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

Questionnaires were sent to 1000 general practitioners (GPs) in the Yorkshire Region to obtain information about their approach to the use of hormone-replacement therapy (HRT) in the menopause. A total of 310 GPs returned completed questionnaires. These showed widely varying views. The majority of GPs estimated that less than 10% of their perimenopausal patients had taken HRT at some time. There was confusion about the reported effects of HRT, on the risks of endometrial carcinoma and on ischaemic heart disease. Thus, while 86% correctly judged that HRT was protective against osteoporosis, 70% concluded against prevailing opinion that combined preparations increase the risk of endometrial cancer. In contrast to the bulk of evidence, nearly 50% of respondents believed that the risk of ischaemic heart disease was also increased by HRT. A number of GPs considered lack of an authoritive lead from epidemiology to be their greatest difficulty in forming an opinion on the desirability of HRT. The general approach to HRT was cautious in respect of both the frequency and the duration of the therapy. Less than a quarter of the GPs were sympathetic to the idea of prophylactic HRT and only 7% routinely discussed this possibility with menopausal patients, while the majority felt that the duration of therapy should be limited to 2 years or less. Most respondents also showed intuitive resistance to the idea of 'mass therapy' at the menopause and expressed concern at the idea of 'interfering with nature'.
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PMID:General practitioners use of hormone-replacement therapy in Yorkshire. 237 79

The objectives of this article on epidemiological studies of health risks from oral contraceptives (OCs) is to review major studies of the association between OCs and circulatory disease and cancer. It is also to emphasize methodologic limitations of the existing data, and to identify unresolved and important questions. A brief discourse on the nature and imputation of relative risk is provided. Cardiovascular diseases covered include ischemic heart disease, stroke, and thromboembolism. Current studies on low dose pills from 3 large US populations reveal that there is no impact of death from use of OCs. A Great Britain and the Walnut Creek study from the US found a slight but not statistically significant increase in ischemic heart disease. These studies also found a statistically significant 3-fold increase in stroke among OC users and, from another study, a 2-fold increase. These studies were based on high levels of ethinyl estradiol where the risk becomes apparent. The risk for idiopathic venous thromboembolism was 3- 8 fold for current OC users. The accuracy of these findings is questioned when the data reflect such heterogeneity. Cancer is differentiated as breast cancer, endometrial cancer, ovarian cancer, cervical cancer, malignant melanoma, and hepatocellular adenoma. For breast cancer, both case control studies as well as cohort studies found no increase in breast cancer. Future additional research will continue to explore unanswered questions about this association. Beneficial effects of OCs occur for endometrial cancer for as long as 15 years after taking the pill. Only 1 year's use resulted in a 50% reduction in risk of endometrial cancer regardless of pill dose and particularly for nulliparous women, who have an increased risk. The longer duration of use of the OCs results in a protective effect against ovarian cancer, i.e., 5 years of use yields as relative risk of below 0.5 and the results of a protective effect can be seen as early as 3 months after pill use. There is about 40% protection against ovarian cancer even with low dose pills; the effect lasts 15 years after cessation of OC use. Cervical cancer studies have shown mixed results. The human papilloma viruses 16 and 18 have been shown to be related to cervical cancer but further research is needed to identify the association with OCs. Data are inconclusive but lean in the direction of no association with malignant melanoma. Hepatocellular adenoma has not been identified in large vital statistics studies, although several small studies have suggested an increased risk. It has been shown by Fortney et al. that with a 50% increase in cervical cancer risk and a 3-4 fold increase in cardiovascular disease risk that OC use for 5 years before the age of 30 years adds 4 days to a health women's life.
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PMID:Results of oral contraceptive epidemiologic studies regarding neoplastic and cardiovascular effects. 257 54

Adverse and beneficial effects, especially with regard to mortality rates, of oral contraceptives (OC) are reviewed. In 1980 approximately 80 million women used OCs worldwide. OCs were first marketed in the United States in the 1960's, but by the 1980's low-dose combination pills with less estrogen and progesterone content became widespread along with the minipill, injectable preparations depo- medroxyprogesterone DMPA, and norethindrone containing capsules. Relative disease risk estimates are based on cohort studies and case- control studies. The Royal College of General Practitioners RCGP Oral Contraceptive Study of 1974 involved 46,000 women aged over 15 (50% were OC users, 50% were nonusers) the Oxford Family Planning Association Contraceptive Study of 1976 recruited 17,032 women aged 25-39, 56% of whom used OCs, and the Walnut Creek Contraceptive Drug Study of 1981 studied 16,638 women aged 18-54 of whom 28% were OC users and 33% were former users. A somewhat elevated mortality among ever-users of OCs in the order of 20% seems to be indicated by these studies mostly attributable to diseases of the circulatory system. Current OC use is also a risk factor in thrombotic stroke of the order of 4 or 5, but former use of OCs lowers the risk to 2. The effect of OC dose and formulation, duration of use, and predisposing factors on hemorrhagic and thrombotic stroke appears to be inconclusive with varying data from different studies. There is evidence for some increase in ischemic heart disease among current OC users, and also a 2-fold increase of myocardial infarction (MI) when smoking, serum cholesterol, and hypertension is taken into account, moreover higher estrogen dosage also contributes to a higher incidence of MI. There is also a 5-fold increase of venous thromboembolism among OC users induced by duration of use and estrogen potency, as OCs seem to promote atherogenesis, although the roles of progesterone and estrogen are conflicting. combination pills reduce the rate of endometrial cancer, provided protection against ovarian cancer, and do not seem to increase breast cancer incidence, although the relative risk of cervical cancer is elevated. Mortality risks with older OCs outweigh the benefits.
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PMID:On the epidemiology of oral contraceptives and disease. 331 96

