicular cysts, seemed not to be influenced in their histological appearance and frequency. As the recovery of the cyclic ovarian function after cessation of the medication compares favorably with the spontaneous cycle, a continuous lynestrenol treatment of 5 mg/day can be regarded as a safe endocrinological regimen.     

What perimenopausal women think about using hormones during menopause

The purpose of this study was to improve our understanding of women's thoughts about taking hormones during menopause. Analysis of the responses of 61 perimenopausal women resulted in the identification of four categories of factors influencing women's opinions about taking hormones: perceptions of need, perceptions of risk, beliefs and values, and knowledge and information. Women used multiple cognitive processes in forming opinions about taking hormones, and the presence of conflicting factors contributed to their uncertainty. Women's references to interactions with their doctors indicated they preferred to take one of three roles in the decision making process: accepting advice, deciding together, or taking control. These findings indicate that women's decisions about hormone use take place in an arena broader and more complex than heretofore acknowledged in some studies.     

Breast cancer and oral contraceptive use in Asian-American women.

Breast cancer incidence has historically been 4-7 times higher in the United States than in Asia. A previous study by the authors in Asian-American women demonstrated a substantial increase in breast cancer risk in women who migrated from Asia to the United States, with the risk almost doubling during the first decade after migration. Increased use of oral contraceptives soon after migration to the United States could possibly explain this rapid rise in risk. In a population-based case-control study of Chinese, Filipino, and Japanese-American women, aged 20-55 years, who lived in San Francisco-Oakland, California; Los Angeles, California; and Oahu, Hawaii during 1983-1987, 597 cases (70% of those eligible) and 966 controls (75%) were interviewed. Controls were matched to cases on age, ethnicity, and area of residence. Oral contraceptive (OC) use increased with time since migration; 15.0% of Asian-born women who had been in the West <8 years, 33.4% of Asian-born women who had been in the West > or =8 years, and 49.6% of Asian women born in the West had ever used OCs. However, duration of OC use (adjusted for age, ethnicity, study area, years since migration, education, family history of breast cancer and age at first full-term birth) was not associated with increased risk of breast cancer. Moreover, neither OC use before age 25 years nor before first full-term birth was associated with increased risk. Results were unchanged when restricted to women under age 45 years or under age 40 years. After adjustment for duration of OC use, women who had been in the United States > or =8 years were still at almost twice the risk of breast cancer compared with women who had been in the United States 2-7 years. This study suggests that OC use cannot explain the elevated risk observed in Asian women who migrated to the United States > or =7 years ago.     

Breast cancer mortality and the change in fertility risk factors at menopause: a prospective study of 800,000 married Norwegian women

I examined breast cancer mortality in relation to fertility factors in a cohort of 800,814 married Norwegian women aged 25-74 years at the start of follow-up. Women aged 25-44 years with a first birth after the age of 35 years had a RR = 2.58 compared with women with a first birth before the age of 20 years. For women aged 45-74 years, the corresponding RR was 1.35. On the other hand, the rate differences between women with a late first birth (35+ years) and an early birth (less than 20 years) were similar for women of different ages. Small rate differences were found for premenopausal women between uniparous women and women with 6-7 children, but postmenopausal women with many children had lower rates of breast cancer mortality than uniparous women. For postmenopausal women the rate differences were stable over age categories. This study points toward a change in fertility risk factors at menopause.     

绝经前后妇女子宫内膜癌209例临床病理分析

目的:探讨绝经前后妇女子宫内膜癌的临床病理特征.方法:将209例患者按是否绝经分为两组即绝经前组和绝经后组,绝经前组69例.绝经后组140例.对照分析两组患者的临床病理特征.结果:绝经前组与绝经后组比较,特殊病理类型少(分别占4.35%和17.14%),病理分级低(G2 G3分别占26.09%和54.29%),深肌层浸润少(大于1/2层分别占18.84和41.42%),雌二醇(E<,2>)水平高(分别占66.67%和27.14%),盆腔淋巴结转移率低(分别占11.59%和24.29%).上述各项差异均有统计学意义(P<0.05,P<0.01).绝经前组漏诊、误诊率高(占14.49%).结论:子宫内膜癌预后与临床病理特征密切相关,绝经前患者出现月经紊乱、经量增多、雌激素水平持续增高应警惕子宫内膜癌的可能,对高度可疑者应多次刮宫、全面刮宫,刮取组织全部送检.     

Breast cancer before age 45 and oral contraceptive use: new findings

The relation between the risk of breast cancer before 45 years of age and oral contraceptive use was examined in a case-control study conducted in New York, Philadelphia, Baltimore, and Boston from 1983 to 1986 of 407 patients with breast cancer and 424 controls. With allowance for confounding, for ever use, the multivariate relative risk estimate was 2.0 (95% confidence interval (CI), 1.4-2.9). For less than 10 years of use, the estimate approximated 2.0 in all categories of duration, including less than three months; for 10 or more years of use it was 4.1 (95% CI, 1.8-9.3). The association was apparent in virtually all subgroups examined, including younger and older women, and women at low and high underlying risk of breast cancer. Contrary to some previous reports, the association was not stronger for use before a first term pregnancy or at an early age. The results suggest that oral contraceptive users, particularly those with very long durations of use, may be at increased risk of breast cancer. However, information bias, particularly for short-term use, could not be ruled out. There may also have been selection bias if oral contraceptive users were under more intensive medical surveillance. It has not been possible to reconcile the findings of the various studies to date, including the authors' earlier results showing no association. The latter results were derived from data collected using methods almost identical to those used in the present study.     

