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

The concensus conclusions reached at a concensus development conference on Estrogen Use and Postmenopausal Women in September 1979 are based on 3 position papers prepared for the conference, the response of the panel, and the general discussion by the audience, followed by the panel and other conference participants. The evidence for the efficacy of estrogens in treating specific conditions associated with menopause was reviewed 1st. It was accepted that estrogens are more effective than placebo in decreasing the frequency and severity of vasomotor symptoms. Estrogens are effective in overcoming the atrophy of the vaginal epithelium and the associated symptoms. Present evidence does not justify the use of estrogens to treat primary psychological problems. The validity of 3 randomized trials indicating that exogenous estrogens can retard bone loss if given around the time of menopause was acknowledged. There is no convincing evidence that estrogens in customary doses increase the risk of thromboembolic phenomena, stroke, or heart disease in women who have undergone natural menopause. Evidence was also reviewed concerning adverse effects associated with post-menopausal estrogen use. In the absence of exogenous estrogens, the incidence of endometrial cancer is about 1/1000 postmenopausal women per year. This rate increases severalfold beginning after about 2-4 years of use of 0.625 or 1.25 mg of conjugated estrogens daily. Cystic hyperplasia of the endometrium, regarded as a premalignant condition, has been associated with unopposed estrogen, whether endogenous or exogenous.
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PMID:Estrogen use and postmenopausal women: a National Institutes of Health Consensus Development Conference. 4 37

A relationship between exposure to exogenous estrogens and endometrial carcinoma has been reported in numerous studies. The incidence among those so exposed has been estimated to have been increased from 7.5 to 8 times that of those not exposed. Long-term therapy with estrogens for menopausal symptoms has been the usual history. Breast cancer patients treated with estrogens and young women taking sequential oral contraceptives have had increased risks. In this study, the records of Olmsted County, Minnesota, residents with endometrial uterine cancer diagnosed between 1945-1974 at the Mayo Clinic or at other medical facilities were reviewed. There were 122 adenocarcinomas and 23 adenoacanthomas. In 3 instances, adenocarcinomas contained zones of uterine sarcoma. For each of the 146 patients there were 4 age-matched controls. Estrogen use for 6 months or more was recorded for 39 (27%) of the 145 cases and for 163 (28%) of the 580 controls. The controls had more frequent histories of short-term estrogen therapy. Cancer patients had relatively more estrogen use for menopausal symptoms. The relative risk of endometrial cancer tended to increase with the duration of exposure to conjugated estrogens from 2.0 with any exposure to 4.9 (p less than .01) after 6 months or more and to 7.9 after 3 years or more. The risk increased with larger doses (1.25 mg or more) and with continuous administration of conjugated estrogen. Myometrial invasion was superficial in 77 cases and deep in 44 cases. Long-term use of conjugated estrogen was frequently associated with low-stage low-grade superficially invasive endometrial malignancy. The 5-year survival rate of the 145 patients was 85%. Patients with Stage 1 had a 95% relative 5-year survival rate. Those with Stages 2, 3, or 4 had 50% survival rates. Of other risk factors, obesity and nulliparity were noted. Patients had more frequent records of benign cystic adenoma and of adenomatous hyperplasia than controls. The corrected age-specific rate for endometiral cancer increased to a maximum of about 90/100,000 population per year in the group aged 55-64 and then diminished with age. An increase in endometrial cancer among those at risk may have been nullified by an increase in those who have had a hysterectomy. In this study the incidence of endometrial carcinoma in Olmsted County does not show an increase in the last 3 decades. It is noted that the long-term use of conjugated estrogens in this area has been relatively low.
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PMID:Exogenous estrogen and endometrial carcinoma: case-control and incidence study. 19 Aug 87

Despite many years of extensive investigation, there has been neither a clear-cut pattern of hormonal production nor milieu found in women with breast cancer. Estrogen replacement therapy for menopause does not significantly increase the risk of breast cancer and one study indicated that estrogen users have a lower incidence of breast cancer than that observed in untreated women. Some studies have shown that the mortality rate from breast cancer is lower in estrogen-treated postmenopausal women. Only one investigator has found any significantly increased risk of breast cancer in oral contraceptive users. In that report, increased duration of birth control pill use decreased the risk of breast carcinoma. Several studies were unable to find an increased risk of breast cancer from oral contraceptives while one investigation observed a lower incidence in birth control pill users than that expected. The mortality from carcinoma of the breast in oral contraceptive users was lower than in non-users, most likely due to earlier detection. Although some retrospective studies have indicated that estrogen use increases the risk of endometrial cancer, a prospective investigation found only an insignificant increase. Progestogens afford some protection from cancer in estrogen-treated postmenopausal women. The incidence of endometrial adenocarcinoma is lower than that observed in untreated postmenopausal women. Combination oral contraceptives are protective against developing adenocarcinoma of the endometrium but sequential birth control pills may afford less protection.
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PMID:The role of hormones in the etiology of breast and endometrial cancer. 29 15

