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1.
Bull Cancer ; 107(11): 1171-1185, 2020 Nov.
Artigo em Francês | MEDLINE | ID: mdl-32988609

RESUMO

Breast cancer is the most frequently diagnosed cancer in women and the first cause of cancer death in France. Among the different subtypes of breast cancer, the predominant form is characterized by positive hormone receptors (more than 70% of breast cancers). Hormone therapy thus plays a key role in the strategy of management of these cancers both in adjuvant and metastatic situations. The two types of adjuvant hormone therapy used are selective estrogen receptor modulators and aromatase inhibitors. Fulvestrant, an anti-estrogen, is used alone or in combination with other molecules in metastatic situations. Hot flashes are one of the symptoms most frequently reported by patients under hormone therapy. Hormone replacement therapy, which is currently the most effective treatment for hot flashes, is contraindicated in patients with a personal history of breast cancer. Various therapeutic classes of drugs have been tested in this indication but without real efficacy in the various studies carried out to date, and moreover associated with non-negligible side effects. The recent discovery of the implication of the kisspeptin system located at the hypothalamic level in the mechanism of genesis of hot flashes opens the way to possible new symptomatic treatments for hot flashes. Neurokinin 3 receptor antagonists have shown encouraging preliminary results in postmenopausal cancer-free patients and could be considered in patients in hormonal therapy for breast cancer. Broader additional studies are needed to confirm these initial results.


Assuntos
Antineoplásicos Hormonais/uso terapêutico , Inibidores da Aromatase/uso terapêutico , Neoplasias da Mama/química , Neoplasias da Mama/tratamento farmacológico , Fogachos/etiologia , Moduladores Seletivos de Receptor Estrogênico/uso terapêutico , Contraindicações de Medicamentos , Terapia de Reposição de Estrogênios/efeitos adversos , Feminino , Fulvestranto/uso terapêutico , Humanos , Kisspeptinas/fisiologia , Ovário/efeitos dos fármacos , Ovário/cirurgia , Receptores da Neurocinina-3/antagonistas & inibidores , Moduladores Seletivos de Receptor Estrogênico/administração & dosagem , Tamoxifeno/administração & dosagem , Tamoxifeno/uso terapêutico
2.
Artigo em Inglês | MEDLINE | ID: mdl-32732107

RESUMO

It is well established that unopposed estrogen, either endogenous or therapeutic, can induce endometrial hyperplasia and potentially endometrial cancer (EC). Anovulatory cycles, obesity, and insulin resistance are major risk factors for EC. Progestogen (progesterone and progestin), including levonorgestrel intrauterine device, are able to prevent or to treat hyperplasia, atypical hyperplasia, and even well-differentiated EC, as presented in this review. During menopausal hormone therapy, progestogens protect the endometrium against the proliferative effects of estrogens in women with a uterus. Whereas, recent epidemiologic data suggest that micronized progesterone (MP) is apparently safer for the breast, it could be less efficient than synthetic progestin on the endometrium. However, several studies from biopsies during treatment with MP do not show any increased risk of hyperplasia. Lack of compliance could explain the results on EC.


Assuntos
Hiperplasia Endometrial , Neoplasias do Endométrio , Hiperplasia Endometrial/induzido quimicamente , Neoplasias do Endométrio/epidemiologia , Endométrio , Terapia de Reposição de Estrogênios/efeitos adversos , Estrogênios , Feminino , Humanos , Progesterona/efeitos adversos , Progestinas/efeitos adversos
3.
Hautarzt ; 71(10): 786-790, 2020 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-32852599

RESUMO

Topical hormonal treatment allows anti-aging of the skin when used during and after the menopause without an increase in the blood level of hormones. Natural hormones are only prescribed by medical doctors. In controlled clinical studies versus placebo and application for months, an increase in skin quality parameters, reduction of dryness, increase of glycosaminoglycanes, increase in elastic fibers und increase of collagen precursers and collagen fibers on the mRNA and protein level could be shown, the latter proven by biopsies. Skin with dramatic sun-damage does not respond to this treatment option. Patients with melasma or seborrhoe should not be treated with hormonal topical preparations. Compared to the natural hormones, phytotherapeutics do not bind to hormone receptors in relevant levels. Growth hormones should not be used in anti-aging treatment due to a potential carcinogenic effect.


