Rates Of Endometrial Cancer Research Articles

Risks of Breast and Endometrial Cancer in Women with Diabetes: A Population-Based Cohort Study

ObjectiveWe investigated the overall and age-specific risks of developing breast and endometrial cancer among women with diabetes in a population-based cohort study.MethodsWomen with diabetes (n = 319310) and age-matched controls (n = 319308), selected from ambulatory care claims and beneficiary registry in 2000, respectively were linked to the in-patient claims (2000–2008) to identify admissions due to breast (ICD-9-CM: 174) and endometrial (ICD-9-CM: 182) cancer. The person-year approach with Poisson assumption was used to estimate the incidence density rate. The age-specific hazard ratios (HRs) of above malignancies in relation to diabetes with multivariate Cox proportional hazard regression.ResultsThe overall incidence density rate of breast and endometrial cancer was estimated at 1.21 and 0.21 per 10,000 patient-years, respectively, for diabetes. The corresponding figures for controls were lower at 1.00 and 0.14 per 10,000 patient-years. Compared with the controls, the covariate adjusted HR for breast and endometrial cancer was 1.42 (95% confidence interval (CI) 1.34–1.50) and 1.71 (95% CI 1.48–1.97), respectively in women with diabetes. Elderly (> = 65 years) diabetes had the highest HR (1.61) of breast cancer, while the highest HR (1.85) of endometrial cancer was observed in diabetes aged < = 50 years.ConclusionsDiabetes may significantly increase the risks of breast and endometrial cancer in all age stratifications. Health education for strict adherence of cancer screening program in women with diabetes is essential.

Abstract 2285: Risk factors for endometrial cancer in black and white women: A pooled analysis from the Epidemiology of Endometrial Cancer Consortium (E2C2).

Abstract Introduction: More than 47,000 women will be diagnosed with endometrial cancer in 2012, making it the most common gynecologic cancer among women in the United States. Data from the SEER registry from 1975-2009 report the incidence rate of endometrial cancer is lower among black women than white women (19.2 and 27.5 cases per 100,000 women, respectively). Tumor histology also varies by racial group, with a larger proportion of black women diagnosed with non-endometrioid tumors compared to their white counterparts. It is possible that risk factors for endometrial cancer may differ between black and white women; the small number of black women in individual studies has precluded these analyses. The aim of this study was to investigate risk factors for endometrial cancer in blacks using a pooled analysis. For comparison, we pooled data on risk factors among non-Hispanic white women in the same studies. Methods: We have data from eleven studies that included &amp;gt;10 black cases and &amp;gt;10 black controls (7 cohort studies and 4 case-control studies). The following information was collected from each study: age at diagnosis/study entry, education, body mass index (BMI), smoking status, reproductive variables, hormone use, and self-reported diabetes and hypertension. Unconditional logistic regression was used to estimate odds ratios and 95% confidence intervals for each risk factor in blacks and whites separately. Estimates for endometrioid tumors will also be presented. Results: Data were pooled for 2,011 black women (516 cases and 1,495 controls) and 19,297 white women (5,693 cases and 13,604 controls). In univariate analyses, the following variables were associated with endometrial cancer in both black and white women: BMI, smoking, oral contraceptive use for 10 years or more, and diabetes. In models adjusted for these variables, along with age and study site, obesity (BMI ≥ 30) was associated with an approximate 3-fold increase in risk for both black and white women (OR=2.80, 95% CI: 2.00, 3.92 and OR=3.26, 95% CI: 2.96, 3.59, respectively). Diabetes was also associated with a 30-40% increase in risk among both groups. Cigarette smoking was associated with reduced risk of endometrial cancer among both blacks and whites (OR=0.66, 95%CI: 0.47, 0.94 and OR=0.62, 95% CI: 0.54, 0.71, respectively). Increasing parity was more strongly associated with decreased risk in whites (p-trend &amp;lt;0.001) than blacks (p-trend = 0.09). Similarly, age at first birth was also more protective in whites (p-trend&amp;lt;0.001) than blacks (p-trend=0.76). Conclusions: Overall, risk factors for endometrial cancer are similar in black and white women, with the exception of some of the reproductive factors, which do not appear to afford protection in blacks to the same extent as in whites. Citation Format: Michele L. Cote, Tala Alhajj, Julie J. Ruterbusch, Louise A. Brinton, William J. Blot, Chu Chen, Brian E. Henderson, Pamela L. Horn-Ross, Laurence N. Kolonel, Timothy R. Rebbeck, Veronica W. Setiawan, Lisa B. Signorello, Michael S. Simon, Noel S. Weiss, Nico Wentzensen, Hannah P. Yang, Sara H. Olson. Risk factors for endometrial cancer in black and white women: A pooled analysis from the Epidemiology of Endometrial Cancer Consortium (E2C2). [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 2285. doi:10.1158/1538-7445.AM2013-2285

