Leiomyomas in an African Caribbean hysterectomy population considered to be ethnically related to African Americans.

BACKGROUND: Uterine leiomyoma has been reported to be a worse problematic disease for African American than Caucasian women in the US. Data are almost non-existent for other populations of African ancestry. Our aim was to investigate the hypothesis of an equivalent influence of ethnicity on uterine leiomyomas for women of a French African-Caribbean population. BASIC PROCEDURES: Retrospective analysis of hysterectomies performed from 2010 to 2015 at the teaching hospital of Guadeloupe (French West Indies), where most inhabitants are of West African origin, was carried out. Data of the 899 hysterectomies, including those for malignancy, were collected, in particular, uterine weight. MAIN FINDINGS: The indications were leiomyoma in 66.5 % of cases and leiomyomas were found in 91 % of all cases. The mean age and uterine weight were 51.7 years and 464 g for the entire population, 50.2 years and 488 g for the population without malignancies, and 47.0 years and 567 g for the population with leiomyomas. PRINCIPAL CONCLUSIONS: The data were compared to those reported in the literature for several populations, notably African Americans and Caucasians in the US and mainland France. This comparison supports the hypothesis that Guadeloupean women, an African-Caribbean population, have characteristics in terms of uterine leiomyoma that are close to those of African Americans. Although confirmation is required, these results highlight the need for specific research, therapeutic approaches, and improved early management of these populations.

Does life-course socioeconomic position influence racial inequalities in the occurrence of uterine leiomyoma? Evidence from the Pró-Saúde Study.

We aimed to investigate whether life-course socioeconomic position mediates the association between skin color/race and occurrence of uterine leiomyomas. We analyzed 1,475 female civil servants with baseline data (1999-2001) of the Pró-Saúde Study in Rio de Janeiro State, Brazil. Life-course socioeconomic position was determined by parental education (early life socioeconomic position), participant education (socioeconomic position in early adulthood) and their combination (cumulative socioeconomic position). Gynecological/breast exams and health insurance status were considered markers of access to health care. Hazard ratios (HR) and 95% confidence intervals (95%CI) were estimated using Cox proportional hazards models. Compared with white women, black and parda ("brown") women had higher risk of reporting uterine leiomyomas, respectively HR: 1.6, 95%CI: 1.2-2.1; HR: 1.4, 95%CI: 0.8-2.5. Estimates were virtually identical in models including different variables related to life-course socioeconomic position. This study corroborated previous evidence of higher uterine leiomyomas risk in women with darker skin color, and further suggest that life-course socioeconomic position adversity does not influence this association.

Does life-course socioeconomic position influence racial inequalities in the occurrence of uterine leiomyoma? Evidence from the Pro-Saude Study / A posicao socioeconomica influencia as desigualdades raciais na ocorrencia de miomas uterinos? Evidencias do Estudo Pro-Saude / El nivel socioeconomico influye en las desigualdades raciales en cuanto a la incidencia de miomas uterinos? Evidencia del Estudio Pro-Saude

We aimed to investigate whether life-course socioeconomic position mediates the association between skin color/race and occurrence of uterine leiomyomas. We analyzed 1,475 female civil servants with baseline data (1999-2001) of the Pró-Saúde Study in Rio de Janeiro State, Brazil. Life-course socioeconomic position was determined by parental education (early life socioeconomic position), participant education (socioeconomic position in early adulthood) and their combination (cumulative socioeconomic position). Gynecological/breast exams and health insurance status were considered markers of access to health care. Hazard ratios (HR) and 95% confidence intervals (95%CI) were estimated using Cox proportional hazards models. Compared with white women, black and parda (“brown”) women had higher risk of reporting uterine leiomyomas, respectively HR: 1.6, 95%CI: 1.2-2.1; HR: 1.4, 95%CI: 0.8-2.5. Estimates were virtually identical in models including different variables related to life-course socioeconomic position. This study corroborated previous evidence of higher uterine leiomyomas risk in women with darker skin color, and further suggest that life-course socioeconomic position adversity does not influence this association.

