Purpose This systematic review summarizes research on the use of progestin and breast cancer risk. Although mainly used for contraception, progestin can help treat menstrual disorders, and benign breast, uterine and ovarian diseases. Breast cancer is the leading site of new, non-skin, cancers in females in the United States, and possible factors that may modulate breast cancer risk need to be identified. Methods ProQuest (Ann Arbor, MI) and PubMed-Medline (US National Library of Medicine, Bethesda MD, USA) databases were used to search for epidemiologic studies from 2000–2015 that examined the association between progestin and breast cancer. Search terms included epidemiologic studies + progesterone or progestin or progestogen or contraceptive or contraceptive agents + breast cancer or breast neoplasms. A total of six studies were included in the review. Results Five of the six studies reported no association between progestin-only formulations (including norethindrone oral contraceptives, depot medroxyprogesterone acetate, injectable, levonorgestrel system users, implantable and intrauterine devices) and breast cancer risk. Duration of use was examined in a few studies with heterogeneous results. Conclusion Unlike studies of other oral contraceptives, studies indicate that progestin-only formulations do not increase the risk of breast cancer, although the literature is hampered by small sample sizes. Future research is needed to corroborate these findings, as further understanding of synthetic progesterone may initiate new prescription practices or guidelines for women’s health.

Breast cancer is the most frequently diagnosed cancer among women and the second-leading cause of cancer death in United States women. African Americans and other minorities in the United States suffer lower survival and worse prognosis than European Americans despite European Americans having a much higher incidence of the disease. Adherence to breast cancer treatment–quality measures is limited, particularly when the data are stratified by race/ethnicity. We aimed to examine breast cancer incidence and mortality trends in South Carolina by race and explore possible racial disparities in the quality of breast cancer treatment received in South Carolina. African Americans have high rates of mammography and clinical breast exam screenings yet suffer lower survival compared to European Americans. For most treatment-quality metrics, South Carolina fairs well in comparison to the United States as a whole; however, South Carolina hospitals overall lag behind SC COC-accredited hospitals for all measured quality indicators including needle biopsy utilization, breast-conserving surgeries, and timely use of radiation therapy. Accreditation may a have a major role in increasing the standard of care related to breast cancer diagnosis and treatment. These descriptive findings may provide significant insight for future interventions and policies aimed at eliminating racial/ethnic disparities in health outcomes. Further risk-reduction approaches are necessary to reduce minority group mortality rates, especially among African-American women.

Background: Obesity is a significant public health problem in the United States, and many studies have established obesity as a significant risk factor for endometrial cancer. Surgery is the standard of care in staging and treatment of endometrial cancer, and obesity may influence surgical outcomes because of its attendant comorbid conditions. Therefore, assessment of the impact of obesity on surgical outcome is important for decreasing morbidity and improving survival in patients with endometrial cancer. Objective: The aims of this research were to evaluate and review epidemiologic data systematically on the impact of obesity on surgical outcomes and to assess safety and feasibility of newer surgical techniques in obese patients. Materials and Methods: A systematic search of PubMed was conducted to identify articles between 2004 and 2013 that focused on the impact of obesity on surgical outcome. Reference lists of retrieved articles were also used to identify other relevant articles. Thirteen relevant articles were reviewed. Results: Evidence from epidemiologic studies showed that obesity impacts surgical outcome adversely. On average, obese patients have worse surgical outcomes than their nonobese counterparts. In addition, surgical outcome worsens as level of obesity increases. However, surgical procedure also influences this association. Minimally invasive surgeries are more useful and are accompanied with fewer complications than conventional laparotomy and can be performed safely in obese patients. Conclusions: Obesity is a significant risk in the etiology, treatment, and surgical outcomes of patients with endometrial cancer. Future research will need more randomized controlled trials and prospective studies to identify the best procedures for maximal outcomes. ( J GYNECOL SURG 32:149)

