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Endometriosis and the risk of skin cancer: a prospective cohort study.

ABSTRACT: PURPOSE:Endometriosis has been associated with an increased risk of skin melanoma. However, associations with other skin cancer types and how they compare with melanoma are unclear. Our objective was to prospectively investigate the relationships between endometriosis and risk of non-melanoma and melanoma skin cancers. METHODS:E3N is a prospective cohort of 98,995 French women aged 40-65 years in 1990. Data on surgically confirmed endometriosis and skin cancer diagnoses were collected every 2-3 years through self-report, with skin cancer cases confirmed through pathology reports. Hazard Ratios (HR) and 95% confidence intervals (CIs) were calculated using Cox regression models. RESULTS:Between 1990 and 2008, 535 melanoma, 247 squamous-cell carcinoma (SCC), and 1,712 basal-cell carcinoma (BCC) cases were ascertained. Endometriosis was associated with an increased overall risk of skin cancer (HR 1.28, 95% CI 1.05-1.55). When considering skin cancer type, endometriosis was associated with melanoma risk (HR 1.64, 95% CI 1.15-2.35), but not with SCC (HR 1.21, 95% CI 0.62-2.36) or BCC (HR 1.16, 95% CI 0.91-1.48) (non-melanoma skin cancers combined: HR 1.17, 95% CI 0.93-1.46), although no heterogeneity was detected across skin cancer types (Phomogeneity = 0.13). CONCLUSION:These data support an association between a personal history of endometriosis and the risk of skin cancer and suggest that the association is strongest for melanoma.

SUBMITTER: Farland LV

PROVIDER: S-EPMC5693730 | biostudies-other | 2017 Oct

REPOSITORIES: biostudies-other

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Endometriosis and the risk of skin cancer: a prospective cohort study.

Farland Leslie V LV Lorrain Simon S Missmer Stacey A SA Dartois Laureen L Cervenka Iris I Savoye Isabelle I Mesrine Sylvie S Boutron-Ruault Marie-Christine MC Kvaskoff Marina M

Cancer causes & control : CCC 20170810 10

<h4>Purpose</h4>Endometriosis has been associated with an increased risk of skin melanoma. However, associations with other skin cancer types and how they compare with melanoma are unclear. Our objective was to prospectively investigate the relationships between endometriosis and risk of non-melanoma and melanoma skin cancers.<h4>Methods</h4>E3N is a prospective cohort of 98,995 French women aged 40-65 years in 1990. Data on surgically confirmed endometriosis and skin cancer diagnoses were colle ...[more]

PMID: 28799019

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Project description:BACKGROUND:Only 2 case-control studies have examined the associations between consumption of meat products and endometriosis risk with inconsistent results. Consumption of animal products has the potential to influence endometriosis risk through effects on steroid hormones levels. OBJECTIVE:We sought to determine whether higher intake of red meat, poultry, fish, and seafood are associated with risk of laparoscopically confirmed endometriosis. STUDY DESIGN:A total of 81,908 participants of the prospective Nurses' Health Study II were followed up from 1991 through 2013. Diet was assessed via food frequency questionnaire every 4 years. Cox proportional hazards models were used to calculate rate ratios and 95% confidence intervals. RESULTS:During 1,019,294 person-years of follow-up, 3800 cases of incident laparoscopically confirmed endometriosis were reported. Women consuming >2 servings/d of red meat had a 56% higher risk of endometriosis (95% confidence interval, 1.22-1.99; Ptrend < .0001) compared to those consuming ?1 serving/wk. This association was strongest for nonprocessed red meats (rate ratio, 1.57; 95% confidence interval, 1.35-1.83 for ?2 servings/d vs ?1 servings/wk; Ptrend < .0001), particularly among women who had not reported infertility (Pinteraction = .0004). Women in the highest category of processed red meat intake also had a higher risk of endometriosis (rate ratio, 1.20; 95% confidence interval, 1.06-1.37 for ?5 servings/wk vs <1 serving/mo; Ptrend = .02). Intakes of poultry, fish, shellfish, and eggs were unrelated to endometriosis risk. CONCLUSION:Our prospective analysis among premenopausal US nurses suggests that red meat consumption may be an important modifiable risk factor for endometriosis, particularly among women with endometriosis who had not reported infertility and thus were more likely to present with pain symptoms. Well-designed dietary intervention studies among women with endometriosis could help confirm this observation.

