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

When choosing a method of contraception, a woman must consider the pros and cons of various methods together with her family physician. In this process, the doctor provides information on the advantages and disadvantages, while the woman decides. A sub-50 pill of the second-generation preparation is the oral contraceptive of choice. If the woman chooses a newly developed method of contraception, she must be carefully informed about the uncertainties with regard to reliability and safety. Oral contraceptives are absolutely contra-indicated in the following cases: a history of myocardial infarction, stroke (CVA), venous thromboembolism, a known coagulation-factor deficiency, breast or endometrial carcinoma or severe liver-function disorders. Non-hormonal methods of contraception are preferred in such a case. If there are two or more risk factors for cardiovascular disease, the doctor and the patient must consider the pros and cons of hormonal contraception. In this connection, stopping smoking is more effective than not using an oral contraceptive. A prescription for an oral contraceptive can be given without a physical examination, not even a measurement of the blood pressure; follow-up is only necessary in the case of side effects or questions. Progestagen-only contraceptives are absolutely contraindicated in the following cases: current venous thromboembolism, vaginal bleeding of unknown origin, progestagen-dependent tumours such as breast cancer, and severe liver function disorders.
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PMID:[Summary of the practice guideline 'Hormonal contraception' (second revision) from the Dutch College of General Practitioners]. 1552 40

Although hormone replacement therapy (HRT) is used by post-menopausal women for the relief of menopausal symptoms and the potential reduction of osteoporosis, HRT also increases their risk of Alzheimer's disease, stroke, breast cancer, and endometrial cancer. Since the majority of these effects are associated primarily with estrogen binding to only one of the estrogen receptors (ER), new assays are needed that can more efficiently evaluate ER-binding and identify ligands selective for ER-alpha and ER-beta. High performance liquid chromatography-tandem mass spectrometry (LC-MS-MS) was combined with ultrafiltration as a new method to investigate the relative binding of compounds to the ERs and to evaluate the structures of these estrogens. Mixtures of estradiol and six equine estrogens, including equilin, equilenin, 8,9-dehydroestrone, and their 17beta-hydroxyl derivatives, were assayed simultaneously to determine their relative binding to human ER-alpha and ER-beta. Estrogens containing a 17beta-OH group were found to have higher relative affinities for the estrogen receptors than their ketone analogs. In addition, 17beta-EN showed selectivity for binding to ER-beta over ER-alpha. The results were compared to the IC50 values obtained by using a conventional radiolabled estradiol competitive binding assay. Finally, the utility of negative ion electrospray tandem mass spectrometry for the unambiguous identification of these estrogen isomers was investigated. Several characteristic recyclization pathways during tandem mass spectrometry were identified, which might be useful for distinguishing related estrogens.
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PMID:Ultrafiltration tandem mass spectrometry of estrogens for characterization of structure and affinity for human estrogen receptors. 1569 77

(1) For postmenopausal women with hormone-receptor-positive breast cancer, the reference adjuvant treatment after surgical excision is tamoxifen (an anti-estrogen), taken orally at a dose of 20 mg/day for 5 years. (2) Anastrozole is the first aromatase inhibitor to be licensed for this use in France. (3) Marketing authorisation was based on the short-term results of a double-blind trial comparing anastrozole (1 mg/day) with tamoxifen (20 mg/day) in 9366 women. The trial is planned to last five years. The results obtained after median follow-up of 4 years showed no difference between the groups in overall survival (109 deaths in each group). But first pathological events were significantly less frequent in the group taking anastrozole (13% versus 15%). Note that these results are undermined by a number of methodological flaws, including relatively short follow-up and definition of relapses using an endpoint mixing heterogeneous prognostic factors. (4) Musculoskeletal disorders, fractures (7.1% versus 4.4%) and hypercholesterolemia were statistically more common with anastrozole than with tamoxifen. Women taking anastrozole found their sex lives less satisfactory than women taking tamoxifen. The following adverse events were statistically less common with anastrozole than with tamoxifen: hot flushes (35.0% versus 40.3%), metrorrhagia, venous thromboembolism (1.1% versus 1.8%), ischaemic stroke (1.1% versus 2.3%), and endometrial cancer (3 versus 15 cases at 4 years). (5) In practice, anastrozole may be beneficial for women who cannot use tamoxifen, such as those at high risk of thrombosis. Anastrozole costs ten times more per day than tamoxifen. Tamoxifen remains the reference adjuvant treatment for all other women.
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PMID:Anastrozole: new indication. Adjuvant treatment of non metastatic breast cancer: useful for some patients. 1587 34

