Dietary factors and endometrial cancer risk. Results of a case-control study in Mexico.

Daily diet factors that could potentially be related to endometrial cancer (EC) in Mexico are still unknown. This study aims to evaluate the association between EC and Mexican dietary factors. A case-control study in Mexico City was conducted during 1995-1997 in a social security hospital, using 85 incident cases of EC and 629 controls. A validated questionnaire with 116 items about the frequency and type of food intake was used. The analysis of nutrients was performed using the residual method, adjusting by predictor variables through logistic regression methods. In addition, partitional models estimated total caloric intake for other sources. We found no association between EC risk and consumption of animal or vegetable proteins, saturated, monounsaturated, or polyunsaturated fat, although high intake of nutrients such as lactose (odds ratio [OR], 0.46; 95% confidence interval [CI], 0.21-1.01, P for trend = 0.004), vitamin D (OR, 0.38; 95% CI, 0.18-0.82, P= 0.003), and calcium (OR, 0.39; 95% CI, 0.17-0.89, P= 0.02) were inversely associated with EC. Our results suggest that dietary vitamin D and calcium play an important role in the development of EC, although the mechanisms postulated should be explained with additional studies with large populations.

Prognostic factors related to cervical cancer survival in Mexican women.

OBJECTIVE: To identify prognostic survival factors among Mexican women with cervical cancer. METHODS: A total of 378 women with cervical cancer admitted from 1984 to 1996 to our referral hospital were evaluated, using survival analysis (Kaplan-Meier and Cox proportional hazards method). We designed a symptom index which included asymptomatic conditions, severity of symptoms and comorbidity. RESULTS: Overall 5-year survival was 66.6%. The shortest survival time was for FIGO stage IV (21.5%, P<0.001) and adenosquamous histologic type (53.1%, P=0.15). The main prognostic factors were primary symptoms (RR, 2.6; 95% CI, 1.02-6.66); systemic symptoms (RR, 3.3; 95% CI, 1.23-9.01); FIGO stage IV (RR, 5.5; 95% CI, 2.36-12.96); and oncogenic symptoms (prognostic comorbidity present) (RR, 2.3; 95% CI, 1.08-4.89). CONCLUSIONS: Our findings show that clinical stage and several types of symptoms influence CC survival. This present strategy to assess morphological and clinical characteristics may be a more accurate indicator of survival rate and potentially an efficient indicator of new therapeutic alternatives.

Case-control study of diabetes, obesity, physical activity and risk of endometrial cancer among Mexican women.

OBJECTIVES: Obesity, hypertension and diabetes are closely associated with endometrial cancer (EC). This study evaluates the relationship between diabetes and risk of EC on the basis of obesity. METHODS: A case control study was carried out in Mexico City from 1995 to 1997. Eighty-five histologically confirmed cases were compared with 668 population-based controls obtained through frequency matching. Diabetes status, weight, height and other factors were determined through personal interviews among both cases and controls. RESULTS: Compared to women without diabetes, those with diabetes had an adjusted odds ratio of 3.6 (95% CI = 1.7, 7.4) for EC. This association was modified by body mass index (p interaction < 0.001). Compared to non-overweight and non-diabetic women, non-overweight (OR = 3.9. 95% CI = 0.88, 18.0) and overweight (OR = 5.9, 95% CI = 1.6, 21.1) diabetic women had a non-significant elevated risk of EC. However, elevated risk estimates were observed for obese diabetic women (OR = 8.0, 95% CI = 2.8, 22.7). CONCLUSIONS: Our results strongly suggest an interaction effect between obesity and diabetes that significantly increases the risk of EC. This, in turn, may explain the growing number of new EC cases recently observed in developing countries with reduced birth rates and an increased incidence of both obesity and diabetes mellitus.

Reproductive factors of ovarian and endometrial cancer risk in a high fertility population in Mexico.

A case-control study was carried out in Mexico City during 1995-1997 among women with epithelial ovarian cancer (84 cases) and endometrial cancer (85 cases). The control group consisted of 668 healthy women, matched according to age categories. In a multivariate analysis, the reproductive risk factors for ovarian and endometrial cancer are similar. The risk of ovarian cancer was inversely related to the number of full-term pregnancies; the odds ratio (OR) was 0.17 and the 95% confidence interval (CI) was 0.05-0.54 when comparing nulliparous women versus those with more than seven pregnancies. For endometrial cancer, a similar association was observed (OR, 0.11; 95% CI, 0.04-0.34). The use of oral contraceptive hormones was inversely associated with both ovarian (OR, 0.36; 95% CI, 0.15-0.83) and endometrial cancer risk (OR, 0.36; 95% CI, 0.14-0.90). In women with a history of more than 8.7 years without ovulation, the risk of ovarian cancer decreased four times (OR, 0.23; 95% CI, 0.10-0.50), and that of endometrial cancer decreased more than five times (OR, 0.17; 95% CI, 0.08-0.35). These two neoplasms are clearly typified as hormone dependent, and it is possible to establish that "ovulation" and "exfoliative" mechanisms jointly determine the level of risk for both ovarian and endometrial cancer.

Conservative surgery for ovarian cancer and effect on fertility.

OBJECTIVE: A survey that compared two alternatives (conservative and radical surgery) is presented on ovarian cancer treatment evaluating its effect on progression-free survival and fertility, in a 10-year time period, in Mexican women. METHODS: 72 women between 11 and 58 years old with unilateral ovarian cancer in different stages were studied. Several methods were analyzed: (1) progression-free survival, using Mantel and Haenzsel test to compare in terms of life curves and the Kaplan-Meier method. The exposure variable was surgery type, using the Mantel-Cox test to evaluate the difference in life curves by clinical stages and by surgery type; (2) fertility was evaluated in women who received conservative surgery, considering the cumulative pregnancy rate in women successfully pregnant after surgical and/or adjuvant treatment. RESULTS: There were no difference in survival curves when evaluating progression-free survival, in either group (Z = 1.09 and Pr > (z) = 0.27). During the study period, we found that 87.5% of patients were alive with no evidence of disease. There were no differences in survival curves when evaluating progression-free survival according to surgery type and clinical stage (chi 2 = 0.66, P = 0.88). Restart of menstruation in patients with conservative surgery occurred before 6 months in 89% of the sample, 22 women with possible parity had a 59.1% cumulative pregnancy rate. CONCLUSION: The outcomes from this survey carried out in Mexico show that conservative treatment of ovarian cancer in early clinical stages is an efficient alternative to preserve reproductive function in young women, and does not show differences in progression-free survival compared to radical surgery.

[Microinvasive cervico-uterine cancer. Diagnosis and treatment]. / Cáncer cervicouterino microinvasor. Diagnóstico y tratamiento.

This is a retrospective review of 63 patients with diagnosis of microinvasive cervical carcinoma. Diagnostic methodology included etiology, colposcopy, biopsy and cervical conization. Study parameters were: age, symptomatology, type of treatment and survival. The treatment to be established was chosen according to adverse prognostic factors, such as invasion depth, lymphovascular permeation, invasion pattern. The patients with an invasion depth up to 1 mm (IA1, FIGO) may be conservatively treated by cervical conization, if fertility is to be kept; there is risk of metastasis or recurrence. The patients with invasion of 1 to 5 mm (IA2, FIGO) may have a greater risk of recurrence and lymph node disease; the treatment should be individualized. There are no specific colposcopic data about microcarcinoma, and because of that, diagnostic precision is not high; however, colposcopy shows the adequate site for biopsy sampling, identifies vaginal extension areas and may influence the treatment.