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Query: UMLS:C0476089 (endometrial cancer)
 11,379 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Estrogens do not have the general biological effect of increasing the occurrence of cancer in various species of laboratory animals. The neoplastic effect of estrogens in animals is strain and species dependent. Estrogens may increase the incidence of uterine cervical cancer in some strains of mice, but not in other strains or other animal species. The progestins and oral contraceptives (OC) have not induced cervical cancer in animals and most studies demonstrate that the steroid anovulants do not increase the occurrence of abnormal cervical smears or cervical cancer in women. Estrogens increase the occurrence of endometrial cancer in the rabbit, occasionally in the mouse, but apparently not in other species. Case-control studies in menopausal and postmenopausal women indicate an increased risk of endometrial carcinoma (EC) associated with use of estrogen. However, in other studies estrogen has not been related to EC. Cases of EC have been reported in women using sequential OC but a causal relationship has not been established. Progestins alone may arrest progress or cause regression of EC in women. EC has not been related to use of the combination OC, and it is unlikely that use of these anovulants will lead to the development of endometrial cancer. Estrogens or OC do not induce a carcinogenic response in the ovary. A decrease in ovarian cysts, is observed during the clinical use of OC.
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PMID:Evaluation of the carcinogenic effects of estrogens, progestins and oral contraceptives on cervix, uterus and ovary of animals and man. 28 71

It is estimated that 10-15 million women use oral contraceptives in the U.S. The 2 types of pills available are combination products containing both an estrogen and progestin, and single entity products with only progestin. Although more side effects are associated with estrogen, combination pills are the preferred prescription. Most often side effects are mild and disappear after continued use or switching to another type of pill. Some of the side effects are nausea; weight gain; chloasma; cervical extrophia and leukorrhea; hypermenorrhea; spotting and breakthrough bleeding; galactorrhea and pituitary tumors; choreiform movement disorder; endometrial cancer; and, hepatic effects. Fetal exposure to exogenous estrogens and progestins has been reported to result in increased risk for the heart and neural tube defects. Teratogenic effects subsequent to discontinuation of OCs does not appear to be a risk. The beneficial side effects of oral contraceptives are that the incidence of menorrhagia, benign breast neoplasm, dysmenorrhea, iron-deficiency anemia, premenstrual tension, acne, and ovarian cysts are lower in OC users. Thryoid diseases may be reduced by OCs.
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PMID:Side effects of oral contraceptives. 50 75

Sexual activity is quite common among women aged 14 to 20 in developed countries, averaging perhaps 10% at age 15 to about 70% at 19. Thus, the need for contraception may begin quite early in life and will continue for as long as 30 years. One of the best candidates for long-term contraception for young sexually active females is the oral contraceptive (OC), which provides health benefits besides contraception. Long-term benefits include lowered rates of ovarian and endometrial cancer, as well as of benign breast disease and ovarian cysts. Another benefit is protection against upper-tract sequelae of sexually transmitted diseases. Short-term benefits are correction of menstrual irregularity, reduction in menstrual flow, and diminished premenstrual syndrome and dysmenorrhea. Recent OC formulations contain only one-third the estrogenic potency of older OCs and therefore are associated with dramatic decreases in what were always the major side effects of OCs: heart attack, stroke, and pulmonary embolism. Other side effects of OCs have been most closely associated with the progestogenic component, and are related to the androgenic effects of progestins, particularly some synthetic progestins. However, some new synthetic progestins have been found to have minimal androgen receptor activity in preclinical testing and to cause minimal or no androgen-related side effects in clinical trials. One of these new progestins having a favorable androgenic profile is norgestimate. Its efficacy and safety in combination with low doses of ethinyl estradiol have been documented in the European and the American literature.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The androgenicity of oral contraceptives: the young patient's concerns. 136 88

Studies show that OCs have several benefits besides prevention of pregnancy. They protect against ovarian and endometrial cancer, pelvic inflammatory disease, and ectopic pregnancy. OCs also prevent iron deficiency anemia, primary dysmenorrhea, functional ovarian cysts, and benign breast disease. They may even protect against some benign uterine tumors, osteoporosis, toxic shock syndrome, and rheumatoid arthritis. Despite many concerns, some large studies have not identified an overall effect of OCs on breast cancer, but subgroup analyses showed increased risk in 30-34 year old women and in women with 1 child. A reanalysis of a large US study indicated an increase risk of breast cancer in nulliparous women with increasing use of OCs by young women. Cervical cancer is the leading cancer of women in developing countries which emphasizes the need to examine the link between OC use and cervical cancer. Several studies show an increased risk of cervical cancer. Several studies show an increased risk of cervical cancer in long term OC users. In 1 study, long term use meant 5 years. Yet these studies did not adequately address confounding factors such as smoking and sexual behavior. 3 case control studies in the US and the UK found an increased risk of liver cancer among OC users, yet a large case control study in developing countries did not find a link between OC use and liver cancer. Studies of high dose OCs found considerable increased risks of cardiovascular disease in OC users, but they did not take into account cigarette smoking which indeed increases the risk. Further health practitioners today do a more thorough job of identifying underlying medical problems before prescribing OCs. Moreover estrogen doses have fallen 10 fold since the original OCs. Finally, despite a transient delay, women who take OCs experience a return to fertility at the same rate as those who use other contraceptives.
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PMID:The safety of oral contraceptives: epidemiologic insights from the first 30 years. 160 84

