Menopausal Patients Research Articles

Alteration of Sex and Non-Sex Hormones and Distribution Features of Blood ABO System Groups among the Women with Uterine Body Tumors

Objectives: The aim of the investigation was to study the hormonal status (sex hormones: estradiol (E2), progesterone (P), testosterone (T); non-sex gonadotropic hormones-luteinizing hormone (LH) and follicle-stimulating hormone (FSH)) of women with benign and malignant tumors of uterine body in the reproductive, menopause and postmenopause periods. Also the distribution features of the blood ABO system phenotype groups and their link to the development of uterine body tumors have been studied. Methods: The determination of hormones was made by the enzyme analysis method (ELAIZA), provided by the proper ELAIZA kits. For the study of blood ABO system antigens, internationally recognized immunoserology methods were used. Results: Investigations revealed the increased level of E2 and T on the background of the reduced P in the blood of the women with uterine tumors in the reproductive, menopause and post-menopause period. As for gonadotropic hormones, the decreased levels of LH and FSH have also been detected. From the ABO system phenotype groups A(II) group had the highest frequency between the women with malignant uterine tumor in the reproductive age. O (I) phenotype group was the most frequent in case of menopause and post-menopause women with uterine malignant tumors. Conclusions: Hormonal imbalance creates good conditions for the proliferation of uterine tissues and hence causes the development of benign and malignant uterine tumors. The imbalance of the sex steroid and gonadotropic hormones in the blood of post-menopause women indicates on the genotoxic mechanism of cancer development on the background of age-related changes. A(II) group had the highest frequency between the reproductive age women with uterine malignant tumor, while O (I) group was the most frequent in case of menopause and post-menopause patients.

Pittsburgh Sleep Quality Index scores and their relationship with body measurements in late menopause patients.

With an increase in life expectancy, women live about one-third of their lives in the postmenopausal period. Our aim was to investigate the findings regarding quality of sleep and sleep apnea in postmenopausal women and research the relationship between sleep complaints and body measurements. The Pittsburgh Sleep Quality Index (PSQI) was administered to all participants and their height, weight, and neck circumferences were measured. A total of 206 patients (mean age: 61.4 ± 8.8 years) were included. Their mean weight gain after menopause was 8.1 ± 12.8 kg, and their mean neck circumference and body mass index was 39.7 ± 2.6 cm and 33.4 ± 2.1, respectively. The rate of patients who snored each night increased from 3.4% to 13.2% (P = 0.000) after menopause. The rate of self-reported poor sleep quality was found in 57.8% of patients according to the PSQI global score (≥5). The prevalence of sleep medication usage increased from 5.8% to 11.2% with menopause. Although body measurements were a little lower in patients with a total PSQI score of less than 5, this difference was insignificant. The prevalence of self-reported poor sleep quality was high in the postmenopausal period and the prevalence of snoring increased significantly with weight gain after menopause.

Comparison of clinicopathological findings among patients whose mammography results were classified as category 4 subgroups of the BI-RADS.

OBJECTIVE:Our aim is to compare mammographic, demographic and clinicopathological characteristics of patients whose mammographies were classified as subgroups of BI-RADS 4 category (Breast Imaging – Reporting and Data System).METHODS:In total, 103 patients with mammography (Senographe 600t Senix HF; General Electric, Moulineaux, France) results classified as BI-RADS 4 were included in the study. Demographic data (age, menopause, and family history) were recorded. All data were compared among BI-RADS 4 subgroups.RESULTS:In all, 68.9% (71/103), 7.8% (8/103) and 23.3% (24/103) the patients were in groups BI-RADS 4A, 4B and 4C, respectively. The incidence of malignancy was higher in Groups 4B and 4C than in Group 4A (p<0.05), but similar in Groups 4B and 4C (p>0.05). Mean age was lower in Group 4B than in Groups 4A and 4C (p<0.05). A positive family history was more common in Group 4A than in Group 4B (p=0.025). The frequency of menopausal patients was greater in Groups 4A and 4C than in Group 4B (p=0.021, and 0.003, respectively).METHODS:The rate of malignancy was higher in Groups 4B, and 4C than in Group 4A. A positive family history was more common in Group 4A than in Group 4C. Groups 4A, and 4C patients tended to be older and were more likely to be menopausal than Group 4B patients.

