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

The largest case control study on the association between oral contraceptive (OC) use and cancer is the US Cancer and Steroid Hormone (CASH) study. Since it did not use hospital-based patients as controls, it eliminated some biases. Since OCs suppress ovulation and suppressed ovulation is linked with reduced risk of ovarian cancer, scientists believe OCs may reduce this cancer risk. The CASH study shows that OC use indeed decreases the risk of ovarian cancer 40% (relative risk [RR]=.6 and this protection lasts for more than 10 years after OC discontinuation. Protection increases with duration of OC use (1 year RR=.6 and 10 years RR=.2). Estrogenic stimulation of the endometrium without ample progestational protection causes endometrial cancer. Thus combined OCs which have estrogen and progestin components should reduce the risk of endometrial cancer. The CASH study reveals OC use for at least 12 months reduces this risk 50%. OCs have a protective effect for at least 15 years after stopping OC use. In addition, UK national mortality data show OC use caused the decline in ovarian cancer mortality and a 40% decrease in endometrial cancer mortality over the last 20 years. A WHO 7-county case control study indicates that OC users in developing countries have the same protective effect against ovarian and endometrial cancer as those in developed countries. Studies of OC use and cervical cancer have had conflicting results due to 3 biases: cervical cancer is associated with sexual behavior and is therefore a sexually transmitted disease; detection bias. A study in Costa Rica conducted by CDC study has addressed the 1st and 3rd biases. It found no increased risk of invasive cervical cancer or carcinoma in situ with OC use. Studies of OC use and breast cancer have also had conflicting results, but the data clearly indicate that OC use does not increase the overall risk of breast cancer. In fact, OC benefits surpass breast cancer risks.
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PMID:Oral contraceptives and gynecologic cancer: an update for the 1990s. 141 42

For women beyond the desire for childbearing, the contraceptive options are discussed as appropriate for the age and in light of risks and benefits. Reeducation and careful history taking are important. A pregnancy for a woman 40 years places a woman at greater risk for an elective abortion and greater risk of maternal mortality from abortion; low dose contraceptive use can have beneficial effects for menopausal women. Methods are grouped as contraceptive steroids (combination pills, progestin-only pills, oral preparations, implants, and injections), IUDs, barrier methods (diaphragms, cervical caps, vaginal sponges, spermicides, and contraceptive film), condoms, sterilization, and natural family planning. Empowering women means providing current scientific information and urging women to examine their lives, and to review how and why contraceptive choices were made, and the consequences of the choices. Sexually transmitted disease counseling is appropriate for women in new relationships. A positive attitude toward menopause needs to be conveyed. Combination pills at the lowest dose possible are recommended for women 35 years who are healthy, nonsmoking (or smoking 15 cigarettes/day), blood group O, and able to derive benefits from the pill. Benefits include a 30% reduction in uterine fibroids and protection against endometrial cancer, and decreased risk of ectopic pregnancy, pelvic inflammatory disease (PID), and iron deficiency anemia. Multivitamin use with the pill is recommended due to reduced liver stores of vitamin A. Women 40 years with a parent dying of cardiac disease 50 years or with a history of hypertension, diabetes, or hyperlipidemia are not suitable candidates. 35 mcg preparations are recommended for women 35-45 years, and 20 mcg for women over 45 years. Progestin-only pills are recommended for those with contraindication to estrogen, but have a higher pregnancy rate. IUD use among older women may be difficult due to cervical or pelvic surgery; there is a higher incidence of PID and ectopic pregnancy with IUD use. Barrier methods are more successful for older women due to the changing vaginal anatomy. Vasectomy is the safest sterilization procedure.
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PMID:Contraception for midlife women. 159 31