The present level of understanding of the known risks of oral contraceptive (OC) use are summarized. The findings of many investigations in the late 1960s and early 1970s may no longer be totally appropriate because OCs available then had higher dosages than today. Also, early studies enrolled predominantly women in their 20s, who are now almost all more than 35 years old. Thus, the risks observed in these studies may not be applicable to younger women using OCs today. Another consideration has been underscored by the results of the Walnut Creek Study. Behavioral characteristics such as smoking, drinking, and sexual activity are factors which can strongly confound risks of OC use and must be considered when assessing current and future investigations. Many studies have clearly shown that the most serious life threatening danger associated with OC use is that of cardiovascular complications arising from the interaction of OC use and smoking. The increased risks attributable to smoking while using OCs account for a substantial number of the deaths recorded. The Walnut Creek Study showed a somewhat different outcome. Its data suggest no significant risk of myocardial infarction (MI), ischemic heart disease, cerebral thrombosis, or ischemic cerebrovascular disease associated with OC use, but there were nonsignificant increases noted in some cardiovascular diseases which appeared to be explained by a synergism between current use and heavy smoking. Age also has a strong influence on risk for cardiovascular disease. The results of earlier studies seem to indicate that OC use is associated with a risk of subarachnoid hemorrhage. The Walnut Creek Study also noted an increased risk of subarachnoid hemorrhage associated with OC use and found that risk increased with use. Several studies have shown that the incidence of venous thrombosis seems dependent on the dosage of the OC used. An overwhelming majority of studies on the carcinogenicity of OCs have found no increased incidence of cancer of the ovaries, uterus, or breast among users. In regard to both ovaries and endometrium, there is some evidence that OCs may be protective. Several studies have concluded that OC users have a slightly increased risk of developing malignant melanoma. The results of the Oxford/Family Planning Study show that although previous use of OC by nulliparous women may delay future childbearing by several months, it does not impair longterm potential for pregnancy. No increase in risk of clinically apparent diabetes mellitus has been reported in users. In addition to their possible protection against ovarian and endometrial cancer, OCs may reduce the risk of at least 5 other diseases: benign breast disease; deficiency anemia; arthritis, pelvic inflammatory disease; and ovarian cysts.
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PMID:The pill: an evaluation of recent studies. 704 36

A women spends about one-third of her life in her postmenopausal years. Some women supplement this period of decreased estrogen production with estrogen replacement therapy (ERT). Many epidemiologic studies have examined the long-term effect of postmenopausal estrogen deprivation and of ERT. Since the 1970s, we have evaluated the risks and benefits of ERT in one population of older women in the California retirement community of Leisure World. ERT is the most effective method for preventing osteoporotic bone loss and fractures in postmenopausal women. In Leisure World, ERT reduced the risk of hip fractures by about 50%. The effect is greatest in longterm users, but may be lost after discontinuation. Postmenopausal osteoporosis affects the bones of the jaws as well as other skeletal bones. Bone loss in the jaws may result in tooth loss. In Leisure World, estrogen users have retained more natural teeth than nonusers. Cardiovascular disease is the leading cause of hospitalization and death in women. In Leisure World, ERT reduced the risk of fatal and nonfatal myocardial infarction, ischemic heart disease, other heart disease, and stroke by 20-40%. The reduction is greatest in long-term and/or current users. ERT is effective in women with and without cardiovascular disease risk factors. One of the most feared aspects of aging is Alzheimer's disease. In Leisure World, women who had used ERT had a reduced risk of Alzheimer's disease. Risk decreased with increasing duration of use. Estrogen use, however, is not without risk. Unopposed estrogen increases risk of endometrial cancer. Risk increases with increasing years of use and remains high after discontinuation.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The risks and benefits of estrogen replacement therapy: Leisure World. 758 89

