History Of Hormone Use Research Articles

Factors Influencing Timely Follow-up After Inconclusive Screening Mammograms at a 3D Mobile Mammography Center.

Background The Linda Fenner 3D Mobile Mammography Center (LFMMC) was created to reduce disparities in screening for breast cancer and improve survival for women with limited access to such screening.However, for screened patients requiring follow-up testing, research has shown a wide variation of time taken to access diagnostic imaging, especially among uninsured women. Aim To explore factors associated with longer (>30 days) time intervals to complete diagnostic imaging after screening. Methods This was a retrospective cohort study using data from the LFMMC from 2014 to 2022. Women living in Miami-Dade County (MDC), over the age of 40, uninsured, and requiring follow-up diagnostic imaging after breast cancer screening were included. Factors assessed included women's age, area of residency, race, primary language spoken, marital status, body mass index (BMI), history of hormone use, previous mammogram, breast implants, breast cancer in immediate family, past breast surgery, and menopause status. The interval of time taken between receiving a screening mammogram result and completing further diagnostic imaging was the outcome, dichotomized into greater than 30 days (longer follow-up time) or up to 30 days.Multivariable binary logistic regression models were used to estimate independent associations (odds ratio [OR] and 95% confidence interval [CI]) of selected factors and longer time intervals to complete diagnostic imaging follow-up. Results We analyzed data from 926 eligible patients. Themean age was 50.1 years (SD = 8.81). A majority werewhite (n = 643; 69%), Hispanic (n = 698; 72%), had a history of previous mammograms (n = 589; 64%), and had no family history of breast cancer (n = 757; 82%).About 50% had a diagnostic follow-up exam performed after 30 days (median time to follow-up was 32, interquartile range 23-46 days). Single women had 30% lower odds of longer follow-up than married women (OR 0.70, 95% CI 0.52-0.93). Residents of Homestead (a city within Miami-Dade County) had 2.5 higher odds of having a longer time to follow-up, compared to non-Homestead residents (OR 2.50, 95% CI 1.60-3.90). Conclusions Being single was associated with a shorter time to follow up with diagnostic imaging while residing in Homestead was associated with a longer time to follow-up. Further research with a larger sample and further details on patient characteristics are warranted to better identify targets for interventions aimed at optimizing continuity of care and detecting breast cancer at earlier stages.

Molecular epidemiology and risk factors for carbapenem-resistant Enterobacteriaceae infections during 2020-2021 in Northwest China

Severe infection caused by Carbapenem-resistant Enterobacteriaceae (CRE) is a challenge for clinical anti-infective therapy, and clinical intervention to improve control of CRE is of great significance. The study aims to determine the molecular epidemiology and risk factors of CRE infections to provide evidence for effective control of nosocomial infection in patients with CRE. A total of 192 non-repetitive CRE strains were collected from January 2020 to December 2021 in Northwest China. To explore the risk factors of CRE infection by univariate and Logistic regression analysis, 1:1 case-control study was used to select Carbapenem sensitive Enterobacteriaceae (CSE) infection patients at the same period as the control group. Among the 192 CRE strains, the most common isolates included Klebsiella pneumoniae (Kpn) and Enterobacter cloacae (Ecl). The CRE strain showed the lowest rate of resistance to amikacin at 58.3. 185 CRE strains carried carbapenemase resistance genes of concern in this study. KPC-2 (n=94) was the most common carbapenemase, followed by NDM-1 (n=69), NDM-5 (n=22) and IMP-4 (n=5). OXA-48 and VIM were not detected. And KPC-2 was the most common in all strains. Logistic regression analysis implicated days of invasive ventilator-assisted ventilation (OR=1.452; 95 % CI 1.250～1.686), antibiotic combination therapy (OR=2.149; 95 % CI 1.128～4.094), hypoalbuminemia (OR=6.137; 95 % CI 3.161～11.913), history of immunosuppressant use (OR=25.815; 95 % CI 6.821～97.706) and days of hospitalization (OR=1.020; 95 % CI 1.006～1.035) as independent risk factors associated with CRE infection. Age (OR=0.963; 95% CI 0.943～0.984) and history of hormone use (OR=0.119; 95 % CI 0.028～0.504) were protective factors for CRE infection (P < 0.05). The resistance of commonly used antibiotics in clinical is severe, and CRE strains mainly carry KPC-2 and NDM-1. Multiple risk factors for CRE infection and their control can effectively prevent the spread of CRE.