A review of the risk of endometrial, ovarian, cervical and breast cancer in oral contraceptive users sets these neoplasms in perspective. Endometrial cancer is the 3rd most common cancer in U.S. women with 34,000 cases annually. The average women is 61 years old. Risk factors are obesity, nulliparity, late menopause and unopposed estrogens. Oral contraception for 1 year or more reduces the risk of endometrial cancer as much as 50%, more so for nulliparous women, and this protection lasts as long as 10 years. Ovarian cancer, with a 5-year survival of only 30%, kills 11,000 women a year. Risk factors are nulliparas, late 1st pregnancy and prior breast cancer. Orals decrease the risk as much as 50%, in proportion to duration of use. Cervical cancer, now only the 6th leading cause of cancer deaths for women because of screening, is probably a venereal disease. This complicates studies on the risk of pill use, which are controversial because of confounding factors such as sexual activity, surveillance, use of barrier contraceptives, and method of grading Pap test. Breast cancer has a long list of known risk factors, but studies linking the pill are controversial, especially regarding latency. The majority of studies report a relative risk around 1.0.
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PMID:Combination oral contraceptives and cancer risk. 220 49

Cervical cancer retains its character as a venereal disease associated with infections and multiple sexual partners, but poverty also is important. Precise incidence figures for cervical and endometrial cancer are almost nonexistent because in areas with precise case counts there is rarely accurate knowledge of hysterectomy prevalence. For endometrial cancer little recent attention has been paid to any risk factor except exogenous estrogen. It is now suggested that a low pregnancy rate is a cause, not a consequence, of ovarian pathology leading to cancer. Some progress has been made in separating the epidemiologies of various kinds of ovarian and uterine cancer. A few clues are available regarding the epidemiology of fallopian tube cancers and vaginal cancers other than those produced by maternal stilbestrol. Vulvar cancer becomes common only after the age of 75 and so has been neglected epidemiologically.
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PMID:High-risk factors in gynecologic cancer. 702 59

Focus in this discussion of the pharmacology of gynecology is on the following: vaginal infections; genital herpes; genital warts; pelvic inflammatory disease; urinary infections; pruritus vulvae; menstrual problems; infertility; oral contraception; and hormone replacement therapy. Doctors in England working in Local Authority Family Planning Clinics are debarred from prescribing, and any patient with a vaginal infection has to be referred either to a special clinic or to her general practitioner which is often preferable as her medical history will be known. Vaginal discharge is a frequent complaint, and it is necessary to obtain full details. 1 of the most common infections is vaginal candidosis. Nystatin pessaries have always been a useful 1st-line treatment and are specific for this type of infection. Trichomonas infection also occurs frequently and responds well to metronidazole in a 200 mg dosage, 3 times daily for 7 days. It is necessary to treat the consort at the same time. Venereal diseases such as syphilis and gonorrhea always require vigorous treatment. Patients are now presenting with herpes genitalis far more often. The only treatment which is currently available, and is as good as any, is the application of warm saline to the vaginal area. Genital warts may be discovered on routine gynecological examination or may be reported to the doctor by the patient. 1 application of a 20% solution of podophyllum, applied carefully to each wart, usually effects a cure. Pelvic inflammatory disease seems to be on the increase. Provided any serious disease is ruled out a course of systemic antibiotics is often effective. Urinary infections are often seen in the gynecologic clinic, and many of these will respond well to 2 tablets of co-trimoxazole, 2 times daily for 14 days. In pruritus vulvae it is important to determine whether the cause is general or local. Menstrual problems regularly occur and have been increased by the IUD and the low-dose progesterone pill. Infertility necessitates investigation. It is helpful to use the temperature chart method to determine whether the patient is ovulating. Oral contraception merits only passing mention, i.e., the introduction of a new sequential pill containing ethynloestradiol and levonorgestrol. There is always the question of a possible relationship between long-term OC use and the development of endometrial cancer. There are certain definite indications for hormone replacement therapy, i.e., hot flushes, sweating and atrophic vaginitis.
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PMID:The pharmacology of gynaecology. 744 23