Some women take an estrogen preparation for as long as several years to ease symptoms of the menopause. Such women appear to have little or no alteration in their risk of endometrial cancer, especially if they are also taking a progestogen, and no alteration in their risk of breast cancer. Similarly, the incidence of fractures is unaffected by relatively short-term hormone use. The risk of ischemic heart disease also is reduced among women who currently take estrogens (with or without a progestogen), but the influence of duration of use on this association is uncertain. Postmenopausal women who take estrogens for an extended period of time (e.g., a decade or more) incur a sharply increased risk of cancer of the endometrium. This is largely abated by use of a progestogen for at least 10 days per month. Such long-term estrogen use, whether accompanied by a progestogen or not, may increase the risk of breast cancer slightly, but this is an area of great controversy, at present unresolved. The incidence of both myocardial infarction and fracture is substantially reduced in long-term users of menopausal hormones.
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PMID:Health consequences of short- and long-term postmenopausal hormone therapy. 869 9

A woman spends about one-third of her life in her postmenopausal years. Some women supplement this period of decreased estrogen production with estrogen replacement therapy (ERT). Since the 1970s, we have evaluated the long-term risks and benefits of ERT in one population of women, the Leisure World retirement community. ERT is the most effective method for preventing osteoporotic bone loss and fractures in postmenopausal women. In Leisure World, ERT reduced the risk of hip fractures about 50 %. The effect is greatest in long-term users but may be lost after discontinuation. Postmenopausal osteoporosis affects the bones of the jaws as well as other skeletal bones. Bone loss in the jaws may result in tooth loss. In Leisure World, estrogen users retain more natural teeth than nonusers. Cardiovascular disease is the leading cause of hospitalization and death in women. In Leisure World, ERT reduced the risk of fatal and nonfatal myocardial infarction, ischemic heart disease, other heart disease, and stroke by 20-40 %. The reduction is greatest in long-term and/or current users. ERT is effective in women with and without cardiovascular disease risk factors. A most feared aspect of aging is Alzheimer's disease. In Leisure World, women who had used ERT had a reduced risk of Alzheimer's disease. Risk both increaseng dose and decreased with increasing duration of use. Estrogen use, however, is not without risk. Unopposed estrogen increases risk of endometrial cancer. Risk increases with increasing years of use and remains high after discontinuation. The most important potential risk of ERT is breast cancer. In Leisure World, women who had used a total accumulated estrogen dose of 1500 mg or more had nearly twice the risk of breast cancer compared with nonusers. Short-term low-dose users showed no substantial increased risk. The Leisure World Study shows risks and benefits of ERT similar to other reports in the literature. For postmenopausal women generally, the benefits of ERT--preventing osteoporotic fractures, reducing heart disease, decreasing mortality, and possibly reducing risk of Alzheimer's disease-out-weigh the risks of endometrial and breast cancers. A woman must be fully informed of the risks and benefits of hormone therapy and play an important role in deciding whether to take hormones and which regimen to use.
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PMID:Estrogen replacement therapy in the elderly. 870 21

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

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

The reduction in estrogen production that occurs at menopause is associated with several long term sequelae. There is an accelerated decrease in bone mineral density leading to an increased risk of osteoporotic fracture. Furthermore, changes in plasma lipid profiles and other cardiovascular parameters increase the risk of cardiovascular and cerebrovascular pathology. These effects are additional to the menopausal symptoms experienced by many women. The effectiveness of estrogen-based hormone replacement therapy (HRT) is well established in preventing bone mineral loss and also in ameliorating menopausal symptoms, with the addition of progestogen maintaining or possibly enhancing the bone-conserving effects. However, prolonged therapy appears to be necessary to conserve bone mineral density and prevent osteoporotic fracture, particularly in women aged greater than or equal to 75 years, and compliance with long term therapy is likely to be poor. Estrogen favourably alters plasma lipid profiles, improves coronary blood flow and inhibits the central distribution of body fat. Effects on haemostatic mechanisms and coronary vasomotor response to acetylcholine have also been suggested as mechanisms for the beneficial effects of estrogen on ischaemic heart disease. The effects of concomitant progestogens on plasma lipids are variable, and may depend on the type, dosage regimen and duration of therapy. Pharmacoeconomic analyses of HRT have used a variety of risk assumptions. Relative risk rates of osteoporotic fracture and mortality from myocardial infarction are assumed to reduce to 0.5 after greater than 5 years' therapy. Long term HRT is associated with a relative risk of approximately 1.3 for breast cancer, whereas the relative risk of endometrial cancer is 4.0 to 8.0 in women with intact uteri receiving prolonged unopposed estrogen therapy. HRT that includes progestogens is assumed to incur no added risk of endometrial cancer, and this treatment is generally recommended for women with intact uteri. Data concerning the effect of HRT on quality of life are limited and utility values for hip fracture of 0.95 to 0.36 have been assigned, depending on assumptions of disability. Cost-benefit, cost-effectiveness and cost-utility studies evaluating HRT in the prevention of osteoporotic fracture have differed widely in methodology, making comparison of results difficult. HRT appears to be most economically useful in the prevention of fracture if used in women who have undergone hysterectomy, in women with high risk of osteoporotic fracture or ischaemic heart disease, and/or in women with menopausal symptoms.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Hormone replacement therapy: II. A pharmacoeconomic appraisal of its role in the prevention of postmenopausal osteoporosis and ischaemic heart disease. 1014 66


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