Balloon thermoablation in patients with hyperplastic processes in endometrium treatment

The experience of treatment of 84 menstruating and postmenopausal patients with hyperplastic processes in endometrium is analyzed in the study. Balloon thermoablation of endometrium using TERMOCHOICE sistem was performed. Clinical effectiveness of ablation was assessed during 12, 24, 36 months. The effectiveness of thermoablation in menstruating women was 83,1 %, in menopause patients 100 %. The technique is safe, effective and uterus-preserving.

Abstract P2-02-09: Accuracy of MRI for estimating residual tumor size after neoadjuvant endocrine therapy in early stage breast cancer with ER positive and HER2 negative

Abstract Back ground Neoadjuvant endocrine therapy (NET) is increasingly being used in the management of breast cancer patients with ER positive and HER2 negative. A major clinical benefit is that patients with large operable tumors may be offered breast-conserving surgery (BCS). Therefore, success of BCS following NAT depends on accurate assessment of the residual tumor extent after NAT. The correlation between the extent of the tumor at pathology and preoperative assessments of the size obtained by physical examination and conventional imaging is impaired by hormonal therapy-induced necrosis and fibrosis. However, the most superior method to assess the extent of residual disease after NAT was unknown. The aim of this study was to evaluate the relative accuracies of mammography(MMG), ultrasound(US), specimen mammography(SMMG) and MRI in predicting residual tumor size and pathological response after neoadjuvant endocrine therapy (NET) in patients with ER positive and HER2 negative. Each prediction method (EPM) was compared with the gold standard of surgical pathology. Patients and methods From April 2010 to December 2012, 50 post menopausal patients with breast cancer at clinical stages T1c-T2N0 were prospectively enrolled in this study on NET. Fifty patients (age range, 52-75 years; mean age, 64.1 years) who received NET with 24 weeks of letrozole were evaluated with EPM before and after NET. We compared the predicted residual tumor size and the predicted response on imaging with residual tumor size and response on the pathologically determined size. We defined the tumor sizes measured by EPM and pathology as in agreement when the greatest tumor dimension measured by EPM was within 70_120% of the measurement determined by microscopic pathology. The EPM assessment was categorized as an underestimation when the longest diameter on imaging was &amp;lt;70% that at pathology and as an overestimation when the longest diameter on imaging was&amp;gt;120% that at pathology. Statistical analysis was performed using logistic regression analysis. Results The correlation coefficient between the residual tumor sizes determined by pathology and the predicted tumor size was 0.721(p = 0.651) for MMG, -0.111(p = 0.642) for US, 0.723(P = 0.001) for SMMG and 0.714 (p&amp;lt;0.000001) for MRI. The rate of agreement between the final response predictions and the responses measured by pathology were 50% for MMG, 40% for US, 35% for SMMG and 78% for MRI. The MMG,US, SMMG and MRI measurement disagreed with the pathologically determined size in 50%,60%,65%,22%, overestimating the size in 0%,12%, 11%,2% and underestimating the size in 50%, 48%,53%,20% respectively. Conclusions Predictions of response and residual tumor size made on MRI were best correlated with the assessments of response and residual tumor size made on pathology than were predictions made on the basis of clinical examination, mammography or ultrasound. MRI is one of the most accurate methods for predicting the extent of residual tumor after NET. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P2-02-09.

Association of Cross Linked C-Telopeptide II Collagen and Hyaluronic Acid with Knee Osteoarthritis Severity

