Objective: To recommend further research on vasectomy based on a systematic review of the effectiveness and safety of vasectomy.
Design: A systematic MEDLINE review of the literature on the safety ...and effectiveness of vasectomy between 1964 and 1998.
Main Outcome Measure(s): Early failure rates are <1%; however, effectiveness and complications vary with experience of surgeons and surgical technique. Early complications, including hematoma, infection, sperm granulomas, epididymitis-orchitis, and congestive epididymitis, occur in 1%–6% of men undergoing vasectomy. Incidence of epididymal pain is poorly documented. Animal and human data indicate that vasectomy does not increase atherosclerosis and that increases in circulating immune complexes after vasectomy are transient in men with vasectomies. The weight of the evidence regarding prostate and testicular cancer suggests that men with vasectomy are not at increased risk of these cancers.
Conclusion(s): Publications to date continue to support the conclusion that vasectomy is a highly effective form of contraception. Future studies should include evaluations of the long-term effectiveness of vasectomy, evaluating criteria for postvasectomy discontinuation of alternative contraception for use in settings where semen analysis is not practical, and characterizing complications including chronic epididymal pain syndrome.
To investigate the relationship between polycystic ovary syndrome (PCOS) and ovarian cancer, and to present three hypotheses regarding hormonal factors and the risk of ovarian cancer in women.
Data ...were analyzed from a population-based, case-control study, the Cancer and Steroid Hormone Study, to test the hypotheses. Four hundred seventy-six subjects with histologically confirmed epithelial ovarian cancer were identified from eight tumor registries of the Surveillance Epidemiology and End Results program. The study included 4081 controls ascertained via random-digit telephone dialing. All subjects and controls were aged 20–54 years.
Seven subjects with ovarian cancer and 24 controls reported that they had been diagnosed with PCOS before the study period. Ovarian cancer risk was found to increase 2.5-fold (95% confidence interval CI 1.1–5.9) among women with PCOS. This association is found to be stronger among women who never used oral contraceptives (odds ratio OR 10.5, 95% CI 2.5–44.2) and women who were in the first quartile of body mass index (13.3–18.5 kg/m
2) at age 18 (OR 15.6, 95% CI 3.4–71.0).
The data suggest that the hormonal status of women with PCOS featuring abnormal patterns of gonadotropic secretion (enhanced levels of LH) in lean women may be a mitigating factor for the observed association between PCOS and ovarian cancer. We hope that our preliminary data stimulate further investigation of the testable hypotheses.
Objective: Our purpose was to estimate the annual risk of death in the United States from cardiovascular disease attributable to low-dose combination oral contraceptives.
Study Design: Estimates of ...the risk of death from cardiovascular disease attributable to low-dose oral contraceptives were modeled on data from studies published through 1997 and from age-specific mortality rates in the United States for 1993 and 1994.
Results: Attributable risk of death from cardiovascular disease resulting from oral contraceptive use is 0.06 and 3.0 per 100,000 nonsmokers 15 to 34 years of age and 35 to 44 years of age, respectively. In smokers this risk increases, respectively, to 1.73 and 19.4 per 100,000 users in these 2 age groups; however, 97% and 85% of this risk is due to the combined effects of smoking and using oral contraceptives. The attributable risk of death from cardiovascular disease in nonsmoking oral contraceptive users is lower than the risk of death from pregnancy in nonusers of oral contraceptives at all ages; however, among smoking oral contraceptive users more than 35 years of age, the excess risk of death from oral contraceptives is higher than the risk of death from pregnancy.
Conclusion: There is virtually no excess attributable risk of death from cardiovascular disease related to oral contraceptive use in young women. However, smokers more than 35 years of age should use a nonestrogen contraceptive. (Am J Obstet Gynecol 1999;180:241-9)
Risk factors for menopausal hot flashes Schwingl, P J; Hulka, B S; Harlow, S D
Obstetrics and gynecology (New York. 1953),
1994-July, Letnik:
84, Številka:
1
Journal Article
Recenzirano
To find predictors of hot flashes at natural menopause.
A cross-sectional sample of 334 black and white, naturally menopausal women was selected from a control group in a population-based study of ...reproductive cancers in central North Carolina. Women reported whether they had experienced hot flashes at the time of menopause. Life-style factors and reproductive histories of those with and without hot flashes were compared.