20 postmenopausal patients with serious and painful decalcifying osteosis were treated with an association of estrogens, progesterone, calcium and phosphates. Symptomatology disappeared completely in 7 cases, and was enormously improved in 9 cases. Improvement was very rapid, beginning after only 4 weeks of treatment. 2 patients did not receive any benefit from the treatment, and 2 more had a relapse after initial improvement. Estrogen therapy does reduce bone resorption and has a definite preventive and curative action whenever there is lack of estrogens. It is imperative, however, to eliminate from this kind of treatment patients with risk of breast or endometrial cancer.
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PMID:[Oestrogen therapy of osteoporosis (author's transl)]. 43 26

A previous leading article on estrogen treatment and endometrial cancer is criticized for not showing scientific appraisal. There was a misunderstanding of the case-control approach. The reasoning is invalid because it is incomplete and misleading. There are 2 previous contradictory case-control studies in which no relationship was found between estrogens and endometrial cancer. Clinical events can create prescribor bias and produce detector bias to show a fallacious relationship. An undetected endometrial cancer may already have been present when the estrogen was prescribed for bleeding, or estrogen given for postmenopausal symptoms may have provoked bleeding that led to diagnostic curettage. Estrogen's alleged carcinogenicity awaits further scientific investigation.
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PMID:Oestrogen treatment and endometrial carcinoma. 56 13

Estrogen treatment of postmenopausal women is effective in relieving the symptoms of vasomotor instability and urogenital atrophy; estrogen treatment is effective in preventing accelerated bone loss and osteoporosis in young women following castration, but in postmenopausal women aging is a more important determinant of accelerated bone loss than is decreased estrogen secretion. Low-dose estrogen treatment of postmenopausal women neither prevents nor increases the risk of arteriosclerotic cardiovascular disease or cerebral vascular disease. It cannot be definitively established that estrogen treatment of postmenopausal women causes an increased incidence of breast tumors, but it is clear that such treatment does not prevent these tumors. It is established that estrogen treatment of postmenopausal women increases the risk ratio of endometrial carcinoma.
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PMID:Estrogen treatment of postmenopausal women. Benefits and risks. 57 21

A continuing education examination of estrogen therapy is discussed. The most common indication of estrogen therapy is for replacement in menopausal women. Estrogens can also be used in the treatment of certain types of cancer such as prostatic cancer. A diagnosis of estrogen deficiency must be established first and then estrogen therapy must be selectively used. Psychoemotional problems must be ruled out. Perimenopausal patients may be treated somewhat differently than postmenopausal patients. 1 of the major controversies surrounding estrogen therapy, other than cancer and osteoporosis, is its implication to coronary heart disease. The evidence indicates that estrogen in some way contributes to endometrial carcinoma. Estrogen administration does not seem to show a correlation to breast cancer. Actual treatment must be individualized, and which estrogen, how much, and how long it should be used is still not clear.
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PMID:Estrogen therapy. 70 1

Horones as a therapeutic agent are practically not used in gynecologic oncology, because gynecological malignomas are hormonally independent. Therapeutically succesful in only the use of Progesterone in metastases and relapses of endometrial cancer and of Estrogen in the palliative treatment of cervical cancer relapses. However, significant results are obtained by cytostatic therapy, particularly in carcinomas of the ovary and in choriocarcinomas; the therapy is somewhat less successful in the cancer of the oviduct and vulva, while in the cancer of the cervix and vagina it is not successful at all. Polychemotherapy is recommended because it results in better remissions and is less aggressive.
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PMID:[Cytostatic and hormonal therapy on oncologic gynecology (author's transl)]. 75 24

Postmenopausal bleeding is associated with a relatively high incidence of malignancy. The lowest incidence reported in the literature was observed among Jewish women in Jerusalem, more than 21 years ago (1). A similar survey of Jewish women admitted to our Department for postmenopausal bleeding during 1962-74 is presented. Fifty-five of 397 cases (13.8%) of postmenopausal bleeding were due to malignancy. There were 34 women with endometrial carcinoma, 11 with cervical carcinoma, five with ovarian carcinoma, four with uterine sarcoma and one with vaginal sarcoma. In 86% of cases, benign pathological states were found, 42.8% being associated with atrophic endometrium. An active endometrium was found in 56 patients (14%), and in two of them the endometrium was secretory. Estrogen therapy was not an important causative factor in these cases. The low incidence of malignancy seems to be due to the fact that cervical carcinoma is less common among Jewish women. Nevertheless, 20% of the malignant tumors in this series were invasive epidermoid carcinomas of the cervix. The need for a cytologic screening program in this country must therefore be reevaluated.
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PMID:Incidence of malignancy in Jewish women with postmenopausal bleeding. 85 67

The use of estrogen during the climacterium is discussed. Estrogen should be used only when objective symptoms of a lack of estrogen can be established. Thrombosis, hypertension, breast cancer, uterine cancer and ruptured blood vessels are contraindications to climacteric estrogen use. Progestagens administered in conjunction with sedatives and diuretics can often relieve climacteric afflictions. Continued administration of estrogen should be avoided; estrogen can be administered with or without gestagens 7-10 days before menstruation or in 21-day periods. General practitioners are qualified to administer estrogen and should give patients regular examinations. There is a risk of developing endometrial cancer under climacteric estrogen treatment. Only women who want and need climacteric estrogen treatment should receive it.
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PMID:[Estrogen treatment only when symptoms are present but complaints should not be neglected]. 86 7


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