(277) Predictors of Cryopreserved Sperm Quality Among Transgender Females Compared to Cisgender Males

Abstract Introduction Approximately 70% of transgender females express future interest in having children (Auer et al, 2018). However, studies have demonstrated poor semen parameters among this population who undergo sperm cryopreservation (Rodriguez-Wallberg et al, 2021). It remains poorly understood the underlying etiologies which place individuals at increased risk of suboptimal semen parameters. Objective We sought to identify clinical predictors of lower sperm quality among a cohort of transgender females and to compare this to a cohort of cisgender males. Methods We retrospectively identified 19 transgender women who underwent sperm cryopreservation at a single andrology lab within an academic institution between November 2021 and April 2023. We identified 16 age-matched cisgender male patients who also underwent sperm cryopreservation prior to oncologic treatment or vasectomy during this period. Data was abstracted from the electronic medical record. Statistical analysis was performed using SPSS version 28. Results Median age and body mass index of the transgender cohort was 25 years (range: 18-35) and 25.1 kg/m2 (range: 18.0-51.5). Median age and BMI of the cisgender cohort was 29 years (range: 17-37) and 25.2 kg/m2 (range: 18.7-38.0). Cisgender patients underwent sperm cryopreservation for oncologic treatment (81%) and pre-vasectomy planning (19%). 32% of transgender patients were initiated on gender affirming hormonal therapy (estradiol, spironolactone, or both) prior to semen analysis, with mean duration of 25 months (range: 1-108). 37% of transgender and 13% of cisgender patients were on a psychiatric medication with mean duration of 7.6 months (range: 1-19) and 7.5 months (range: 3-12) preceding sperm cryopreservation. 11% of transgender and 6% of cisgender patients endorsed tobacco use. 37% of transgender and 38% of cisgender patients endorsed alcohol use. Mean total motile sperm count (TMSC) was 61 million in the cisgender cohort and 105 million in the transgender cohort (p=0.159). 21% and 38% of the transgender and cisgender cohort had low TMSC (&amp;lt;10 million). Mean post-thaw motility recovery was similar among the two groups (56% vs 57%, p=0.894). Transgender women on hormonal therapy had lower TMSC (p=0.867) and post-thaw motility recovery (p=0.535; Table 1) compared to their hormone-naïve counterparts. Alcohol use was a significant predictor of decreased post-thaw motility recovery among cisgender patients (63% vs 46%; p=0.011; Table 2). Conclusions Cisgender men had lower TMSC, but this was likely confounded by underlying malignancy. There was a trend toward worse semen parameters among transgender women with a history of hormone use, but larger studies are needed to validate this finding. Psychiatric medications similarly did not appear to be significant predictors of sperm quality among transgender women. Further studies are needed with a larger sample size and cisgender males without malignancy to validate the effect of these modifiable lifestyle factors. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific, Endo Pharmaceuticals.

Associations of gut microbiome with endogenous estrogen levels in healthy postmenopausal women.

The gut microbiome is a potentially important contributor to endogenous estrogen levels after menopause. In healthy postmenopausal women, we examined associations of fecal microbiome composition with levels of urinary estrogens, their metabolites, and relevant metabolic pathway ratios implicated in breast cancer risk. Eligible postmenopausal women (n = 164) had a body mass index (BMI) ≤ 35kg/m2 and no history of hormone use (previous 6months) or cancer/metabolic disorders. Estrogens were quantified in spot urine samples with liquid chromatography-high resolution mass spectrometry (corrected for creatinine). Bacterial DNA was isolated from fecal samples and the V1-V2 hypervariable regions of 16S rRNA were sequenced on the Illumina MiSeq platform. We examined associations of gut microbiome's indices of within-sample (alpha) diversity (i.e., Shannon, Chao1, and Inverse Simpson), phylogenetic diversity, and the ratio of the two main phyla (Firmicutes and Bacteroidetes; F/B ratio) with individual estrogens and metabolic ratios, adjusted for age and BMI. In this sample of 164 healthy postmenopausal women, the mean age was 62.9years (range 47.0-86.0). We found significant inverse associations of observed species with 4-pathway:total estrogens (p = 0.04) and 4-pathway:2-pathway (p = 0.01). Shannon index was positively associated with 2-catechols: methylated 2-catechols (p = 0.04). Chao1 was inversely associated with E1:total estrogens (p = 0.04), and 4-pathway:2-pathway (p = 0.02) and positively associated with 2-pathway:parent estrogens (p = 0.01). Phylogenetic diversity was inversely associated with 4-pathway:total estrogens (p = 0.02), 4-pathway:parent estrogens (p = 0.03), 4-pathway:2-pathway (p = 0.01), and 4-pathway:16-pathway (p = 0.03) and positively associated with 2-pathway:parent estrogens (p = 0.01). F/B ratio was not associated with any of the estrogen measures. Microbial diversity was associated with several estrogen metabolism ratios implicated in breast cancer risk. Further studies are warranted to confirm these findings in a larger and more representative sample of postmenopausal women, particularly with enrichment of minority participants.