Nós investigamos se posição socioeconômica ao longo da vida medeia a associação entre cor/raça e ocorrência de mioma uterino. Analisamos 1.475 funcionárias públicas com dados na linha de base (1999-2001) do Estudo Pró-Saúde no Rio de Janeiro, Brasil. A posição socioeconômica ao longo da vida foi determinada pela escolaridade dos pais (posição socioeconômica precoce), escolaridade da participante (posição socioecônomica no inicio da vida adulta) e suas combinações (posição socioeconômica acumulada). Exames ginecológicos/mama e plano de saúde foram considerados marcadores de acesso à saúde. Razão de hazards (RH) e intervalos de 95% de confiança (IC95%) foram estimados por modelos de riscos proporcionais de Cox. Comparadas às mulheres brancas, as de cor preta e parda tiveram maior risco de relatarem mioma uterino (RH: 1,6, IC95%: 1,2-2,1; RH: 1,4, IC95%: 0,8-2,5, respectivamente). As estimativas foram praticamente idênticas nos modelos que incluíram as diferentes variáveis de posição socioeconômica ao longo da vida. Este estudo corrobora evidências prévias de maior risco de mioma uterino entre mulheres de cor da pele mais escura e também sugere que a posição socioeconômica ao longo da vida não influencia esta associação.

Hemos investigado si es estatus socioeconómico durante toda la vida influye en la asociación entre raza y presencia de mioma uterino. Se analizaron a 1.475 funcionarias, con datos provenientes de la cohorte Pró-Saúde (1999-2001) en Río de Janeiro, Brasil. La posición socioeconómica durante toda la vida se determinó por la educación de los padres (posición socioeconómica temprana), educación de la participante (posición socioeconómica principio de la edad adulta) y combinaciones de los mismos (posición socioeconómica acumulada). Exámenes ginecológicos/mama y el plan de salud se consideran marcadores de acceso a la salud. La razón de riesgo (hazards ratio, HR) y el intervalo de un 95% de confianza (IC95%) se calcularon utilizando modelos de riesgos proporcionales. La comparación entre mujeres blancas, negras y mulatas/mestizas concluyó que tenían un riesgo más elevado de mioma uterino, en los siguientes porcentajes respectivamente HR: 1,6 IC95%: 1,2-2,1; HR: 1,4 IC95%: 0,8-2,5. Las estimaciones fueron prácticamente idénticas en los modelos que incluyen diferentes variables de posición socioeconómica para toda la vida. Este estudio apoya la evidencia de mayor riesgo de mioma uterino entre mujeres de color de piel más oscuro y también sugiere que la posición socioeconómica para toda la vida no influye en esta asociación.

Evolução de lesões precursoras de câncer de colo uterino nas coletas de citologia realizadas nas Unidades Básicas de Saúde (UBS) da Região Norte / Secretaria Municipal da Saúde – SP no período de 2009 até 2013 / Injury evolution Precursor of Cervical Cancer in cytology samples taken in Basic Health Units (BHU) of the North / Municipal Health Region - SP from 2009 until 2013

A tendência à queda da maioria das alterações citológicas, principalmente nas de maior gravidade (LIEAG/ Ca), reforça a importância dos três pilares do Programa: educação permanente dos profissionais do nível primário e secundário, integração das UBSs com os serviços de Colposcopia, monitoramento e tratamento dos casos com alterações (AU)

The p.L750V mutation in the NLRP7 gene is frequent in Mexican patients with recurrent molar pregnancies and is not associated with recurrent pregnancy loss.