The beneficial effects of combined estrogen-progestin-containing oral contraceptives (OCs) include prevention of pregnancy (less than 1 failure out of 100 regular users); the prevention of ectopic pregnancy; the reduction of preeclampsia (2.4 times lower risk compared with barrier methods); and reduction of pelvic inflammation to about one-half. The effects on menstruation include the reduction of sideropenic anemia (by lowering the incidence and duration of menstruation, OCs reduce the loss of iron to 50% or to as much as 33%); dysmenorrhea by 40% (symptoms receded in 90% of users); and premenstrual syndrome by 30%. OCs exert a favorable effect on menstrual epilepsy; reduce sports-related accidents in the premenstrual and menstrual periods; and reduce intermenstrual bleeding. The protection from cancer includes the lowering of endometrial cancer risk (every 2 years of use reduces the risk by 38%, 12 years of use by 70%, and the beneficial effects last 3-15 years); reduction of the risk of the ovarian cancer (already 3-6 months of use reduces the risk by 30%, and more than 5 years by 50% in women under 50 years of age with a longterm effect of 10 years or more, which drops sharply in women over 60 who are mostly at risk). Among other beneficial effects, they reduce benign mastopathy by 50-75%; reduce the risk of follicular ovarian cysts to 50% and the risk of corpus luteal ovarian cysts to 1/5; and they lessen bone loss which favorably affects osteoporosis. Low-dose OCs minimize the well-known risks of thrombotic and cerebrovascular accidents, myocardial infarction, hypertension, altered carbohydrate metabolism, gallbladder diseases, and liver cancer. A new OC with 30 mcg of ethinyl estradiol was tested with daily doses of 150 mcg of desogestrel. The high density lipoprotein (HDL) either increased or did not change with desogestrel: the HDL2 subfraction that protects from atherosclerosis did not change, and probably the HDL3 raised the HDL level.
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PMID:[Favorable effects of oral estrogen-progestin contraception]. 181 41

TNF-alpha levels in sera from patients with gynecological cancers were evaluated by ELISA and compared with those of patients with benign ovarian cysts or of anonymous healthy donors. Patients with cervical and endometrial carcinoma and with benign ovarian cysts showed levels of TNF-alpha similar to those of healthy donors. In contrast, significantly increased levels of TNF-alpha were found in patients with ovarian carcinoma, regardless of the stage of disease.
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PMID:Evaluation of circulating tumor necrosis factor-alpha in patients with gynecological malignancies. 204 May 31

Tumor-associated trypsin inhibitor (TATI) is a fairly specific serum marker for mucinous ovarian cancer. Very high levels occur in mucinous ovarian cyst fluid, indicating that the elevated levels of TATI in serum are derived from the tumor. However, elevated levels of TATI may also occur in inflammatory disease and after major surgery, suggesting that TATI may also behave as an acute-phase reactant. To further elucidate these questions we have measured the concentration of TATI in urine before and after intracavitary radiotherapy in 13 patients with cervical cancer and 29 patients with endometrial cancer. In 11 patients the concentrations of serum TATI and C-reactive protein (CRP) were also measured. The treatment caused a moderate but significant elevation in the urinary concentration of TATI but affected the serum levels of TATI and CRP only occasionally. The apparent discrepancy between the changes in serum and urine levels of TATI may be explained by the very short (6 min) half-life of TATI in serum. Our results indicate that the mechanisms causing elevation of TATI in urine and of CRP in serum are different. TATI appears to react more rapidly to radiation-induced tissue destruction, whereas CRP is a much more sensitive indicator of bacterial infections.
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PMID:Effect of intracavitary radiotherapy on tumor-associated trypsin inhibitor (TATI) in patients with cervical and endometrial cancer. 235 15