Compared to women who were older at menopause, those reporting natural menopause before age 52 years had a significantly increased probability of having hot flashes (prevalence ratio 1.5, P = .04). Less than a high school education was significantly related to an increased probability of hot flashes (prevalence ratio 1.4, P = .20). There was significant interaction between cigarette smoking and body mass index (BMI), so that thin women who smoked in the premenopausal period were most likely to experience hot flashes (prevalence ratio 1.9, P = .03). Among non-smokers, BMI appeared to have no effect on the probability of hot flashes. Alcohol use, although not statistically significant, suggested a positive relation with hot flashes over and above that incurred from smoking. In addition, menarche before the age of 12 (prevalence ratio 0.6, P = .08) and a history of irregular menstrual cycles (prevalence ratio 0.6, P = .08) were marginally related to a decreased prevalence of hot flashes. Race, parity, and age at first and last pregnancy had no relation to hot flashes.
Socioeconomic factors and those related to the decline of estrogen production are related to the occurrence of hot flashes at the time of menopause.
Reproductive-tract anomalies after administration of the potent oestrogen, diethylstilboestrol, in pregnant women raised concerns about the reproductive effects of exposure to weakly oestrogenic ...environmental contaminants such as bis4-chlorophenyl-1,1,1-trichloroethane (p, p′-DDT) or its metabolites, such as bis4-chlorophenyl-1,1-dichloroethene (p, p′-DDE). We measured p, p′-DDT and p, p′-DDE in preserved maternal serum samples drawn 1–3 days after delivery between 1960 and 1963. We recorded time to pregnancy in 289 eldest daughters 28–31 years later. Daughters' probability of pregnancy fell by 32% per 10 μg/L p, p′-DDT in maternal serum (95% CI 11–48). By contrast, the probability of pregnancy increased 16% per 10 μg/L p, p-DDE (6·27). The decreased fecundability associated with prenatal p, p′-DDT remains unexplained. We speculate that the antiandrogenic activity of p, p -DDE may mitigate harmful androgen effects on the ovary during gestation or early life.
The Sister Study was designed to address gaps in the study of environment and breast cancer by taking advantage of more frequent breast cancer diagnoses among women with a sister history of breast ...cancer and the presumed enrichment of shared environmental and genetic exposures.
The Sister Study sought a large cohort of women never diagnosed with breast cancer but who had a sister (full or half) diagnosed with breast cancer.
A multifaceted national effort employed novel strategies to recruit a diverse cohort, and collected biological and environmental samples and extensive data on potential breast cancer risk factors.
The Sister Study enrolled 50,884 U.S. and Puerto Rican women 35-74y of age (median 56 y). Although the majority were non-Hispanic white, well educated, and economically well off, substantial numbers of harder-to-recruit women also enrolled (race/ethnicity other than non-Hispanic white: 16%; no college degree: 35%; household income <$50,000: 26%). Although all had a biologic sister with breast cancer, 16.5% had average or lower risk of breast cancer according to the Breast Cancer Risk Assessment Tool (Gail score). Most were postmenopausal (66%), parous with a first full-term pregnancy <30y of age (79%), never-smokers (56%) with body mass indexes (BMIs) of <29.9
kg/m
(70%). Few (5%) reported any cancer prior to enrollment.
The Sister Study is a unique cohort designed to efficiently study environmental and genetic risk factors for breast cancer. Extensive exposure data over the life-course and baseline specimens provide important opportunities for studying breast cancer and other health outcomes in women. Collaborations are welcome. https://doi.org/10.1289/EHP1923.
Celotno besedilo
Dostopno za:
CEKLJ, DOBA, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
Although the influence of paternal smoking on birth defects is of great public interest, epidemiological evidence concerning this potential relationship is extremely limited. A stratified random ...sample of 29 hospitals in the Shanghai Municipality, China, was used to select 1012 birth defects cases and controls. Mothers of the cases and controls were interviewed in the hospitals from October 1986 to September 1987. A modest relationship between paternal smoking and overall birth defects in offspring was identified odds ratio (OR) = 1.21, 95% confidence interval (CI): 1.01-1.45. More markedly elevated risks were identified for anencephalus (OR = 2.1), spina bifida (OR = 1.9), pigmentary anomalies of the skin (OR = 3.3) and varus/valgus deformities of the feet (OR = 1.8). Our analysis also shows that paternal smoking is more likely to be associated with multiple rather than isolated malformations. A paternally-mediated effect of smoking on birth defects is suggested and further studies are encouraged.
Early Onset Baldness and Prostate Cancer Risk Denmark-Wahnefried, W; Schildkraut, J M; Thompson, D ...