Recent changes in endometrial cancer trends among menopausal-age US women

BackgroundChanges in endometrial cancer incidence rates after the precipitous decline in menopausal hormone therapy (MHT) use in 2002 have not been evaluated. MethodsUsing data from the Surveillance, Epidemiology, and End Results Program from 1992 to 2009 (SEER 13), we identified 63428 incident endometrial cancer cases among women ages 20–74. We compared annual percent change (APC) in endometrial cancer incidence rates from 1992 to 2002 to rates from 2003 to 2009. ResultsIn contrast to the constant endometrial cancer rate pattern observed from 1992 to 2002 (APC 0.0%), rates increased after 2002 in women 50–74 years old (2.5%; PAPC comparison<0.01). Endometrial cancer incidence increased over the entire time period among women ages 20–49 (1992–2002: 1.1%; 2003–2009: 2.1%; PAPC comparison=0.21). Post-2002 increases in incidence among women ages 50–74 were specific to Type I endometrial tumors (1992–2002: −0.6%; 2003–2009: 1.6%; PAPC comparison<0.01). DiscussionThe increase in endometrial cancer incidence rates after 2002 may be related to the widespread decrease in estrogen plus progestin MHT use, which has been reported to lower endometrial cancer risk in overweight and obese women.

Trends in Endometrial Cancer Incidence by Race and Histology with a Correction for the Prevalence of Hysterectomy, SEER 1992 to 2008

Incidence rates of endometrial cancer are routinely calculated without removing women who have had a hysterectomy from the denominator, which leads to an underestimate. Furthermore, as the number of women who have had a hysterectomy (hysterectomy prevalence) varies by race, the estimate of racial difference in endometrial cancer incidence is incorrect. Data from 1992 to 2008 from the SEER Program were used to calculate incidence rates of endometrial cancer (corpus uterus and uterus, NOS) for 67,588 women 50 years and older. Data from the Behavioral Risk Factor Surveillance System were used to estimate hysterectomy prevalence. SEER area populations were reduced by hysterectomy prevalence, and corrected incidence rates were calculated. For women 50 years and older, the corrected incidence rate of endometrial cancer was 136.0 per 100,000 among whites and 115.5 among blacks, a 73% and 90% increase respectively compared with the uncorrected rate. The increase was greater for black women because hysterectomy prevalence was higher among black women (47%) than white women (41%). The corrected incidence among black women significantly increased 3.1% per year compared with a 0.8% significant decrease among white women resulting in higher rates among black women toward the end of the study period. Correcting the incidence rate for hysterectomy prevalence provides more accurate estimates of endometrial cancer risk over time. Comparisons of rates of endometrial cancer among racial groups may be misleading in the absence of denominator correction for hysterectomy prevalence.

