BMC Women's Health最新文献

Background: The optimal duration of extended endocrine therapy (ET) for women with hormone receptor-positive (HR-positive) early-stage postmenopausal breast cancer remains uncertain. This meta-analysis systematically evaluated the optimal time to prolong aromatase inhibitors ( AIs) therapy for postmenopausal early stage breast cancer who received initial endocrine therapy.

Methods: PubMed, Web of Science, Ovid, Scopus, EmBase, and Cochrane Library were searched for randomized controlled trials (RCTs) using keywords related to breast cancer, HR-positive, AIs, and tamoxifen (TAM). Disease-free survival (DFS) was used as the primary endpoint. Meta-analysis was performed using STATA 16.0 and Revman 5.4 statistical software. Hazard ratio (HR) with its corresponding 95% confidence intervals (CI) was used as an effective indicator to assess DFS, OS, and subgroups of extended ET. Relative ratio (RR) was used to assess adverse events.

Results: The study included four RCTs involving 8,748 patients with HR-positive breast cancer. Pooled data showed an improvement in DFS when extending endocrine therapy from 5 to 7-8 years (HR = 0.82, 95% CI: 0.73 ~ 0.93), especially in patients with tumor size ≥ 2 cm (HR = 0.69, 95% CI: 0.49 ~ 0.98), estrogen receptor (ER) and progesterone receptor (PR) positive (HR = 0.77, 95% CI: 0.67 ~ 0.89), human epidermal growth factor receptor 2 (HER-2) positive or negative (HR = 0.85, 95% CI: 0.74 ~ 0.97; HR = 0.44, 95% CI: 0.22 ~ 0.89) and previous chemotherapy (HR = 0.80, 95% CI: 0.68 ~ 0.95). However, DFS has not improved with the extension from 7-8 to 10 years (HR = 0.97, 95% CI: 0.85 ~ 1.10). Furthermore, we found no significant difference in overall survival (OS), adverse events (AEs) analysis revealed a significant increase in the incidence of arthralgia, osteoporosis, bone fractures and asthenia after extended AIs.

Conclusions: The proportion of patients with breast cancer receiving ET extended beyond 5 years has increased, while the extension of AIs treatment from 5 to 7-8 years may be an option for high-risk patients with well-tolerated tumor size ≥ 2 cm, HR-positive, and previous chemotherapy. However, a variety of adverse events may accompany ET therapy, the identification of factors that may benefit breast cancer patients requires further randomized controlled studies.

Prospero registration number: CRD42022335497.

Background: Adenomyosis is a common gynecological disorder characterized by the invasion of endometrial tissue into the myometrium, resulting in severe dysmenorrhea and menorrhagia. This study aimed to explore the role of SMOC2 (SPARC related modular calcium binding 2), an extracellular matrix (ECM) -associated protein, in the pathogenesis of adenomyosis and its potential as a therapeutic target.

Methods: We conducted a clinical study involving 35 patients diagnosed with adenomyosis and 30 controls. Ectopic endometrial tissue samples were collected and analyzed using immunohistochemistry (IHC), Masson staining, and cell culture techniques. The proliferative effect of SMOC2 on cells was evaluated using CCK- 8 assay, while the expression of SMOC2 and epithelial-mesenchymal transition (EMT) was assessed using real-time PCR and western blot analysis.

Results: SMOC2 expression was significantly higher in the ectopic endometrial tissue of adenomyosis patients compared to controls. SMOC2 could promote cell proliferation. Overexpression of SMOC2 significantly upregulated mesenchymal markers N-cadherin and α-SMA, and downregulated epithelial marker E-cadherin. Conversely, knocking down SMOC2 with siRNA reversed these effects. These findings indicate that SMOC2 promotes EMT in adenomyotic stromal cells. Additionally, SMOC2 also activated the MMP9 signaling pathway, which plays a crucial role in the extracellular matrix (ECM) remodeling.

Conclusions: SMOC2 appears to be a key regulator in the pathogenesis of adenomyosis, promoting ECM remodeling and EMT, both of which are characteristic of the disease. Targeting SMOC2 may provide a novel therapeutic strategy for the treatment of adenomyosis.