IntroductionAfrican-American (AA) women in the U.S. experience the lowest breast cancer survival rates among all ethnic groups compared to European Americans. 1,2 Breast cancer (BrCA) is the second leading cause of cancer death in South Carolina regardless of race. 3 Additionally, South Carolina has an overall BrCA mortality rate that is greater than the national average, driven exclusively by the high BrCA mortality rates seen in AAs. 4 The state ranks 7 th in diabetes prevalence in the United States, affecting approximately 375,000 people. 5 Because diabetes may promote the proliferation of cancer cells and metastasis 6 the increasing prevalence of diabetes raises important questions about the possible relationship between diabetes and BrCA.Recent meta-analytic studies suggest that type 2 diabetes (T2DM) can have incongruous effects depending on the anatomic site of cancer; e.g., diabetes may show a protective effect in prostate cancer and a detrimental effect in BrCA. 6 The population of SC is an ideal environment to examine the ethnic differences in T2DM and BrCA due to the large percentage of AAs (28%) residing in SC 7 and the excellent quality of available cancer incidence and mortality data. 1,4 Also, T2DM prevalence has increased 51% over the past 10 years in SC and now affects 1 in 8 AAs. 5Address of correspondence to : Marsha Samson, Cancer Prevention and Control Program, 915 Greene Street, Columbia, SC, 29208 [ msamson@email.sc.edu], 786.877.7287. Conflict of interest: None of the authors have conflicts of interest to discloseCompliance with Ethical Standards" on the title page when submitting a paper: Ethical approval: This article does not contain any studies with human participants or animals performed by any of the authors. HHS Public Access Author Manuscript Author ManuscriptAuthor Manuscript Author ManuscriptFor this analysis, we sought to link information from the South Carolina Central Cancer Registry (SCCCR) 4 and Medicaid records, as we previously had done with colorectal cancer, 8 to examine the association between incident T2DM and BrCA stage at diagnosis and mortality due to the disease. The rising disparities between EAs and minorities in BrCA patterns of incidence and mortality has been well-documented in the US. 1,9 These racial disparities are evident in age at diagnosis, disease virulence, and prognosis; and, ultimately, survival and death. Reasons for the differences are unclear; however, they may be attributed to actual biological differences by race in the nature of the disease; comorbidities; and variable access to, and willingness to use, health care services. In this study, we examine the association of T2DM and BrCA stage and survival rates in both AA and EA women. In addition to understanding the relationship between T2DM and BrCA, we also will compare the association by race to consider potential differences that might be necessary to include in future implementations of race-specific health interventions related to diabetes and BrCA. MethodsFor the use of de-identified da...

IntroductionAlthough screening rates for colorectal cancer are increasing, 22 million Americans are not up-to-date with recommendations. People with diabetes are an important and rapidly growing group at increased risk for colorectal cancer. Screening status and predictors of being up-to-date on screening are largely unknown in this population.MethodsThis study used logistic regression modeling and data from the 2012 Behavioral Risk Factor Surveillance System to examine the association between diabetes and colorectal cancer screening predictors with being up-to-date on colorectal cancer screening according to criteria of the US Preventive Services Task Force for adults aged 50 or older. State prevalence rates of up-to-date colorectal cancer screening were also calculated and mapped.ResultsThe prevalence of being up-to-date with colorectal cancer screening for all respondents aged 50 or older was 65.6%; for respondents with diabetes, the rate was 69.2%. Respondents with diabetes were 22% more likely to be up-to-date on colorectal cancer screening than those without diabetes. Among those with diabetes, having a routine checkup within the previous year significantly increased the odds of being up-to-date on colorectal cancer screening (odds ratio, 1.90). Other factors such as age, income, education, race/ethnicity, insurance status, and history of cancer were also associated with up-to-date status.ConclusionRegardless of diabetes status, people who had a routine checkup within the past year were more likely to be up-to-date than people who had not. Among people with diabetes, the duration between routine checkups may be of greater importance than the frequency of diabetes-related doctor visits. Continued efforts should be made to ensure that routine care visits occur regularly to address the preventive health needs of patients with and patients without diabetes.