Epidemiologic studies of oral contraception are of two main types: case-control and cohort. The best known cohort studies are the Royal College of General Practitioners' study and the Oxford-Family Planning Association study, both of which have been conducted in the United Kingdom. Combination oral contraceptives--both the older, higher-dose type, and the newer, lower-dose type--are highly effective if used properly. Noncontraceptive benefits of combination oral contraceptives include protective effects against menstrual disorders, anemia, benign breast disease, functional ovarian cysts, ovarian cancer, endometrial cancer, pelvic inflammatory disease, and uterine fibroids. Adverse effects include various cardiovascular problems, liver tumors, and the temporary impairment of fertility after stopping use, especially in older, nulliparous women. Effects, if any, on breast cancer and cervical cancer are still under evaluation. The often quoted cardiovascular risks of combination oral contraceptives are derived from studies of the older, higher-dose pills used in an outmoded way. There is evidence that modern pills, used by properly selected young women who are subsequently kept under surveillance, carry a minimal cardiovascular risk. A national study is currently in progress in the United Kingdom to try to confirm this.
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PMID:Epidemiologic studies of oral contraception. 257 63

From the extensive research conducted over the past 28 years, there is a clear picture that the noncontraceptive benefits of steroidal contraceptives are considerable and the benefits outweigh the risks. The risks associated with the increased incidence of thromboembolic disease have reduced with lower doses of both estrogen and progesterone. Also, the increased risk of hepatocellular carcinoma is very low, compared with the benefits. One benefit is the reduction in primary dysmenorrhea which was discovered in 1940. This occurs due to the suppression of ovulation and decrease in endometrial growth. Ovarian cysts resolve spontaneously; 3500 fewer hospitalizations due to ovarian cysts are reported for 1982. 11,000 fewer cases of ectopic pregnancy/year are a result of oral contraceptive (OC) use. Retrospective case studies have found that pelvic inflammatory disease (PID) is prevented by use of OCs. This happens because the cervical mucus remains thick throughout the menstrual cycle with OC use, and thus prevents transportation of bacteria by sperm from the lower to the upper genital tract. Another reason is the decreased amount of blood flow at the time of withdrawal provides a less conducive environment for bacteria growth. 15,000 annual hospitalizations for PID are estimated to have been prevented by OC use. The data on breast cancer are conflicting, but most do not show a link between OCs and breast cancer. In fact, benign breast disease may be reduced by 23,000 annual hospitalizations due to OC use. Another benefit of OC use is the decreased incidence of endometrial and ovarian cancer. The relative risk among OC users in 1987 was estimated at P = 0.6 for primary endometrial cancer. This beneficial effect continues after OC use is discontinued. There is a 40% reduction in the incidence of ovarian cancer among OC users compared with nonusers, and is related to duration of use, but the protective effect continues after OC use discontinuation. Bone mass is increased in women who use OCs, although further study is required to determine whether the increased bone mass protects from osteoporosis after menopause.
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PMID:Noncontraceptive health benefits and risks of steroidal contraception. 257 66

The risks and benefits of using oral contraceptives are reviewed critically, considering only large controlled, statistically sound studies. Generally insufficient time has elapsed to evaluate the current generation of low dose combined and triphasic pills. The most salutary effect of oral contraceptives is an approximate 60% reduced risk for ovarian cancer, the leading gynecologic neoplasm, invariably fatal. Endometrial cancer risk is cut by about half. Both ovarian and endometrial cancer risk reduction persists after discontinuation. Pills reduce the incidence of benign fibrocystic and fibroadenomatous breast disease, avoiding about 20,000 hospitalizations yearly. Also numbers of functional ovarian cysts are reduced in pill users, eliminating about 3000 major hospitalizations annually. Pills reduce risk of pelvic infection of 10-70%, thereby lowering the potential for ectopic pregnancy: about 10,000 hospitalizations for ectopic pregnancy are said to be prevented. In contrast, pills do modestly increase the risk of developing idiopathic venous thromboembolism, by about 2.8-fold, as estimated in 1985. Due to recent reductions in steroid doses, the statistics on thromboembolism will probably improve. Pills also cause mild elevations in blood pressure, about 4 mm Hg systolic and 1 mm Hg diastolic, in 1,5% of users, which resolve on discontinuation. There are inconsistent results from studies on chance of strokes in pill users. Studies on heart attack find increased risk largely confined to smoker and older women, up to 34-fold higher risk to heavy smokers over 40. Generally in young healthy women, risk of heart attack is less than that in term pregnancy. Although there are some indications of increased breast cancer risk in some subgroups of women, most recent large studies find no association. Similarly, certain women are at increased risk of cervical cancer while using pills, although the specific risk factors have not been delineated. The risk of liver tumors is enhanced statistically, but the absolute numbers of cases are so low as to be unmeasurable. No sound evidence now exists for heightened risk of pituitary tumors or malignant melanoma.
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PMID:The risks and benefits of oral contraceptives. 264 61


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