植物雌激素防治围绝经期综合征

植物雌激素是天然植物化合物，结构或功能与雌二醇相同。有雌激素或抗雌激素双向调节作用，对激素相关性疾病具有广泛防治作用。已有研究显示植物雌激素对围绝经期血管舒缩症状及绝经后的风险有益，安全而无增加阴道出血、子宫内膜增生、子宫内膜癌及乳房癌。植物雌激素是有希望的围绝经期综合征替代药物。 Phytoestrogens are natural plant compounds that are structurally or functionally similar to estradiol, which have both estrogenic and anti-estrogenic activity, displaying a two-way regulation ability and extensive preventive and therapeutic effects on hormone-related diseases. Studies demonstrate the benefit of phytoestrogens in addressing the perimenopausal vasomotor symptoms and postmenopausal health risks. Phytoestrogens have a safe side-effect profile with no increased rates of vaginal bleeding, endometrial hyperplasia, endometrial cancer, and breast cancer. They offer a promising alternative to conventional hormone replacement therapy for perimenopausal syndrome.

Systematic lymphadenectomy in endometrial cancer

Approximately 17% of patients with endometrial cancer eventually relapse and die of this disease. 1 From this viewpoint, improvements are needed in the treatment for endometrial cancer, especially patients at high risk of a poor prognosis. On the other hand, the International Federation of Gynecology and Obstetrics (FIGO) annual report demonstrated that the survival rates of endometrial cancer have continued to increase during recent decades. 3 This trend applies to all cases, including stage IIIC. Meanwhile, surgery has been playing the leading role in treatment of endometrial cancer, and there has been no paradigm shift except for the introduction of lymphadenectomy. Whether many patients with endometrial cancer can benefit from lymphadenectomy must be determined. Two recent randomized controlled trials showed negative effects of lymphadenectomy on prognosis, 4,5 and many gynecologists have since declared at conferences that standard surgery for endometrial cancer does not include lymphadenectomy. However, such a declaration is an overgeneralization of the results of the randomized studies. In the present manuscript, we tried to interpret the results of these two randomized controlled trials properly, and discussed pitfalls of randomized controlled trials in surgical intervention. A surgical field to be treated is proposed in a group of patients who require lymphadenectomy. In addition, a new strategy for preventing leg edema, the most frequent complication after lymphadenectomy, is introduced.

Down-regulation of Sox7 is associated with aberrant activation of Wnt/β-catenin signaling in endometrial cancer

Although the mortality rate of endometrial cancer is comparatively low in gynecologic malignancies, a rising trend of this cancer has been observed for the past decade. The understanding of the molecular mechanism will favor for the clinical management of this disease. Aberrant activation of Wnt/β-catenin signaling pathway plays a major role in the pathogenesis of endometrioid adenocarcinoma including this cancer type. In this study, we reported that Sox7, one of Sox transcriptional factors, was frequently underexpressed in endometrial cancer and importantly, it was associated with dysregulation of the Wnt/β-catenin signaling activity. Immunohistochemical and quantitative RT-PCR analyses showed that Sox7 was underexpressed and was associated with high-grade tumor (P=0.021), increased expressions of β-catenin (P=0.038) and its downstream targets; CyclinD1 (P less than 0.001) and FGF9 (P less than 0.001). In addition, using HEK293T cell model, we found that Sox7 was able to inhibit TCF/LEF-1-dependent luciferase activity induced by Wnt-1. This was further proved by that Sox7 could significantly suppress the expressions of Wnt targets; Cyclin D1 and C-myc in endometrial cells. Immuno-fluorescent microscopy revealed that Sox7 was co-localizaed with either mutant β-catenin or TCF4 protein in nucleus, while co-immunopreciptation assay demonstrated that Sox7 could physically interact with not only wild-type but also mutant β-catenin, as well as TCF4 proteins. Functionally, enforced expression of Sox7 could significantly inhibit endometrial or endometrioid ovarian cancer cells (OEA) harboring either wild-type or mutant β-catenin. These data suggest Sox7 is a negative regulator of Wnt/β-catenin signaling pathway through impeding the transcriptional machinery of β-catenin/TCF/LEF-1 transcriptional complex, and the loss of expression may be involved in the pathogenesis of endometrial cancer.