BACKGROUND: This study was carried out to investigate the association of Cross Linked C-Telopeptide Type I &amp; II Collagen (CTX-I and II) and hyaluronic acid (HA) with knee osteoarthritis (OA) severity.METHODS: Sixty menopause women with primary knee OA were enrolled in this study during their visits to the Outpatient Department. Patients with knee pain during weight bearing, active or passive range of motion, or tenderness with Kellgren-Lawrence (KL) grade of more than I were included. Patients with injury, inflammatory and metabolic diseases were excluded. Patients were put in a 10-hour fasting prior to withdrawal of morning blood samples for examinations of HA, CTX-I, interleukin 1 beta (IL-1β), and high sensitivity C reactive protein (hs-CRP) level. Second void morning urine specimens were taken for CTXII assessment. HA, CTX-I and II levels were measured by enzyme-linked immunosorbent assay.RESULTS: Sixty menopausal female patients were included in this study, 35 with KL grade II, 17 grade III, and 8 grade IV. Means of CTX-II were significantly different between subjects KL grade IV and III (p=0.021). Correlation of KL grade was significant with CTX-II (p=0.001, r=0.412) and HA (p=0.0411, r=0.269). KL grades were not significantly associated with CTX-I (p=0.8364, r=-0.0272); IL-1β (p=0.5773, r=0.0853) and hs-CRP (p=0.2625, r=0.1470).CONCLUSION: CTX-II and HA were associated with severity of knee OA, suggesting that CTX-II and HA can be used as marker for knee OA severity.KEYWORDS: CTX-II, hyaluronic acid, otestoarthritis, knee

Association of Mammographic Density with Pathologic Findings

BackgroundBreast cancer is one of the most common cancers in the world and is the first cause of death due to cancer among women. Mammography is the best screening method and mammographic density, which determines the percentage of fibro glandular tissue of breast, is one of the strongest risk factors of breast cancer. Because benign and malignant lesions may present as dense lesions in mammography so it is necessary to take a core biopsy of any suspicious lesions to evaluate pathologic findings.ObjectivesThe aim of this study was to assess the association between mammographic density and histopathological findings in Iranian population. Moreover, we assessed the correlation between mammographic density and protein expression profile. We indeed, determined the accuracy and positive predictive value and negative predictive value of mammographic reports in our center.Patients and MethodThis study is a cross-sectional study carried out among 131 eligible women who had referred to imaging center for mammographic examination and had been advised to take biopsy of breast tissue. All participants of the study had filled out the informed consent. Pathologic review was performed blinded to the density status. Patients were divided into low density breast tissue group (ACR density group 1-2) and high density breast tissue group (ACR 3, 4) and data was compared between these two groups. Statistical analysis performed using SPSS for windows, version 11.5. We used chi-square, t-test, and logistic regression test for analysis and Odds Ratio calculated where indicated.ResultsIn patients with high breast densities, malignant cases (61.2%) were significantly more in comparison to patients with low breast densities (37.3%) (P= 0.007, OR=2.66 95% CI=1.29-5.49). After adjusting for age, density was associated with malignancy in age groups <46 years (P=0.007), and 46-60 years (P=0.024) but not in age group >60yrs (P=0.559). Adjusting for menopausal status, density showed association with malignancy in both pre-menopause (P=0.041) and menopause (P=0.010) patients. Using logistic regression test, only age and density showed independent association with risk of breast cancer. No association was found between density and protein profile expression. Mammographic method has a false negative percent of 10.3% for negative BI-RADS group and a Positive Predictive Value (PPV) of 69.6% for positive BI-RADS group. PPVs for BI-RADS 4a, 4b, 4c and 5 were 16%, 87.5%, 84.6%, and 91.5% respectively. NPVs for BI-RADS 1, 2 and 3 were 66.7%, 95.8% and 90.0% respectively.ConclusionsIn this study we found that increasing in mammographic density is associated with an increase in malignant pathology reports. Expression of ER, PR and HER-2 receptors didn't show association with density. Our mammographic reports had a sensitivity of 94.1% and a specificity of 55.6%, which shows that our mammography is an acceptable method for screening breast cancer in this center.

Metformin Decreases Circulating Androgen and Estrogen Levels in Nondiabetic Women With Breast Cancer