Assuntos
Terapia de Reposição de Estrogênios/efeitos adversos , Menopausa/fisiologia , Envelhecimento da Pele/efeitos dos fármacos , Pele/efeitos dos fármacos , Administração Tópica , Envelhecimento , Feminino , Humanos , Pele/anatomia & histologia , Pele/metabolismo
4.
J Bone Miner Res ; 35(6): 1009-1013, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32406536

RESUMO

Osteoporosis is a chronic condition that reflects reduced bone strength and an associated increased risk for fracture. As a chronic condition, osteoporosis generally requires sustained medical intervention(s) to limit the risks for additional bone loss, compromise of skeletal integrity, and fracture occurrence. Further complicating this issue is the fact that the abrupt cessation of some therapies can be associated with an increased risk for harm. It is in this context that the COVID-19 pandemic has brought unprecedented disruption to the provision of health care globally, including near universal requirements for social distancing. In this Perspective, we provide evidence, where available, regarding the general care of patients with osteoporosis in the COVID-19 era and provide clinical recommendations based primarily on expert opinion when data are absent. Particular emphasis is placed on the transition from parenteral osteoporosis therapies. It is hoped that these recommendations can be used to safely guide care for patients with osteoporosis until a return to routine clinical care standards is available. © 2020 American Society for Bone and Mineral Research.


Assuntos
Infecções por Coronavirus , Osteoporose/terapia , Pandemias , Pneumonia Viral , Absorciometria de Fóton , Biomarcadores/sangue , Densidade Óssea , Conservadores da Densidade Óssea/administração & dosagem , Conservadores da Densidade Óssea/efeitos adversos , Conservadores da Densidade Óssea/uso terapêutico , Continuidade da Assistência ao Paciente , Infecções por Coronavirus/sangue , Infecções por Coronavirus/complicações , Denosumab/efeitos adversos , Denosumab/uso terapêutico , Gerenciamento Clínico , Esquema de Medicação , Terapia de Reposição de Estrogênios/efeitos adversos , Fraturas Espontâneas/prevenção & controle , Fraturas Espontâneas/terapia , Serviços de Assistência Domiciliar , Humanos , Imunossupressão/efeitos adversos , Osteoporose/sangue , Osteoporose/diagnóstico por imagem , Osteoporose/tratamento farmacológico , Pneumonia Viral/sangue , Pneumonia Viral/complicações , Cloridrato de Raloxifeno/efeitos adversos , Cloridrato de Raloxifeno/uso terapêutico , Recidiva , Telemedicina , Trombofilia/induzido quimicamente , Trombofilia/etiologia , Procedimentos Desnecessários
5.
PLoS One ; 15(5): e0233703, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32469976

RESUMO

BACKGROUND: Over a third of menopausal hormone therapy (HT) prescriptions in the US are written for women over age 60. Use of HT more than 5 years is associated with increased risk for cardiovascular disease; breast, ovarian, and endometrial cancers; thromboembolic stroke; gallbladder disease; dementia; and incontinence. OBJECTIVES: To explore older women's perceptions of the benefits and risks of long-term HT and examine factors influencing their decisions to use HT > 5 years despite medical risks. METHODS: A qualitative approach was selected to broadly explore thought processes and social phenomena underlying long-term users' decisions not to discontinue HT. Interviews were conducted with 30 women over age 60 reporting use of systemic HT more than 5 years recruited from an urban area in California and a small city in the Rocky Mountain region. Transcripts of interviews were analyzed using conventional grounded theory methods. RESULTS: Women reported using HT to preserve youthful physical and mental function and prevent disease. Gynecologists had reassured participants regarding risk, about which all 30 expressed little concern. Participants, rather than providers, were the principal drivers of long-term use. CONCLUSIONS: Participants perceived estrogen to have anti-aging efficacy, and using HT imparted a sense of control over various aspects of aging. Maintaining this sense of control was prioritized over potential risk from prolonged use. Our findings provide an additional perspective on previous work suggesting the pharmaceutical industry has leveraged older women's self-esteem, vanity, and fear of aging to sell hormones through marketing practices designed to shape the beliefs of both clinicians and patients. Efforts are needed to: 1) address misconceptions among patients and providers about medically supported uses and risks of prolonged HT, and 2) examine commercial influences, such as medical ghostwriting, that may lead to distorted views of HT efficacy and risk.