Cancer epidemiology, biomarkers & prevention,
03/2000, Letnik:
9, Številka:
3
Journal Article
Recenzirano
Prostatic carcinoma is the leading cancer among American men, yet few
risk factors have been established. Although increased androgen levels
have long been associated with both prostatic carcinoma ...and baldness,
to date no studies have shown an association between hair patterning
and prostate cancer risk. A lack of standardized instruments to assess
baldness or the assessment of hair patterning during uninformative
periods of time may have precluded the ability of previous studies to
detect an association. We hypothesized that baldness, specifically
vertex baldness, should be assessed using standardized instruments and
during early adulthood if an association with prostate cancer risk is
to be found. To test this hypothesis, we included identical items
related to hair patterning in surveys that were administered in two
distinct prostate cancer case-control studies (Duke-based study,
n = 149; 78 cases; 71 controls and community-based
study, n = 130; 56 cases; 74 controls). In each,
participants were provided with an illustration of the Hamilton Scale
of Baldness and asked to select the diagrams that best represented
their hair patterning at age 30 and again at age 40. From these data,
the following five categories were created and compared: not bald
(referent group); vertex bald early onset (by age 30); vertex bald
later onset (by age 40); frontal bald early onset (by age 30); frontal
bald later onset (by age 40); and frontal (at age 30) to vertex bald
(at age 40). Separate analyses of the two studies are consistent and
suggest an association between vertex baldness and prostate cancer{
vertex bald early onset odds ratios, 2.44 confidence interval
(CI), 0.57–10.46) and 2.11 (CI, 0.66–6.73), respectively; vertex
bald later onset odds ratios, 2.10 (CI, 0.63–7.00) and 1.37
(CI, 0.47–4.06), respectively}. Although statistical significance
was not achieved in either one of these studies, the concordance
between the data suggests a need for future studies to determine
whether early onset vertex baldness serves as a novel biomarker for
prostate cancer and whether androgen production, metabolism, or
receptor status differs among these men when compared to those who
exhibit other types of hair patterning.
Consistent reports from several recent studies suggest that users of third generation oral contraceptives (OCs) containing gestodene and desogestrel may be at increased risk of venous thromboembolic ...disease (VTE). Paradoxically, other reports indicate that these users may be at decreased risk of acute myocardial infarction (MI) compared with users of second generation OCs. To determine whether the potentially increased risk of VTE would outweigh the potentially reduced risk of MI in users of third generation OCs, we conducted an analysis to quantify the trade-offs providers and users may be faced to make between these formulations.
The baseline rates of VTE and MI among non-users were calculated using US data on incidence and mortality of these conditions and estimates of the proportion of women exposed to these formulations in the US. These were multiplied by relative risks published in recent studies on third generation progestins to produce age- and formulation-specific risks. Results indicate that there would be small differences in disease burden between users of second and third generation OCs under the model assumptions at younger ages. However, among women 35–44 years of age, modeling results indicate that the potentially decreased incidence of MI among users of third generation OCs more than offsets the potentially increased risk of VTE at this age.
Most low-resource settings depend on hormonal contraceptives for their family planning programmes and cervical cancer occurs in higher frequency in these populations. To determine whether hormonal ...contraception use increases cervical carcinoma in-situ (CIS) risk, a case-control study was conducted in the Kingston and St Andrew Corporate area of Jamaica, using 119 cases from the Jamaica Tumour Registry and 304 population controls matched on year of Papanicolaou (Pap) smear and clinic where Pap smear was obtained. While CIS cases were more likely to have 'ever used' combined oral contraceptives (COC) (OR = 1.4, 95% CI: 0.8, 2.5), depo-medroxyprogesterone acetate (DMPA) use was similar. Compared to women who never used hormonal contraceptives, the risk of CIS was elevated in: women who had used COCs five years or more (OR = 2.1, 95% CI: 1.0, 4.6), women who first used COC for less than 10 years prior to the interview (OR = 1.8, 95% CI: 0.9, 3.7) and women who were 18 to 24 years old when they first used COCs (OR = 1.8, 95% CI: 0.9, 3.4). Similarly, compared to women who never used DMPA, the risk of CIS was elevated in: women using DMPA five years or more (OR = 1.9, 95% CI: 0.7, 4.8), women reporting use within a year prior to interview (OR = 2.8, 95% CI: 0.7, 10.7) and women who initiated use of DMPA when they were 20 and 24 years old (OR = 1.4, 95% CI: 0.7, 3.1). These results suggest that if hormonal contraceptive use confers any risk of CIS, it is confined to long-term users. Increased risk in some groups, however, warrant further study.
PDF
