Role of xenoestrogens and endogenous sources of estrogens on the occurrence of premenopausal breast cancer in Iran.

Breast cancer affects Iranian women one decade younger than their counterparts in other countries and the underlying risk factors have remained controversial. The aryl hydrocarbon receptor (AhR) mediates endocrine disruptive activities of polyaromatic hydrocarbons (PAHs) and dioxins, which may compromise ovarian functions of women in polluted environments. This study focused on tissue expression levels of AhR and associations with exposure to chemicals with estrogen-like activities (xenoestrogens) and other reproductive factors in premenopausal breast cancer patients. Fifty cases who underwent surgery from June 2009 to June 2010 were matched with 100 controls by age and hospital records. AhR overexpression was detected in 87% of epithelial cells of young breast cancer patients. Living near factories generating PAHs and dioxins was considered as a major risk factor in premenopausal breast cancer (p=0.001, OR=4.8). History of idiopathic infertility was identified as a second significant risk factor (p=0.002, OR=3.50), which could be affected by endogenous estrogen levels. Long term (>5 yrs) consumption of oral contraceptive pills was identified as the third most important risk factor (p=0.006, OR=2.27). Adiposity and abnormal weight gain after 18 years were considered as two major background factors, which may contribute to the levels of endogenous estrogens. Direct and indirect exposure to cigarette smoke (p=0.005, OR=1.43) was considered as a weak risk factor without association with AhR levels. It seems that AhR overexpression is affected by exposure to xenoestrogens and by adiposity. Early occurrence of breast cancer in Iran may be a result of interactions between hormonal and environmental factors.

Assessment of short-term outcomes following unintentional ingestions of "oral contraceptive pills" by toddlers.

BACKGROUND: Cases of unintentional pediatric ingestions of oral contraceptive pills are commonly reported to Poison Information Centers (PICs). No study had examined clinical outcomes in the past 30 years, although the hormone content of these preparations has been substantially reduced. We assessed short-term outcomes to determine the relevance of advice provided, particularly that vaginal bleeding can occur. METHODS: Prospective observational study of cases reported to a state PIC were followed up over a 5-month period. RESULTS: There were 63 cases with complete follow-up, average age was 2 years and 10 months; 65% of the patients were female. Median number of pills ingested was 5.0 [Interquartile Range (IQR) 3-16.5]. Minor symptoms including vomiting and irritability were reported in 44% of cases. No case of vaginal bleeding was reported. CONCLUSION: No major clinical effects and no instances of vaginal bleeding were reported.

Transposition of the great vessels in an infant exposed to massive doses of oral contraceptives.

PIP: Drawing from evidence of complete dextro-transposition of the great vessels in approximately 2.0% of newborn infants with congenital heart disease, the authors suggest that this transposition may be associated with antenatal exposure to female sex hormones in the form of massive doses of oral contraceptives taken to induce abortion. Although causes of transpositions of the great vessels may be associated with single mutant gene defects or chromosomal aberrations, the study of familial aggregates, twin concordance, and animal models suggests that the majority of causes of congenital heart disease are a result of inherited genetic susceptibility to environmental events. Through previous intensive studies of pregnancies which have been inconclusive as well as data derived from the Collaborative Perinatal Project in which 50,282 mother-child pairs were tested, the increased relative risk of cardiovascular defects with female sex hormones was found to be 2.1 with a predominance of truncoconal anomalies. Since the important variables in the development of congenital malformation are: 1) the gestational age at the time of exposure, 2) the susceptibility of the individual to a given teratogen, and 3) the dose and duration of exposure to the teratogenic influence, the case study given in the article strengthens the hypothesis that truncoconal defects are associated with antenatal exposure to sex hormones.^ieng

[Children's accidents by ingestion of contraceptives (author's transl)]. / Ingestionsunfälle mit Ovulationshemmern bei Kindern

PIP: The cases of 166 children, up to 6 years of age, who swallowed oral contraceptives are studied. 26 of the children showed symptoms, mostly vomiting, 10-15 hours after ingestion. Nausea, diarrhea, and psychic disturbances were also attributed to the contraceptives. The causal relationship had not yet been established for cases of a swollen face epixtaxis, swelling of external genitals, and red spots on the face. It is noted that children who took more pills often had fewer or no symptoms, and that laxatives increased the incidence of vomiting. Stomach irrigation elimated symptoms completely. No severe poisoning occurred in these children, some of whom had taken up to 20 tablets.^ieng