Assuntos
Envelhecimento/psicologia , Terapia de Reposição de Estrogênios , Pós-Menopausa/fisiologia , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/psicologia , Cultura , Terapia de Reposição de Estrogênios/efeitos adversos , Terapia de Reposição de Estrogênios/psicologia , Feminino , Humanos , Pessoa de Meia-Idade
6.
Internist (Berl) ; 61(6): 558-564, 2020 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-32333087

RESUMO

Peri- and postmenopausal disorders can have a significant impact on quality of life. Hormone replacement therapy (HRT) might be necessary in order to decrease women's symptoms. The German S3 guideline "Peri- and Postmenopause-Diagnostics and Therapy" (2020) provides recommendations that include the most recent evidence as well as the Women's Health Initiative (WHI) study results from 2002 and 2004. These results led to reduced prescription patterns due to a high risk of cardiovascular diseases as well as an increased risk for breast cancer if HRT had been administered. Both ongoing analyses of subgroups and other studies extenuated the WHI data, since the increased risks were neither generalizable to the typical postmenopausal patient (regarding age and risk profile) nor to the medication being used today. This article summarizes all aspects of HRT in peri- and postmenopausal women (indications, contraindications, practical approaches, risks, prevention) and provides recommendations with respect to the most recent S3 guideline.


Assuntos
Terapia de Reposição de Estrogênios/efeitos adversos , Estrogênios/efeitos adversos , Terapia de Reposição Hormonal , Perimenopausa/efeitos dos fármacos , Pós-Menopausa/efeitos dos fármacos , Pós-Menopausa/psicologia , Progesterona/efeitos adversos , Idoso , Terapia de Reposição de Estrogênios/métodos , Estrogênios/uso terapêutico , Feminino , Humanos , Pessoa de Meia-Idade , Perimenopausa/fisiologia , Perimenopausa/psicologia , Pós-Menopausa/fisiologia , Progesterona/uso terapêutico , Qualidade de Vida , Saúde da Mulher
7.
BMC Womens Health ; 20(1): 64, 2020 03 30.
Artigo em Inglês | MEDLINE | ID: mdl-32228557

RESUMO

BACKGROUND: Impaired sleep is common in menopausal women. The aim was to examine associations between uses of systemic menopausal hormone therapy (MHT) and sleep disturbance in a large population sample. METHODS: Female participants aged 45 to 75 years were selected from the Norwegian Health Study in Nord-Trøndelag (HUNT3, 2006-2008) (N = 13,060). Data were linked to the Norwegian Prescription Database, identifying use of prescribed MHT and use of sleep medication. Data were analyzed using multiple linear regression. RESULTS: In total, 996 women used systemic MHT (7.6%), with the highest prevalence of 10.3% among women 55 to 64 years of age. Despite high reports of frequent nocturnal awakening (24.7%) and high reports of hot flashes, use of MHT was low in this large population based survey. Although MHT use was associated with more sleep disturbance in unadjusted analyses, the association was not significant after adjusting for relevant covariates. Using sleep medication, reporting poor health, tobacco and alcohol use, doing daily exercise, having higher levels of anxiety, and being less satisfied with life were factors showing the strongest associations with sleep disturbance. CONCLUSION: The lack of association between MHT and sleep disturbance suggests that other factors, such as self-perceived good health, a healthy lifestyle and anxiety/depression, are more relevant to sleep than MHT.