Clinical Outcome of Atypical Endometrial Hyperplasia Diagnosed on an Endometrial Biopsy

The aims of this study were: (1) to review the rate of concurrent endometrial cancer in patients with a preoperative diagnosis of atypical endometrial hyperplasia (AEH); and (2) to determine the features of concurrent endometrial carcinoma and their impact on the subsequent management of AEH. We reviewed a retrospective series of 219 AEHs diagnosed locally in routine practice, over 24 years, and followed by a repeat biopsy or hysterectomy. Another series of 65 cases with a malignant diagnosis on preoperative sampling was included as a control group. Clinicopathologic parameters were obtained. In addition, published data on the risk of malignancy and features of malignant tumors after a diagnosis of AEH were collected and analyzed. This study reported on 2571 patients diagnosed in 31 published studies in addition to the current one. This showed a wide variation in the positive predictive value (PPV) of AEH in detecting endometrial cancer (6% to 63%) with an overall PPV of 37%. This variation is not only based on the differences among studies but also on the degree of atypia [mild/moderate (PPV 13%) or severe (PPV 50%)], the type of subsequent intervention (biopsy vs. hysterectomy), and more importantly the time period of diagnosis (around 20% in studies published before 1990s and up to 40% to 48% in recently published cases). Of the benign outcome cases, nearly 40% to 50% showed AEH with a potential risk of progressing to invasive carcinoma in 25% of cases. Malignant tumors after AEH diagnosis are associated with features of good prognosis with endometrioid morphology, lower grade, and early stage. Although the overall PPV of AEH is 37%, a figure of 40% to 48% is expected in the cases currently diagnosed in routine practice. Providing qualifying criteria for AEH will help identify its different associated risks and therefore should be included in routine pathology reports whenever possible. Unless there is a clinical contraindication, hysterectomy should be performed to treat concurrent carcinoma and to reduce the risk of subsequent carcinoma in nonmalignant cases with residual AEH.

Aberrant steroid hormone response and increased pro-inflammatory cytokine secretion in endometrial stromal fibroblasts from women with PCOS

The endometrium of women with polycystic ovary syndrome (PCOS) is associated with progesterone (P4) resistance and abnormal steroid receptor/co-activator profile which likely contribute to increased miscarriage rate and risk of endometrial cancer in these women. Whether there is an inflammatory component in PCOS endometrium that relates to endometrial dysfunction is not known. We hypothesized that endometrial stromal fibroblasts (eSF) show aberrant steroid hormone responsiveness and production of pro-inflammatory cytokines in PCOS.

Outcomes in women age 40 years and older with cytologically benign endometrial cells

We sought to estimate cytologically benign endometrial cell (CBEC)-associated endometrial hyperplasia and cancer rates, and describe clinical and histologic outcomes. Medical records of women age >40 years with CBEC in 2005 through 2010 were reviewed for clinical characteristics; assessment with endometrial biopsy, ultrasound, or hysteroscopy; and consequent outcomes. Of 658 women, 281 (42.7%) were assessed: 39.4% of 330 premenopausal, and 46.0% of 328 postmenopausal women. Among these, cancer rate was 3.6% and differed between premenopausal (0.8%) and postmenopausal (6.0%) women (P = .019). Hyperplasia rate was similar in premenopausal (3.9%) and postmenopausal (3.3%) women. Of 20 assessed women with endometrial pathology, 4 (1 premenopausal) women with cancer and 4 (2 premenopausal) women with hyperplasia had no abnormal bleeding. Cancer was more common in postmenopausal women with assessed CBEC while hyperplasia was comparably distributed between premenopausal and postmenopausal women. Findings support CBEC assessment regardless of menopausal status or abnormal bleeding.

