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

Estrogens and progesterone seem to have at times antagonistic, at times synergetic action on breast and uterine tissues. While estrogens stimulate cell proliferation, progestrerone favors secretion. While estrogens favor myometrial and endometrial hyperplasia, progesterone seems to dominish congestive phenomena caused by estrogens, especially on breast tissues. Women who experience menopause at 55 have a twice as high risk of breast cancer than women who menopause at 45. Breast and endometrial cancer are often associated with a history of menstrual disorders, and it is very possible that endometrial hyperplasia and cystic mastosis are connected. While treatment with estrogens helps to avoid vaginal atrophy and to arrest osteoporosis, it is doubtful whether the treatment should be systematic over 45. Breast examination and a thorough gynecological examination are essential once a year.
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PMID:[Menopause, estrogens and genital cancer]. 24 20

Despite reports of studies linking menopausal estrogen therapy with endometrial cancer in 1975, physicians have persisted in considering menopause a condition needing medication--with estrogens. To assess the risks and benefits, NIH held a conference on estrogen usage in postmenopausal women. A panel of physicians heard the therapeutic, epidemiologic, and sociologic evidence and summarized the findings in a final report. It was agreed that estrogen therapy will be effective in combating vasomotor flushes (hot flashes) and vaginal atrophy and dryness. Evidence to justify estrogen use for coronary vascular disease and depression does not exist. Further evidence is needed to deterine whether estrogen therapy will decrease osteoporosis-related fractures. The risk of endometrial cancer increases 4-8-fold following 2-4 years of continuous estrogen usage. It was concluded that estrogens should be prescribed in the lowest effective dosages and for short terms, not exceedng 2-4 years. Cyclic progestin administration and yearly curettage sampling for endometrial cancer might reduce the risk of developing endometrial cancer while on estrogen therapy.
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PMID:Estrogen prescribing practices scrutinized at NIH conference. 52 51

The use of estrogens almost tripled during the 1965-75 period, with usage concentrated as a cure-all for aging, for the degenerative diseases associated with aging, and for the emotional difficulties of middle age. 3 separate studies published in the last year have shown a high level of association between estrogen use and the development of endometrial cancer. Results of these studies coupled with the significant recent increase in the incidence of cancer in women over 50 who are in the high socioeconomic groups--the groups most likely to use estrogen therapy--emphasize the association. The U.S. FDA has proposed a modification in the labeling for estrogens, and a package insert for patients which would warn of possible hazards of estrogen therapy. It is recommended that estrogen be used only for vasomotor symptoms and vaginal atrophy. The lowest possible effective dosage should be used and for the shortest possible amount of time. Earlier studies had suggested that estrogen replacement therapy might protect against breast cancer; most recent studies suggest the opposite. In addition, estrogen may trigger high blood pressure and increase some blood clotting. Women with high blood pressure or a family history of early heart attacks are contraindicated from using estrogen therapy. Even for the treatment of osteoporosis, there may be safer alternative therapies. Women are cautioned as to their own responsibilities when taking estrogens.
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PMID:Estrogen therapy: the dangerous road to Shangri-La. 102 54

Although hormone replacement therapy (HRT) has been available for almost 100 years, conflicting opinions still exist about its efficacy and safety. There is uniform agreement that vasomotor instability and vaginal atrophy are totally reversible with HRT. Effective treatment of bone loss with HRT depends on the number of years of estrogen deprivation, peak bone mass, and rapidity of bone loss. Oral, transdermal, and pellet estrogens are equality effective. Mortality from coronary heart disease decreased 20% to 40% in women on HRT, yet the mechanism has not yet been ascertained. The increased risk of endometrial cancer has been confirmed, but better diagnostic techniques for detection in the precancerous state have been developed. The relationship of breast cancer to estrogen use has not been conclusive. Meta-analysis of 13 studies results in a relative risk of 1.06, whereas a large case-control study reveals a relative risk of 0.9. However, it is clear that in the average, healthy woman, low-dose estrogen replacement for less than 10 years does not increase the risk of breast cancer. Physicians are encouraged to help patients weigh the risks and benefits of HRT.
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PMID:Hormone replacement therapy. 145 Mar 57

In postmenopausal women estrogens alone are effective in reversing vasomotor symptoms and vaginal atrophy. They also prevent the bone loss associated with osteoporosis and reduce the risk of cardiovascular disease, probably through their beneficial effects on lipid metabolism. Unopposed long-term estrogen therapy, however, increases the risk of developing endometrial hyperplasia, endometrial cancer, and possibly breast cancer as well. The risk of developing endometrial cancer can be reduced by combining a progestin with the estrogen, by controlling obesity, and by rigorous clinical screening and surveillance. The effect of progestins on the risk of developing breast cancer is still controversial. Although some progestins may reverse the cardioprotective effect of estrogens, those with minimal androgenicity appear less likely to do so. Hormone replacement therapy that combines estrogen with a progestin of minimal androgenicity is thus a rational alternative to unopposed estrogen therapy. Current epidemiologic knowledge suggests that the benefits of hormone replacement therapy, with or without any progestins, strongly outweigh the risks.
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PMID:The benefits and risks of hormone replacement therapy: an epidemiologic overview. 160 89