Toremifene has been in clinical use for 8 years for the treatment of advanced hormone-sensitive breast cancer and the adjuvant treatment of early breast cancer. More than 350,000 patient treatment years have accumulated, sufficient to allow evaluation of its longer-term safety profile in comparison with tamoxifen and, where possible, with raloxifene and aromatase inhibitors. We reviewed all preclinical and clinical safety data from 1978 to 2004 and comparative clinical safety data between October 1995 and the end of 2004. Secondary endometrial cancer incidence was lower with toremifene than with tamoxifen and was similar to that with raloxifene. It is speculated that toremifene may unmask existing endometrial tumors rather than induce new events. The risk of stroke, pulmonary embolism, and cataract may be lower with toremifene than with tamoxifen and the risk of pulmonary embolism and deep vein thrombosis lower than with raloxifene. Beneficial estrogen agonistic effects were equivalent to those of tamoxifen regarding bone mineral density and superior regarding lipid profiles.
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PMID:Toremifene: an evaluation of its safety profile. 1628 4

(1) In 2004, the first results of the British Million Women Study, a prospective cohort study that included more than a million women, showed that women using tibolone had nearly 1.5 times the risk of breast cancer as women who never used hormone replacement therapy. The difference was statistically significant. (2) In 2005, after a mean follow-up of 3.4 years, there were 31 cases of endometrial cancer per 10 000 women who used tibolone. This was almost double the level of risk experienced by women who never used hormone replacement therapy. (3) In another British cohort study, based on a general practice database, the risk of endometrial cancer among 4995 women treated with tibolone was almost double that of women who used sequential estrogen-progestin hormone replacement therapy. (4) Tibolone has no proven advantage over estrogen-progestin hormone combinations for treatment of symptoms of menopause, either in terms of efficacy or cancer risks. It is associated with an increased risk of stroke. There is no justification for using tibolone as a treatment for menopausal symptoms.
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PMID:Tibolone: cancers of the breast and endometrium. 1676

Obesity is a major public health problem associated with a wide range of health problems. This study estimates the prevalence of obesity, calculates the proportion (or population-attributable fraction [PAF]) of major chronic diseases which is attributable to obesity, estimates the deaths attributable to it and projects its future prevalence trends. In Canada, the overall age-standardized prevalence proportion of obesity has increased from 10 percent in 1970 to 23% in 2004 (8 percent to 23 percent in men and 13 percent to 22 percent in women). The increasing prevalence of obesity was observed for all five age groups examined: 20-34, 35-44, 45-54, 55-64 and 65+. On average, the PAF of prevalence of selected major chronic diseases which is attributable to obesity from 1970 to 2004 has increased by 138 percent for men and by 60 percent for women. Overall, in 2004, 45 percent of hypertension, 39 percent of type II diabetes, 35 percent of gallbladder disease, 23 percent of coronary artery diseases (CAD), 19 percent of osteoarthritis, 11 percent of stroke, 22 percent of endometrial cancer, 12 percent of postmenopausal breast cancer, and 10 percent of colon cancer could be attributed to obesity. In 2004, 8,414 (95 percent CI: 6,881-9,927) deaths were attributable to obesity. If current obesity prevalence trends remain unchanged, the prevalence proportion of obesity in Canada is projected to reach 27 percent in men and 24 percent in women by the year 2010. These increases will have a profound impact on the treatment needs and prevalence of a wide variety of chronic diseases, and also on the health care system in terms of capacity issues and resource allocation.
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PMID:The burden of adult obesity in Canada. 1762 59

