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

Women who self-select to take postmenopausal hormones have lower risks of coronary heart disease, their leading cause of mortality. Women and their primary health care providers must weigh this and other clear (osteoporosis), and possible (stroke, colon cancer, and Alzheimer's disease) benefits against clear (endometrial cancer) and possible (breast cancer) risks. Because all existing data derive only from observational studies, reliable information on the balance of risks and benefits must await the results of the Women's Health Initiative, a large-scale, randomized clinical trial.
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PMID:Postmenopausal hormones and coronary heart disease. 887 56

The main adverse effects of tamoxifen, aspirin, oral contraceptives (OCs) and retinoids used as chemopreventive agents in humans are reviewed and quantified here. With regard to tamoxifen, there are suggestions of some excess risk of liver, and perhaps gastrointestinal, cancers. The public health impact of such associations, if any, is still unclear. Tamoxifen use is associated with endometrial and myometrial hyperplasia. Data from five studies based on 174 cases indicate that the overall relative risk (RR) of endometrial cancer in ever tamoxifen users is 1.73 (95% confidence interval = 1.1-2.6). However, there is a significant difference between the results of American and European studies, so the relationship between tamoxifen and endometrial cancer remains open to debate. The major side-effect of aspirin is gastrointestinal lesions; the risk of these is increased two- to tenfold, depending on the dose. Aspirin is also associated with an increased risk of haemorrhagic stroke, although its protection against other types of stroke and against myocardial infarction leads to a favourable pattern of risk for all cardiovascular conditions. Short-term side-effects of OCs include vascular diseases and a moderately increased risk of breast cancer. The RR of cervical cancer and hepatocellular carcinoma are also increased in OC users, although the public health impact of such associations is small. Toxicity associated with retinoid treatment is rarely serious as most effects observed are reversible on stopping use. Side-effects include changes in the skin and mucous membranes (dry skin, hair loss, dry nose, conjunctivitis), musculoskeletal symptoms, ophthalmological effects, changes in transaminase activity, changes in clinical chemistry markers (increase in serum triglycerides and decrease in high-density lipoproteins) and, rarely, central nervous system effects. A serious toxicological aspect of retinoid treatment is teratogenesis; its use should therefore be avoided in women with childbearing potential, and, in cases of use, conception should be delayed for a long time after stopping treatment. Thus, when considering side-effects of chemoprevention, the major issues of concern are the rare long-term effects (chiefly neoplasms), and the need for more precise overall risk-and cost-benefit assessment, particularly for healthy people.
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PMID:Adverse effects of preventive therapy in humans. 892 25

To assess the risks and benefits of menopausal hormone replacement therapy, we followed a 23,346-member, population-based cohort of Swedish women who were prescribed menopausal estrogens for an average of 8.6 years for mortality. Compared with the general population, the standardized mortality ratio for all-cause mortality in this cohort was 0.77 (95% confidence limits = 0.73, 0.81). Deaths in each of the 12 major categories of causes of death except for injuries occurred 12% to 86% less frequently than expected. We examined in detail four specific causes of death according to the type of hormone prescribed, namely weak estrogens (primarily estriol), more potent estrogens (primarily estradiol and conjugated estrogens) in combination with a progestin, and more potent estrogens without a progestin. Mortality from endometrial cancer was not related to the prescription of weak estrogens or an estrogen-progestin combination, but mortality was 40% higher in women prescribed more potent estrogens without a progestin. Women prescribed weak estrogens, more potent estrogens, and the combined estrogen-progestin regimen were at reduced risk of death from ischemic heart disease (standardized mortality ratios of 0.7, 0.6, and 0.4, respectively). The more potent estrogens and the estrogen-progestin combination were associated with a marked reduction in risk of intracerebral hemorrhage (standardize mortality ratios of 0.4 and 0.6, respectively) and "other" cerebrovascular disease, but not other types of stroke. The concern that use of progestins would lead to psychic disorders related to suicide received no support from our results. Breast cancer results are described elsewhere. These data provide little evidence of an adverse effect of the combined estrogen-progestin regimen as compared with estrogens alone on mortality. They do indicate, however, that both selection factors and biology may contribute to the almost across-the-board-reduction in mortality associated with hormone replacement therapy.
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PMID:Cause-specific mortality in women receiving hormone replacement therapy. 911 97