Regression, relapse, and live birth rates with fertility-sparing therapy for endometrial cancer and atypical complex endometrial hyperplasia: a systematic review and metaanalysis

The objective of the study was to evaluate the regression, relapse, and live birth rates of early-stage endometrial cancer (EC) and atypical complex hyperplasia (ACH) with fertility-sparing treatment. This was a metaanalysis of the proportions from observational studies with a random-effects model and a meta-regression to explore for heterogeneity. Thirty-four observational studies, evaluating the regression, relapse, and live birth rates of early-stage EC (408 women) and ACH (151 women) with fertility-sparing treatment. Fertility-sparing treatment for EC achieved a pooled regression rate of 76.2%, a relapse rate of 40.6%, and a live birth rate of 28%. For ACH the pooled regression rate was 85.6%, a relapse rate of 26%, and a live birth rate of 26.3%. Twenty women were diagnosed with ovarian cancer (concurrent or metastatic) during follow-up (3.6%) and 10 progressed to higher than stage I EC (1.9%) from which 2 women died. Fertility-sparing treatment of EC and ACH is feasible and selected women can satisfy their reproductive wishes.

Canadian breast implant cohort: Extended follow‐up of cancer incidence

Cosmetic breast implants are not associated with increased breast cancer incidence, but variations of risk according to implant characteristics are still poorly understood. As well, the assessment of cancer risk for sites other than breast needs to be clarified. The purpose of this study was to fill these research gaps. This study presents an extended analysis of 10 more years of follow-up of a large Canadian cohort of women who received either cosmetic breast implants (n = 24,558) or other cosmetic surgery (15,893). Over 70% of the implant cohort was followed for over 20 years. Cancer incidence among implant women was compared to those of controls using multivariate Poisson models and the general female population using the standardized incidence ratios (SIRs). Women with breast implants had reduced rates of breast and endometrial cancers compared to other surgery women. Subglandular implants were associated to a reduced rate of breast cancer compared to submuscular implants [incidence rate ratio (IRR) = 0.78, 95% confidence interval (CI) = 0.63-0.96] and this reduction persisted over time. We observed a sevenfold increased rate (IRR = 7.36, 95% CI = 1.86-29.12) of breast cancer in the first 5 years after the date of surgery for polyurethane-coated subglandular implant women but this IRR decreased progressively over time (p value for trend = 0.02). We also observed no increased risk of rarer forms of cancer among augmented women. A reduction in breast cancer incidence was observed for women with subglandular implants relative to women with submuscular implants. Possible increase of breast cancer incidence shortly after breast augmentation with polyurethane implants needs to be verified.

High rates of endometrial cancer among Pacific women in New Zealand: the role of diabetes, physical inactivity, and obesity

To determine the endometrial cancer rates, and the proportion attributable to diabetes mellitus (DM), physical inactivity, and overweight/obesity, by ethnicity with a focus on Pacific women in New Zealand. Linked census-cancer records (1981-2004) were used to determine incidence rates of endometrial cancer by ethnicity. Health survey data (2006-2007) were used to determine risk factor prevalence by ethnicity. Relative risks for the association between diabetes, obesity, physical inactivity and endometrial cancer were sourced from published studies. Population attributable risk (PAR) methods, with Monte Carlo simulation, were used to estimate the PAR% by ethnicity and applied to 2001-2004 cancer rates. Pacific women had 2.61 (95% confidence interval 2.22-3.05) times the endometrial cancer rate of European/Other women pooled over time, and the most rapidly increasing rates over time with the rate ratio increasing from 1.96 (1.14-3.37) in 1981/1986 to 3.78 (3.03-4.71) in 2001/2004 (p for trend=0.14). Pacific women had the highest PAR% for DM, physical inactivity, and overweight/obesity (63.1%), followed by Māori (58.6%) and European/Other (48.6%). Applying these PAR% to 2001-2004 endometrial cancer rates, the rate ratio comparing Pacific to European/Other endometrial cancer reduced from 3.8 for total cancer (attributable plus non-attributable) to 2.3 for non-attributable cancer, and the rate difference reduced by 79% from 51 to 11 per 100,000. Pacific women have high endometrial cancer rates in New Zealand. Some, but not all, of the ethnic inequalities were explained by measured differences in obesity/overweight, DM, and physical inactivity.

