Women in the sunniest countries seem to get endometrial cancer less often than those who live far from the equator.

Using a large World Health Organization database, researchers have found lower rates of the cancer, which strikes the lining of the uterus, in populations with a higher exposure to UVB radiation, the ultraviolet light that causes the skin to produce vitamin D.

“There is a mathematical relationship,” said Cedric Garland, a professor of family and preventive medicine at the University of California, San Diego, and a co-author of the study, which appears in the November issue of Preventive Medicine.

The researchers assembled information on endometrial cancer in 107 countries. In both Northern and Southern hemispheres, the higher the latitude, the higher the risk - even after adjusting for many variables. They also found that higher rates of meat eating, per capita health expenditure and the percentage of the population that was overweight were each associated with a higher risk of endometrial cancer.

Though the researchers did not measure vitamin D levels, Garland said, “we believe that vitamin D accounts for the finding, since the geographic distribution corresponds to that of other cancers which have been shown in studies of individuals to be related to levels of vitamin D.”

Stress disorder and asthma A new study has found a link between asthma and post-traumatic stress disorder, though the reasons remain unknown.

The stress disorder, PTSD for short, is common among combat veterans and others who have endured severe trauma. Previous studies have demonstrated a connection between asthma and psychiatric illnesses, but no one knows whether one disorder increases the risk for the other or whether they share a common risk factor, either environmental or genetic.

Researchers used data on 3,065 male twin pairs who had lived together as children and had active duty in the Vietnam War. They adjusted the findings to eliminate the influence of depression, smoking, age, body mass index, exposure to combat and other variables.

One-fourth of men with the most severe symptoms of the stress disorder were more than twice as likely to suffer from asthma as the quarter with the fewest PTSD symptoms.

The association cannot be fully explained by familial or genetic factors; identical twins, who have exactly the same genes, were no more likely to suffer from both illnesses than fraternal twins, who share only half their genes.

The researchers, whose paper appears in the Nov. 15 issue of The American Journal of Respiratory and Critical Care Medicine, are still seeking the explanation.

“It may be a common environmental exposure that increases vulnerability to both disorders,” said Renee Goodwin, the lead author and an assistant professor of epidemiology at the Mailman School of Public Health at Columbia.

‘Dragon’s blood’ may fight ulcer bacterium Researchers have discovered that a plant widely used in traditional Chinese medicine contains compounds that slow the growth of the germ that causes most peptic ulcers.

The chemists, led by Weimin Zhao of the Chinese Academy of Sciences, isolated 22 compounds from the treelike plant, Dracaena cochinchinensis, which gives off a dark-red resinous substance called dragon’s blood. They found two that were effective against the ulcer bacterium, Helicobacter pylori, and eight others that worked as blood thinners.

Their report appears in the October issue of The Journal of Natural Products.

“Many traditional Chinese medicines have been confirmed to possess various beneficial effects,” Zhao said in an e-mail message, “but it is still not easy to understand thoroughly how they work.”

Zhao does not claim that Dracaena, used in China for stomach ailments, fractures and wounds, is a substitute for modern medicine.

Its antibacterial compounds would need to be taken in much higher concentrations than amoxicillin, an antibiotic used for peptic ulcers.

The blood-thinning compounds the researchers found were effective, but not nearly as powerful as, for example, heparin, a common blood thinner.

 

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BACKGROUND: Women with polycystic ovary syndrome (PCOS) are assumed to be at increased risk of endometrial cancer (EC), albeit of a more differentiated type with better prognosis than in normal women. This study was designed to test these assumptions, as evidence for them is lacking. METHODS: The prevalence of polycystic ovaries (PCO), as a marker of PCOS, was investigated in ovarian sections from 128 women with EC and 83 with benign gynaecological conditions. The expression of the prognostic markers p53, Ki67, Bcl2 and cyclin D1 was also investigated by immunohistochemistry in endometrial tumours from 11 women with PCO and 16 with normal ovaries. RESULTS: Overall, PCO were similarly prevalent in women with EC (8.6%) and benign controls (8.4%); however, in women aged <50 years, PCO were more prevalent in women with EC (62.5 versus 27.3%, P = 0.033). Cyclin D1-expressing endometrial tumours tended to be more prevalent in women with PCO compared to normal ovaries (36.4 versus 6.25%, respectively, P = 0.071). Bcl2-, p53- and Ki67-expressing tumours were similarly prevalent. CONCLUSIONS: The association between PCOS and EC appears confined to premenopausal women. The tendency for cyclin D1-expressing endometrial tumours to be more prevalent in women with PCO challenges the assumption that EC prognosis is improved in women with PCOS.

