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Query: UMLS:C0011849 (diabetes)
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205 patients with endometrial carcinoma, excluding carcinoma in situ, were seen in 1 private practice between 1947-1976. A control for each case was chosen from patients who had had a hysterectomy for a benign condition. Average age of patients with cancer was 56.5 years and parity 1.5. The cancer patients weighed significantly more than controls. A history of diabetes was recorded for 8 study patients, and 1 control. Of the 205 cancer patients, 55, and of the control patients, 31, had used some form of estrogen-containing medication. The relative risk (RR) for all users of systemic estrogens was 2.6. Most had used conjugated estrogens giving an RR of 3.1 for this form of the drug. There was no increased risk associated with vaginal estrogenic preparations or oral contraceptives. The RR increased with increasing duration of use, with no appreciable increase in the risk for those using the medication for less than 5 years. Those using these drugs for 5-9 years had a risk 11.5 times that of nonusers. Those using the 1.25 mg tablet had a risk markedly above that for users of the .3 or .625 mg tablets. The study group had more frequent histories of abnormal uterine bleeding than the control group. The lifetime risk of developing endometrial cancer is estimated as 2.2% for whites and 1.1% for blacks. A 70.9% 5-year survival rate and a 55.8% 10-year survival rate have been recorded. With early diagnosis, the cure rate may approach 95%. Many of the symptoms of women in the manopause may be alleviated by estrogenic therapy. Many of these women will have had a hysterectomy and no longer be at risk of endometrial cancer. Therefore, such therapy seems justified.
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PMID:Estrogens and endometrial carcinoma. 19 72

A review of the literature concerning the relationship between menopausal estrogen treatment and endometrial carcinoma is presented. Results from animal studies indicate that estrogens may work in conjunction with carcinogenic substances to stimulate proliferation of cancerous growths. Since estrone is produced by fatty tissue, obesity and certain correlated diseases, such as hypertension or diabetes, may be predisposing factors to developing endometrial cancer. Other risk factors are a hereditary predisposition and age. Several American epidemiologica studies showed an increased risk of developing endometrial cancer among women who undergo hormone treatments during menopause. It must be remembered, however, that such studies cannot establish causal relationships. Also, in the American studies, several biases complicate evaluation of the data, e.g. a disregard for social factors, the uncertainty of the state of the endometrium before the beginning of the study, and the inclusion of the problematic "stage 0" into the study. Furthermore, in America there is a tendency to proscribe estrogens alone in high dosages for menopausal treatment over long periods of time. It is concluded that individually determined low-dosage cyclical estrogen therapy during menopause does not increase the risk of endometrial cancer.
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PMID:[Oestrogens during the menopause and the risk of endometrial carcinoma (author's transl)]. 21 69

An increasing incidence of endometrial cancer caused by a higher life expectancy and a number of other facters (i.e. obesity, diabetes, hypertension, lower pregnancy rate) as well as the unfavorable location for early detection when compared with cervical cancer has initiated this review in order to single out women with increased risk. Clinical characteristics of patients with endometrial cancer represented by age, menstrual disorders, reduced fertility, obesity, diabetes, hypertension, hirsutism, hyperplasia of the ovarian stroma or hilus cells in connection with an increased oestrogen effect in the vaginal smear and proliferative changes of the endometrium can be explained by extraglandular respectively peripheral aromatization of androgens to oestrogens, particular by the conversion of androstenedione to oestrone. This is supported by an increased plasma oestrone/oestradiol-ratio and increased conversion rate with age and overweight. In vivo- and in vitro-investigations have demonstrated the participation of adipose tissue in peripheral oestrogene production. The compiled data point towards the importance of the extraglandular oestrone production for the etiology of endometrial cancer by effecting the endometrium over a long period of time. The counter action of the normally cyclic changes of oestradiol and progesterone is lacking. Therefore, a dysoestrogenic effect of oestrone upon the endometrium can be fully effective, depending on the hormone receptor content of the respective endometrium. Based upon these data including recent publications, pre- and postmenopausal oestrogen therapy has to be critically reevaluated.
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PMID:[Endometrial cancer and extraglandular oestrogen biosynthesis (author's transl)]. 32 98

For a population-based, case-control study of cancer of the endometrium in Greater Boston from 1965 through mid-1969, 440 cases were drawn from nearly all hospitals in the area; controls were drawn at random from the general population. The age-adjusted incidence rate was 18.1/100,000 woman-years, with a peak at ages 55-59 and a gradual decline thereafter. Information was provided from 212 cases and 1,198 controls by mall questionnaire. A trend of reduced risk of endometrial cancer with increased parity was noted, the relative incidence (RI) for multiparous women being 0.3 compared to a RI of unity for married nulliparous women. The association of risk with age at first birth was irregular. Early menarche (RI=1.6) and late menopause (RI=1.7) were associated with increased risk of disease. Endometrial cancer risk was also found to be directly related to socioeconomic status, relative weight, diabetes, hypertension, and arthritis. The findings supported the idea that hormone activity during, and perhaps after, reproductive life is an important cause of this disease.
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PMID:Epidemiology of endometrial cancer. 33 20

