Influence of race/ethnicity on prevalence and presentation of endometriosis: a systematic review and meta-analysis.

BACKGROUND: Understanding the impact of race/ethnicity on the prevalence and presentation of endometriosis may help improve patient care. OBJECTIVE: To review systematically the evidence for the influence of race/ethnicity on the prevalence of endometriosis. SEARCH STRATEGY: CENTRAL, MEDLINE, PubMed, Embase, LILACS, SCIELO, and CINAHL databases, as well as the grey literature, were searched from date of inception until September 2017. SELECTION CRITERIA: Randomised control trials and observational studies reporting on prevalence and/or clinical presentation of endometriosis. DATA COLLECTION AND ANALYSIS: Twenty studies were included in the review and 18 studies were used to calculate odds ratio (OR) with 95% confidence interval (CI) through a random effects model. Methodological quality was assessed using the Newcastle-Ottawa risk of bias scale (NOS). MAIN RESULTS: Compared with White women, Black woman were less likely to be diagnosed with endometriosis (OR 0.49, 95% CI 0.29-0.83), whereas Asian women were more likely to have this diagnosis (OR 1.63, 95% CI 1.03-2.58). Compared with White women, there was a statistically significant difference in likelihood of endometriosis diagnosis in Hispanic women (OR 0.46, 95% CI 0.14-1.50). Significant heterogeneity (I2  > 50%) was present in the analysis for all racial/ethnic groups but was partially reduced in subgroup analysis by clinical presentation, particularly when endometriosis was diagnosed as self-reported, CONCLUSIONS: Prevalence of endometriosis appears to be influenced by race/ethnicity. Most notably, Black women appear less likely to be diagnosed with endometriosis compared with White women. There is scarce literature exploring the influence of race/ethnicity on symptomatology, as well as treatment access, preference, and response. TWEETABLE ABSTRACT: Prevalence of endometriosis may be influenced by race/ethnicity, but there is limited quality literature exploring this topic.

Histomorphological changes in endometriosis in a patient treated with ulipristal: A case report.

BACKGROUND: Selective progesterone receptor modulators have shown efficacy in the treatment of endometriosis, however they are not currently licensed in Canada for this purpose. Their histomorphological effects have been well documented in the endometrium, but not in endometriosis. CASE REPORT: The patient presented with uterine fibroids and heavy menstrual bleeding, and was treated with ulipristal acetate over three 90-day courses. She eventually elected to undergo definitive surgical management. On pathological examination, she was found to have a focus of endometriosis in the para-tubal soft tissue showing a morphology similar to progesterone receptor modulator associated endometrial changes (PAEC). CONCLUSIONS: To our knowledge this is the first reported case of PAEC involving a focus of endometriosis. This case demonstrates histomorphological evidence of the effects of ulipristal acetate on endometriosis, and thus provides evidence of a pharmacological effect.

Clinical Considerations of BRCA1- and BRCA2-Mutation Carriers: A Review.

Individuals who carry an inherited mutation in the breast cancer 1 (BRCA1) and BRCA2 genes have a significant risk of developing breast and ovarian cancer over the course of their lifetime. As a result, there are important considerations for the clinician in the counseling, followup and management of mutation carriers. This review outlines salient aspects in the approach to patients at high risk of developing breast and ovarian cancer, including criteria for genetic testing, screening guidelines, surgical prophylaxis, and chemoprevention.