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      Increased risk of breast cancer in women with uterine myoma: a nationwide, population-based, case-control study

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          Abstract

          Objective

          To evaluate if uterine myoma is associated with breast cancer.

          Methods

          This case-control study used a nationwide database in Taiwan. We identified 24,315 patients with newly diagnosed breast cancer as cases and matched them with 24,281 patients without breast cancer on age, sex, urbanization, income, and initial diagnosis date. Patients with prior mastectomy were excluded. We used logistic regression analysis to assess the association between uterine myoma and breast cancer while adjusting for confounders. We evaluated the impact of surgical removal of uterine myoma on subsequent breast cancer among patients with uterine myoma.

          Results

          We found that 2,892 (11.9%) patients with newly diagnosed breast cancer and 2,541 (10.5%) patients without breast cancer had a history of uterine myoma. The association between breast cancer and uterine myoma was significant (adjusted odds ratio [aOR]=1.14; 95% confidence interval [CI]=1.07–1.21; p<0.001). This association remained in patients who used hormone (aOR=1.20; 95% CI=1.08–1.33; p=0.001) or who did not use hormone (aOR=1.11; 95% CI=1.03–1.19; p=0.005) within 5 years prior to the index date. Surgical removal of uterine myoma was not associated with a decreased risk of breast cancer (aOR=0.99; 95% CI=0.88–1.10; p=0.795).

          Conclusion

          A minor increased risk of breast cancer was found in women with a history of uterine myoma. This association remained in patients with recent hormone use. Removal of uterine myoma was not associated with decreased risk of breast cancer.

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          Most cited references15

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          The frequency of uterine leiomyomas.

          As a leading cause of hysterectomy in premenopausal women. uterine leiomyomas are a major public health problem. However, very little work has been done on their epidemiology. Indeed, their true frequency has never been established using systematic and meticulous methods. In this study, gross serial sectioning at 2-mm intervals was applied as an adjunct to routine pathology processing in 100 consecutive total hysterectomy specimens. This tripled the number of leiomyomas noted in routine pathology reports. There were 649 leiomyomas in 77 of 100 uteri, with multiplicity of leiomyomas in 84%. Although leiomyomas were more numerous and larger in women with a clinical diagnosis of myomatous uterus, the incidence was no higher than in uteri removed for other reasons. The postmenopausal incidence of leiomyomas was no lower than the premenopausal incidence, although postmenopausal leiomyomas were smaller and fewer. These findings suggest that epidemiologic studies of leiomyomas may not be valid if they are based only on clinical diagnoses or routine pathology reports.
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            Etiology, symptomatology, and diagnosis of uterine myomas.

            To review the currently available literature regarding the biology, etiology, symptoms, and diagnosis of uterine myomas. Literature review of 220 articles pertaining to uterine myomas. Although uterine myomas presently are not well understood, many advances have been made in the understanding of the hormonal factors, genetic factors, growth factors, and molecular biology of these benign tumors. Prospective, longitudinal studies are underway to characterize the risk factors for their development. When needed, the position of myomas can be best imaged by sonohysterography or magnetic resonance imaging. Evidence suggests that only submucous myomas appear to interfere with fertility, and only very rarely do myomas effect pregnancy outcome. A summary of the available literature regarding the biology, etiology, symptomatology, and diagnosis of myomas shows that, although they are still not well understood, much has been learned about uterine myomas.
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              Etiology and pathogenesis of uterine leiomyomas: a review.

              Uterine leiomyomas, or fibroids, represent a major public health problem. It is believed that these tumors develop in the majority of American women and become symptomatic in one-third of these women. They are the most frequent indication for hysterectomy in the United States. Although the initiator or initiators of fibroids are unknown, several predisposing factors have been identified, including age (late reproductive years), African-American ethnicity, nulliparity, and obesity. Nonrandom cytogenetic abnormalities have been found in about 40% of tumors examined. Estrogen and progesterone are recognized as promoters of tumor growth, and the potential role of environmental estrogens has only recently been explored. Growth factors with mitogenic activity, such as transforming growth factor- (subscript)3(/subscript), basic fibroblast growth factor, epidermal growth factor, and insulin-like growth factor-I, are elevated in fibroids and may be the effectors of estrogen and progesterone promotion. These data offer clues to the etiology and pathogenesis of this common condition, which we have analyzed and summarized in this review.
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                Author and article information

                Journal
                J Gynecol Oncol
                J Gynecol Oncol
                JGO
                Journal of Gynecologic Oncology
                Asian Society of Gynecologic Oncology; Korean Society of Gynecologic Oncology
                2005-0380
                2005-0399
                May 2017
                22 February 2017
                : 28
                : 3
                : e35
                Affiliations
                [1 ]Department of Obstetrics and Gynecology, Taichung Veterans General Hospital, Taichung, Taiwan.
                [2 ]Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan.
                Author notes
                Correspondence to Ching-Heng Lin. Department of Medical Research, Taichung Veterans General Hospital, No. 1650, Sect. 4, Taiwan Boulevard, Xitun District, Taichung 40705, Taiwan. epid@ 123456vghtc.gov.tw
                Author information
                http://orcid.org/0000-0002-4543-705X
                http://orcid.org/0000-0002-9419-3004
                http://orcid.org/0000-0002-4205-2787
                http://orcid.org/0000-0002-2450-6108
                Article
                10.3802/jgo.2017.28.e35
                5391394
                28382798
                c6f74427-eb07-42d4-9210-7a848f6b8d1c
                Copyright © 2017. Asian Society of Gynecologic Oncology, Korean Society of Gynecologic Oncology

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 23 November 2016
                : 23 January 2017
                : 07 February 2017
                Funding
                Funded by: Taichung Veterans General Hospital;
                Award ID: TCVGH-1057329D
                Award ID: TCVGH-105G213
                Award ID: TCVGH-NHRI10505
                Award ID: TCVGH-1057308C
                Categories
                Original Article
                Breast

                Oncology & Radiotherapy
                uterus,leiomyoma,breast neoplasms,hormone replacement therapy,case-control studies,national health programs

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