Current literature focuses on the complications and treatment of Type 2 Diabetes Mellitus (T2DM) while clustering environmental and genetic factors to explain the disease. Interventions proposed to reduce diabetes prevalence should focus predominantly on initiating active rapports of family members and promoting a more communicationoriented preventative approach between diabetics and non-diabetics. Due to varying risks in T2DM by race and ethnicity, these populations should follow race-appropriate guidelines to prevent further T2DM occurrence and complications. The review consists of information related to the genetic component of T2DM to help identify high-risk groups and focuses on the environmental aspect of the disease to help consider appropriate techniques to reduce disease burden. Genetic factors play important roles in the pathogenesis of diabetes and thus are an essential element of understanding the cause of the disease and possible methods of prevention. Focusing on high-risk groups with T2DM could have profound effects on the current health care situation. In this review, we discuss the epidemiology of diabetes in the United States and propose methods of preventing and delaying the development of T2DM in high-risk individuals.

Introduction Certain types of oral contraceptives can produce favorable effects on lipid metabolism and vascular tone, while others have potentially detrimental effects. Endogenous and exogenous hormones exert different effects on high-density lipoprotein (HDL) and low-density lipoprotein (LDL) depending on the type, combination, and dose of the hormone. The estrogenic and progestogenic effects of exogenous hormones on HDL and LDL are inconsistent. Studying surrogate end points (LDL, HDL levels) may provide a misleading picture of OCs. Methods Medicaid data from 2000 to 2013 were used to assess the relationship between the type of OCs and CVD incidence. Multivariable logistic regression was used to model relationships between cardiovascular disease and OC use adjusting for potential confounders. Results Compared to combined oral contraceptives (COC), progestin-only oral contraceptives (POC) were associated with decreased heart disease and stroke incidence after adjusting for important covariates (OR: 0.74; 95% CI: 0.57, 0.97 and OR: 0.39; 95% CI: 0.16, 0.95, respectively). However, there was a positive association between POC+COC and both heart disease and stroke incidence (OR: 2.28; 95% CI: 1.92, 2.70 and OR: 2.12; 95% CI: 1.34, 3.35, respectively). Conclusion In light of an association between POC use and decreased heart disease and stroke, women's CVD risk factors should be carefully considered when choosing which OC to use. Baseline CVD risk should be a part of the discussion between women and their primary care providers when making choices regarding OCs.

Introduction Oral contraceptive pills have been implicated in the pathophysiology of breast cancer. Although many studies have examined the relationship between combined oral contraceptives (COCs) and breast cancer, there is a paucity of literature that discusses progestin-only oral contraceptives (POCs) and breast cancer. The purpose of this investigation is to examine potential associations between different types of oral contraceptives and breast cancer mortality in the South Carolina Medicaid population among different racial/ethnic groups. Methods Subjects included 4,816 women diagnosed with breast cancer between 2000 and 2013. Kaplan-Meier curves were calculated to determine time-to-mortality rates among users of oral contraceptives. Competing-risks models and Cox multivariate survival models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) of breast cancer and other-cause mortality, as well as all-cause mortality. Results POCs were associated with a significantly decreased risk of breast cancer mortality (HR: 0.07; 95% CI: 0.01, 0.52) and a non-significant increased risk of all-cause mortality (HR: 1.04; 95% CI: 0.52, 2.07). COCs increased the risk of breast cancer mortality (HR: 1.61; 95% CI: 1.14, 2.28) and all-cause mortality (HR: 1.83; 95% CI: 1.30, 2.57). Conclusion Use of POCs may be associated with a decreased risk of breast cancer mortality. Due to the small sample size of POC users in the current study, additional research is needed to confirm these findings.