In patients with early-stage breast cancer, all recurrences are associated with an increased risk of mortality, especially distant metastases. Adjuvant tamoxifen therapy for 5 years is effective in postmenopausal patients for the prevention of disease recurrence but is associated with increased risk of rare, potentially fatal adverse events such as endometrial cancer, stroke, and pulmonary embolism. Recently, randomized clinical trials have shown aromatase inhibitor therapy to be superior to tamoxifen therapy for the prevention of disease recurrence. Switching to an aromatase inhibitor after 2-3 years of tamoxifen treatment has been shown to provide superior disease-free survival compared with completing 5 years of tamoxifen. Among approved aromatase inhibitors (letrozole, anastrozole, and exemestane), letrozole is the only one approved as extended adjuvant therapy after completing 5 years of tamoxifen. These results suggest that 10 years of adjuvant endocrine therapy is superior to 5 years of tamoxifen alone.
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PMID:Adjuvant and extended adjuvant use of aromatase inhibitors: reducing the risk of recurrence and distant metastasis. 1806 55

The use of aromatase inhibitors (AIs) as adjuvant endocrine therapy for hormone-sensitive breast cancer is increasing, as these drugs are more effective than tamoxifen alone in improving disease-free survival in breast cancer patients-whether used in lieu of tamoxifen as upfront therapy or after tamoxifen treatment periods of 2 years or longer. AIs differ from tamoxifen in their mechanism of action, effectively suppressing estrogen levels in postmenopausal women to near-undetectable levels. AI-associated adverse events largely mimic menopausal symptoms, including hot flashes, losses in bone mineral density, gynecologic symptoms, and arthralgias. The AIs lack the infrequent but potentially serious adverse events associated with tamoxifen (eg, endometrial cancer, thromboembolic events, and stroke). Large randomized studies of AIs in the adjuvant setting have not demonstrated an adverse effect on lipids and cardiovascular health, but postmenopausal women receiving AIs are at risk for age-related changes in lipid parameters and an increased risk for cardiovascular events. To optimize the overall benefits of adjuvant endocrine therapy with an AI, patients should be monitored for bone loss and cardiovascular risk factors, and symptoms such as joint pain and vaginal dryness should be anticipated and managed proactively.
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PMID:Safety of adjuvant endocrine therapy in postmenopausal women with breast cancer. 1906 May 94

The authors further analyzed results from the Women's Health Initiative randomized trials (1993-2004) of conjugated equine estrogens, with or without medroxyprogesterone acetate, focusing on health benefits versus risks among women who initiated hormone therapy soon after menopause. Data from the Women's Health Initiative observational study (1993-2004) were included in some analyses for additional precision. Results are presented here for incident coronary heart disease, stroke, venous thromboembolism, breast cancer, colorectal cancer, endometrial cancer, or hip fracture; death from other causes; a summary global index; total cancer; and total mortality. Hazard ratios for breast cancer and total cancer were comparatively higher (P < 0.05) among women who initiated hormone therapy soon after menopause, for both regimens. Among these women, use of conjugated equine estrogens appeared to produce elevations in venous thromboembolism and stroke and a reduction in hip fracture. Estrogen plus progestin results among women who initiated use soon after menopause were similar for venous thromboembolism, stroke, and hip fracture but also included evidence of longer-term elevations in breast cancer, total cancer, and the global index. These analyses provide little support for the hypothesis of favorable effects among women who initiate postmenopausal estrogen use soon after menopause, either for coronary heart disease or for health benefits versus risk indices considered.
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PMID:Benefits and risks of postmenopausal hormone therapy when it is initiated soon after menopause. 1946 78

Aromatase inhibitors are now the first choice endocrine therapy in the metastatic setting for postmenopausal women.These endocrine agents also seem likely to soon become the standard adjuvant therapy for postmenopausal patients with hormone-responsive breast cancer, either alone or in sequence with tamoxifen. In the treatment with aromatase inhibitors, the incidence of some adverse effects such as endometrial cancer, stroke or pulmonary tromboembolism treatment associated with tamoxifen is reduced. Questions remain about the long-term side-effects and safety profile of aromatase inhibitors--monitoring and handling of bone loss associated with their application are essential and are being addressed in ongoing trials. Further studies with longer follow-up are required to clarify the effects of aromatase inhibitors on lipid metabolism and cardiovascular health.
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PMID:[Evaluation of aromatase inhibitors' side effects in clinical and experimental studies]. 1970 41


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