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Purpose: Endometrial cancers classified as “intermediate risk” based on clinical and/or pathologic features are associated with a 15% to 20% risk of recurrence. Here, we test whether global gene expression profiling can distinguish intermediate-risk tumors into high-risk and low-risk subgroups.

Experimental Design: Tumor specimens were obtained from 75 intermediate-risk endometrial cancer patients, 13 who had recurred and 62 who had not recurred with a median follow-up of 24 months. Gene expression profiles were obtained using the Affymetrix U133A GeneChip oligonucleotide microarray. The genes most associated with risk of recurrence were used to create a risk score using a leave-one-out cross-validation method and the univariate Cox proportional hazards regression model. Time to recurrence curves for the high-risk and low-risk subgroups were estimated using the Kaplan-Meier method, and the difference in time to recurrence between these two subgroups was tested using the log-rank test.

Results: There was a significant difference in time to recurrence between high-risk and low-risk patients using risk scores as defined above (P = 0.04). The estimated hazard ratio (95% confidence interval) was 3.07 (1.00-9.43).

Conclusions: Patients with intermediate-risk endometrial cancers identified as high-risk for recurrence according to a gene expression–based risk score have a significantly increased risk for recurrence compared with those classified as low risk. These findings suggest that gene expression profiling can potentially contribute to the clinical classification and management of intermediate-risk endometrial cancers.

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Endometrial cancer is the fourth most common cancer in women, accounting for approximately 6,000 deaths per year in the United States. It is more common in women who are older, white, affluent, obese and of low parity. Hypertension and diabetes mellitus are also predisposing factors. Because any condition that increases exposure to unopposed estrogen increases the risk of endometrial cancer, tamoxifen therapy, estrogen replacement therapy without progestin and the presence of estrogen-secreting tumors are all risk factors. Smoking and the use of oral contraceptives appear to decrease the risk. Women with an increased risk and those with postmenopausal bleeding should be screened for endometrial cancer. Endometrial sampling is currently the most accurate and widely used screening technique, but ultrasonographic measurement of endometrial thickness and hysteroscopy have also been studied. Patients with endometrial specimens that show atypia have about a 25 percent likelihood of progressing to carcinoma, compared with less than 2 percent in patients without atypia. Endometrial cancer is usually treated surgically, but in patients with appropriate pathologic findings who decline surgical treatment, progestin therapy may be satisfactory.

Uterine cancer, the most common malignant neoplasm of the female genital tract and the fourth most common cancer in women, is currently diagnosed in about 34,000 women each year. In 1997, about 6,000 women in the United States died of this disease. It is more frequent in affluent and white women, especially obese, postmenopausal women of low parity.2 Hypertension and diabetes mellitus are also predisposing factors.3 Uterine cancer is most frequently diagnosed in industrialized western nations, with the lowest rates occurring in India and Southeast Asia.

Advances in the past two decades have expanded our knowledge of endometrial cancer, giving us a better definition of the histologic subtypes and providing us with better screening and surgical tools with which to diagnose and treat this disease.

Pathogenesis

It was originally hypothesized that endometrial hyperplasia represented a morphologic continuum from benign cystic hyperplasia to atypical complex hyperplasia, which may be the immediate precursor of endometrial carcinoma. Several recent studies have suggested that endometrial hyperplasia and endometrial cancer are two different entities, and the distinguishing feature is the presence or absence of cytologic atypia. Studies have shown that patients who have endometrial hyperplasia without atypia respond well to progestin therapy and are not at increased risk for cancer; however, patients with cytologic atypia show only a 50 percent response to progestin therapy, and cancer develops in 25 percent of cases.