OBJECTIVE: The aim of this study is to analyze NLRP7 mutation frequency in 20 Mexican patients with recurrent hydatidiform moles (RHMs). PATIENTS: Twenty patients with RHMs, 50 couples with recurrent pregnancy loss (RPL), and 100 controls were included in the study. Molecular analysis of the NLRP7 coding region was performed in patients with RHMs. Restriction enzyme digestion analysis and direct sequencing of the identified mutations were performed in controls and patients with RPL. RESULTS: Patients displayed between two and six moles, and 10 of them presented other forms of pregnancy loss. Twelve (60%) patients were homozygous for the missense mutation c.2248C > G (p.L750V), five (25%) patients were heterozygous for the p.L750V mutation and the c.1018 G > A (p.E340K) variant, and three (15%) patients were heterozygous for the c.1018 G > A (p.E340K) variant. Five (5%) control women and four women and one man (5%) with RPL were heterozygous for the p.L750V mutation and two (2%) patients with RPL were heterozygous for the p.E340K variant. CONCLUSIONS: A total of 60% of our RHM patients presented homozygous p.L750V mutations, 25% were compound heterozygotes for p.L750V mutation and the p.E340K variant, and 15% were heterozygous for p.E340K variant. Heterozygous p.L750V mutations were frequently observed in our population. Homozygous mutations were also present in patients with RHMs. Additional studies are needed to understand the role of the p.E340K variant in RHMs and RPL.

Racial and ethnic disparities in lifetime risk of corpus uterine cancer: a comparative study of Puerto Rico and the United States SEER population.

BACKGROUND: Corpus uterine cancer is the most common gynecologic malignancy in Puerto Rico and the United States. METHODS: We assessed the lifetime risk of developing and dying of corpus uterine cancer in women living in Puerto Rico (PR) and among Hispanics, non-Hispanic whites (NHW), and non-Hispanic blacks (NHB) in the United States. Data from the PR Central Cancer Registry and the Surveillance, Epidemiology, and End Results program were analyzed from 1993-2004. RESULTS: In PR, the probability of developing corpus uterine cancer increased from 1.21% in 1993-1995 to 1.69% in 2002-2004. The probability of developing this malignancy from 2002-2004 was 1.59% for NHB, 1.80% for Hispanics and 2.54% for NHW. The ratio of estimated probabilities only showed significant lower risk in PR as compared to NHW (.67, 95% CI = .59-.74). The probability of dying from corpus uterine cancer during 2002-2004 was .47% for Hispanics, .49% for NHW, .53% for PR and .76% for NHB. The ratio of estimated probabilities only showed significant lower risk of death in PR as compared to NHB (.70, 95% CI = .54-.85). CONCLUSIONS: The lifetime risk of developing corpus uterine cancer has increased in PR, suggesting higher exposure to risk factors in this population. Despite the lower lifetime risk of this malignancy in PR as compared to NHW, the similar lifetime risk of death in these groups suggests a disparity that may be influenced by differences in disease etiology and/or access or response to treatment. Assessment of risk factors, in addition to access to health services, is required to further understand these patterns.

Early-life exposures and early-onset uterine leiomyomata in black women in the Sister Study.

BACKGROUND: Uterine leiomyomata (fibroids) are hormonally responsive tumors, but little is known about risk factors. Early-life exposures may influence uterine development and subsequent response to hormones in adulthood. An earlier analysis of non-Hispanic white women who participated in the Sister Study found associations between several early-life factors and early-onset fibroids. OBJECTIVES: We evaluated associations of early-life and childhood exposures with early-onset fibroids among black women and compared the results with those found among white women. METHODS: We analyzed baseline data from 3,534 black women, 35-59 years of age, in the Sister Study (a nationwide cohort of women who had a sister diagnosed with breast cancer) who self-reported information on early-life and childhood exposures. Early-onset fibroids were assessed based on self-report of a physician diagnosis of fibroids by the age of 30 years (n = 561). We estimated risk ratios (RR) and 95% confidence intervals (CI) from log-binomial regression models. RESULTS: Factors most strongly associated with early-onset fibroids were in utero diethylstilbestrol (DES; RR = 2.02; 95% CI: 1.28, 3.18), maternal prepregnancy diabetes or gestational diabetes (RR = 1.54; 95% CI: 0.95, 2.49), and monozygotic multiple birth (RR = 1.94; 95% CI: 1.26, 2.99). We also found positive associations with having been taller or thinner than peers at the age of 10 years and with early-life factors that included being the firstborn child of a teenage mother, maternal hypertensive disorder, preterm birth, and having been fed soy formula. CONCLUSIONS: With the exception of monozygotic multiple birth and maternal hypertensive disorder, early-life risk factors for early-onset fibroids for black women were similar to those found for white women. However, in contrast to whites, childhood height and weight, but not low socioeconomic status indicators, were associated with early-onset fibroids in blacks. The general consistency of early-life findings for black and white women supports a possible role of early-life factors in fibroid development.