IntroductionDiabetic patients treated with metformin have a lower risk of developing BC or a better BC prognosis. Metformin might reduce cancer growth through direct antiproliferative effects or through indirect mechanisms, particularly the reduction of insulin. In a randomized study on nondiabetic BC patients in natural menopause with high testosterone levels, we observed a significant decrease in insulin and in testosterone levels with metformin 1500 mg/d compared with 1000 mg/d. We present the results of a new analysis of our study on the effect of metformin on the bioavailability of sex hormones. Patients and MethodsOne hundred twenty-four eligible women were initially invited to take metformin 500 mg/d for 3 months. The 108 women who completed the first 3 months continued the study using 1000 mg/d for 1 month. The women were then randomized into 2 groups, and, for the subsequent 5 months, 1 group increased the dose to 1500 mg/d, and the other group continued with 1000 mg/d. ResultsNinety-six women completed the study, 43 receiving metformin 1500 mg/day, and 53 receiving 1000 mg/day. The women receiving 1500 mg/d showed a greater and significant reduction of free testosterone (−29%) and estradiol (−38%), a borderline significant reduction of estrone and insulin-like growth factor-1, and a nonsignificant reduction of androstenedione. They also showed a nonsignificant increase of dehydroepiandrosterone sulfate. ConclusionMetformin does not interfere with the production of dehydroepiandrosterone sulfate. Besides, it decreases estradiol levels, basically through the reduction of testosterone. These hormonal changes might have clinical relevance.

Abstract B251: Androgen receptor expression can predict benefit of tamoxifen treatment in patients with ER negative breast cancer.

Abstract The androgen receptor (AR) is frequently expressed in normal breast epithelium and in a substantial fraction of malignant breast tumors, even though the importance of AR in breast cancer is not established. In estrogen receptor (ER) positive breast cancer, AR binds to estrogen responsive element and inhibits proliferation, on the contrary in ER negative and HER2 positive cells AR activates the Wnt and HER2 pathways and induces proliferation. There are several therapies against the ER pathway and resistance to treatment is a big problem, targeting AR may be one alternative for some of these patients. In this study, we investigate the role of AR protein expression with immunohistochemistry in a defined cohort of 912 lymph node negative post menopausal breast cancer patients with a long follow up period randomized to no endocrine treatment or tamoxifen independent of ER expression, to examine if AR is a prognostic factor and/or predictor of tamoxifen treatment. In our cohort 82.4% showed AR expression in the tumour cells. In the case of ER positive patients without tamoxifen treatment, no significant difference was found when grouped by AR status (p&amp;gt;0.05). Tamoxifen treated patients with ER positive tumours showed benefit from the treatment regardless of AR expression (negative cases (p=0.038); positive cases (p=0.00001)). Further, if ER negative tumours from patients treated with tamoxifen were investigated AR expression was a tamoxifen predictive factor (p=0.014) (HR = 0.40 95% C.I. 0.18-0.89; p=0.024) but among cases with ER negative and AR negative tumours treatment with tamoxifen tended to have a worse outcome (p=0.06) HR = 2.26 95% C.I. 0.99-5.15; p=0.053. The multivariate interaction tests was significant (HR = 0.18 95% C.I. 0.056-0.56 p=0.003). There was a significant correlation between expression of the androgen receptor and small tumour size (p=0.002), PgR expression (p&amp;lt;0.001) ER expression (p&amp;lt;0.001), Cyclin D1 (p&amp;lt;0.001) and HOXB13 (p&amp;lt;0.001). The expression of AR was inversely correlated to HER2 (p=0.002). Tamoxifen is known to bind strongly to ER, however there are studies showing that tamoxifen also binds to AR. In prostate cancer, cell growth and AR activity were inhibited by tamoxifen and the ER antagonist fulvastrant effectively down regulates AR in several human prostate cancer cells and induce growth inhibition. These results suggest an anti-androgenic aspect of anti-estrogen. Our results indicate that AR is a tamoxifen predictive factor in ER negative breast cancer and suggest that this group of patients could benefit from tamoxifen treatment. Citation Information: Mol Cancer Ther 2013;12(11 Suppl):B251. Citation Format: Erik Hilborn, Jelena Gacic, Tommy Fornander, Lambert Skog, Bo Nordenskjöld, Olle Stål, Agneta Jansson. Androgen receptor expression can predict benefit of tamoxifen treatment in patients with ER negative breast cancer. [abstract]. In: Proceedings of the AACR-NCI-EORTC International Conference: Molecular Targets and Cancer Therapeutics; 2013 Oct 19-23; Boston, MA. Philadelphia (PA): AACR; Mol Cancer Ther 2013;12(11 Suppl):Abstract nr B251.