Uterine cancer is a general term used to describe many different histopathologic types of tumors found in the uterus. The most common cancer of the uterus is adenocarcinoma. Several other histologic subtypes also occur. The less common forms are associated with a lower overall survival rate and a higher risk of metastatic disease at the time of surgical staging.2 Patients with serous (also known as papillary serous) and clear cell carcinomas tend to be older than those with other types (mean age: 66 versus 59 years) and are more likely to have abnormal cervical cytology. Serous carcinoma invades the myometrium and lymph-vascular spaces early and has been shown to metastasize without deep myometrial invasion.

Risk Factors

Any characteristic that increases exposure to unopposed estrogen increases the risk for endometrial cancer. Conversely, decreasing exposure to estrogen limits the risk. Unopposed estrogen therapy, obesity, anovulatory cycles and estrogen-secreting neoplasms all increase the amount of unopposed estrogen and thereby increase the risk for endometrial cancer. Smoking seems to decrease estrogen exposure, thereby decreasing the cancer risk, and oral contraceptive use increases progestin levels, thus providing protection.9 Tamoxifen (Nolvadex) therapy, often used in women with breast cancer, has an estrogenic effect on the female genital tract and, through this unopposed estrogen exposure, increases the risk for endometrial cancer.10 Physicians should be aware that endometrial ablation is not a treatment for endometrial hyperplasia or carcinoma, and a previous ablation does not protect against the development of endometrial disease.

Hormone Replacement Therapy

Unopposed estrogen treatment of menopause is associated with an eightfold increased incidence of endometrial cancer. The addition of progestin decreases this risk dramatically.12 For maximum endometrial protection, administration of medroxyprogesterone acetate (Provera), in a dosage of 10 mg daily, or norethindrone acetate (Aygestin), in a dosage of 2.5 mg daily, for a minimum of 12 to 14 days per month has been recommended. However, some physicians prescribe lower dosages, either 5.0 or 2.5 mg of medroxyprogesterone daily.

A 13-day “progestin challenge” course of either 10 mg of medroxyprogesterone or 2.5 to 5 mg of norethindrone given to postmenopausal women resulted in withdrawal bleeding and correlated with a high likelihood of endometrial pathology. In this study, it was found that low dosages may not provide maximal endometrial protection.13 However, the Postmenopausal Estrogen/Progestin Interventions (PEPI) trial14 found no difference in the risk for endometrial disease between patients taking placebo and those taking estrogen with medroxyprogesterone, in a dosage of either 10 mg per day for 12 days or 2.5 mg per day continuously.

One possible explanation for these contradictions can be found in the patient groups studied. Many of the patients in one study had one or more risk factors for endometrial disease whereas the PEPI trial involved a randomly selected cohort.14 These findings suggest that patients at high risk for endometrial disease should receive higher dosages of progestins than patients at low risk, a suggestion that is supported, in theory, by the pathophysiology. Further studies may be necessary for more definitive recommendations.

Screening

Population screening is not economically feasible; therefore, assessing the risk of individual patients is essential to reduce the morbidity and mortality of uterine cancer. By identifying women who are at high risk for endometrial neoplasia), physicians can be selective about the use of endometrial sampling.

The Papanicolaou (Pap) test is not helpful in identifying women who are at increased risk for endometrial neoplasia. In one study, the presence of normal endometrial cells in postmenopausal women not on hormonal therapy was associated with a 19 percent risk for endometrial hyperplasia or carcinoma. Although a normal Pap smear does not indicate that a woman is at low risk for endometrial neoplasia, the presence of endometrial cells on a Pap smear in a postmenopausal woman who is not receiving hormonal therapy should be evaluated by endometrial biopsy.