Background: This study aims to investigate the temporal trends and survival outcomes of bilateral breast-conserving surgery (BCS) in women diagnosed with metachronous bilateral breast cancer (MBBC) in the USA from 2000 to 2019.

Methods: Patients with stage T0-T3 and stage 0-III MBBC who underwent unilateral BCS on one side and different surgical procedures on the contralateral side from 2000 to 2019 were identified from the Surveillance, Epidemiology, and End Results (SEER) database. The Cochrane-Armitage test for trend was employed to assess the trends in contralateral breast surgical procedures, including BCS, mastectomy (M) and breast-reconstruction (BR). Overall survival (OS) and breast cancer-specific survival (BCSS) were analyzed using Kaplan-Meier curves and univariate and multivariate Cox proportional hazards regression analyses. Since BR is typically performed following M, survival data for the BR and M groups were combined and collectively analyzed as the M group.

Results: A total of 9571 patients with stage T0-T3 and stage 0-III who underwent unilateral BCS were included in this study, with 75.84% (n = 7,259) opting for BCS treatment. The proportion of BCS was decreased significantly from 90.79% in 2000 to 74.04% in 2019 (P < 0.0001). Older age was positively correlated with BCS, while recent diagnosis, late T stage, lymph node metastasis, invasive lobular carcinoma and chemotherapy were negatively correlated with BCS. Kaplan-Meier survival analysis indicated that BCS patients had better OS (P < 0.001) and BCSS (P < 0.001) compared with patients receiving M. Univariate Cox analysis indicated that BCS showed significant statistical differences in both OS and BCSS. Specifically, the hazard ratio (HR) for OS and BCSS were 0.717 (95% CI 0.649-0.791, P < 0.001) and 0.484 (95% CI 0.422-0.556, P < 0.001), respectively. Multivariate Cox analysis indicated that BCS was not an independent prognostic factor for OS (HR = 1.012, 95% CI 0.904-1.132, P > 0.05), suggesting no significant difference in OS between the BCS and M groups. Conversely, BCS was an independent favorable prognostic factor for BCSS (HR = 0.746, 95% CI 0.634, 0.877; P < 0.05).

Conclusion: Despite the initial high utilization of BCS in MBBC patients, our study revealed a decline in its usage over the course of the study period. Importantly, this decrease did not impact OS, suggesting the safety of BCS for MBBC patients. In light of these findings, clinicians are encouraged to recommend BCS for eligible MBBC patients, emphasizing its viability as a treatment option.

Background: Endometriosis is a chronic gynecological disease that affects various aspects of the women's lives, so considering its impacts and improving health-promoting lifestyle is important. The present study aimed to determine the association between health-promoting lifestyle and endometriosis impacts on women lives.

Methods: This cross-sectional study was conducted on 200 women with endometriosis in the endometriosis clinic of Imam Reza Hospital in Mashhad-Iran. The data was collected using the HPLP-II (health-promoting lifestyle) and EIQ tools (endometriosis impact questionnaire), as well as socio-demographic and obstetrics characteristics questionnaires. Data was analyzed in SPSS 21 software. Spearman's test was used to investigate the correlation between health-promoting behaviors and the impacts of endometriosis on women's lives.

Results: In the total of three recall periods of EIQ, there was a negative significant correlation between the overall lifestyle score of HPLP and the physical impact of endometriosis disease (r=-0.23; P < 0.001), the psychological impact (r=-0.29; P < 0.001), social impact (r=-0.30; P < 0.001), as well as education dimensions of EIQ (r=-0.52; P = 0.016).

Conclusions: Considering the negative significant correlation between the health-promoting lifestyle and the physical, psychological, social, as well as education impacts of endometriosis, adopting a healthy lifestyle for women with endometriosis seems useful and necessary. In future studies, it is recommended to provide information for writing a program with a clear and concise explanation for these women to improve affected women's lives.

Background: Reproductive health has broad implications for individuals, families, and society. This study aims to explore how an educational intervention, centered around PMT, can enhance reproductive health protective behaviors among female students.