This review of the research literature on the cardiovascular safety of oral contraceptives (OCs) containing less than 50 mcg of estrogen and second- or third-generation progestins suggests that these formulations are safer than earlier OCs were. Although some recent studies detected an increased risk of venous thromboembolism of 1.5-2.0 in users of OCs containing desogestrel or gestodene compared with second-generation progestins, these studies are marred by detection bias and the tendency for high-risk women to be prescribed third- rather than second-generation OCs. Studies of the association between combined OCs and myocardial infarction have yielded discrepant results; one found an increased risk with second- but not third-generation OCs. Studies on stroke indicate little or no increase in risk in users of modern OCs without other cardiovascular risk factors. Overall, the available research indicates that use of second- or third-generation OCs carries less risk of venous thromboembolism than pregnancy. In addition to the prevention of pregnancy and its attendant risks, low-dose OCs confer additional health benefits such as reductions in the incidence of ovarian and endometrial cancer.
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PMID:Modern oral contraceptives and cardiovascular disease. 932 46

Combined oral contraceptives (OCs) have been implicated with an increased risk of a number of illnesses, particularly vascular conditions such as stroke, ischemic heart disease, venous thrombosis, and peripheral vascular disease. This study assessed the balance of risk of serious illness among a cohort of OC users followed for up to 28 years. Data from the Royal College of General Practitioners' Oral Contraception Study were examined to determine the rate of such conditions during 335,181 woman-years of observation for ever-users and 228,727 woman-years for never-users. The rates were standardized for age, parity, social class, and smoking. Results of the study indicated that in comparison with never-users, ever-users had a small increased risk of any serious disease. Ever-users had an excess risk of cerebrovascular disease, pulmonary embolism, and venous thromboembolism, and reduced risk of ovarian and endometrial cancer. The increased risk was seen only in younger women; by the age of 50, ever-users had the same risk as never-users. The risk appeared to be confined to women using OCs containing 50 mcg or more of estrogen. In conclusion, past users of higher-dose OCs can be reassured that the small increased risk of serious disease seen during current use does not persist after stopping and that latent effects do not appear later in life. Currently available OCs containing less than 50 mcg of estrogen, accompanied by the progestogen, levonorgestrel, or norethisterone acetate, do not appear to be associated with an increased net risk of serious disease.
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PMID:The risk of serious illness among oral contraceptive users: evidence from the RCGP's oral contraceptive study. 1019 18

This article reviews epidemiological data on potential adverse effects of hormone replacement therapy (HRT) on the risk of breast, endometrial and ovarian cancer, on the risk of stroke, and on the risk of venous and pulmonary thromboembolism. As for the potential adverse effects on cancer risk, most information on HRT and breast cancer is included in a re-analysis of individual data from 51 epidemiological studies (including over 90% of the world's data), showing a 2.3% increase of the relative risk of breast cancer for each year of use which, however, levels off after stopping use. This corresponds to a cumulative excess of approximately 2 in 1,000 women who started taking HRT at age 50 and used it for 5 years, 6 in 1,000 women who used it for 10 years and 12 in 1,000 women who used it for 15 years. Unopposed estrogen use is strongly related to endometrial cancer risk mainly in lean women, but the cyclic combined oestrogen-progestin treatment appears to largely or totally reduce this effect if progestin is taken for more than 10 days per cycle. The data on epithelial ovarian cancer allows exclusion of any strong association with HRT, although a moderate positive relationship remains open to debate. As for other adverse effects of HRT, the relationship between HRT and stroke is still debated, although any strong and consistent association can be excluded. Current HRT use, but not past use, is associated with venous and pulmonary thromboembolism. Thus, most adverse effects of HRT are restricted to current or recent use, and long term HRT use should be carefully considered on an individual basis, taking into account any other personal risk factors for breast and endometrial cancer and for venous/pulmonary thromboembolism, and the potential benefits of HRT on cardiovascular disease and osteoporosis.
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PMID:The adverse effects of hormone replacement therapy. 1040 35