Clinical Signs and Symptoms

Ninety percent of patients with endometrial cancer have abnormal vaginal bleeding. This usually presents as menometrorrhagia in a perimenopausal woman or menstrual-like bleeding in a woman past menopause.2 Perimenopausal women relate a history of intermenstrual bleeding, excessive bleeding lasting longer than seven days or an interval of less than 21 days between menses. Heavy, prolonged bleeding in patients known to be at risk for anovulatory cycles should prompt histologic evaluation of the endometrium.

Elderly women who have had many years of estrogen deficiency occasionally present with pelvic pain and are found to have retained blood in the uterine cavity (hematometra) related to cervical stenosis. These patients may require surgical intervention to obtain a specimen of the endometrium.

Although physicians should have a high index of suspicion for endometrial cancer in women who are obese, have diabetes and are past menopause, 35 percent of patients with endometrial cancer show no signs of obesity or hyperestrogenism.The findings on abdominal examination are usually normal, and the pelvic examination may show only evidence of mild vaginal bleeding. Any suspicious palpable lesions of the vulva, vagina or cervix should be carefully inspected and, if warranted, a biopsy specimen should be obtained to exclude metastatic disease or other causes of vaginal bleeding.

The physician should note particularly the size, contour, mobility and position of the uterus. These findings can be helpful in determining risks for complications with diagnostic testing, such as endometrial biopsy, and the possibility of metastatic or locally advanced disease. The adnexal examination is extremely important because endometrial cancer may be the result of a coexisting estrogen-secreting ovarian tumor such as a granulosa cell tumor.2

Diagnosis and Evaluation

Patients who report abnormal vaginal bleeding and have risk factors for endometrial cancer should have histologic evaluation of the endometrium. Premenopausal patients with amenorrhea for more than six to 12 months should be offered endometrial sampling, especially if they have risk factors associated with excessive estrogen exposure. Postmenopausal women with vaginal bleeding who either are not on hormonal replacement therapy or have been on therapy longer than six months should be evaluated by endometrial sampling.

Diagnosis

Over the past decade, pathologists have defined the patterns of endometrial hyperplasia and atypia. Using small specimens, they can usually arrive at an accurate diagnosis. Most endometrial biopsy findings fall into one of four categories  Based on current research, the presence of atypia indicates risk for progression to cancer. In several studies of women with endometrial hyperplasia, more than 80 percent of those without atypia responded to progestin therapy, compared with only 50 percent of those with atypia. Carcinoma developed in 25 percent of patients with atypia as opposed to less than 2 percent of those without atypia.4-6

Endometrial Sampling

The gold standard for histologic evaluation of the endometrium has been dilatation and curettage (D&C). In-office endometrial sampling devices, however, have proved to be effective in screening the endometrium for disease without the inconvenience, cost or risk of an operating-room procedure. Numerous studies have found the results of office sampling to approach those of D&C, with an accuracy of 90 to 95 percent.

Several devices have been developed for in-office sampling of the endometrial lining. These include the Novak or Kevorkian curet, the Pipelle endometrial-suction curet and the Vabra aspirator

Before having an in-office biopsy, the patient should take a preoperative dose of a nonsteroidal anti-inflammatory drug (NSAID). With the patient in the lithotomy position, a speculum is inserted in the vaginal canal. The cervix should be clearly visualized and cleansed with a small amount of an antiseptic solution. Many physicians generally perform the endometrial biopsy without anesthesia, and most patients are able to tolerate this well. However, use of a paracervical block, as well as an NSAID, greatly improves patient tolerance and compliance.

After 1 mL of a local anesthetic is infused into the anterior lip of the cervix, a tenaculum can be placed. The paracervical block is then performed using 1 or 2 percent lidocaine (Xylocaine) without epinephrine (Figure 1). When the block is achieved, patients with slight cervical stenosis can be dilated with lacrimal dilators without causing great discomfort. This is followed by the use of a uterine sound to determine the direction and measure the length of the uterine cavity.