Assuntos
Terapia de Reposição de Estrogênios/efeitos adversos , Menopausa/psicologia , Pós-Menopausa/psicologia , Qualidade de Vida , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Transtornos do Sono-Vigília/epidemiologia , Idoso , Terapia de Reposição de Estrogênios/métodos , Feminino , Fogachos/epidemiologia , Humanos , Pessoa de Meia-Idade , Noruega/epidemiologia , Sono , Distúrbios do Início e da Manutenção do Sono/psicologia , Transtornos do Sono-Vigília/psicologia , Estresse Psicológico/epidemiologia , Estresse Psicológico/psicologia
8.
Toxicol Appl Pharmacol ; 393: 114928, 2020 04 15.
Artigo em Inglês | MEDLINE | ID: mdl-32092384

RESUMO

The female gender is protected against immunological complications of endotoxemia. Here we investigated whether gonadal hormone depletion by ovariectomy (OVX) uncovers inflammatory and cardiovascular effects of endotoxemia and whether these effects are reversed by hormone replacement therapies. Changes in inflammatory cytokines, blood pressure (BP), left ventricular (LV) function, and cardiac autonomic activity caused by lipopolysaccharide (LPS) in conscious female rats with different hormonal states were determined. In contrast to no effects in sham-operated females, treatment of OVX rats with LPS (i) decreased BP, (ii) increased spectral low-frequency/high-frequency ratio of HRV, denoting enhanced cardiac sympathetic dominance, (iii) attenuated reflex tachycardic responses to sodium nitroprusside, and (iv) increased systolic contractility (dP/dtmax). The developed hypotension was (i) fully eliminated in estrogen (E2)-pretreated OVX rats, (ii) partially counteracted after selective activation of estrogen receptor-α (PPT) or ß (DPN). All estrogenic compounds abrogated LPS enhancement of cardiac sympathetic drive. However, PPT was more successful than E2 or DPN in compromising LPS depression in baroreflex activity and elevation in dP/dtmax. Molecular studies showed that PPT was most effective in attenuating the upregulated myocardial expressions of NF-κB and iNOS in endotoxic OVX rats. Myocardial expression of the defensive HSP70 was comparably increased by all estrogenic products. Except for improved cardiac spectral activity, none of these functional or molecular entities was affected by medroxyprogesterone acetate (MPA). Overall, our data suggest diverse therapeutic advantages for gonadal hormones in the worsened endotoxic complications in rats with surgical menopause, with probably more favorable role for ERα agonism within this context.


Assuntos
Doenças Cardiovasculares/tratamento farmacológico , Doenças Cardiovasculares/etiologia , Endotoxemia/complicações , Endotoxemia/tratamento farmacológico , Terapia de Reposição de Estrogênios/métodos , Inflamação/tratamento farmacológico , Inflamação/etiologia , Ovariectomia/efeitos adversos , Animais , Barorreflexo/efeitos dos fármacos , Pressão Sanguínea , Citocinas , Endotoxemia/induzido quimicamente , Estradiol/uso terapêutico , Receptor alfa de Estrogênio/agonistas , Terapia de Reposição de Estrogênios/efeitos adversos , Feminino , Frequência Cardíaca/efeitos dos fármacos , Lipopolissacarídeos , Acetato de Medroxiprogesterona/uso terapêutico , Ratos , Ratos Wistar , Moduladores Seletivos de Receptor Estrogênico/uso terapêutico , Função Ventricular Esquerda/efeitos dos fármacos
10.
Curr Vasc Pharmacol ; 18(3): 254-261, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-30843488

RESUMO

Supplementary estrogen plays important roles for female patients as convenient birth control, relief of postmenopausal symptoms, and in the management of other selected problems. However, as is the case for essentially all medications, there are side effects. Short of a major pulmonary embolus, the most severe side effect of estrogen would appear to be sporadic, rare, and severe hypertriglyceridemia associated with acute pancreatitis. The occurrence of this fortunately rare problem usually happens in the presence of some preexisting and usually mild increase in triglycerides (TG). A case of chronic and severe recurrent acute pancreatitis is described in the introduction and the management was complete estrogen avoidance. Started close to menopause and continued for a relatively short period, estrogens may have some cardiovascular (CV) benefit but the general recommendation is not to prescribe them for CV disease prevention. Estrogens may contribute to decreased diabetes mellitus (DM) risk and control. Administration of estrogens by the transdermal route may decrease some problems such as venous thromboembolism (VTE) and elevation of TG. Administration of estrogen in the right situation brings significant benefit to the female patient but skillful, careful, and knowledgeable use is essential.