For patients with previous endometrial cancer, ERT is not the accepted practice in the U.S. The therapeutic dictum that estrogen is contraindicated in patients with previous uterine adenocarcinoma is, however, not substantiated by clinical data. The relation of unopposed estrogen stimulation to endometrial hyperplasia and carcinoma, and the published studies relating ERT to endometrial cancer, have resulted in the clinical perception--and cautionary statements to that effect--that estrogen is contraindicated for patients with a history of endometrial carcinoma. The exact biologic effects of ERT on endometrial adenocarcinoma have not yet been studied adequately, however; the initial clinical data suggest that there is no increase in recurrence or mortality. In the meantime, the clinician is left with contradictory data as a basis for determining the proper management of symptomatic patients. The total impact of estrogen deficiency on the health of women and the ratio of benefits and risks of ERT are yet to be defined completely. The preponderance of evidence suggests that estrogen has a beneficial effect on the major cause of death in women, coronary heart disease, by increasing the high-density lipoprotein (HDL) fraction of cholesterol. It is established that estrogen prevents the demineralization of bone and delays the ravages of osteoporosis. No one has died from vaginal atrophy, bladder dysfunction, or hot flashes; the quality of life and marriage have been improved, however, by relieving these symptomatic conditions with ERT. Several studies have attempted to analyze with various statistical models the ratio of benefits to risks, and the majority of authors have concluded that the beneficial effect on cardiovascular disease alone clearly outweighs any known risk.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Estrogen-replacement therapy in patients with previous endometrial carcinoma. 240 7

This review briefly outlines the pharmacology of natural and synthetic estrogens, and synthetic progestins, and summarizes their beneficial and adverse effects for contraceptive and menopausal therapy. Currently, oral contraceptives contain 30-50 mc synthetic estrogen, and 1-5 mg nor-progestin; menopausal therapy may be either 0.625-1.25 mg natural estrogen or estrogen plus 10 mg medroxyprogesterone acetate daily if the woman has her uterus. The biologic effects of estrogens are : decrease in lipoproteins, increased blood coagulation factors, increased blood pressure, decreased glucose tolerance. Progestins increase blood lipids and increase insulin and glucose. Oral contraceptives increase the risk of cardiovascular disease, particularly in smokers and in women over 35, in proportion to dose. These studies should be recapitulated in more detail with the newer low-dose pills. Orals have far more beneficial effects, besides providing an inexpensive, effective method contraception. The death rate of users of oral contraceptives is 3.7/100,000 (1.8 in nonsmokers and 6.5 in smokers), but the risk is 5.5 times higher in nonusers exposed to pregnancy and childbirth. The risk for users of barrier methods backed up by abortion is lower, but pills are cheaper and more acceptable. If woman did not take oral contraceptives, they would not be protected from cancer of the breast, ovary, endometrium, and ovarian and breast cysts. Menopausal therapy puts woman at increased risk of endometrial cancer only if the estrogen is taken alone, not if progestin is combined with the estrogen. There are no other adverse effects except decreased glucose tolerance and possible comprise of lipoproteins if a norprogestin of menopausal estrogens effectively treat hot flashes, depression, vaginal atrophy and bones loss.
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PMID:The adverse effects of hormonal therapy. 351 31