The cannula is then placed in the uterus and placement is confirmed with the help of the centimeter markings along the cannula. Light downward traction on the tenaculum can be used to straighten the cervical canal and allow for easier passage of the sampling device. The inner sleeve is then pulled back while the cannula is held within the cavity. This generates a vacuum in the cannula that can be used to collect endometrial tissue for diagnosis. Moving the cannula in and out of the cavity no more than 2 to 3 cm with each stroke while turning the cannula clockwise or counterclockwise is helpful in obtaining specimens from the entire cavity.

Once material is seen in the top of the cannula, the instrument can be removed. The specimen is then placed in formalin and sent to the laboratory for histologic diagnosis. If no tissue is obtained, a second cannula can be used, or a small Novak curet can be placed in the uterine cavity and a gentle curettage can be performed. Some patients have atrophic endometrium, and little or no tissue will be obtained. In these patients, close observation can be maintained, or a D&C can be performed with general or spinal anesthesia.

Other Screening Techniques

Ultrasonographic measurement of endometrial thickness has been suggested as a screening technique to obtain an image of the endometrial lining and predict the likelihood of disease based on its thickness. However, current information does not support routine use of this approach. Numerous studies measuring endometrial thickness with the use of transvaginal ultrasonography have indicated that an endometrial thickness of less than 5 mm is rarely associated with carcinoma. In the Nordic trial,26 the largest study to date, a cutoff of less than 5 mm was associated with 96 percent sensitivity, 68 percent specificity and an accuracy of 78 percent for detecting histologically abnormal endometrium in patients with postmenopausal bleeding.

In other studies of transvaginal ultrasonography, investigators concluded that the data support its use for surveillance of women on tamoxifen therapy and those with postmenopausal bleeding and endometrial cells seen on cervical cytologic examination.

Transvaginal ultrasonography may be helpful in determining which patients should have a biopsy (endometrial thickness greater than 4 mm) and in detecting other pelvic abnormalities in women reporting abnormal uterine bleeding.

Sonohysterography is now being used to look at the features of the endometrial lining, in particular to distinguish thickness from polyps and leiomyomas, which are the common uterine abnormalities missed by endometrial biopsy.

Inpatient or outpatient hysteroscopy, which is the direct inspection of the endometrium, has been used to evaluate cases of abnormal uterine bleeding. Its many advantages over endometrial biopsy, transvaginal ultrasonography, sonohysterography and D&C include direct visualization of the endometrium, which provides the opportunity to obtain a biopsy specimen and remove lesions, especially polyps and leiomyomas. Its disadvantages include surgical risks, which are similar to those of D&C, and the additional concerns of cost and the possible spread of malignant cells into the peritoneal cavity.

Treatment

The treatment of endometrial cancer is usually surgical, such as total abdominal hysterectomy, bilateral salpingo-oophorectomy and evaluation for metastatic disease, which may include pelvic or para-aortic lymphadenectomy, peritoneal cytologic examination and peritoneal biopsies. The extent of the surgical procedure is based on the stage of disease which can be determined only at the time of the opera

For most patients whose cancers have progressed beyond stage IB grade 2, postoperative radiation therapy is recommended. This may include simple vaginal vault irradiation or external pelvic irradiation with or without extended abdominal irradiation, based on the extent of disease.

Because tumor response to cytotoxic chemotherapy has been poor, chemotherapy is used only for palliation. Progestin has also been used to treat recurrent endometrial cancer, but the response rates have been poor

Endometrial hyperplasia with atypia should be treated with hysterectomy except in extraordinary cases. Progestin treatment is a possibility in women younger than 40 years of age who refuse hysterectomy or who wish to retain their childbearing potential, but an endometrial biopsy should be performed every three months.16 Investigators have reported that treatment of atypical hyperplasia and well-differentiated endometrial cancer with progestins in women younger than 40 years of age resulted in complete regression of disease in 94 percent and 75 percent, respectively.32 This was a group of women who wished to preserve their fertility, and medical therapy may not be justified in patients for whom fertility is not an issue. When women who choose medical therapy complete childbearing, reevaluation of the endometrium should be performed, and hysterectomy should be recommended if hyperplasia with atypia is identified.