Assuntos
Anticoncepcionais Orais Hormonais/efeitos adversos , Terapia de Reposição de Estrogênios/efeitos adversos , Estrogênios/efeitos adversos , Hipertrigliceridemia/induzido quimicamente , Triglicerídeos/sangue , Animais , Biomarcadores/sangue , Tomada de Decisão Clínica , Estrogênios/administração & dosagem , Feminino , Humanos , Hipertrigliceridemia/sangue , Hipertrigliceridemia/diagnóstico , Hipertrigliceridemia/epidemiologia , Pancreatite/induzido quimicamente , Pancreatite/epidemiologia , Seleção de Pacientes , Prognóstico , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Regulação para Cima
11.
Menopause ; 27(2): 243-248, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31738735

RESUMO

OBJECTIVE: The aim of the study was to review the role of hormone therapy in menopausal patients with breast cancer and gynecologic malignancies. METHODS: We searched MEDLINE (via PubMed) using a combination of keywords and database-specific subject headings for the following concepts: menopause, hormone therapy, and cancer. Editorials, letters, case reports, and comments were excluded, as were non-English articles. Additional references were identified by hand-searching bibliographies of included articles. The searches yielded a total of 1,484 citations. All citations were imported into EndNote X9, where they were screened by the authors. RESULTS: In breast cancer survivors, systemic hormone therapy is not recommended, whereas local low-dose estrogen therapy may be considered after discussion with the patient's oncologist. Among endometrial cancer survivors, hormone therapy is considered safe in low-risk cancers but should be avoided in high-risk subtypes. For survivors of epithelial ovarian cancer and cervical cancer, hormone therapy can be considered, but should be avoided in women with estrogen-sensitive histologic subtypes. CONCLUSIONS: The risks of hormone therapy should be assessed on an individual basis, with consideration of age, type of hormone therapy, dose, duration of use, regimen, route, and prior exposure. Systemic hormone therapy is not recommended in breast cancer survivors, whereas vaginal low-dose estrogen appears safe. Hormone therapy may be used by endometrial, cervical, and ovarian cancer survivors with low-risk, non-estrogen-receptor-positive subtypes. Video Summary: http://links.lww.com/MENO/A516.


Assuntos
Neoplasias da Mama/fisiopatologia , Terapia de Reposição de Estrogênios/efeitos adversos , Estrogênios/uso terapêutico , Neoplasias dos Genitais Femininos/fisiopatologia , Menopausa/efeitos dos fármacos , Adulto , Sobreviventes de Câncer , Contraindicações de Medicamentos , Terapia de Reposição de Estrogênios/métodos , Feminino , Humanos , Pessoa de Meia-Idade
12.
Arch Gynecol Obstet ; 301(1): 289-294, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31858234

RESUMO

PURPOSE: Postmenopausal hormone therapy (HT) is known to affect the development of hormone-dependent endometrial carcinoma (type I EC). Several studies on breast and ovarian carcinoma have shown that HT influences the molecular profile and prognostic behavior of these tumors. This study aimed to investigate the influence of prior HT and other risk factors on the prognosis in a cohort of patients with invasive endometrial carcinoma (EC). METHODS: Among 525 patients diagnosed with EC between 1987 and 2010, 426 postmenopausal patients were identified. Information regarding HT was available in 287 of these patients, 78 of whom had a history of HT and 209 of whom did not. Both overall survival (OS) and progression-free survival (PFS) were analyzed. In addition to OS and PFS, risk factors such as age at diagnosis, postmenopausal HT, body mass index (BMI), diabetes mellitus, tumor stage, EC type (I or II), and recurrences were analyzed. RESULTS: Relative to HT alone, women with EC and a history of HT had a longer survival than those with no HT. However, the Cox proportional hazards model showed that it was not HT itself, but rather other characteristics in the HT group that were causally associated with longer survival. CONCLUSIONS: Age (the older, the worse) and tumor stage (the higher, the worse) were significant influences on overall survival. Patients with HT also had lower BMIs, less diabetes, more type I EC, and fewer recurrences in comparison with the non-HT group. With regard to the PFS, it made no difference whether the patient was receiving HT.