Aspectos sociales en el control del cáncer uterino en el departamento de Caldas / Social aspects in the control of the uterine Cancer in the department of Caldas

Este trabajo y su impacto es el resultado dela unión del sector político administrativo, académicoy comunitario; está dentro de las propuestasde la atención primaria elaboradas enla conferencia internacional en 1.978 enKazacstan (Unión de Republicas SocialistaSovieticas) con el eslogan ®Salud para todosen el año 2000¼ que planteó: La Atención Primariarefleja las condiciones económicas, políticasy socioculturales de las comunidades yse basa fundamentalmente en la aplicación delos resultados obtenidos en las investigacionessociales y biomédicas y está orientada hacialos principales problemas de salud de la comunidad,utilizando los servicios de promoción,prevención, tratamiento y rehabilitación, necesariospara enfrentarlos...

Ethnic differences at risk for gestational trophoblastic disease in New Mexico: A 25-year population-based study.

OBJECTIVE: The purpose of this study was to compare gestational trophoblastic disease incidence rates with the use of population-based data. STUDY DESIGN: All incident cases between 1973 and 1997 and live birth, pregnancy, and women at risk were tabulated with the use of data that were derived from the New Mexico Tumor Registry and Vital Records and Health Statistics Annual Reports. Statistical methods included trends analyses, odds ratios, and Poisson regression. RESULTS: Of 939 total cases, 312 non-Hispanic white women, 399 Hispanic white women, 201 American Indian women, and 27 other women were affected. Age-adjusted incidence rates were significantly higher for American Indian women (11.16%) compared with non-Hispanic (3.57%) or Hispanic white women (5.32%); the probability value was <.001. When live birth (1:438 women) and pregnancy (1:486 women) denominators were considered, American Indian women alone were at increased risk, and the ratio increased by 56% over 25 years. American Indian women were also at increased risk for partial mole (relative risk, 4.03; 95% CI, 2.57-6.31), invasive mole (relative risk, 26.7; 95% CI, 7.81-93.14), and choriocarcinoma (relative risk, 6.29; 95% CI, 1.81-22.66) variants. CONCLUSION: American Indians are at increased risk relative to the other predominant ethnic groups in New Mexico. Age-adjusted standardization provided a reproducible measurement that may be applicable across other registries.

Risk factors for uterine leiomyoma: a practice-based case-control study. I. African-American heritage, reproductive history, body size, and smoking.

The authors conducted a case-control study among premenopausal women in the Baltimore, Maryland, area to examine the associations of uterine leiomyoma with ethnicity and hormone-related characteristics. Cases of uterine leiomyoma (n = 318) were surgically or sonographically first confirmed between January 1990 and June 1993. A total of 394 controls were selected from women who were visiting their gynecologist for a routine checkup. Data were collected through telephone interviews and abstraction of medical records; 77.8% of eligible cases and 78.0% of eligible controls were interviewed. Positive adjusted associations were observed between risk of uterine leiomyoma and self-described African-American ethnicity (vs. Whites: odds ratio (OR) = 9.4; 95% confidence interval (CI): 5.7, 15.7), early menarche (<11 years vs. >13 years: OR = 2.4; 95% CI: 1.1, 5.6), and high body mass index (upper quartile vs. lower quartile: OR = 2.3; 95% CI: 1.4, 3.8). Inverse associations were observed with use of oral contraceptives (current use vs. never use: OR = 0.2, 95% CI: 0.1, 0.6) and duration of smoking (> or =19 years vs. never: OR = 0.6; 95% CI: 0.4, 1.1). Younger ages at infertility diagnosis and at first and last childbirth were more common among cases; however, analyses of data on tumor location suggested that these associations represent predominantly consequences of uterine leiomyoma. These results suggest that development of uterine leiomyoma is associated with increased exposure to ovarian hormones. Possible reasons for the very elevated risk among African-American women need further investigation.