Patients found to have hyperplasia without atypia should be treated with progestins and have an endometrial biopsy every three to six months.16 Hysterectomy is an option for those who are unwilling to take progestins or who have persistent hyperplasia despite progestin treatment The ideal type and amount of progestin necessary to protect the endometrium is still unknown, and no data define the optimal duration of treatment.33 If risk factors remain unchanged, the clinician should consider continuing progestin treatment for an additional 12 months after a normal biopsy, with annual endometrial biopsies performed as follow-up. Many clinicians still recommend that women above 50 years should consider hysterectomy as a definitive treatment.

 

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Circulating levels of adiponectin, a hormone with insulin-sensitizing properties, are decreased in conditions related to obesity and hyperinsulinemia, which are recognized risk factors for endometrial cancer. Eighty-seven cases with incident, histologically confirmed endometrial cancer and 132 controls admitted for acute, nonneoplastic diseases were interviewed in northeastern Italy between 1999 and 2002, and blood samples were collected. Levels of adiponectin were evaluated in samples by means of a RIA. An inverse association with endometrial cancer risk emerged for plasma adiponectin levels [odds ratio (OR), 0.42; 95% confidence interval, 0.19–0.94] when comparing the highest vs. the lowest tertiles. Similar results emerged for serum adiponectin (OR, 0.30; 95% confidence interval, 0.14–0.68). The association was stronger in pre- than in postmenopausal women, but no significant heterogeneity was observed across strata of body mass index (BMI) or parity. BMI and adiponectin showed independent effects on the risk of endometrial cancer according to a multiplicative model (OR, 6.45 in the highest level of BMI and in the lowest one of adiponectin).

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Population based case-control study

Objective: To evaluate the association of intake of soya food, a rich source of phytoestrogens, with the risk of endometrial cancer.

Design Population based case-control study, with detailed information on usual soya food intake over the past five years collected by face to face interview using a food frequency questionnaire.

Setting Urban Shanghai, China.

Participants 832 incident cases of endometrial cancer in women aged of 30 to 69 years diagnosed during 1997-2001 and identified from the Shanghai Cancer Registry; 846 control women frequency matched to cases on age and randomly selected from the Shanghai Residential Registry.

Main outcome measures: Odds ratios for risk of endometrial cancer in women with different intakes of soya foods.

Results: Regular consumption of soya foods, measured as amount of either soya protein or soya isoflavones, was inversely associated with the risk of endometrial cancer. Compared with women with the lowest quarter of intake, the adjusted odds ratio of endometrial cancer was reduced from 0.93 to 0.85 and 0.67 with increasing quarter of soya protein intake (P for trend 0.01). A similar inverse association was observed for soya isoflavones and soya fibre intake. The inverse association seemed to be more pronounced among women with high body mass index and waist:hip ratio.

Conclusion: Regular intake of soya foods is associated with a reduced risk of endometrial cancer.

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Abstract:

A common gynaecological malignancy in the industrialised world is Endometrial cancer . Unopposed stimulation of the endometrium by oestrogens is the classic aetiological factor associated with the development of this malignancy. However, not all are associated with oestrogen exposure and two different clinicopathological types can be distinguished: the oestrogen-related of endometrioid type (type I) and the non-oestrogen-related of non-endometrioid type (mainly papillary serous or clear cell carcinomas) (type II). Recent advances in the knowledge on the molecular genetics of endometrial cancer have shown that the molecular changes involved in its the development differ in oestrogen-dependent type I and non-oestrogen-dependent type II. Type I carcinomas frequently show mutations of DNA-mismatch repair genes (MLH1, MSH2, MSH6), PTEN, k-ras and beta-catenin genes whereas type II malignancies are characterised by aneuploidy, p53 mutations and her2/neu amplification. This article reviews the latest findings concerning common gene mutations involved in the development and progression of endometrial cancer.