Assuntos
Neoplasias do Endométrio/tratamento farmacológico , Terapia de Reposição de Estrogênios/efeitos adversos , Idoso , Estudos de Coortes , Neoplasias do Endométrio/mortalidade , Neoplasias do Endométrio/patologia , Feminino , Humanos , Recidiva Local de Neoplasia , Prognóstico , Fatores de Risco , Taxa de Sobrevida
13.
Vascul Pharmacol ; 124: 106600, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31629918

RESUMO

Cardiovascular disease (CVD) is the major cause of morbidity and mortality worldwide. The implication of estrogen in this disease has been extensively studied. While the vast majority of published research argue for a cardioprotective role of estrogen in vascular inflammation such as in atherosclerosis, the role of estrogen in hypertension remains far from being resolved. The vasorelaxant effect of estrogen has already been well-established. However, emerging evidence supports a vasoconstrictive potential of this hormone. It has been proposed that the microenvironment dictates the effect of estrogen-induced type 1 nitric oxide synthase-1 (nNOS) on vasotone. Indeed, depending on nNOS product, nitric oxide or superoxide, estrogen can induce vasodilation or vasoconstriction, respectively. In this review, we discuss the evidence supporting the vasorelaxant effects of estrogen, and the molecular players involved. Furthermore, we shed light on recent reports revealing a vasoconstrictive role of estrogen, and speculate on the underlying signaling pathways. In addition, we identify certain factors that can account for the discrepant estrogenic effects. This review emphasizes a yin-yang role of estrogen in regulating blood pressure.


Assuntos
Pressão Sanguínea , Estrogênios/metabolismo , Hipertensão/metabolismo , Músculo Liso Vascular/metabolismo , Miócitos de Músculo Liso/metabolismo , Vasoconstrição , Animais , Anticoncepcionais Orais Hormonais/efeitos adversos , Terapia de Reposição de Estrogênios/efeitos adversos , Estrogênios/efeitos adversos , Feminino , Humanos , Hipertensão/epidemiologia , Hipertensão/fisiopatologia , Masculino , Músculo Liso Vascular/fisiopatologia , Fatores de Risco , Fatores Sexuais , Transdução de Sinais , Vasodilatação
14.
Phytother Res ; 34(3): 435-447, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31747092

RESUMO

Skin undergoes degenerative changes as it ages, which include the loss of elasticity, reductions in the epidermal thickness and collagen content, elastic fiber degeneration, and increased wrinkling and dryness. Skin aging can be significantly delayed by the administration of estrogen. Estrogen deficiency following menopause results in atrophic skin changes and the acceleration of skin aging. Estrogen administration has positive effects on human skin by delaying or preventing skin aging manifestations, but the use of estrogen replacement is a risk factor for breast and uterine cancer. Phytoestrogens are a large family of plant-derived molecules possessing various degrees of estrogen-like activity; they exhibit agonist or antagonist estrogenic properties depending on the tissue. These molecules could be ideal candidates to combat skin aging and other detrimental effects of hypoestrogenism. In this paper, we review the effects of phytoestrogens on human skin and the mechanisms by which phytoestrogens can alleviate the changes due to aging.


Assuntos
Colágeno/metabolismo , Antagonistas de Estrogênios/farmacologia , Terapia de Reposição de Estrogênios/efeitos adversos , Estrogênios/administração & dosagem , Fitoestrógenos/farmacologia , Envelhecimento da Pele/efeitos dos fármacos , Epiderme/efeitos dos fármacos , Estrogênios/agonistas , Feminino , Humanos , Menopausa/efeitos dos fármacos , Estresse Oxidativo/efeitos dos fármacos , Fatores de Risco , Pele/efeitos dos fármacos , Água/análise
15.
Hum Reprod ; 34(12): 2418-2429, 2019 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-31803923

