This study suggests a link between diet and risk of endometriosis.
Objective To analyse the association between oral contraceptive use and the risk of uterine fibroids. Design ParticipantsWe considered data collected in a case-control study on risk factors for uterine fibroids.We studied 843 women with uterine fibroids, whose clinical diagnosis dated back no more than two years. Controls were 1557 non-hysterectomised patients younger than 55 years admitted for acute, non-gynecological, non-hormonal, non-neoplastic conditions.A total of 254 cases (30.1 %) and 360 controls (23.1 %) reported ever using oral contraceptives: the odds ratio (OR) for ever vs never users was 1-1 (95% CI 0-8-1.3). The risk in current users was below unity when compared with never users (OR 0.3,95% CI 0.2-0-6), while ex-users had a risk of fibroids comparable with never users (OR 1 . I , 95% CI 0.9-1.4). The risk of uterine fibroids decreased with duration of oral contraceptive use: compared with never users, the estimated OR was 0.8 (95% CI 0.5-1.2) in ever users for four to six years and 0.5 (95% CI 0 . 3 4 9 ) for seven years or more (x' trend = 4.6, P = 0.03).Although the role of selection bias should be carefully evaluated, the present data suggest that uterine fibroids should not be considered a contra-indication for oral contraceptive use.
We considered the association between diabetes and risk of endometrial cancer using data from a large case-control study conducted in Italy. Cases were 752 women with incident, histologically confirmed endometrial cancer F75 years of age (median age 60 years, range 28-74) admitted to a network of hospitals in Milan. Controls were 2,606 patients (median age 54 years, range 25-74) aged F75 years, admitted for acute non-neoplastic, non-gynecological, non-hormonerelated conditions to the same network of hospitals where cases had been identified. A total of 132 (17.6%) cases and 116 controls (4.5%) reported a history of diabetes. The corresponding multivariate odds ratio (OR) was 2.9 [95% confidence interval (CI) 2.2-3.9]. No association emerged with diabetes diagnosed under age 40 (likely to be insulin-dependent diabetes), whereas the OR of endometrial cancer was 3.1 (95% CI 2.3-4.2) for diabetes diagnosed at age H40 years. The OR of endometrial cancer in women with history of diabetes was 3.0 for women with a body mass index (BMI) (QI) kg/m 2 F25, 3.6 for those with a BMI of 25-29, and 3.3 for those with a BMI H30. No consistent interaction or modifying effect was observed for any other covariate. Our results confirm that non-insulin-dependent diabetes is associated with the risk of endometrial cancer. The association may be mediated through elevated oestrogen levels in diabetic women, hyperinsulinemia or insulin-like growth factor-I (IGF-I). Int. J. Cancer 81:539-542, 1999. Wiley-Liss, Inc.Several studies have reported an increased risk of cancer of uterine corpus in women with a history of diabetes (Brinton et al., 1992;La Vecchia et al., 1994;Levi et al., 1993;Maatela et al., 1994;O'Mara et al., 1985;Parazzini et al., 1991;Rubin et al., 1990; Weiderpass et al., 1997;Wideroff et al., 1997). The biological explanation of this association, however, remains unclear. The observations that diabetes is more common in overweight women (a well-defined risk factor for endometrial cancer; Parazzini et al., 1991) and that endometrial cancer is a disease of affluent societies, have suggested that a history of diabetes may represent an indicator of nutritional factors related to endometrial cancer risk. Few studies, however, have taken into account the potential confounding role of obesity and other potential confounding factors (O'Mara et al., 1985).Attention has been paid to the role of hyperinsulinemia, a feature of non-insulin dependent diabetes mellitus (NIDDM), on hormonerelated neoplasias (Kazer, 1995). Hyperinsulinemia appears to increase ovarian steroid production (Poretsky and Kalin, 1987), stimulate conversion of testosterone to oestradiol (Garzo and Dorrington, 1984) and suppress circulating concentrations of sex-hormone-binding-globulin (SHBG) (Nestler et al., 1991). Further, hyperinsulinemia is associated with high levels of insulinlike growth factor-I (IGF-I; Kazer, 1995), which may act synergistically with an increased oestrogen activity, and IGF-I has been suggested to have a carcinogenic effect on breast an...
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