Methods: This quasi-experimental study was conducted on female students of Khomein University of Medical Sciences in Markazi Province, Iran, from December 2023 to August 2024. A random cluster sampling method was used for sampling, resulting in 51 female students being selected for the intervention group and 54 female students for the control group. The data collection tool was a researcher-developed questionnaire, which included demographic information and PMT constructs with confirmed validity and reliability. The educational intervention for the intervention group consisted of three one-hour sessions spaced one week apart, incorporating methods such as lectures, group discussions, Q&A sessions, brainstorming, role-playing exercises, as well as distribution of educational booklets. The collected data was then analyzed using various statistical methods including independent t-tests, t-tests, chi-square tests, simple linear regression, and multiple linear regression models.

Results: After the intervention, the mean score for all constructs in the intervention group was higher than that of the control group, except for perceived cost. A statistically significant difference was noted in the mean scores of most constructs, such as perceived susceptibility, perceived severity, perceived self-efficacy, protection motivation, fear, and behavior, between the two groups being studied (p < 0.05).

Conclusion: The PMT-based educational intervention has proven to be effective in promoting reproductive health protective behaviors among female students. Given the significance of infertility issues and the value of preserving fertility in young women, it is recommended to implement PMT-based educational programs to safeguard women's reproductive health.

Introduction: The human papillomavirus (HPV) significantly impacts women's physical and psychological health, and there is a notable absence of specialized tools to assess its psychosocial effects comprehensively. The HPV Impact Profile (HIP) was developed to address this need. This study focuses on the translation and validation of the HIP for use among Iranian women.

Methods: This methodological study was conducted among women diagnosed with HPV from May 2022 to July 2023. A total of 300 women participated by completing an online self-administered questionnaire. The HIP was translated into Persian following standardized procedures. The psychometric properties of the Persian version were evaluated through multiple validation methods: face validity (qualitative and quantitative), content validity (qualitative and quantitative), construct validity (exploratory factor analysis and confirmatory factor analysis), convergent and divergent validity, and reliability (Cronbach's alpha and McDonald's omega).

Results: The original HIP consisted of 29 items. Following the translation process, the Persian version underwent rigorous psychometric validation. During the face validity assessment, no items were removed. However, during the content validity evaluation, 2 items were deleted, resulting in 27 items for further analysis. Exploratory factor analysis led to the removal of an additional 2 items, reducing the number to 25 items. Three factors were extracted, which collectively explained 81.65% of the total variance. Confirmatory factor analysis confirmed a good model fit, with all indices meeting the recommended thresholds. Reliability assessments demonstrated high internal consistency and stability, with Cronbach's alpha calculated at 0.932 and McDonald's omega at 0.996.

Conclusion: The Persian version of the HIP-25 exhibits strong psychometric properties, including high validity and reliability. It is a robust tool for assessing the quality of life among Iranian women with HPV, and it can be effectively utilized in clinical and research settings to better understand and address the psychosocial impacts of HPV.

Background: Since the introduction of the birth control pill in 1960, Canadians have been offered a number of different options for hormonal contraceptives, yet oral contraceptives remain the most popular methods. Research from other countries indicates this may be shifting, but the last comprehensive survey of Canadian hormonal contraceptive usage was published in 2009. Therefore, the aim of this study was to determine current hormonal contraceptive usage among pre-menopausal Canadians.

Methods: An online survey was distributed to pre-menopausal females aged 19-49 years via a third-party survey company. The survey included questions on respondents' demographics and current and past hormonal contraceptive use. Prevalence of current hormonal contraceptive use was calculated by age. Chi-squared tests were conducted to determine whether there was an association between contraceptive choice and various demographic categories.

Results: Responses of 2306 female Canadians (age 33.4 ± 8.1 years) were analyzed and 29% of these respondents were currently using hormonal contraceptives. The most common choices were oral contraceptives (56.4%) and intrauterine device (IUD) (28.4%). Over 30% of hormonal contraceptive users were currently using a long-acting reversible contraceptive method.