RESUMO

STUDY QUESTION: Is hormone replacement therapy (HRT) associated with an increased risk of melanoma skin cancer or prognostic outcomes amongst post-menopausal women? SUMMARY ANSWER: Whilst we found evidence of an association with melanoma risk, the lack of dose-response and associations observed with recent use, localised disease and intravaginal oestrogens suggests this is a non-causal association. WHAT IS KNOWN ALREADY: Evidence on HRT and melanoma risk remains inconclusive, with studies providing conflicting results. Furthermore, evidence on melanoma survival is sparse, with only one previous study reporting protective associations with HRT use, likely attributable to immortal time bias. STUDY DESIGN, SIZE, DURATION: We conducted a nation-wide population-based case-control study and a retrospective cohort study utilising the Danish healthcare registries. Case-control analyses included 8279 women aged 45-85 with a first-ever diagnosis of malignant melanoma between 2000 and 2015, matched by age and calendar time to 165 580 population controls. A cohort of 6575 patients with a diagnosis of primary malignant melanoma between 2000 and 2013 and followed through 2015 was examined to determine if HRT use had an impact on melanoma survival outcomes. PARTICIPANTS/MATERIALS, SETTING, METHODS: Based on prescriptions dispensed since 1995, ever-use of HRT was defined as having filled at least one prescription for HRT prior to the index date. In total, 2629 cases (31.8%) and 47 026 controls (28.4%) used HRT. Conditional logistic regression was used to calculate odds ratios (ORs) for melanoma risk according to HRT use, compared with non-use, adjusting for potential confounders. For cohort analyses, Cox proportional hazards models was used to estimate adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) for second melanoma incidence and all-cause mortality associated with HRT. MAIN RESULTS AND THE ROLE OF CHANCE: High use of HRT was associated with an OR of 1.21 (95% CI 1.13-1.29) for melanoma risk, with no evidence of a dose-response pattern. Results were most pronounced amongst recent high users (OR, 1.28; 95% CI 1.17-1.41), for localised disease (OR, 1.25; 95% CI 1.15-1.36) and for intravaginal oestrogen therapy (OR, 1.38; 95% CI 1.13-1.68). Compared with non-use, there was no evidence of an association for secondary melanoma for post-diagnostic new-use (fully adjusted HR, 1.56; 95% CI 0.64-3.80) or continuous HRT use (fully adjusted HR, 1.26; 95% CI 0.89-1.78). Similar associations were observed for all-cause mortality. LIMITATIONS, REASONS FOR CAUTION: Despite the large sample size and the use of robust population-based registries with almost complete coverage, we lacked information on some important confounders including sun exposure. WIDER IMPLICATIONS OF THE FINDINGS: Whilst we cannot rule out an association between HRT use and melanoma risk, the associations observed are also compatible with increased healthcare utilisation and thus increased melanoma detection amongst HRT users. No association between HRT use and melanoma survival outcomes was observed. This should provide some reassurance to patients and clinicians, particularly concerning the use of HRT in patients with a history of melanoma. STUDY FUNDING/COMPETING INTEREST(S): B.M.H. is funded by a Cancer Research UK Population Research Postdoctoral Fellowship. The funding source had no influence on the design or conduct of this study. A.P. reports participation in research projects funded by Alcon, Almirall, Astellas, Astra-Zeneca, Boehringer-Ingelheim, Servier, Novo Nordisk and LEO Pharma, all with funds paid to the institution where he was employed (no personal fees) and with no relation to the work reported in this article. The other authors have no competing interests to declare. TRIAL REGISTRATION NUMBER: N/A.


Assuntos
Terapia de Reposição de Estrogênios/efeitos adversos , Melanoma/epidemiologia , Sistema de Registros , Neoplasias Cutâneas/epidemiologia , Idoso , Dinamarca/epidemiologia , Feminino , Humanos , Melanoma/induzido quimicamente , Pessoa de Meia-Idade , Estudos Retrospectivos , Neoplasias Cutâneas/induzido quimicamente
16.
Presse Med ; 48(11 Pt 1): 1295-1300, 2019 Nov.
Artigo em Francês | MEDLINE | ID: mdl-31735524

RESUMO

Can menopausal hormone therapy (HT) be used in hypertensive women? The group of experts of the French Society of Hypertension has carried out a review of the recent literature in order to answer this question, based on the most recent scientific publications. If use of oral HT is associated with a discreet increase in blood pressure, the transdermal route seems to be safer. The first results of major randomized trials of HT had alerted to an increase in cardiovascular events and breast cancer with the use of oral HT, generally, tipping the benefit-risk balance of the deleterious side. Complementary analyzes have shown the importance of the window of intervention (less than 10 years after the menopause) and the age of the woman to start the HT. On the contrary, they have shown a significant decrease of the coronary events. For woman suffering from hypertension and important climacteric symptoms, it is important to evaluate the whole cardiovascular risk in order to decide the possibility of prescribing a HT. Thus, the group of experts proposes a prescription assistance algorithm based on the stratification of cardiovascular risk, always favoring, when it is authorized, HT by transdermal route of administration.