Pelvic exenteration is generally not considered an operation with curative value for women with recurrent endometrial carcinoma. We reviewed our experience with pelvic exenteration performed in patients with recurrent endometrial adenocarcinoma from 1947 through 1994. A total of 44 patients were identified, with a mean age of 60 years (range 35-69 years). Primary therapy usually consisted of total abdominal hysterectomy with bilateral salpingo-oophorectomy, with most receiving either pre- or postoperative radiotherapy. Prior to exenteration, 10 of 44 (23%) patients had never received any form of radiotherapy. The median interval between initial surgery and exenteration was 28 months (range 2-189 months). The type of exenteration performed was total in 23 patients (52%), anterior in 20 patients (46%), and posterior in 1 patient. Major postoperative complications occurred in 35 patients (80%) and included urinary/intestinal tract fistulas, pelvic abscess, septicemia, pulmonary embolism, and cerebrovascular accident. Median survival for the entire group of patients was 10.2 months. Nine patients (20%) achieved long-term survival (>5 years). Pelvic exenteration for recurrent endometrial cancer is associated with a high operative morbidity and poor overall survival. Although only 20% of patients achieved long-term survival, this procedure remains the only potentially curative option for the few patients with central recurrence of endometrial cancer who have failed surgical and radiation therapy.
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PMID:Pelvic exenteration for recurrent endometrial cancer. 1050 33

A new era has been entered with the first demonstration that an antiestrogen can prevent breast cancer. In a landmark study tamoxifen was shown to reduce the incidence of breast cancer by approximately 50%. The reduction was observed in pre- and postmenopausal women at increased risk of breast cancer. Invasive cancers were reduced, the reduction being in the estrogen receptor-positive cancers. No preventive effect was observed for estrogen receptor-negative tumors. In situ cancers were also significantly reduced. A collateral benefit was a significant reduction in fractures due to osteoporosis. Adverse effects included a very small increase in the incidence of endometrial cancer, cataracts, and stroke. The benefits appear to outweigh the risks for those at high risk. Preliminary studies of a new selective estrogen receptor modulator (SERM 2), raloxifene, developed for the prevention of osteoporosis, have shown that the breast cancer rate was reduced by more than 50% without any concomitant increase in endometrial cancer. The search for a SERM 3, and beyond, may lead to the development of drugs that have the beneficial effects of estrogen while preventing breast cancer and osteoporosis.
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PMID:Breast cancer prevention by antiestrogens. 1066 91

Oral contraceptives are one of the most highly effective forms of contraception and provide many short- and long-term noncontraceptive health benefits. They control menstrual cycle irregularities, such as breakthrough bleeding and amenorrhea, and are effective in treating dysfunctional uterine bleeding. In addition, for decades after oral contraceptive use is discontinued they are associated with substantial decreases in the risk of ovarian cancer (up to 80%) and of endometrial cancer (40%-50%), and nearly eliminate benign functional ovarian cysts. Long-term oral contraceptive use confers protection against benign breast disease and colorectal cancer, may help prevent rheumatoid arthritis, decreases ectopic pregnancy and hospitalizations for pelvic inflammatory disease, and helps preserve bone mineral density to reduce risk of fractures. Large bodies of evidence from extensive research have clarified the perceived association of oral contraceptive use with cardiovascular disease and with breast cancer. Findings indicate that there is no increased risk of myocardial infarction or stroke associated with oral contraceptive use in healthy, nonsmoking, normotensive women. Although there is a 3- to 4-fold increased risk of venous thromboembolism with current oral contraceptive use, the absolute risk is very small and is half that associated with pregnancy. Women of all reproductive ages, including perimenopausal women, can realize many health benefits through oral contraceptive use, including improved health status later in life.
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PMID:Current perspectives on oral contraceptive use. 1152 Nov 17

In order to weigh the risks and benefits of intervention with selective estrogen response modifiers for preventing breast cancer, one needs to consider the effects of intervention on several health outcomes. For example, tamoxifen was shown to reduce the risks of breast cancer and hip fracture while increasing the risks of endometrial cancer and cardiovascular end points, including stroke. One approach to weighing risks and benefits is to estimate the net effect of the intervention on the absolute risk of each of the relevant health outcomes. To estimate this net effect, one needs to know not only the relative risk from the intervention, but also the absolute risk of the health outcome in the absence of intervention. Intervention trials yield unbiased estimates of intervention relative risks, but data are usually too limited to estimate these relative risks precisely for subgroups or for rare health outcomes. Moreover, intervention trials are usually too small to provide data for developing a model for estimating the individualized absolute risk of various health outcomes in the absence of intervention. The model of Gail et al. for projecting the individualized risk of breast cancer, as modified for use in the Breast Cancer Prevention Trial, has been validated. To weigh various risks and benefits of interventions, there is a need for research to develop such models for a range of health outcomes.
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PMID:The estimation and use of absolute risk for weighing the risks and benefits of selective estrogen receptor modulators for preventing breast cancer. 1179 64


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