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A dose-response meta-analysis

Background: Endometrial cancer is the most common female gynecologic cancer in the United States. Excessive and prolonged exposure of the endometrium to estrogens unopposed by progesterone and a high body mass are well-established risk factors for endometrial cancer. Although dietary fiber has been shown to beneficially reduce estrogen concentrations and prevent obesity, its role in endometrial cancer has received relatively little attention.

Objective: The objective was to summarize and quantify the current evidence of a role of dietary fiber consumption in endometrial cancer risk and to identify research gaps in this field.

Design: We conducted a systematic literature review of articles published through February 2007 to summarize the current evidence of a relation between dietary fiber consumption and endometrial cancer risk and to quantify the magnitude of the association by conducting a dose-response meta-analysis.

Results: Ten articles representing 1 case-cohort study and 9 case-control studies that evaluated several aspects of fiber consumption and endometrial cancer risk were identified through searches in various databases. On the basis of 7 case-control studies, the random-effects summary risk estimate was 0.82 (95% CI: 0.75, 0.90) per 5 g/1000 kcal dietary fiber, with no evidence of heterogeneity (I2: 0%, P for heterogeneity: 0.55). The random-effects summary estimate was 0.71 (95% CI: 0.59, 0.85) for the comparison of the highest with the lowest dietary fiber intake in 8 case-control studies, with little evidence of heterogeneity (I2: 20.8%, P for heterogeneity: 0.26). In contrast, the only prospective study that evaluated this association did not find an association.

Conclusions: Although the current evidence, based on data from case-control studies, supports an inverse association between dietary fiber and endometrial cancer, additional population-based studies, particularly cohort studies, are needed before definitive conclusions can be drawn.

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Women with hereditary non-polyposis colorectal cancer (HNPCC) have a 40-60% risk for developing endometrial cancer. We are studying agents which may decrease the risk of endometrial cancer. Oral contraceptives and progestins have been shown to decrease the risk of endometrial cancer. The two study drugs used in this clinical research trial are the oral contraceptive agent LoOvral and the injectable contraceptive depoProvera. Both of the study drugs are standard approved contraceptive methods. The goal of this randomized clinical research study is to study the effects of these agents on the endometrial lining in women with HNPCC after three months of using the oral contraceptive LoOvral or depoMPA. The total length of participation in this study is 12-14 weeks. Women with a known mutation, between the age of 30-50 are eligible for this study. Funds are available for genetic testing and travel expenses. This is an NCI/DCP funded study (N01-CN-05127).

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Scientists from the Medical Research Council, UK say that the high levels of prostaglandin, a hormone-like molecule found in semen, may fuel cervical and womb (uterine) cancers in women. They say women with either womb or cervical cancer should seriously consider asking their partners to use a condom.

 

The cells in the lining of the female reproductinve organs contain prostagrandin - it regulates cell growth and makes the womb thicken and also shed during the menstrual cycle. However, prostaglandin levels in semen are about one thousand times higher.

 

By exposing cervical and uterine cell receptor molecules to prostaglandin, the scientists found that the signalling between the cells increased - leading to faster tumour growth.

 

The scientists say that by preventing prostaglandin from reaching the tumour cell receptors, there may be treatment one day to undermine the tumour’s growth.

 

Team leader, Dr. Henry Jabbour, said “Sexually active women who are at risk of cervical or uterine cancer should encourage their partners to wear a condom to prevent increased exposure to the prostaglandins that might make their condition worse. This also highlights the potential for a new therapeutic approach that will tackle both possible sources of prostaglandin - those produced naturally by women and those introduced to the body by sperm.”

 

Jabbour believes it is quite possible that pre-cancerous cells may also have prostaglandin receptors. He said further research is needed.

 

Cervical cancer is more common in the developing world where screening programmes are less common. In the United Kingdom, for example, screening programmes detect most abnormal cell changes before the cancer progresses. Cervical cancer is usually triggered by long-term human papilloma virus (HPV) infection. Prostaglandins do not cause the cancer - they fuel tumour growth, say the researchers.

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