Ethnic differences in uterine corpus cancer incidence and mortality in New Mexico's American Indians, hispanics and non-Hispanic whites.

BACKGROUND: Although ethnic and radical differences in uterine corpus cancer incidence and mortality have been reported worldwide, few published data have addressed the epidemiology of uterine cancer among US American Indians and Hispanics. METHODS: We reviewed uterine corpus cancer incidence and survival data from New Mexico's population-based cancer registry collected from 1969 to 1992, and examined State vital records data for uterine cancer deaths collected from 1958 to 1992, focusing on ethnic differences in occurrence and outcomes of uterine malignancies. RESULTS: Non-Hispanic white women had age-adjusted incidence rates that were substantially higher (20.8 per 100,000) than rates for Hispanics (10.3) and American Indians (6.0) over the 24-year period. Uterine cancer mortality rates were also higher for non-Hispanic whites and Hispanics than for American Indian women, although mortality rates were substantially lower than incidence rates. Five-year survival for uterine cancer was comparable among all groups for all stages combined (87.3% for non-Hispanic whites, 81.4% for Hispanics, and 84.6% for American Indians). CONCLUSIONS: Our population-based data show ethnic differences in uterine corpus cancer incidence rates for non-Hispanic white women that were double those for Hispanics, and triple those for American Indian women. Ethnic differences in survival were comparable. Aetiologic studies are warranted to investigate the dramatic ethnic differences in occurrence of uterine cancer.

Adenomyosis uteri: a prospective study in Trinidad and Tobago (January-May, 1986)

A prospective study of the incidence of adenomyosis uteri encountered in 200 consecutive hysterectomies and 21 consecutive myomectomies was conducted at the Port-of-Spain General Hospital during the period January to May 1986. The observed incidence of adenomyosis was 47 percent. Adenomyosis uteri was commonest amongst the most highly fertile group of women, namely the East Indian group. There was no case of adenomyosis uteri amongst the Caucasians in this study. Adenomyosis uteri was seen most often in women in their fifth decade of life; 62.8 percent of the patients had menorrhagia and or dysmenorrhea. The average dimension of the corpus uteri with classical adenomyosis uteri was 10x8x4 cm which corresponded to a uterus of 8-10 week size gestation. Basal and proliferate glands were seen in 53.9 percent of the adenomyotic foci. Hyperoestrogenic lesions had a 53.9 percent association with adenomyosis uteri which was diagnosed in only 4.8 percent of cases pre-operatively (AU)

Adenomyosis uteri: a prospective study in Trinidad & Tobago, January-May, 1986

A prospective study of the incidence of adenomyosis uteri encountered in 200 consecutive hysterectomies and 21 consective myomectomies was conducted at the Port-of-Sapin General Hospital during the period January to May, 1986. The observed incidence of adenomyosis was 47%. Adenomyosis uteri was commonest amongst the most highly fertile group of women, namely the East Indian group. There was no case of adenomyosis uteri amongst the Caucasians in this study. Adenomyosis uteri was seen most often in women in their fifth decade of life; 62.8% of the patients had menorrhagia and or dysmenorrhea. The average dimension of the corpus uteri with classical adenomyosis uteri was 10 x 8 x 4 cm which corresponded to a uterus of 8 - 10 week sixe gestation. Basal and proliferative glands were seen in 53.9% of the adenomyotic foci. Hyperoestrogenic lesions had a 53.9% association with adenimyosis uteri which was diagnosed in only 4.8% of cases pre-operatively