Incidence rates of endometrial hyperplasia, endometrial cancer and hysterectomy from 1980 to 2003 within a large prepaid health plan

Obesity strongly increases the risk of endometrial cancer and is projected to increase current and future endometrial cancer incidence. In order to fully understand endometrial cancer incidence, one should also examine both hysterectomy, which eliminates future risk of endometrial cancer, and endometrial hyperplasia (EH), a precursor that prompts treatment (including hysterectomy). Hysterectomy and EH are more common than endometrial cancer, but data on simultaneous temporal trends of EH, hysterectomy and endometrial cancer are lacking. We used linked pathology, tumor registry, surgery and administrative datasets at the Kaiser Permanente Northwest Health Plan to calculate age-adjusted and age-specific rates, 1980-2003, of EH only (N = 5,990), EH plus hysterectomy (N = 904), hysterectomy without a diagnosis of EH or cancer (N = 14,926) and endometrial cancer (N = 1,208). Joinpoint regression identified inflection points and quantified annual percentage changes (APCs). The EH APCs were -5.3% (95% confidence interval [CI] = -7.4% to -3.2%) for 1980-1990, -12.9% (95% CI = -15.6% to -10.1%) for 1990-1999 and 2.4% (95% CI = -6.6% to 12.2%) for 1999-2003. The EH-plus-hysterectomy APCs were -8.6% (95% CI = -10.6% to -6.5%) for 1980-2000 and 24.5% (95% CI = -16.5% to 85.7%) for 2000-2003. Hysterectomy rates did not significantly change over time. The endometrial cancer APCs were -6.5% (95% CI = -10.3% to -2.6%) for 1980-1988 and 1.4% (95% CI = -0.2% to 3.0%) for 1988-2003. Hysterectomy rates were unchanged, but increased endometrial cancer incidence after 1988 and the reversal, in 1999, of the longstanding decline in EH incidence could reflect the influence of obesity on endometrial neoplasia.

Comparative rate of endometrial cancer from ablation versus medical management of dysfunctional uterine bleeding: A population-based cohort study

Objective: Endometrial ablation is an increasingly popular treatment for dysfunctional uterine bleeding (DUB), but its effect on endometrial cancer and possible delay in cancer diagnosis remains unknown. This study investigated if endometrial ablation was associated with a differing rate of endometrial cancer or a delayed cancer diagnosis among women with DUB.

The Effect of Isoflavone Soy Protein (ISP) Supplementation on Endometrial Thickness, Hyperplasia and Endometrial Cancer Risk in Postmenopausal Women: A Randomized Controlled Trial

Soy isoflavones are structurally similar to 17β-estradiol and possess selective estrogen receptor modulator (SERM)-like activity. In postmenopausal women, isoflavone soy protein (ISP) supplementation has been shown to have multiple health benefits, such as reduction of subclinical atherosclerosis when initiated within 5 years of menopause [1]. However, the effect of ISP supplementation on the endometrium has not been studied. To determine whether long term ISP supplementation affects endometrial thickness and rates of endometrial hyperplasia and cancer in postmenopausal women. In this randomized, double-blind, placebo-controlled trial, 350 postmenopausal women 45-92 years of age without diabetes and cardiovascular disease (CVD) were randomized to 2 evenly divided daily doses of 25 g soy protein containing a total of 154 mg of ISP or a milk protein matched placebo for a 3-year period. Participants with a surgically absent uterus were excluded from this analysis. For the remaining 222 participants, ultrasonographic and histopathologic characteristics of the endometrium were compared between intervention and control groups. Compliance with ISP supplementation was confirmed by plasma and urine isoflavone measurements. Endometrial thickness was measured by transvaginal ultrasound at baseline and at 18 and 30 months of follow-up, as well as at 36 months in some participants. The mean change of endometrial thickness from baseline was recorded and compared between treatment groups. Participants with endometrial thickness ≥5 mm and those with vaginal bleeding underwent endometrial biopsies. Incidences of endometrial sampling, endometrial hyperplasia and endometrial cancer were compared between groups. A total of 666 visits among 222 participants were evaluated. There was no statistically significant difference between groups in the baseline endometrial thickness or in changes of endometrial thickness over the trial follow-up (Table 1, p>0.8). Of the 101 placebo-treated participants, 7 (6.9%) underwent an endometrial biopsy; 6 (85.7%) of these biopsies were benign. Of these, 4 were benign, not otherwise specified, and 2 were atrophic. One placebo subject was diagnosed with atypical endometrial hyperplasia and underwent a hysterectomy. The pathology result from this surgery was Stage IB endometrial cancer. Of the 121 participants in the soy group, 9 (7.4%) underwent an endometrial biopsy. The results were benign in all 9 cases (100%). Of these, 5 were benign, not otherwise specified, 3 were atrophic, and 1 proliferative. Although the rate of hyperplasia / malignancy was higher in the placebo group (14.3% versus 0%), the difference was not statistically significant (Table 2). Three-year isoflavone soy protein (ISP) supplementation has no effect on endometrial thickness or on rates of endometrial hyperplasia and cancer in postmenopausal women.