A shift from treatment to prevention of the three major gynecologic cancers is overdue. The traditional approach to cervical, endometrial, and ovarian cancers has been secondary or tertiary prevention--early detection and treatment or mitigation of damage, respectively. We reviewed the literature on these cancers to identify strategies for primary prevention. Cervical cancer behaves as a sexually transmitted disease. As with other such diseases, barrier and spermicidal contraceptives lower the risk of cervical cancer; the risk reduction approximates 50%. Combination oral contraceptives help prevent both endometrial and epithelial ovarian cancers. The risk of endometrial cancer among former oral contraceptive users is reduced by about 50% and that of ovarian cancer by about 30% to 60%. Weight control confers strong protection against endometrial cancer. Breast-feeding and tubal sterilization also appear to protect against ovarian cancer. Although women have a range of practical, effective measures available to reduce their risk of these cancers, few are aware of them. Without this information, women cannot make fully informed decisions about their health.
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PMID:Primary prevention of gynecologic cancers. 784 46

Currently, more than 50% of married women of childbearing age are using a form of contraception. Between 1960-65 and 1985-90, the number of contraceptive users in all developing countries increased from 31 to 381 million, in East Asia from 18 to 217 million, in Latin America from 4 to 44 million, in South Asia from 8 to 94 million, and in Africa from 2 to 18 million. WHO has recently estimated that over 500,000 women die each year from causes related to pregnancy and childbirth. With a worldwide estimate of 36-53 million induced abortions performed each year, between 125,000 and 170,000 women die each year because of unsafe abortions. According to data from the World Fertility Survey, short spacing between births raises the average chances of offspring dying in infancy by 60-70% and the chances of dying before the age of 5 years by about 50%. WHO's minimal estimate for yearly incidence of bacterial and viral STDs (excluding HIV infection) is 130 million. Most STDs have more serious sequelae in women than in men and lead to pelvic inflammatory disease (PID), permanent infertility, and the risk of ectopic pregnancy. African countries with high incidence of STDs have the lowest prevalences of contraceptive use. A recent examination of the WHO international data base of 22,908 IUD insertions and 51,399 woman-years of follow-up indicates that the occurrence of PID in IUD users is most strongly related to the insertion process and to background STD risk and suggests that PID is an infrequent occurrence after the insertion period. A WHO Scientific Working Group review confirmed the beneficial effects of oral contraceptives in reducing the risk of ovarian cancer, endometrial cancer, and biopsy-proven benign breast diseases. A WHO collaborative study in 5 centers in Kenya, Mexico, and Thailand provided assurance that women who used DMPA for a long time and who initiated use many years previously are not at increased risk of breast cancer.
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PMID:Contraception and women's health. 832 13

This review focuses on etiologic factors and hormonal correlates of the three major gynecologic cancers-uterine cervix, uterine corpus and ovary- and breast cancer. The incidence rate of the three gynecologic cancers combined is only 40 percent of the breast cancer rate (43.6 vs 109.5 per 100,000), whereas the combined mortality rate is half that for breast cancer (14.3 vs 27.3 per 100,000). Cervical cancer is distinctive in that it's hormonal correlates are few; it exhibits the epidemiologic characteristics of a sexually transmitted disease. Integration of Human Papilloma Virus DNA types 16, 18 (or other) within the cellular genome has been identified in more than 80% of high grade cervical intraepithelial neoplasias and invasive carcinomas. Epithelial ovarian cancers occur most commonly in nulliparous, infertile women and familial carriers of BRCA1. Oral contraceptive (OC) use reduces ovarian cancer risk by at least one-half, a benefit which increases with increasing duration of use and persists for at least 15 years after discontinuation. Pregnancy and OCs suppress gonadotropin secretion, whereas fertility drugs enhance follicle-stimulating hormone production. These indicators of alterations in the hypothalmic-pituitary-ovarian axis provide some support for both the excess gonadotropin and the incessant ovulation theories of ovarian carcinogenesis. Endometrial carcinoma is the prototype hormonally-determined disease. Increased estrogen from either endogenous or exogenous sources increases risk. Lowering the estrogen load or adding progestin reduces risk. This explains the marked protection achieved by combined estrogen/progestin OC's and the dramatic increased risk uncurred by long-term estrogen replacement therapy (ERT). Breast tissue, also a target for sex steroid hormones, displays a more complex risk profile. Current ERT use increases breast cancer risk by about 30%; adding a progestin to the estrogen does not improve the situation (40% increased risk). Furthermore, OCs do not reduce breast cancer risk, but may increase it for current OC users under age 45. The magnitude of these hormonal effects is much smaller than that exhibited with endometrial cancer.
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PMID:Epidemiologic analysis of breast and gynecologic cancers. 910 87