Effect of Combined Oral Contraceptive on Lipid Profile Level and Cardiovascular Risk

Background: Combined oral contraceptive pills are an effective and widely used method for contraception. Combined oral contraceptives have been shown to alter lipid profiles among various population groups with different patterns of dyslipidemia and cardiovascular risk. Objectives: The study aimed at determining the lipid profile pattern and cardiovascular risk among combined oral contraceptive users. Methods: This cross-sectional analytical study was conducted in the Department of Physiology, Rajshahi Medical College, from January 2018 to December. 2018. The study group was made of 100 women. (mean age 24.1 ± 5 years), who took combined oral contraceptive pills (30 mg ethinyl estradiol, 150 mg Levonorgestrel) for a period ranging from 1-60 months, while 100 age-matched women with regular mentruation with no history of hormonal use within the last six months before the investigation were used as controls. Fasting blood samples from all study subjects were collected and analyzed for lipid profile [ Total cholesterol (TC), High-Density Lipoprotein- cholesterol (HDL-c), Low-Density Lipoprotein- cholesterol (LDL-c) and Triglyceride (TG)] using standard calorimetric Techniques. Results: Combined oral contraceptive use was associated with increased levels of total cholesterol (p ≤ 0.001), Low-density lipoprotein cholesterol (p ≤ 0.001), triglyceride (p ≤ 0.001), as well as decreased high-density lipoprotein cholesterol (HDL-c) (p = .408) in comparison to controls. Conclusion: Combined oral contraceptive use is associated with alteration in lipid profile, particularly increases total cholesterol triglyceride, LDL and decreased HDL-c. These changes carry a potential risk in the development of cardiovascular disease. Evaluating the most effective and safest contraceptive methods is important to avoid the potential risk of developing cardiovascular disease.

Efficacy and Prognostic Factors of Immune Checkpoint Inhibitors in the Treatment of Advanced Non-small Cell Lung Cancer.

To discuss the efficacy and potential prognostic factors of immune checkpoint inhibitors (ICIs) in patients with advanced non-small cell lung cancer (NSCLC). A retrospective study was conducted to analyze the medical history of patients (n=111) confirmed with advanced NSCLC in the Affiliated Hospital of Putian University from 2018 to 2020. All enrolled patients with adenocarcinoma (n=69), squamous cell carcinoma (n=28), and other types of lung cancer (n=14) were treated with the programmed death-ligand 1 (PD-1) inhibitors. They were divided into groups of PD-1 inhibitors, PD-1 inhibitors in combination with chemotherapy, and PD-1 inhibitors in combination with chemotherapy and angiogenesis inhibitors according to the treatment regimen. General clinical data of all patients were collected, and the Kaplan-Meier analysis was applied to estimate progression-free survival (PFS) and overall survival (OS). In addition, univariate and multivariate Cox regression analyses were performed to analyze prognostic factors associated with PFS and OS after treatment. Of 111 patients with advanced NSCLC treated with ICIs, 6 were fully responsive, 33 were partially responsive, 55 were stable, and 17 were progressive. There was no significant difference in objective response rate between the 3 groups. In the subgroup analysis according to the lines of therapy, the objective response rate of patients receiving first-line treatment was 46.7%, which was significantly higher than that of other line treatment groups ( P =0.014). The results of multivariate Cox regression analysis indicated that the history of hormone use (HR=1.593; P =0.033), second-line or further lines of therapy (HR=2.871; P <0.001), and high neutrophil/lymphocyte ratio (NLR; HR=1.498; P =0.045) were independent risk factors for PFS after immunotherapy for advanced NSCLC. And the history of hormone use (HR=1.518; P =0.015) and high NLR (HR=3.053; P =0.001) were as well the independent risk factors for OS after immunotherapy for advanced NSCLC. ICIs therapy clearly had a greater survival benefit in patients who received first-line therapy, had no history of hormone use, and showed low NLR after initial treatment. ICIs can be an effective treatment for advanced NSCLC.

Associations of established breast cancer risk factors with urinary estrogens in postmenopausal women.