Legume, Soy, Tofu, and Isoflavone Intake and Endometrial Cancer Risk in Postmenopausal Women in the Multiethnic Cohort Study

Phytochemicals found in soy and other legumes have been speculated to reduce the risk of endometrial cancer; however, inconsistent findings have been reported in the few epidemiological studies conducted to date. We conducted a prospective analysis of 46 027 nonhysterectomized postmenopausal women who were recruited into the Multiethnic Cohort (MEC) Study between August 1993 and August 1996 and provided detailed baseline information on diet and other endometrial cancer risk factors. A total of 489 women diagnosed with incident endometrial cancer were identified through the Surveillance, Epidemiology, and End Results tumor registry linkages during a median follow-up period of 13.6 years. Cox proportional hazards models were used to estimate multivariable-adjusted relative risks (RRs) and 95% confidence intervals (CIs) for endometrial cancer associated with dietary intake of legumes, soy, and tofu, and for total isoflavones and specific isoflavones (daidzein, genistein, or glycitein). Truncated (age 50-89 years) age-adjusted incidence rates were calculated by applying age-specific rates within isoflavone quintiles to the overall MEC population eligible for endometrial cancer. To estimate the percentage of endometrial cancers that may have been prevented by consuming the highest quintile of total isoflavones, the partial population attributable risk percent was calculated. A reduced risk of endometrial cancer was associated with total isoflavone intake (highest vs lowest quintile, ≥7.82 vs <1.59 mg per 1000 kcal/d, RR = 0.66, 95% CI = 0.47 to 0.91), daidzein intake (highest vs lowest quintile, ≥3.54 vs <0.70 mg per 1000 kcal/d, RR = 0.64, 95% CI = 0.46 to 0.90), and genistein intake (highest vs lowest quintile, ≥3.40 vs <0.69 mg per 1000 kcal/d, RR = 0.66, 95% CI = 0.47 to 0.91). No statistically significant association with endometrial cancer risk was observed for increasing intake of legumes, soy, tofu, or glycitein. Truncated age-adjusted incidence rates of endometrial cancer for the highest vs lowest quintile of total isoflavone intake were 55 vs 107 per 100 000 women per year, respectively. The partial population attributable risk percent for total isoflavone intake lower than the highest quintile was 26.7% (95% CI = 5.3% to 45.8%). This study suggests that greater consumption of isoflavone-containing foods is associated with a reduced risk of endometrial cancer in this population of nonhysterectomized postmenopausal women.

Social inequalities or inequities in cancer incidence? Repeated census-cancer cohort studies, New Zealand 1981–1986 to 2001–2004