Conclusions: These findings demonstrate a change in hormonal contraception use, notably an increase in the use of hormonal IUDs from 4 to 28% among Canadian hormonal contraceptive users over the last 15 years. This study also shows a high prevalence of alternative contraceptive options that may influence hormone levels differently than oral forms.

Introduction: Since 2017, Burkina Faso has rolled out a plan to eliminate vertical transmission of HIV (eMTCT). Elimination will only be achieved when mothers have regular follow-up and good compliance with antiretroviral therapy (ART). The aim of this article is to study the incidence and associated factors for loss to follow-up (LTFU ), in women living with HIV (WLHIV) monitored as part of the eMTCT.

Methods: This study consisted of a retrospective analysis of routinely collected data from pregnant women who were screened and initiated ART in the Do and Dafra health districts of Bobo-Dioulasso between 2017 and 2020 as part of the eMTCT. The study ran from May 2023 to March 2024. The Kaplan-Meier model was used to estimate the rate of LTFU; the Cox model was used for identification of factors associated with LTFU and verification of Kaplan-Meier results.

Results: Three hundred and four newly diagnosed pregnant WLHIV were included in this study. The median age of the mothers was 30 [24; 36] years. The incidence of LTFU was 22.9 per 100 person-years. Younger age (HR = 2.40; 95%CI: 1.37-4.20) was associated with a higher incidence of LTFU, whereas urban residence (HR = 0.57; 95%CI: 0.39-0.85), in contrast to rural residence, was associated with a lower incidence of LTFU.

Conclusion: The study showed a high incidence of LTFU, associated with younger age and rural residence, in the eMTCT programme in Burkina Faso.

Background: Adenomyosis, characterized by endometrial tissue within the uterine muscle, often presents with severe pelvic pain and menorrhagia. This case series demonstrates the efficacy of sequential therapy involving relugolix followed by dienogest in managing adenomyosis.

Case presentation: In five patients with adenomyosis, the gonadotropin-releasing hormone antagonist relugolix initially mitigated symptoms and reduced the levels of serum CA125, a marker associated with disease activity. After six months of relugolix, patients were transitioned to dienogest. This sequential approach maintained symptom relief and further stabilized CA125 levels.

Conclusions: Our findings demonstrate that sequential therapy provides effective symptom management and long-term disease control. Further, CA125 remains a valuable biomarker for monitoring therapeutic success.

Purpose: In Sub-Saharan Africa (SSA), resource-stratified guidelines for breast cancer treatment are increasingly recommended, but treatment receipt and outcomes according to these guidelines are underreported. Here, we describe breast cancer treatment patterns by stage and curative-intent guideline-concordant treatment (GCT) receipt among Malawian women.

Methods: A prospective cohort of breast cancer patients were enrolled from December 2016 to October 2018 at Kamuzu Central Hospital with an assessment of demographics, stage, and treatment received, including neoadjuvant (NAC), adjuvant (AdC) and palliative chemotherapy and breast surgery. Curative-intent GCT was defined as having completed breast surgery and at least 4 cycles of chemotherapy. Overall survival (OS) was calculated using Kaplan Meier methods and odds ratios using logistic regression.

Results: 91 patients were included, of whom 13 (14%) presented as stage II, 54 (59%) as stage III, and 24 (26%) as stage IV. Curative treatment was recommended for 65 of 91 (71%) patients, of whom 47 (72%) were initiated on NAC, 14 (22%) on upfront breast surgery, and 4 (6%) received no treatment. Only 63% (41/65) of patients received curative-intent GCT as recommended with non-GCT associated with stage III (vs. stage II) disease (OR 0.10 CI (0.01-0.89)), HIV positivity ((OR 0.25 CI (0.06-0.99)) and hormone receptor (HR) negative/HER2 positive subtype ((OR 0.07 CI (0.01-0.49)). Curative-intent GCT was associated with improved OS (44.1 vs. 23.2 months; p = 0.00) compared to non-GCT.

Conclusion: While curative-intent GCT was associated with improved survival in this Malawian cohort, treatment completion rates were suboptimal. Resource-stratified guidelines must be paired with locally relevant, multilevel implementation strategies to target barriers to treatment completion.