Circulating estrogens are an established risk factor for postmenopausal breast cancer (BCa). We describe the distribution of urinary estrogens, their metabolites, and relevant metabolic pathway ratios among healthy postmenopausal women and examine associations of several known BCa factors with these estrogen measures. Eligible postmenopausal women (n = 167) had no history of hormone use (previous 6months) and cancer/metabolic disorders and had a body mass index (BMI) ≤ 35kg/m2. Estrogens were quantified in spot urine samples with liquid chromatography-high-resolution mass spectrometry and corrected for creatinine. We assessed overall distributions of estrogens and associations of age, BMI, race/ethnicity, parity/age at first birth, age at menarche, alcohol, and smoking with log-transformed estrogen measures using multivariate regression. BMI was positively associated with estrone (β per unit = 0.04, 95% Confidence Interval [CI] 0.00; 0.07), combined parent estrogens (β = 0.04, 95% CI 0.01; 0.07), and E2:total estrogens (β = 0.04, 95% CI 0.02; 0.06), and inversely associated with 4-MeOE1 (β = -0.17, 95% CI -0.33; -0.02), E3:parent estrogens (β = -0.04, 95% CI -0.07; -0.00), and 16-pathway:parent (β = -0.04, 95% CI -0.07; -0.01). Being African American vs. white was associated with higher levels of 4-MeOE1 (β = 3.41, 95% CI 0.74; 6.08), 17-epiE3 (β = 1.19, 95% CI 0.07; 2.31), 2-pathway:parent (β = 0.54, 95% CI 0.04; 1.04), and lower levels of E2:total estrogens (β = -0.48, 95% CI -0.83; -0.13). Having < 7 alcohol drinks/week vs. none was associated with higher levels of 16-ketoE2 (β = 1.32, 95% CI 0.36; 2.27), 16-epiE3 (β = 1.02, 95% CI 0.24; 1.79), and 17-epiE3 (β = 0.55, 95% CI 0.02; 1.08). Smoking was positively associated with E3:parent (β = 0.29, 95% CI 0.01; 0.57), 16-pathway:parent (β = 0.25, 95% CI 0.01; 0.49), and inversely associated with estradiol (β = -0.52, 95% CI -0.93; -0.10). As compared to nulliparous, parous women with age at first birth ≥ 25years had lower levels of estrone, combined parent estrogens, 2-OHE1, and 2-OHE2. Our findings suggest that BMI, race/ethnicity, and some reproductive and lifestyle factors may contribute to postmenopausal BCa through their effects on circulating estrogens.

Epidemiological Study Based on China Osteonecrosis of the Femoral Head Database.

ObjectiveThe aim of the present study was to reveal the case characteristics of osteonecrosis of the femoral head (ONFH) in Mainland China.MethodsThis cross‐sectional epidemiological study derived data for ONFH patients from July 2016 to December 2018 from the China Osteonecrosis of the Femoral Head Database (CONFHD). The derived data included gender, age, body mass index (BMI), height, occupation, region, and etiology of femoral head necrosis. A descriptive analysis was performed to summarize the epidemiological characteristics of the case data in the CONFHD.ResultsA total of 1844 ONFH patients (2945 hips) were included in this study, comprising 1302 men and 542 women. The age of patients ranged from 18 to 95 years, with a median of 50 years, and the male to female ratio was 2.4. Male patients are younger than female patients (48.26 ± 12.56 years old and 55.56 ± 14.94 years old, respectively). Among the 1844 patients (2945 hips), there were 528 (17.92%) hips at ARCO stage I, 941 (31.99%) hips at ARCO stage II, 873 (29.63%) hips at ARCO stage III, and 603 (20.46%) hips at ARCO stage IV. In the subclassification of ARCO stages I and II, the majority of cases were type C; type A comprised the majority in the subclassification of ARCO stage III. According to the Kellgren–Lawrence classification system, among the 603 ARCO stage IV hips, there were 178 (29.52%) grade 1 hips, 201 (33.34%) grade 2 hips, 176 (29.18%) grade 3 hips, and 48 (7.96%) grade 4 hips. Most were from three provinces: Henan (27.3%), Shanxi (13.9%), and Shandong (11.9%). Regarding BMI, 982 patients (53.25%) were overweight or obese. Among all patients, the largest proportion of patients engaged in level IV manual work. Of all the patients, there were 495 (26.84%) with steroid‐induced ONFH, 685 (37.15%) were alcoholics, and 290 (15.73%) had traumatic ONFH. The 495 patients with steroid‐induced ONFH included 278 men (56.16%) and 217 women (43.84 %), had a complete history of hormone use. Among the primary diseases, there were 195 cases (39.39%) of immune system diseases, followed by dermatological diseases, respiratory diseases, nephropathy, and other diseases. There were a total of 685 patients with alcoholic ONFH, 589 of these patients (85.99%) were men. A total of 188 (27.45%) patients had drunk alcohol for 6–10 years (comprising the highest proportion), and 280 patients (40.88%) consumed 3001–3500 mL of alcohol each week (the highest proportion).ConclusionOsteonecrosis of the femoral head most commonly occurs after the age of 40. Male patients have an earlier onset than female patients, and the number of male patients is approximately twice that of female patients. The BMI of patients was mainly in the overweight and obese range, and half of these patients engaged in level IV manual work. From the imaging findings, the numbers of hips at ARCO stages II and III were greatest, and the number at stage I was relatively small. Among all the causes of disease, alcohol, steroid use and trauma were the three most common reasons for ONFH.

