RESUMEN
BACKGROUND: Metabolism and excretion of the phytoestrogen enterolactone (ENL), which has been associated with breast cancer risk, may be affected by variation in steroid hormone and xenobiotic-metabolizing genes. METHODS: We conducted a randomized, crossover flaxseed intervention study in 252 healthy, postmenopausal women [137 European ancestry (EA) and 115 African ancestry (AA)] from western New York. Participants were randomly assigned to maintain usual diet or consume 10 g/day ground flaxseed for 6 weeks. After a 2-month washout period, participants crossed over to the other diet condition for an additional 6 weeks. Urinary ENL excretion was measured by gas chromatography-mass spectrometry and 70 polymorphisms in 29 genes related to steroid hormone and xenobiotic metabolism were genotyped. Mixed additive genetic models were constructed to examine association of genetic variation with urinary ENL excretion at baseline and after the flaxseed intervention. RESULTS: SNPs in several genes were nominally (P < 0.05) associated with ENL excretion at baseline and/or after intervention: ESR1, CYP1B1, COMT, CYP3A5, ARPC1A, BCL2L11, SHBG, SLCO1B1, and ZKSCAN5. A greater number of SNPs were associated among AA women than among EA women, and no SNPs were associated in both races. No SNP-ENL associations were statistically significant after correction for multiple comparisons. CONCLUSIONS: Variation in several genes related to steroid hormone metabolism was associated with lignan excretion at baseline and/or after flaxseed intervention among postmenopausal women. IMPACT: These findings may contribute to our understanding of the differences observed in urinary ENL excretion among AA and EA women and thus hormone-related breast cancer risk.
Asunto(s)
4-Butirolactona/análogos & derivados , Inactivación Metabólica/genética , Lignanos/orina , Polimorfismo de Nucleótido Simple , 4-Butirolactona/metabolismo , 4-Butirolactona/orina , Complejo 2-3 Proteico Relacionado con la Actina/genética , Negro o Afroamericano/genética , Anciano , Proteína 11 Similar a Bcl2/genética , Catecol O-Metiltransferasa/genética , Estudios Cruzados , Citocromo P-450 CYP1B1/genética , Citocromo P-450 CYP3A/genética , Proteínas de Unión al ADN/genética , Dieta , Receptor alfa de Estrógeno/genética , Femenino , Lino , Humanos , Lignanos/metabolismo , Transportador 1 de Anión Orgánico Específico del Hígado/genética , Persona de Mediana Edad , Modelos Genéticos , Posmenopausia , Globulina de Unión a Hormona Sexual/genética , Factores de Transcripción/genética , Población Blanca/genéticaRESUMEN
OBJECTIVES: To investigate whether cancer patients who sought a second opinion received better medical care. STUDY DESIGN: A total of 1358 newly diagnosed colorectal cancer patients undergoing resection were identified from Taiwan's National Health Insurance Research Database between 2004 and 2008. The frequency of doctor shopping and hospital shopping in the 6 months before resection was used to define "seeking a second opinion." METHODS: A generalized hierarchical linear model was used to determine the influence of doctor shopping and hospital shopping on in-hospital complications and prolonged hospitalization after colorectal resection. RESULTS: The risk of in-hospital complications for heavy doctor shoppers was significantly higher than that for patients who were not doctor shoppers (odds ratio [OR] = 1.675, P = .037). However, the risk was significantly lower for heavy hospital shoppers compared with those who were not hospital shoppers (OR = 0.272, P = .007). The frequency of doctor shopping and hospital shopping was not significantly associated with prolonged hospitalization. CONCLUSIONS: For colorectal resection patients, the selection of a proper hospital for surgery resulted in better surgical care. The quality of surgical care was worse with heavy doctor shopping. We suggest that healthcare authorities disclose data about the quality of a hospital's cancer treatment to increase patient access to such information. This may help patients find quality healthcare providers more quickly and reduce the waste of medical resources resulting from the long process of seeking medical care.