In 1995, in France, the estimation of the cervix cancer incidence, with 3,300 new cases, is of 10.3 per 100,000, and the incidence of the endometrial cancer with 3,268 new cases, is of 13.8 per 100,000. The decrease of the incidence of the cervical cancer is of more than 50%, in 1975, the incidence was of 22.4 per 100,000. For the endometrial cancer, the decrease is insignificant, as in 1975, the incidence was of 14.4 per 100,000. This phenomenon has been observed in most european countries. The incidence of the adenocarcinoma of the cervix remains stable. The relative survival at 5 years, at all ages in the French cancer registry of Bas-Rhin is of 65% for the cervical cancer and of 73% for the corpus uteri cancer. However, no improvement has been observed since 1975. The risk factors are quite well-known concerning the cervical cancer, there is a strong correlation with the sexual activities, age at first intercourse, the multiplicity of the partners, which clearly shows that the cervical cancer is a sexually transmitted disease. Concerning the endometrial cancer, the risk factors are mostly linked with the reproductive life: age at menarche, parity, age at first birth, menstrual irregularities, infertility and menopause.
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PMID:[Epidemiology of cervical and endometrial cancer]. 952 81

In the past decade, attention has shifted from family planning (often made available through population programs) to reproductive health--a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity, in all matters related to the reproductive system and its function and processes. Reproductive health has three components: the ability to procreate, regulate fertility and enjoy sex; the successful outcome of pregnancy through infant and child survival and growth; and the safety of the reproductive process. According to Mitchell et al., the following are key elements in a reproductive health program: (a) Family planning services that offer complete and accurate information about all contraceptive methods and that make contraceptive services, supplies and counseling accessible. (b) Antenatal care, which research suggests lowers rates of maternal mortality. (c) Safe delivery services, so that all women deliver under some type of supervised care and so that referral systems are established to provide emergency treatment of life-threatening complications of delivery. (d) Postnatal care that contributes to a woman's ability to have a speedy and complete recovery from the stress of pregnancy and childbirth, to enjoy sexual relations without pain and to have safe pregnancies and deliveries in the future. (e) Management of the complications of abortion where safe abortions are not available. (f) Infertility services that enable women to achieve their reproductive goals; and effective screening for or control of reproductive tract infections (RTIs), because RTIs are the most common preventable cause of involuntary infertility and ectopic pregnancy, as well as of chronic pelvic pain and recurrent infection. (g) Management and treatment of systemic sexually transmitted diseases (STDs), such as HIV and hepatitis B. (h) Symptomatic treatment of urinary tract infections. (i) Detection and treatment of breast and reproductive tract cancers, such as cervical cancer. (j) Attention to and treatment of dysmenorhea, which in some cases is the first sign of other problems, such as pelvic inflammatory disease, endometriosis, fibroids, endometrial cancer and ectopic pregnancy. (k) Nutritional supplementation to meet the special needs of adolescents, pregnant or lactating women, and women older than 50 years. (1) Services for menopause and other health problems that women encounter as they grow older. (m) Services for adolescents, including family planning and STD prevention and treatment. It shall be clear that many institutions delivering reproductive health services operate significantly below their physical capacity to see clients, and that much of the equipment required for expanding reproductive health services may already be available for use in family planning and other health services. In this context, we would therefore like to discuss the dynamics of IUDs.
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PMID:The intrauterine device and its dynamics. 1099 94


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