Risk of breast cancer among female teachers of physical education and languages.

A retrospective follow-up study on 924 physical education (PE) and 3,239 language (L) teachers was performed to study whether life-long high physical activity affects the risk of breast cancer. The Finnish Cancer Registry found 128 malignant breast cancers among these women in a follow-up during 1967-1987. The standardized incidence ratio (SIR) for all PE teachers was 1.28 (n.s.) and for L teachers 1.59 (p less than 0.001). Before the menopause (below age 50) SIR for PE teachers was 0.93 (n.s.) and for L teachers 1.51 (p less than 0.05). These results suggest that before menopause the risk of breast cancer in physically active PE is smaller than in the less active L. A Poisson regression analysis, taking into account the reproductive factors together with age and observation period, did not show any significant difference between PE and L teachers, probably due to the relatively small number of cases (n = 22) in the PE teacher group.

Factors influencing the success of microsurgery for distal tubal occlusion.

Ninety-three infertile women with distal tubal occlusion were subjected to salpingostomy in 1982-1984. In 78 of them follow-up data were available for 2-5 years. Second look laparoscopy was performed in 47 patients at a median of 4 months postoperatively. It showed one or both tubes patent in 45 (96%). In the total series of 93 patients, 13% had live births, 7.5% spontaneous abortions, and 13% ectopic pregnancies. Severe adnexal adhesions and the extent of fimbrial damage found at operation or at second look laparoscopy were the most significant factors related to the poor outcome of microsurgery. Our experience suggests that cases with severe adhesions and poor tubal status should be primarily directed to in vitro fertilization program rather than to microsurgery.

Steroids and the risk of breast cancer.

The search for major abnormalities as causes for breast cancer have not been successful, whether they have been directed to patients with this disease, different groups, or populations at risk. Anovulation or progesterone deficiency are not characteristic for those at risk for breast cancer or those patients with early breast cancer. In contrast, early-onset long-lasting ovulatory cycle function seems to be prevalent in different risk categories. Women with early menarche are additionally characterized by having higher serum estradiol and lower sex hormone-binding globulin concentrations than women with later menarche, at least during the early years of their fertile life. Estradiol is a central agent in the process of breast cancer appearance, and progesterone does not seem to have an opposing action. A decrease in the number of ovulatory cycles may exert a protective effect against breast cancer. If the decrease is affected by endocrine mechanisms maintaining breast ethelial stimulation comparable to that during the normal menstrual cycle, the protective effect would be nullified.

The epidemiology and endocrinology of the menarche in relation to breast cancer.

The search for major endocrine abnormalities as causes for breast cancer has not been successful, whether it has been directed to patients with this disease, or to different groups or populations at risk, such as women who have had an early menarche. There were, however, clear-cut differences in a number of variables when the pubertal development of girls with an early menarche was compared with that in other girls. The girls with an early menarche, compared to those with a late menarche, had an early increase in serum concentrations of follicle stimulating hormone, higher circulating oestradiol concentrations before and for several years after menarche and lower serum sex hormone-binding globulin concentrations for several years after menarche, the last two leading to higher 'free oestradiol indices' in the serum. Early menarche was characterized by early onset of ovulatory cycles. We found that the times from menarche until 50% of the cycles were ovulatory were about 1, 3 and 4.5 years, when the ages at menarche were less than 12, 12-12.9 and more than or equal to 13 years, respectively. In addition, the luteal phase of the menstrual cycles of subjects with an early menarche was adequate more frequently than that of subjects with a later menarche. These findings are compatible with the view that girls with an early menarche have a more profound decrease in the sensitivity of the hypothalamic-pituitary axis to the negative feedback of circulating steroids. The associations between endocrine variables and body weight and percentage of fat seem to be primarily determined by the endocrine variables. Altogether the data on early menarche suggest that early-onset regular cyclic ovarian function is related to the increased risk of breast cancer that is associated with this category of women. Athletic activities may delay menarche, which may have relevance for reducing the risk of breast cancer.

Steroids in ovarian and peripheral venous blood in polycystic ovarian disease.

Ovarian and peripheral venous blood samples were collected at operation in six patients with polycystic ovaries (PCO) and seven control subjects with normal ovarian function in the follicular phase of the cycle. Plasma concentrations of unconjugated testosterone, dihydrotestosterone (DHT), androsterone, androstenedione, dehydroepiandrosterone (DHEA), pregnenolone, progesterone, 17 alpha-hydroxyprogesterone (17 alpha-OH-P) and oestradiol were determined by specific radioimmunoassay techniques, and concentrations of DHEA, androsterone and pregnenolone sulphates by gas chromatography. In the control group, ovarian vein concentrations of all unconjugated steroids, except progesterone, were significantly higher than the corresponding peripheral vein concentrations, suggesting ovarian secretion. No significant differences were demonstrated between ovarian and peripheral plasma levels of steroid sulphates. Ovarian vein levels of androstenedione, testosterone and DHEA were markedly elevated in PCO patients compared with the control group, and the levels of DHT and androsterone to a lesser degree. Polycystic ovaries appear to secrete androsterone sulphate, but no significant secretion of DHEA sulphate could be demonstrated. Ovarian venous levels of oestradiol in the PCO group did not differ from those in the control group. Elevated ovarian venous androgen levels in the PCO group seemed to correlate with thecal cell hyperplasia as indicated by histological examination of ovarian biopsies. In one PCO patient, blood levels of different steroids were followed for a month after ovarian wedge resection. Testosterone fell to half the pre-operative value and a temporary fall was also noticed in other androgens. A marked rise in plasma progesterone concentration at the end of the follow-up period suggested that ovulation had occurred.