During a 25 year period in a university hospital gynecology service, 300 obese women, weighing 200 pounds or more, underwent abdominal total hysterectomy. In comparison with nonobese controls, the overweight patients were more likely to have carcinoma of the endometrium, hypertension and diabetes mellitus. Postoperatively, the most striking difference between the obese and nonobese groups was in the incidence of wound complications, with no significant difference in the occurrence of other disorders. The incidence of wound complications was 29 per cent with obesity, seven times that in patients of normal weight, and all types of wound disorders, except evisceration, occurred more frequently in obese patients. Among identifiable factors potentially responsible for wound infection were an increased incidence of diabetes, longer operating time and greater blood loss in overweight patients. The increased incidence of wound infection was responsible for greater febrile morbidity and the more frequent need for prolonged hospitalization. The mortality rate was 1 per cent in the obese group and zero per cent in the control group, a statistically insignificant difference. Since abdominal hysterectomy in obese women is associated with increased risk of morbidity, although not necessarily of mortality, obesity per se should rarely, if ever, contraindicate necessary surgical therapy. In situations in which surgical treatment is more elective, its complications should be borne in mind.
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PMID:Abdominal hysterectomy in obese women. 76 2

In a retrospective study characteristics of 729 climacteric and postmenopausal women with hyperplasia and adenocarcinoma of the endometrium are compared with those of 82 women with atrophic endometrium and 96 women with carcinoma of the cervix. In a prospective study 225 women with glandular-cystic, adenomatous and atypical hyperplasia of the endometrium have been checked by a control-curettage within a period of two months until four years following the first diagnosis. Low parity, disturbances of menstruation with anovulatoric bleedings during fertility period, adipositas, hypertension and diabetes mellitus in climacteric and postmenopausal women indicate a high risk of carcinoma of the endometrium. Hyperplasias of the endometrium in climacteric women cannot be considered as precursors of corpus carcinoma. They are the result of a temporary hormonal dysfunction. Prophylactic hysterectomy, however, should be performed, if adenomatous or atypical hyperplasia appears in older postmenopausal women with the indicators of high risk of endometriumcarcinoma as mentioned above.
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PMID:[Epidemiology of endometrial hyperplasia and adenocarcinoma]. 97 98

Dr. Boyd C. Quint recently presented important data regarding the relationship of estrogen therapy to the risk of endometrial carcinoma, but the data seem to have been inappropriately analyzed. Dr. Quint studied 291 postmenopausal women who received primary treatment for endometrial carcinoma at the Swedish Hospital Medical Center in Seattle, Washington between 1960 and 1973. The 1st step in Quint's analysis was a determination of the ratio of new endometrial carcinoma cases to the total "major gynecologic operations" for the intervals 1960-1966 and 1966-1973. This ratio was observed to increase from about 2% for 1960-1966 to about 4% for 1966-1973, but this change -- while statistically significant - cannot be used to support the hypothesis that the absolute incidence of endometrial carcinoma increased from the 1st to the 2nd interval. The 2nd step in the analysis was a determination of the incidence of nulliparity, obesity and hypertension, and/or diabetes and prior estrogen therapy among the endometrial carcinoma patients 1st treated in each of the 2 intervals. The prevalence of the constitutional stigma commonly associated with endometrial carcinoma, obesity and hypertension and/or diabetes can be seen to be significantly lower among the 203 patients 1st treated between 1966 and 1973 than among the 88 patients 1st treated between 1960 and 1966. Conversely, the prevalence of prior estrogen therapy is seen to be much higher. Data indicating that approximately 50% of Seattle area women had used or were using estrogen therapy by 1973 to 1974 - median use of about 10 years - are in press. Quint's data do support the hypothesis that estrogen therapy may be an etiologic factor among the more recent cases of endometrial carcinoma.
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PMID:Estrogen therapy and endometrial carcinoma. 98 96

Diabetes and obesity were noted in 21.3% and 42.3% respectively of 94 patients with adenocarcinoma corporis uteri. Hypertension and ovarian or mammary neoplasia were also common. Obese and diabetic subjects proved more sensitive to treatment with high doses of medroxyprogesterone acetate. Screening for precancerous states or carcinoma of the endometrium in obese and diabetic women is suggested.
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PMID:[Diabetes, obesity and adenocarcinoma of corpus uteri]. 99 85

An analysis is made of 3 reports of American studies which linked the postmenopausal use of estrogens to endometrial cancer. In regard to the accuracy of these studies, the author emphasizes that proper attention must be paid 1st to the state of those subjects in the control group and, more importantly, to the presence of other risk factors in the patients. Most disorders and diseases in which estrogens are employed as therapy are also noted to be risk factors in the diagnosis of endometrial carcinoma. These include adiposity, diabetes, high blood pressure, infertility, prolonged cyclical disruptions, menopause, and the social status of the patient (in which the increased use of estrogens and other possible carcinogens is noted to exceed that of poorer class patients). The possible dangers of the use of estrogens are recognized, however, and must certainly be particularly considered when the patient shows 1 or more other risk factors. A guideline for postmenopausal administration of estrogens is given.
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PMID:[Estrogens and carcinoma of the endometrium]. 100 92

142 patients with endometrial cancer, and an equal size control group, were compared in regard to age, obesity, diabetes, hypertension, vaginal cytology, and endometrial histology. In a 2nd study, 335 patients with endometrial cancer were treated with abdominal hysterectomy, bilateral salpingo-oophorectomy, and radiation applications. In an experimental study, the percent of conversion of androstenedione to estrone in subcutaneous adipose tissue in 20 patients was studied using an in vitro method. The 1st clinical study showed that the frequency of diabetes, hypertension, the estrogen effect in the vaginal smear, and proliferative changes in the endometrium were significantly higher than in the control group. Obesity was also more frequent. The 2nd clinical study showed a survival rate of more than 5 years in certain parameters. The experimental in vitro study showed a higher aromatization of androstenedione to estrone in cancer patients, indicating etiological correlations between endometrial cancer and extraglandular estrone production.
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PMID:Estrogens and endometrial cancer: aspects of etiology and survival rate. 102 Oct 8


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