Invasive Breast Carcinoma: Influence of Prognosis and Patient-related Factors on Kinetic MR Imaging Characteristics

Purpose To retrospectively compare the kinetic magnetic resonance (MR) imaging characteristics of invasive breast carcinomas with both prognostic tumoral and patient-related parameters. Materials and Methods This HIPAA-compliant retrospective study was approved by the institutional review board, and informed consent was waived. From January 2008 to January 2011, 273 consecutive women (mean age, 55 years; range, 23–83 years) with invasive breast cancers who had undergone MR imaging were selected. The kinetic curves were retrospectively classified according to the Breast Imaging Reporting and Data System lexicon. Initial enhancement and maximal enhancement percentages, time to peak enhancement, and the signal enhancement ratio were calculated for each lesion. Kinetic characteristics were compared according to tumoral parameters (size, pathologic type, grade, hormone receptor status, and c-erbB-2 status) and patient parameters (menopausal status, personal history of breast carcinoma) by means of univariate and then multivariate analysis by using false-discovery-rate statistics. Results Lesions in menopausal patients exhibited less suspicious quantitative and qualitative characteristics than lesions in nonmenopausal patients. There was an independent association between the kinetic characteristics and menopausal status, with an odds ratio of 2.94 for the lack of rapid initial contrast material uptake and of 2.38 for the lack of washout in menopausal patients as compared with nonmenopausal patients. The odds ratio was 4.00 for not having rapid initial contrast material uptake in patients with a personal history of ipsilateral breast cancer. Conclusion Kinetic data in invasive breast cancer are associated with the patient’s menopausal status, with a typical kinetic pattern of malignancy being less common in menopausal patients. © RSNA, 2013

Invasive Breast Carcinoma: Influence of Prognosis and Patient-related Factors on Kinetic MR Imaging Characteristics

To retrospectively compare the kinetic magnetic resonance (MR) imaging characteristics of invasive breast carcinomas with both prognostic tumoral and patient-related parameters. This HIPAA-compliant retrospective study was approved by the institutional review board, and informed consent was waived. From January 2008 to January 2011, 273 consecutive women (mean age, 55 years; range, 23-83 years) with invasive breast cancers who had undergone MR imaging were selected. The kinetic curves were retrospectively classified according to the Breast Imaging Reporting and Data System lexicon. Initial enhancement and maximal enhancement percentages, time to peak enhancement, and the signal enhancement ratio were calculated for each lesion. Kinetic characteristics were compared according to tumoral parameters (size, pathologic type, grade, hormone receptor status, and c-erbB-2 status) and patient parameters (menopausal status, personal history of breast carcinoma) by means of univariate and then multivariate analysis by using false-discovery-rate statistics. Lesions in menopausal patients exhibited less suspicious quantitative and qualitative characteristics than lesions in nonmenopausal patients. There was an independent association between the kinetic characteristics and menopausal status, with an odds ratio of 2.94 for the lack of rapid initial contrast material uptake and of 2.38 for the lack of washout in menopausal patients as compared with nonmenopausal patients. The odds ratio was 4.00 for not having rapid initial contrast material uptake in patients with a personal history of ipsilateral breast cancer. Kinetic data in invasive breast cancer are associated with the patient's menopausal status, with a typical kinetic pattern of malignancy being less common in menopausal patients.

Breast Cancer, Hormone Exposure, and Cognitive Function

Although published findings conflict, estrogen seems to have a beneficial effect on cognitive function. In contrast, breast cancer diagnosis has been associated with diminished cognitive function that has been attributed to the effects of adjuvant therapy. Investigators at a single U.S. institution compared medical histories, verbal intelligence, depressive symptoms, and cognitive function in 264 menopausal breast cancer patients before receiving adjuvant therapy (mean age, 61) with 95 healthy age- and …

Hormone therapy (HT) in menopausal women with rheumatoid arthritis: a systematic review of ht effects on disease activity

A systematic review of the existing published literature was conducted to evaluate the effect of post-menopausal hormone therapy (HT) on disease activity in menopausal patients with rheumatoid arthritis (RA).