Application of fracture liaison service model in patients with osteoporotic vertebral compression fractures

Objective To investigate the effects of fracture liaison service (FLS) model on the medication compliance of patients, quality of life, pain and re-fracture rate in patients with osteoporotic vertebral compression fracture (OVCF). Methods A prospective case control study was conducted to analyze the clinical data of 117 OVCF patients admitted to Department of Pain of Guizhou Provincial People's Hospital from January 2017 to September 2017. According to the random table method, patients were divided into control group (58 patients) and intervention group (59 patients). Routine nursing was adopted in the control group, and fracture liaison service mode was adopted in the intervention group on the basis of the control group until 3 months after discharge. Morisky scale was used to compare the medication compliance of patients on admission, at discharge, 1 month, and 3 months after discharge, and SF-36 was used to evaluate the quality of life. The SF-36 scale contained eight dimensions including physiological function, physiological performance, physical pain, overall health, vitality, social function, emotional function and mental health. Visual analogue scale (VAS) was used to evaluate the pain of patients. The re fracture rates of the two groups were compared. Results There were no significant differences between the two groups concerning gender, age, history of diabetes, history of hormone use, number of vertebral fractures, fracture site and cause of injury (P>0.05). In the intervention group, the medication compliance scores of patients in the first and third months after discharge were (5.5±2.0)points and (6.3±1.8)points, which were higher than those in the control group [(3.5±2.2)points and (3.3±1.8)points] (P 0.05). Conclusion The FLS model can effectively alleviate the pain of OVCF patients, improve the medication compliance and quality of life of patients after discharge, but it cannot reduce the short-term re fracture rate after discharge. Key words: Fracture, compression; Osteoporosis; Quality of life; Liaison service

Hormone Therapy and Factors Affecting Fertility of Women Under 50-Year-Old with Breast Cancer.

BackgroundAlthough the use of contraceptive hormones is a risk factor for development of breast cancer, level of risk is unknown; thus the current research was conducted to investigate the effect of factors related to fertility and hormone use on risk of breast cancer in women aged under 50 years old in the west of Iran.MethodsIn this case-control study, all incidence cases of breast cancer aged between 25–49 years old (n=212) were selected. Twice as many as the case group, the individuals referred to other outpatient sections of the same hospital at the time of study and up to 2 years after the follow-up not diagnosed with breast or other cancers were selected as a control group. The data were collected using healthy fertility program and middle-aged periodical care forms developed by Iran’s Ministry of Health (MOH).ResultsAfter controlling for confounding variables, history of hormonal use for contraception (OR=2.02, 95% CI=1.2–3.3) and hormone therapies (OR=1.9, 95% CI=1.2–3.04) were identified as factors increasing the risk of breast cancer. Dose-response relationships between breast cancer and the use of hormones for contraception and hormone therapy indicated that these factors increased the risk of breast cancer. The risk was found to be higher in women who had been under hormone therapy for more than 120 months. With an increase in the age of the first menstruation, risk of breast cancer increased linearly, but with an increase in the age of the first pregnancy, risk of breast cancer increased exponentially. After 20 years of age, the risk increased with a steeper slope.ConclusionConsidering the effect of hormone therapy and fertility factors on breast cancer and changeability of listed risk factors, the researchers suggest planning for sensitizing, increasing the awareness, and educating women and professionals regarding the influence of fertility and hormonal factors including pregnancy at lower ages, minimizing the use of hormones for contraception, and hormone therapy.

Insights from outside BJOG

Insights from outside BJOG

Overexpression of p53 in the endometrial gland in postmenopausal women.

