RISK FACTORS FOR UTERINE LEIOMYOMA

子宫肌瘤的危险因素

• 批准号: 2102883
• 负责人: MOYSES A SZKLO
• 金额: $ 7.02万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 1993
• 资助国家: 美国
• 起止时间: 1993-09-01 至 1995-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/2102883
• 关键词: African American; cancer risk; diabetes mellitus; estrogens; family genetics; female; hormone related neoplasm /cancer; human subject; hypertension; interview; leiomyoma; neoplasm /cancer epidemiology; nondrug contraceptive; obesity; pelvic inflammatory disease; questionnaires; racial /ethnic difference; socioeconomics; tobacco abuse

Uterine leiomyoma (UL) occurs in 20-40% of women, mainly in their late reproductive years; it is widely quoted that UL frequency is much higher among blacks. Symptomatic cases comprise up to 50% of the total; abnormal vaginal bleeding, pelvic pain, infertility and adverse pregnancy events may occur. An unknown proportion of the cases is estimated to undergo malignant transformation into leiomyosarcomas. Although conservative management is now more common, UL is still the leading cause of hysterectomy in the United States. Clinical observations support the idea that unopposed estrogenic stimulation of the myometrium is associated with UL. However, only three epidemiologic studies have been published; consistent findings were a positive association with nulliparity, and a negative association with menopause and smoking. Conflicting data emerged regarding the role of oral contraceptives, replacement estrogens, obesity, and duration of menstrual life. These studies were potentially subject to selection bias, as they were based only on surgical cases of a predominantly asymptomatic or mildly symptomatic condition. A practice-based case-control study will be conducted among Baltimore area women under the care of a group of gynecologists affiliated with The Johns Hopkins Medical Institutions. The primary aim is to determine whether UL is associated with several markers of increased uterine exposure to unopposed endogenous and exogenous estrogens. Other factors to be studied include race and socioeconomic status; atherogenic risk factors (self-reported obesity, hypertension, and diabetes, and smoking history); family history of UL; and possible sources of uterine irritation (pelvic inflammatory disease, use of intrauterine contraceptive device, vaginal douching, and perineal use of talc). Cases of UL diagnosed by these practitioners, and histologically or sonographically confirmed, will be ascertained. Eligible cases will be area residents, premenopausal, with no history or presence of invasive breast or gynecologic cancers. Controls will be frequency matched to cases on age within 5-year groups, randomly selected among women visiting the same physician for routine gynecologic evaluation during the calendar month when the case's tumor was first clinically suspected. Controls will be excluded if they are postmenopausal, hysterectomized, have clinical UL, or history or presence of invasive breast or gynecologic cancers. About 350 cases and 350 controls are expected to be ascertained in nine months. Trained female interviewers will utilize a structured questionnaire in telephone interviews; in addition, selected information will be abstracted from medical records. Data on medical monitoring and health behavior indicators will also be collected, to allow control for confounding. Bivariate and stratified analyses will be conducted, and logistic regression models will be fitted; agreement between interview and medical records data will be studied. Study findings are expected to provide currently undefined demographic and epidemiologic information for preventive strategies, and for identification of high risk groups in need of monitoring.

子宫肌瘤 (UL) 发生在 20-40% 的女性中，主要发生在晚期 生育年龄；人们普遍认为 UL 频率要高得多 在黑人中。 有症状病例占总数的50%； 阴道异常出血、盆腔疼痛、不孕和不良妊娠 可能会发生事件。 估计病例中比例未知 发生恶性转化为平滑肌肉瘤。 虽然 保守管理现在更普遍，UL仍然是主要原因 美国的子宫切除术。 临床观察结果支持 认为对子宫肌层的无抵抗雌激素刺激是 与 UL 相关。 然而，只有三项流行病学研究 发表；一致的研究结果表明与 未生育，与更年期和吸烟呈负相关。 关于口服避孕药的作用出现了相互矛盾的数据， 替代雌激素、肥胖和月经持续时间。 这些 研究可能会受到选择偏差的影响，因为它们基于 仅适用于主要无症状或轻度的手术病例 有症状的情况。 一项基于实践的病例对照研究将在巴尔的摩进行 该地区的妇女受到附属于该协会的一组妇科医生的照顾 约翰·霍普金斯医疗机构。 主要目的是确定 UL 是否与子宫增大的几种标志物相关 暴露于不受对抗的内源性和外源性雌激素。 其他因素 要研究的内容包括种族和社会经济地位；动脉粥样硬化风险 因素（自我报告的肥胖、高血压、糖尿病、吸烟 历史）; UL 家族史；以及子宫的可能来源 刺激（盆腔炎、宫内节育器的使用 避孕装置、阴道冲洗和会阴使用滑石粉）。 案例 由这些从业者诊断的 UL，以及组织学或 经超声检查证实，即可确定。 符合条件的案件将 该地区居民，绝经前，无侵入性病史或存在 乳腺癌或妇科癌症。 控制频率将匹配 年龄在 5 岁组内的病例，在来访的女性中随机选择 日历期间由同一位医生进行常规妇科评估 临床上首次怀疑该病例患有肿瘤的月份。 控制 如果绝经后、子宫切除、患有 临床 UL，或侵入性乳腺或妇科病史或存在 癌症。 预计将查明约 350 例病例和 350 例对照病例 九个月内。 训练有素的女性采访员将使用结构化的 电话访谈中的问卷调查；此外，选定的信息 将从医疗记录中提取。 医疗监测数据 还将收集健康行为指标，以便控制 令人困惑。 将进行双变量和分层分析，并且 将拟合逻辑回归模型；面试之间的协议 并将研究医疗记录数据。 研究结果预计 提供当前未定义的人口统计和流行病学信息 制定预防策略并识别高风险人群 需要监控。