下丘脑-垂体激素与卵巢癌

卵巢癌在发现时多属晚期,多药耐药和药物副反应又使治疗受限,导致生存率难以提高.虽然下丘脑-垂体激素是卵巢功能的主要调节者,但是这些激素在卵巢癌中具有特异的分布模式以及特殊的信号转导网络,这将为卵巢癌的病因研究和治疗研究提供突破口和新思路.     

Peptide hormones and lung cancer

Several peptide hormones have been identified which alter the proliferation of lung cancer. Small cell lung cancer (SCLC), which is a neuroendocrine cancer, produces and secretes gastrin releasing peptide (GRP), neurotensin (NT) and adrenomedullin (AM) as autocrine growth factors. GRP, NT and AM bind to G-protein coupled receptors causing phosphatidylinositol turnover or elevated cAMP in SCLC cells. Addition of GRP, NT or AM to SCLC cells causes altered expression of nuclear oncogenes, such as c-fos, and stimulation of growth. Antagonists have been developed for GRP, NT and AM receptors which function as cytostatic agents and inhibit SCLC growth. Growth factor antagonists, such as the NT1 receptor antagonist SR48692, facilitate the ability of chemotherapeutic drugs to kill lung cancer cells. It remains to be determined if GRP, NT and AM receptors will served as molecular targets, for development of new therapies for the treatment of SCLC patients. Non-small cell lung cancer (NSCLC) cells also have a high density of GRP, NT, AM and epidermal growth factor (EGF) receptors. Several NSCLC patients with EGF receptor mutations respond to gefitinib, a tyrosine kinase inhibitor. Gefitinib relieves NSCLC symptoms, maintaining stable disease in patients who are not eligible for systemic chemotherapy. It is important to develop new therapeutic approaches using translational research techniques for the treatment of lung cancer patients.     

Habitual dietary calcium intake and blood pressure change around the menopause: a longitudinal study.

In a 10-year follow-up study, blood pressure and dietary intake were measured annually in 167 healthy perimenopausal normotensive women. Their initial ages ranged between 49 and 56 years and habitual calcium intake between 560 and 2580 mg/day (mean 1110 mg/day); they lived in the mixed rural/industrial community of Ede, the Netherlands. The longitudinal design provided an opportunity to study the 'natural history' of blood pressure and the effect of dietary calcium during and after the period of ovarian failure. For data analysis, person-time experience was divided into three menopausal periods. Based on years relative to menopause three menopausal cohorts were created starting 2 years before, 2 years after and 6 years after menopause, each was followed for 4 years. Changes in systolic (SBP) and diastolic blood pressure (DBP) during the menopausal periods were adjusted for change in body mass index and other relevant variables in multiple regression analysis. An average decline in SBP of 6 mm Hg was observed in the period of 2 years before menopause to 6 years after menopause, and an increase of almost 5 mm Hg in the period between 6 and 10 years after menopause. A significant change in DBP was not observed. Neither changes in, nor the absolute level of, calcium intake showed any relevant association with blood pressure change. Ovarian failure seems to reverse temporarily the increase in blood pressure due to aging. The results do not suggest that a habitual calcium intake exceeding 800-1000 mg/day (the current Recommended Daily Allowance for adults) is effective in preventing hypertension during the peri- and postmenopausal period.     

Breast cancer and the consumption of coffee

The hypothesis has been raised that coffee consumption may increase the incidence of breast cancer, based on the report that fibrocystic breast disease, a risk factor for breast cancer, regresses after abstention from coffee and other methylxanthines. The relation between recent coffee consumption and the risk of breast cancer was evaluated in a case-control study, based on interviews conducted 1975-1982 at several mainly eastern US teaching and community hospitals. The responses of 2,651 women with newly diagnosed breast cancer were compared with those of 1,501 controls with nonmalignant conditions and 385 controls with cancers at other sites. The relative risk estimates for levels of coffee drinking up to seven or more cups daily, relative to none, approximated 1.0 with narrow 95% confidence intervals. After allowance for confounding, the relative risk estimate for drinking at least five cups a day was 1.2 (95% confidence interval, 0.9-1.6) using the noncancer controls and 1.1 (0.7-1.6) using the cancer controls. Coffee consumption was not associated with an increase in the risk of breast cancer among women with a history of fibrocystic breast disease, nor were tea or decaffeinated coffee associated with an increase in the risk of breast cancer. The results suggest that the recent consumption of coffee does not influence the incidence of breast cancer.