Reproductive and external hormonal factors and the risk of renal cell cancer in the Netherlands Cohort Study.

BACKGROUND: Several reproductive and hormonal factors, like age at menarche, parity, age at menopause, use of oral contraceptives and postmenopausal treatment, have been associated with the risk of renal cell cancer (RCC) in women, but results have not always been consistent. We therefore investigated the association between these factors and the risk of RCC in postmenopausal women participating in the Netherlands Cohort Study on Diet and Cancer. METHODS: Information on reproductive history, exogenous hormone use and gynecological surgery was obtained through a self-administered questionnaire at baseline in 1986. After 20.3 years of follow-up, 204 cases and 2280 subcohort members were available for case-cohort analysis. Multivariable hazard ratios (HR) were calculated using Cox Proportional Hazard analysis. RESULTS: Women who reported a hysterectomy had an increased RCC risk compared to women who did not (HR, 1.42, 95%CI, 1.01-2.00). Women with a natural age at menopause between 45 and 49 years compared to 50-54 years had an increased RCC risk (HR, 1.61; 95%CI, 1.10-2.35). RCC risk was slightly and not statistically significant increased among parous women with three or more children and age at first birth before 25 years compared to nulliparous women (HR, 1.36; 95% confidence interval (CI), 0.84-2.20). No associations were observed with RCC risk for age at menarche, use of oral contraceptives and use of hormonal replacement therapy. CONCLUSION: Hysterectomy and age at natural menopause were associated with an increased RCC risk. Other hormonal and reproductive factors and RCC risk were not increased. Further studies are required to establish the mechanism(s) that explain the observed association.

Asymptomatic anomalous left anterior descending artery arising from the right coronary artery with a rare anterior course.

The presence of a malignant course on the coronary circulation is the second leading cause of sudden cardiac death in young adults. One type of malignant conformation is an anomalous left anterior descending artery (LAD) arising from the right coronary artery (RCA). In a study examining 70,850 patients undergoing coronary angiography, the prevalence of this anomaly was noted in 0.006% of total patients and in 2.3% of congenital coronary anomaly cases. Of the four patients presenting with this anomaly, only one was noted to have an interarterial course of the LAD between the aorta and pulmonary artery. We describe the case of a patient who was incidentally found to have a malignant anomalous LAD arising from the RCA when he presented with a non-ST elevation myocardial infarction due to a ruptured plaque in an obtuse marginal branch. This patient survived for 57 years with no symptoms.