The p53 signature, which (although morphologically unremarkable) displays diffuse and strong p53 nuclear staining, has been proposed to be a precursor of serous endometrial intraepithelial carcinoma. We examined the overexpression of p53 in postmenopausal endometrial glands. Postmenopausal endometrial tissues of 82 women with benign disease, including 10 hormone users, were evaluated in this study. Tissues with endometrial hyperplasia and/or polyps were excluded based on a histopathologic review. Expressions of estrogen receptor-α, Ki-67, and p53 were immunohistochemically examined. Apoptotic cells were identified using a terminal deoxynucleotidyl transferase dUTP nick end labeling assay. Overexpression of p53 was categorized as moderate to strong in more than 50% of glandular cell nuclei. Focal glandular overexpression of p53 was observed in 1 (9%) of 10 and in 8 (11%) of 72 postmenopausal endometrial tissue specimens in women with and women without a history of hormone use, respectively. Among nonhormone users, the median Ki-67 and apoptotic indices in the postmenopausal endometrial glands of women with and women without overexpression of p53 were 16% and 6% (P = 0.007) and 1% and 1% (P = 0.345), respectively. All postmenopausal endometrial glands were positive for estrogen receptor-α, regardless of the overexpression of p53. The postmenopausal endometrial glands of estrogen users exhibited significantly higher Ki-67 and apoptotic indices than those of nonestrogen users (P = 0.001 and P < 0.001, respectively). Overexpression of p53 may be responsible for the high proliferative activity of postmenopausal endometrial glandular cells associated with conditions of low apoptotic cell death.

Mixed Epithelial and Stromal Tumor of the Kidney: A Rare Case Report

Mixed epithelial and stromal tumor of the kidney (MESTK) is a rare kidney tumor that is composed of both epithelial and mesenchymal components with solid and cystic architecture. Up to the present, approximately 100 cases have been reported. It was introduced in the World Health Organization 2004 renal tumor classification. Here, we report a 49-year-old female with mixed epithelial and stromal tumor (MEST) in her kidney with no cystic components and no history of hormone use. J Med Cases. 2014;5(6):362-365 doi: http://dx.doi.o rg/10.14740/jmc1797 w

The Average Age of Menopause and Its Associated Factors Among Women in Tehran

Background: Menopause means the permanent cessation of menstruation and lead to the fixed and permanent changes in women and is predisposing factors of chronic diseases. So the investigating of average age of menopause and some predictive factors are very important that this study was designed with this goal. Methods: This study was a cross sectional study with descriptive and analytical aspects that was done on the 403 women residing in 1 to 4 regions of Tehran and they had at least 1 year of the last menstruation and their menopause had occurred naturally. Data collection tool was a researcher made questionnaire. Then data were analyzed with SPSS software and Chi square, t-test, analysis of variance and correlations. Results: The mean age of subjects was 51.30±4.8 years. 89.4 percent were married and the average number of children was 2.61±1.07 and mean body mass index was 26.19±3.66. The average age at first menarche was 13.59±1.58 years. The average age at menopause in the understudy population was 46.57±4.95 years. Also, association between menopause and underlying demographic variables including age at menarche, education, height, weight, BMI, number of children, abortion, history of hormone use were examined in this study. Conclusion: With regard to life expectancy, women spend approximately one third of their life after menopause. Identification of factors associated with these issue particularly aspects of quality of life is important.

Management of hepatocellular adenoma: comparison of resection, embolization and observation

IntroductionHepatocellular adenoma (HA) is an uncommon benign hepatic tumour with the potential for malignant change or spontaneous haemorrhage. Resection has been the recommended treatment, but outcomes with other approaches are ill defined. MethodsDemographic and outcomes data were retrospectively collected on patients diagnosed with HA at a tertiary hepatobiliary centre from 1992–2011 whom underwent resection, bland embolization or observation. ResultsIn total, 52 patients with 100 adenomas were divided into single HA (n = 27), multiple HA (n = 18), and adenomatosis (n = 7) groups. Eighty‐seven per cent were female and 37% had a history of hormone use. Median sizes of resected, embolized and observed adenomas were 3.6 cm, 2.6 cm and 1.2 cm, respectively. Forty‐eight adenomas were resected as a result of suspicion of malignancy (39%) or large size (39%); 61% of these were solitary. Thirty‐seven were embolized for suspicion of malignancy (56%) or hsemorrhage (20%); 92% of these were multifocal. Two out of three resected adenomas with malignancy were ≥10 cm and recurred locally [4%, confidence interval (CI) 1–14%]. Ninety‐two per cent of the embolized adenomas were effectively treated; three persisted (8.1%, CI 2–22%). Most observed lesions did not change over time. conclusionsWhile solitary adenomas are often resected, multifocal HAs are frequently embolized. Small adenomas can safely be observed. Given low recurrence rates, select HAs can be considered for embolization.