Omega-3 polyunsaturated fatty acids and left ventricular diastolic dysfunction in postmenopausal women

Purpose: To asses fatty acids composition of erythrocyte membrane lipids in postmenopausal women depending on left ventricular (LV) filling parameters. Methods: 203 postmenopausal women were included in the investigation: 142 women with surgical menopause (average age 44,3±5,4 years, menopause duration 3,8±2,4 years); and 61 women with natural menopause (average age 46,2±4,7 years, menopause duration 4,3±2,1 years). All patients underwent general clinical examination, echocardiographic examination with systolic and diastolic LV function assessment. Besides that we assessed the proportion of different fatty acids in lipids of erythrocyte membranes. Control group consisted of 27 healthy menstruating women (mean age 39,2±4,2). Statistical methods such as Cruskell-Walles criteria and τ Kendall statistics were used. Results: 117 (57.6%) postmenopausal women had LV diastolic function disturbance (1st group) and 86 women had no (2nd group). Nobody of included postmenopausal women had LV systolic function failure. All patients in menopause had significant changes in fatty acids composition of erythrocyte membrane lipids in comparison with healthy women: saturated acids relative content was increased, and unsaturated acids relative content was decreased, especially in women with LV diastolic dysfunction. The most serious changes concerned omega-3 polyunsaturated acids: relative contents of alpha-linoleic acid in patients of the 1st group was 3,1 times less than in control group (P<0.001); patients of the 2nd group demonstrated 2,7 times decrease of this index in comparison with healthy women (P<0.001). The content of eicosapentaenoic acid in the 1st and the 2nd groups was 1,7 and 1,4 times less than in control group, respectively (P<0.01). The same changes in the 1st and the 2nd groups concerned to docosapentaenoic and arachidonic acids: they were 2,1 – 3 times less and 2,4 – 2,8 times less than in healthy women, respectively (P<0.001). The presence of LV diastolic dysfunction correlated negatively with alpha-linoleic, eicosapentaenoic acid content and common polyunsaturated acids content (τ from –0.32 to –0.58, P<0.001) and positively – with saturated acids relative content (τ = 0.55, P<0.001). Conclusions: Thus, disturbances in fatty acids composition of erythrocyte membrane lipids may play role in left ventricular dysfunction formation in postmenopausal women.

FRI0316 Clinical predictors of pregnancy outcomes and premature menopause in patients with systemic lupus erythematosus

BackgroundSystemic lupus erythematosus (SLE) is predominantly affects women of child bearing-age. Pregnancies in SLE has still associated with poor maternal and fetal outcomes. Pharmacotherapy for SLE are limited during pregnancy...

AB0625 Prevalence of post menopausal osteoporosis in patients with rheumatoid arthritis undergoing lower limb arthroplasty

BackgroundRheumatoid disorder is a common systemic disorder that causes joint destruction and frequently require joint replacement surgery. Osteoporosis is a recongnize complication of rheumatoid arthritis. Osteoporosis can affect the final...

Euestrogenemia and healthy mitochondria

the review “Pleiotropic actions of estrogen: a mitochondrial matter” by Velarde ([10][1]) gives us physiological insight to the clinical responses we have observed in hormone replacement menopausal patients for many years. The improved quality of life and other benefits seen in the observational

Hormone receptor alterations and treatment responses after neoadjuvant therapy in patients with ER+/HER2- breast cancer.