We examine incidence trends for 18 adult cancers, by ethnicity and socioeconomic position in New Zealand. The 1981 to 2001 censuses were linked to subsequent cancer registrations, giving 47.5 million person-years of follow-up. RESULTS ETHNICITY: Pooled over time, differences were marked: Pacific and Māori rates of cervical, endometrial, stomach and pancreatic cancers were 1.5-2.5 times European/Other rates; Māori, Pacific and Asian rates of liver cancer were 5 times European/Other; European/Other rates of colorectal, bladder and brain cancers were 1.5-2 times the rates of other groups and melanoma rates 5-10 times higher; Pacific and Asian kidney cancer rates were half those of Māori and European/Other. Over time, Māori and Pacific rates of cervical cancer fell faster and Māori rates of colorectal and breast cancer increased faster, than European/Other rates. Male lung cancer rates decreased for European/Other, were stable for Māori and increased for Pacific. Female lung cancer rates increased for all ethnic groups. INCOME: Other than lung (rate ratio 1.35 men, 1.56 women), cervical (1.35) and stomach cancer (1.23), differences in incidence by income were modest or absent. Tobacco explains many of the social group trends and differences and constitutes an inequity. Cervical cancer trends are plausibly explained by screening and sexual practices. Faster increases of colorectal and breast cancer among Māori are presumably due to changes in dietary and reproductive behaviour, but the higher Māori breast cancer rate is unexplained. Ethnic differences in bladder, brain, endometrial and kidney cancer cannot be fully explained.

Toremifene is an effective and safe alternative to tamoxifen in adjuvant endocrine therapy for breast cancer: results of four randomized trials

Compared to tamoxifen, the efficacy and side effects of toremifene in adjuvant endocrine therapy for breast cancer were not very clear. This meta-analysis was conducted to give a more precise estimation of the efficacy and severe side effects of toremifene given in the adjuvant setting in comparison to tamoxifen. The electronic database PubMed was searched for randomized trials comparing toremifene with tamoxifen as adjuvant therapies. Four randomized trials published in three articles were eligible, including 1,890 pooled cases treated with toremifene and 1,857 cases treated with tamoxifen. Compared to patients in tamoxifen group, patients in toremifene group did not have a significantly different overall survival rate (risk ratio (RR): 1.07, 95% confidence interval (CI): 0.97-1.19, P=0.994 for heterogeneity) or a disease-free survival (DFS) rate (RR: 1.05, 95% CI: 0.95-1.17, P=0.431 for heterogeneity) at the end of the follow-up time. The rates of thromboembolic events in toremifene group, including deep vein thrombosis (odds ratio (OR): 0.68, 95% CI: 0.40-1.17, P=0.926 for heterogeneity), cerebrovascular accident (OR: 0.59, 95% CI: 0.32-1.09, P=0.438 for heterogeneity), and pulmonary embolism (OR: 0.91, 95% CI: 0.42-2.01, P=0.618 for heterogeneity), were not significantly different from those in tamoxifen group. The rates of endometrial polyps and endometrial cancer between the two groups were almost the same. This meta-analysis suggested that toremifene was as effective as tamoxifen in the adjuvant setting for both perimenopausal and postmenopausal breast cancer patients with similar severe adverse effects to tamoxifen. Toremifene was a convincing and safe change for tamoxifen in adjuvant endocrine therapy.

Cigarette Smoke Increases Progesterone Receptor and Homeobox A10 Expression in Human Endometrium and Endometrial Cells: A Potential Role in the Decreased Prevalence of Endometrial Pathology in Smokers1

Cigarette smoking has long been tied to a multitude of poor health outcomes; however, in reproductive biology, smoking has shown several unintuitive findings. Smoking is associated with significantly decreased rates of endometriosis and endometrial cancer. Here, we show that treatment with cigarette smoke extract leads to increased mRNA and protein expression of homeobox A10 (HOXA10) and progesterone receptor (PGR) as well as more rapid decidualization of endometrial stromal cells in vitro. In vivo, mice exposed to cigarette smoke similarly showed increased expression of HOXA10 and PGR in the endometrium. Both HOXA10 and PGR drive endometrial differentiation and are suppressed in endometrial tumors and in endometriosis. The increased expression found upon exposure to cigarette smoke may provide a protective effect, mediating the decreased incidence of endometrial disease among smokers. This mechanism contrasts with the accepted paradigm that the effects of smoking on the uterus are secondary to ovarian alterations rather than direct effects on endometrium as demonstrated here.