Abstract B6: Exploratory study of contralateral prophylactic mastectomy in women with breast cancer: Potential role for preoperative genetic counseling

Abstract Background: Breast cancer is the second most common cancer in women and the second leading cause of cancer death in the US. Women with a diagnosis of breast cancer have a risk of developing contralateral breast cancer of up to 11%. Despite lack of clear evidence supporting an increase in the rate of the procedure, rates of contralateral prophylactic mastectomy (CPM) increased dramatically in the past 10 years. Genetic predisposition to breast cancer is an indication for CPM, however it is inconsistently documented. We sought to explore the trends in CPM and variables associated with CPM and genetic counseling within a large healthcare system over a 15-year period. Methods: Retrospective review of CPM documented by the Network Tumor Registry period 1994 — 2008 performed within a four hospital health system in Louisville, KY. We calculated time trends of CPM as a proportion of mastectomy patients each year, and we analyzed clinical, pathologic, and demographic variables among mastectomy patients who underwent CPM compared to those who did not have procedure. Descriptive variables included: age, year of diagnosis, tumor grade, tumor stage, tumor size, tumor histology type, estrogen receptor status, progesterone receptor status, lymph node status, node dissection type previous cancer diagnosis, family history, menopausal status, use of immediate reconstruction, and type of insurance. Our statistical analysis included chi-square (x2), and odds ratios (OR) to determine differences among groups. We evaluated the prevalence and timing of genetic testing among CPM patients by matching CPM patient level data with a prospectively maintained genetic testing comprehensive database. CPM patient level data was matched with corresponding genetic counseling data to determine the trends in usage of genetic counseling. Results: During the study period, 2,496 women with stage I-III invasive breast cancer underwent mastectomy: 2,288 (91.7%) had unilateral mastectomy (UM) alone and 208 (8.7%) underwent UM and CPM. The proportion of all female mastectomy patients who had CPM increased from 0% in 1994 to 27.1% in 2008. Variables significantly associated with CPM were: Age under 65, immediate breast reconstruction, private insurance, family history of cancer and lobular tumor histology. Favorable tumor characteristics such as stage I and tumor size of &amp;lt; 1cm were associated with higher CPM rates, compared to &amp;gt; Stage I disease and tumors &amp;gt; 1cm. There was a statistically significant association with CPM and negative lymph nodes and a history of hormone use. No differences were found in UM vs. UM+CPM by race, ethnicity, tumor grade, ER/PR status or previous history of cancer. Among the 208 CPM patients, 44 (21.2%) received genetic testing and 6 (2.9%) were positive for BRCA mutations. Of the 44 women who received genetic testing, 5 (11.4%) did so prior to surgery. Conclusions: Performance of CPM was associated factors such as small tumor size and age &amp;lt;65 and private insurance. Genetic counseling was rarely used in the risk-assessment of potential CPM patients. Given the increasing frequency of this procedure, this warrants further investigation. Citation Information: Cancer Prev Res 2010;3(12 Suppl):B6.

Caractéristiques individuelles et mortalité associées au traitement hormonal substitutif de la ménopause : étude d’une cohorte française de femmes d’âge compris entre 60 et 69 ans

Given the specificity of French postmenopausal hormonal replacement therapy, we study the link with overall mortality. A cohort of 1200 women from 60 to 69 years of age was followed up from 2001 to 2009. We computerized from the health care repayment database the current reimbursement of behind-the-counter hormonal therapy. We sent a questionnaire to identify their lifetime history of hormone use. We test whether current and former users have higher risk of death from all cause combined. We adjusted the survival analysis on the individuals factors associated to the hormone use. The statistical methods Kaplan-Meier curves in univariate analysis and Cox Regression Model in multivariate analysis were used. Current users present a reduced all-cause mortality rate while former users have a higher all-cause mortality rate. This trend suggests a "healthy estrogen user survivor effect" bias. After adjustment on confounding factors, hormonal users do not have a statistically significant increased risk of overall mortality. Postmenopausal hormone replacement therapy is not linked with mortality for women from 60 to 69 years of age covered by the self-employed workers health and retirement French insurance fund.

The Use of Sonography and Mammography in the Evaluation of Eritrean Women with Breast Pain.