Assuntos
Neoplasias da Mama/induzido quimicamente , Doenças Cardiovasculares/induzido quimicamente , Terapia de Reposição de Estrogênios/métodos , Hipertensão , Menopausa , Administração Cutânea , Administração Oral , Fatores Etários , Algoritmos , Pressão Sanguínea/efeitos dos fármacos , Contraindicações de Medicamentos , Terapia de Reposição de Estrogênios/efeitos adversos , Feminino , Humanos , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto , Medição de Risco , Fatores de Risco , Fatores de Tempo
17.
Presse Med ; 48(10): 1085-1091, 2019 Oct.
Artigo em Francês | MEDLINE | ID: mdl-31662219

RESUMO

Most of breast cancers are hormonedependent. Hormone treatment (contraception and menopause hormone treatment) has a promoter effect on preexisting lesions: the increase in risk decreases after stopping treatment. Hormonal contraception increases modestly the risk in current users but the amplitude of the risk remains low up to 40 years when this increase is more significant due of the number of breast cancer occurring at that age. Pregnancy decreases the risk if at a young age but after 25 years may increase the risk. Combined menopause hormone treatment is associated to a greater risk than estrogens alone. Breast cancer associated with hormone treatment is estradiol receptor positive. There is an increase in the risk with duration. Combining the hormone treatment with an anti-estrogen could decrease the risk of breast cancer and help to keep the benefits of estrogens.


Assuntos
Neoplasias da Mama/etiologia , Contraceptivos Hormonais , Terapia de Reposição de Estrogênios/efeitos adversos , Estrogênios/efeitos adversos , Menopausa , Fatores Etários , Neoplasias da Mama/prevenção & controle , Feminino , Humanos , Gravidez
19.
Radiography (Lond) ; 25(4): e79-e87, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31582256

RESUMO

INTRODUCTION: Papua New Guinea (PNG), has experienced an increase in breast cancer incidence correlating to the westernisation of the country. Increased breast density is known to increase breast cancer risk. This study investigates if there are any factors unique to the women of PNG that may impact breast density and breast cancer risk. METHOD: A survey was undertaken of 1,161 women who had undergone mammographic imaging at the Pacific International Hospital (PIH). Results were correlated with the five Tabár mammographic parenchymal patterns (TP), recorded for each woman and geographical location, parity, breast size, occupation, marital and menstrual status, smoking and alcohol consumption, hormone replacement therapy (HRT), and exercise. Statistical analysis was undertaken using chi-square test, Fisher's exact test and Odds Ratio (OR). RESULTS: Relationships were identified between TP and parity (p < 0.001), marital status (p < 0.001), smoking (p < 0.001), alcohol intake (p = 0.029) and HRT (p = 0.029). There was no evidence of a relationship between pattern type and geographical location (p = 0.290), breast size (p = 0.592), occupation (p = 0.724), menstruation (p = 0.866) or exercise (p = 0.290). Married women, OR = 0.4004, CI 95% (0.2873-0.5579) and those with higher parity, OR 0.5034, CI 95% (0.3693-0.6862) were half as likely to have increased breast density reducing risk. CONCLUSION: There was no clear relationship across almost all data. Factors associated with increased breast density in PNG included parity, marital status, smoking, alcohol, and HRT use were evidenced in this snapshot of PNG women. Breast cancer risk was shown to be reduced for married women and those with increased parity.


Assuntos
Densidade da Mama , Neoplasias da Mama/etiologia , Adulto , Consumo de Bebidas Alcoólicas/efeitos adversos , Mama/diagnóstico por imagem , Mama/patologia , Densidade da Mama/efeitos dos fármacos , Terapia de Reposição de Estrogênios/efeitos adversos , Feminino , Humanos , Mamografia , Estado Civil , Pessoa de Meia-Idade , Papua Nova Guiné/epidemiologia , Paridade , Fatores de Risco , Fumar/efeitos adversos
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