e11605 Background: Hormone therapy is recommended for treating patients with luminal A type early breast cancer by the International Conference in St. Gallen, 2011. However, precisely which neoadjuvant therapeutic strategies are optimal for such patients still remains controversial. We retrospectively evaluated the treatment responses to neoadjuvant chemotherapy (NAC) or neoadjuvant endocrine therapy (NAE) in patients with ER (+)/HER2 (-) breast cancer. Methods: Four hundred and sixty-one patients with primary breast cancer underwent surgery between November 2007 and October 2012. Of 243 patients with hormone receptor (+)/HER2 (-) breast cancer, 63 with ER (+)/HER2 (-) breast cancer were preoperatively treated with either NAC (n=47, median age: 49 years) or NAE (n=16, median age: 63 years). Four cycles (c) of FEC 100 (epirubicin 100 mg/m2 + 5-fluorouracil and cyclophosphamide 500 mg/m2) followed by 4 cycles of Docetaxel (75 mg/m2) every 3 weeks were administered for the NAC treatment regimen, while Letrozole was administered for 6 months for the menopausal patients in the NAE treatment protocol. Results: NAC did not alter the ER status, while the ER status was decreased by NAE (from 83% to 62%). NAE altered the ER status (positive rate; from 83 % to 62 %), but NAC did not. The PR status was decreased by both NAC and NAE (from 51% to 30% and from 63% to 9%, respectively). ER (P=0.0327) and PR (P=0.0019) were statistically decreased after NAE compared to that observed after NAC. The response rates determined by RECIST {PD/SD/PR/CR (%)} in the NAC- and NAE-treated patients were 2/34/58/6 and 0/50/50/0, respectively. The rate of tumor shrinkage was 41% (3.9 to 2.3 cm) after NAC and 39% (2.3 to 1.4 cm) after NAE. The pathological complete response rate was 9% after NAC and 6% after NAE. The recurrence rate in the stage I/II patients was 5% (2/38) after NAC and 0% (0/16) after NAE for short-term outcomes. Conclusions: The hormone status significantly changed after NAE compared to that observed after NAC. Both of the NAC and NAE treatment protocols caused a decrease in the tumor size. As a result, both of these therapeutic modalities were found to improve the rate of breast-conserving surgery.

Glucocorticoid therapy as a significant risk factor for osteoporosis and fractures in an Italian postmenopausal population

Objective: To analyze the potential effects of glucocorticoid treatment without an osteoporosis prevention strategy and to precociously identify patients at high risk of osteoporosis and fragility fractures in the postmenopausal period.Methods: A total of 382 postmenopausal patients, 177 exposed and 205 not exposed to glucocorticoid therapy, were studied using a standard questionnaire. Epidemiological as well as clinical data that included the most recent absorptiometry test results were examined.Results: Osteoporosis and fractures were frequent in the postmenopausal glucocorticoid-treated patients. Fragility fractures occurred more frequently in glucocorticoid-treated patients (vertebral fractures represented 45% of all fractures) than in the non-glucocorticoid-treated patients. In particular, the highest fracture percentage was found in 50- to 65-year-old glucocorticoid-treated patients, a subset of patients showing a prevalence of osteoporosis similar to that of non-exposed menopausal subjects older than 65. Glucocorticoid therapy increases the risk of fragility fractures fivefold and doubles the risk of osteoporosis in menopausal patients.Conclusions: Glucocorticoid treatments put menopausal patients at a high risk of incurring fragility fractures even in the early postmenopausal period. The management of strategies for fracture prevention must take into consideration early intervention in patients undergoing or about to undergo glucocorticoid treatment.

Thyroid hormone status interferes with estrogen target gene expression in breast cancer samples of menopausal women

We investigated thyroid hormone levels in menopausal BrC patients, and verified the action of triiodothyronine (T3) on genes regulated by estrogen (E2) and by T3 itself in BrC tissues. We selected 15 postmenopausal BrC patients and a control group of 18 postmenopausal women without BrC. We measured serum thyroid peroxidase antibody, TSH, free thyroxine, and estradiol, before and after surgery, and used immunohistochemistry to examine E2 and progesterone receptors. BrC primary tissue cultures received the following treatments: ethanol, T3, T3+tamoxifen (TAM), TAM, E2, or E2+TAM. Genes regulated by E2 (TGFA, TGFB1, PGR) and by T3 (TNFRSF9, BMP‐6, THRA) in vitro were evaluated in each patient. Three BrC patients presented with clinical hyperthyroidism. Thyroxine levels of BrC patients were statistically higher than controls (1.78±0.20 vs. 0.95±0.16 ng/dl). TGFA and TGFB1 were upregulated and downregulated, respectively, after E2 and T3 treatment. T3 treatment increased PGR expression, however TAM did not block T3 action on PGR expression. TAM, alone or associated with T3, modulated gene expression of TNFRSF9, BMP‐6 and THRA, similar to T3 treatment, showing that TAM can interfere with gene expression modulated by T3. Our results reinforce that the thyroid hormone status of BrC patients can influence E2‐controlled processes, even after TAM intervention and/or in the absence of circulating E2 postmenopause.