Objective: To assess the outcome of sonography and mammography in Eritrean women with breast pain in order to give background information for setting a standard practice of evaluation. Methods: All women with diffuse or focal breast pain referred to the departments of radiology of Orotta national referral hospital and Selam poly clinic between Jan., 2005 and Dec, 2007 were included. Patients with pain and associated palpable abnormality are excluded from the study. All patients underwent sonography and mammography. Finally, a review of all the pathology reports for breast cytology studies or biopsies was done to identify any interval cancer or false interpretations of the imaging of the subjects. Results: 470 patients underwent breast imaging during the study period. Pain alone was mentioned as reason for referral in 105 cases (22%). The mean age at presentation was 32.23. 47 (44.8%) were below the age of 30 year. 16 (15.2%) had family history of breast cancer and 11 (10.5%) had history of hormone use at the time of examinations. The pain was unilateral in 76 patients (72.4%). Most (53.3%) of the referrals were made by surgeons. FNA findings showed that 13 patients (52%) have benign mastopathy, 3 (12%) fibro adenoma, 2(8%) benign fibro epithelial alterations and the rest 6 different cytologic diagnosis, including mastitis ,tuberculous lymphadenitis, and non specific inflammatory changes. FNA cytology examination was suspicious for cancer in one patient but this was not histologically confirmed as the patient was lost to follow up. The negative predictive value for mammography and sonography was 95.7%. Conclusion: The primary use of sonography and mammography in women with breast pain is reassuring to the patients and to the treating clinician.

Liver Cell Adenoma: A Multicenter Analysis of Risk Factors for Rupture and Malignancy

Liver cell adenoma (LCA) is a benign hepatic tumor with poorly characterized risk for spontaneous rupture and malignant transformation. Records from five tertiary hepatobiliary centers were reviewed for all patients treated for LCA from 1997 to 2006. Clinicopathological data were collected and analyzed, and factors that were associated with rupture and/or malignant transformation were assessed by using multivariable logistic regression. A total of 124 patients were analyzed, of which 8 (6.5%) were men; 119 patients underwent resection, and 5 patients had embolic therapy only. Mean patient age was 39+/-11 years, and 55% had history of hormone use. Rupture occurred in 31 (25%) cases. Ruptured tumors were larger (10.5+/-4.5 cm vs. 7.2+/-4.8 cm; p=0.001), and no tumor <5 cm ruptured. Patients with ruptured LCAs were more likely to require preoperative blood transfusion (32% vs. 9%, p=0.006), preoperative embolization (16% vs. 1%, p=0.021), and major (>or=3 segments) hepatic resection (65% vs. 32%, p=0.003). By multivariate analysis, increasing tumor size (odds ratio (OR), 7.8; 95% confidence interval (CI), 2.2-26.3; p<0.01) and recent (within 6 months) hormone use (OR, 4.5; 95% CI, 1.5-13.3; p<0.01) remained independently associated with risk of rupture. Five cases (4%) had evidence of underlying malignancy, but none had LCA <8 cm in diameter. In this multicenter analysis of patients with LCAs, risk of rupture correlated with increasing tumor size and recent hormone use. Rupture is associated with greater need for preoperative blood transfusion and major hepatic resection. These data suggest that patients with asymptomatic LCAs approaching 4 cm and those requiring hormonal therapy should undergo surgical therapy.

T03-O-08 Social stigma, homosexuality and transsexuality in Iran

In Iran, gay male sex carries the death penalty, but hundreds of people are having their sex changed legally, bolstered by the blessings of members of the ruling Shiite clergy. Iranians with the inclination, means and connections could obtain the necessary medical treatment and new identity documents. To obtain legal permission for sex-change operations and new birth certificates, applicants must provide medical proof of gender-identity disorder. There are now several clinics staffed by psychiatrists and clinical psychologists who are authorized to provide a clinical assessment of the patients requesting a sex change operation. The objective of this study was to examine the main sources and characteristics of social stigma in this population; to examine the difference in perceived social stigma between homosexuals transsexuals, and to examine the associations among stigma, mental health and HIV risk behaviors. The sample included 70 homosexuals and transsexuals selected through snowball sampling with Initial recruits selected from a sexual disorder clinic. To our knowledge this is the first study of its kind among this population. The self-administered interviews included measures of health status and demographics, history of hormone use and sex reassignment surgery, LGBT stigma, perceived discrimination, visibility, and acceptability, religiosity, coping mechanism, and social support, Internalized homophobia, HIV risk-taking behaviors and mental health: SCL-90 and self-esteem. Preliminary analysis demonstrates a significant level of homophobia and systematic and institutionalized discrimination against LGBT populations in Iran. We are currently analyzing the relationship among perceived social stigma, mental health and HIV risk behaviors.