Project description:Objective To investigate the association between lifetime breast feeding, exclusive breast feeding, postpartum amenorrhea, and incidence of endometriosis among parous women.Design Prospective cohort study.Setting Nurses' Health Study II, 1989-2011.Participants 72?394women who reported having one or more pregnancies that lasted at least six months, 3296 of whom had laparoscopically confirmed endometriosis. For each pregnancy, women reported duration of total breast feeding, exclusive breast feeding, and postpartum amenorrhea. Main outcome measures Incident self reported laparoscopically confirmed endometriosis (96% concordance with medical record) in parous women. Multivariable Cox proportional hazard models were used to calculate hazard ratios and 95% confidence intervals for diagnosis of endometriosis.Results Duration of total and exclusive breast feeding was significantly associated with decreased risk of endometriosis. Among women who reported a lifetime total length of breast feeding of less than one month, there were 453 endometriosis cases/100?000 person years compared with 184 cases/100?000 person years in women who reported a lifetime total of ?36 months of breast feeding. For every additional three months of total breast feeding per pregnancy, women experienced an 8% lower risk of endometriosis (hazard ratio 0.92, 95% confidence interval 0.90 to 0.94; P<0.001 for trend) and a 14% lower risk for every additional three months of exclusive breast feeding per pregnancy (0.86, 0.81 to 0.90; P<0.001 for trend). Women who breastfed for ?36 months in total across their reproductive lifetime had a 40% reduced risk of endometriosis compared with women who never breast fed (0.60, 0.50 to 0.72). The protective association with breast feeding was strongest among women who gave birth within the past five years (P=0.04 for interaction). The association with total breast feeding and exclusive breast feeding on endometriosis was partially influenced by postpartum amenorrhea (% mediated was 34% (95% confidence interval 15% to 59%) for total breast feeding and 57% (27% to 82%) for exclusive breast feeding).Conclusion Among women who experienced at least one pregnancy that lasted at least six months, breast feeding was inversely associated with risk of incident endometriosis. This association was partially, but not fully, influenced by postpartum amenorrhea, suggesting that breast feeding could influence the risk of endometriosis both through amenorrhea and other mechanisms. Given the chronic and incurable nature of endometriosis, breast feeding should be further investigated as an important modifiable behavior to mitigate risk for pregnant women.

Project description:Identification of blood biomarkers that prospectively predict progression of Mycobacterium tuberculosis infection to tuberculosis disease might lead to interventions that combat the tuberculosis epidemic. We aimed to assess whether global gene expression measured in whole blood of healthy people allowed identification of prospective signatures of risk of active tuberculosis disease. RESULTS:Between July 6, 2005, and April 23, 2007, we enrolled 6363 from the ACS study and 4466 from independent South African and Gambian cohorts. 46 progressors and 107 matched controls were identified in the ACS cohort. A 16 gene signature of risk was identified. The signature predicted tuberculosis progression with a sensitivity of 66Â·1% (95% CI 63Â·2â68Â·9) and a specificity of 80Â·6% (79Â·2â82Â·0) in the 12 months preceding tuberculosis diagnosis. The risk signature was validated in an untouched group of adolescents (p=0Â·018 for RNA sequencing and p=0Â·0095 for qRT-PCR) and in the independent South African and Gambian cohorts (p values <0Â·0001 by qRT-PCR) with a sensitivity of 53Â·7% (42Â·6â64Â·3) and a specificity of 82Â·8% (76Â·7â86) in 12 months preceding tuberculosis. Interpretation: The whole blood tuberculosis risk signature prospectively identified people at risk of developing active tuberculosis, opening the possibility for targeted intervention to prevent the disease. In this prospective cohort study, we followed up healthy, South African adolescents aged 12â18 years from the adolescent cohort study (ACS) who were infected with M tuberculosis for 2 years. We collected blood samples from study participants every 6 months and monitored the adolescents for progression to tuberculosis disease. A prospective signature of risk was derived from whole blood RNA sequencing data by comparing participants who developed active tuberculosis disease (progressors) with those who remained healthy (matched controls). After adaptation to multiplex qRT-PCR, the signature was used to predict tuberculosis disease in untouched adolescent samples and in samples from independent cohorts of South African and Gambian adult progressors and controls. Participants of the independent cohorts were household contacts of adults with active pulmonary tuberculosis disease.

Project description:OBJECTIVE:To estimate the effectiveness and safety of laparoscopic surgical excision of rectovaginal endometriosis. DESIGN:A multicentre, prospective cohort study. SETTING:51 hospitals accredited as specialist endometriosis centres. PARTICIPANTS:5162 women of reproductive age with rectovaginal endometriosis of which 4721 women had planned laparoscopic excision. INTERVENTIONS:Laparoscopic surgical excision of rectovaginal endometriosis requiring dissection of the pararectal space. MAIN OUTCOME MEASURES:Standardised symptom questionnaires enquiring about chronic pelvic pain, bladder and bowel symptoms, analgesia use and quality of life (EuroQol) completed prior to surgery and at 6, 12 and 24 months postoperatively. Serious perioperative and postoperative complications including major haemorrhage, infection and visceral injury were recorded. RESULTS:At 6 months postsurgery, there were significant reductions in premenstrual, menstrual and non-cyclical pelvic pain, deep dyspareunia, dyschezia, low back pain and bladder pain. In addition, there were significant reductions in voiding difficulty, bowel frequency, urgency, incomplete emptying, constipation and passing blood. These reductions were maintained at 2?years, with the exception of voiding difficulty. Global quality of life significantly improved from a median pretreatment score of 55/100 to 80/100 at 6?months. There was a significant improvement in quality of life in all measured domains and in quality-adjusted life years. These improvements were sustained at 2?years. All analgesia use was reduced and, in particular, opiate use fell from 28.1% prior to surgery to 16.1% at 6?months. The overall incidence of complications was 6.8% (321/4721). Gastrointestinal complications (enterotomy, anastomotic leak or fistula) occurred in 52 (1.1%) operations and of the urinary tract (ureteric/bladder?injury or leak) in 49 (1.0%) procedures. CONCLUSION:Laparoscopic surgical excision of rectovaginal endometriosis appears to be effective in treating pelvic pain and bowel symptoms and improving health-related quality of life and has a low rate of major complications when performed in specialist centres.

Dataset Information

Endometriosis and the risk of skin cancer: a prospective cohort study.

Publications

Endometriosis and the risk of skin cancer: a prospective cohort study.

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