Endometrial carcinoma is a disease of menopausal and postmenopausal women with 74% of cases occurring between the ages of 50-69 years and 16% at age 70 or older. Recent reports suggest an increase in the frequency of the lesion and occurrence at an earlier age. Any single test by most of the conventional methods will miss about 50% of the carcinomas of the endometrium. To obtain greater accuracy in diagnosis, it is necessary to obtain large numbers of well-preserved cells directly from the endometrial cavity. Cervical patency should be proved in the examination of all postmenopausal women. The device described uses a silicone rubber tube 33.5 cm in length and 2 mm in diameter. A wire stylet for stiffness and a rounded plastic tip facilitate passage through the sometimes stenotic cervical canal. Near the tip many small holes permit aspiration of endocervical secretions. A plastic collar around the tubing facilitates the aspiration. An aspirating syringe adapter is needed. After conventional Pap smears are obtained the aspirating tube is passed into the uterus. Little or no pain is produced. Negative pressure for aspiration is obtained with a syringe. The contents of the aspirating tube are expelled onto a slide. The slide preparations are immediately fixed in a bottle of absolute alcohol containing 3% glacial acetic acid. The acid lyses most red blood cells. This method was used in 983 outpatients and 500 hospitalized patients. There were only 5 patients in whom the endometrial aspirator could not be passed, due to previous cervical trauma in 3 and vaginal atrophy and distortion in 2. No uterine perforations or infections occurred. There were no positive tests for carcinoma in the 983 outpatients. Endometrial carcinoma was diagnosed histologically in 32 of the 500 hospitalized patients. IN 27 of these 32 cases the endometrial carcinoma had been detected by cytological examination of the aspirate. There were 5 carcinoma cases in which the aspirate did not show malignant cells. In 3 of them external radiation had been given prior to surgery and some residual cancer was found in the hysterectomy specimen. Excessive blood on the slide had prevented adequate cytologic evaluation in the other 2. In 6 cases adenocarcinoma was suspected from the examination of the aspirate but not found histologically. 4 of them showed abnormal endometrial curettings. Polyps were found in 3 and hyperplasia in 1. 8 cases of in situ or early invasive carcinoma of the cervix were discovered. Results show that the method is safe and accurate to an 84.4% degree for detecting endometrial adenocarcinoma. In an accompanying discussion, better fixation of material on slides was suggested. Annual mass population screening by this method was not considered practical. Others have depended on a jet wash of the endometrium and on endometrial biopsies to obtain material for histologic study, but many patients do not like having the needed dilatation and fail to return for reexaminations.
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PMID:An acceptable yearly screening device for endometrial carcinoma. 459 64

Controversy regarding almost all aspects of hormone replacement therapy continues. Interest in active management of the menopause and its problems is increasing at a time when it is becoming more and more difficult to evaluate the literature -- over 100 articles each year on the subject. Currently, few authorities disagree with the concept of short-term estrogen therapy for hot flashes or vaginal atrophy, yet when long-term hormonal replacement therapy is advocated the controversy begins. Some women appear to need long-term therapy for persistent vasomotor symptoms and genital atrophy, and a strong economic argument has been made for long-term estrogen replacement in all postmenopausal women to reduce the later incidence of symptomatic osteoporosis. Estrogens in a dosage equivalent to 0.625 to 1.25 mg of estrone sulphate can greatly reduce the rate of postmenopausal cortical bone loss, demonstrable osteoporosis and the incidence of fractures in later years. Most leading authorities are against unrestricted estrogen use. The primary concern is that of endometrial cancer developing in a few susceptible women who receive long-term estrogen therapy. Recent evidence supports that a dose and duration related risk exists, but that the risk is probably low, that the cancer is generally diagnosed early, is of relatively low malignancy, and responds with an excellent prognosis to adequate surgical treatment. There is no question that patients receiving long-term estrogen therapy need continuing medical supervision.
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PMID:Long-term oestrogen usage and the postmenopausal woman. 678 Jul 71

The US Food and Drug Administration (FDA) approved marketing of diethylstilbestrol in 1941 and conjugated equine estrogens (CEE) in 1942 for treatment of menopausal symptoms. Estrogen sales doubled and tripled in the mid-1960s to mid-1970s, until 1975, when reports of increased endometrial cancer in estrogen users resulted in a dramatic decline. Estrogen use increased again, with evidence of protective effects of progestins on estrogen-induced endometrial changes, combined with a 1982 report that Premarin (conjugated estrogen tablets; Wyeth Pharmaceuticals, Philadelphia, PA) retained bone mass and a 1984 National Institutes of Health (NIH) Consensus Conference on Osteoporosis statement that estrogens were the most effective means for preventing bone loss. Despite conflicting reports in 1985 regarding the relation between estrogens and coronary heart disease (CHD), many published observations of reduced CHD risk in estrogen users--reinforced by clinical trial findings in 1995 of favorable lipoprotein changes in women assigned to CEE with or without a progestin--promoted increased use through the 1990s. By 2001, approximately 15 million US women were using estrogen therapy, with or without progestins. The 2002 Women's Health Initiative (WHI) report of greater harm than benefit of combined CEE plus a progestin resulted in a precipitous decrease in estrogen and progestin use and a serious reevaluation of menopausal hormone therapy, as well as increased interest in alternative approaches to managing menopausal symptoms, including use of "bioidentical" hormones. FDA guidelines regarding treatment indications for vasomotor symptoms, vaginal atrophy, and osteoporosis prevention have resulted in approval of several estrogen (and progestin) formulations, doses, and routes of administration, thereby providing many options for women who seek conventional therapy.
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PMID:Estrogens and progestins: background and history, trends in use, and guidelines and regimens approved by the US Food and Drug Administration. 1641 29


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