The fibroid growth study: determinants of therapeutic intervention.

AIMS: The demographics, ethnicity, symptoms, lifestyle characteristics, and treatment outcomes are analyzed in participants of a study designed to evaluate uterine leiomyoma growth and correlate symptoms and outcomes in a clinically relevant population of women (Fibroid Growth Study). METHODS: Women included in the Fibroid Growth Study (FGS) completed a medical history and physical examination, underwent T1-weighted and T2-weighted magnetic resonance image (MRI) scans, provided urine and blood samples at each scheduled MRI, and responded to an initial extensive telephone-administered questionnaire followed by abbreviated monthly questionnaire updates. Summary scores were developed to quantify stress, pain, and bleeding. The Wilcoxin test was used for statistical comparisons between study participant characteristics and tumor-related characteristics. RESULTS: Participants included 116 premenopausal women, ranging in age from 20 to 54 years; 48% were black women, 41% were white women, 10% were women of other or multiple racial backgrounds, and 1% did not self-identify. Over 90% of participants had multiple leiomyomas, and nearly a third had more than 10. Black women were younger and had more fibroids, but no differences were found in the proportions of black and white women choosing an intervention; 44% of black women and 40% of white women chose intervention during the study. CONCLUSIONS: There was no correlation between number of leiomyomas or uterine size and choosing treatment. However, women who opted for treatment were more symptomatic, with higher bleeding and pain scores, compared with the women with no intervention. Consequently, our study suggests that once women are symptomatic, black and white women choose surgery as a treatment method for the same reasons and at about the same rates. Moreover, our data suggest that bleeding and pain, not the size or multiplicity of fibroids, determine the choice for intervention. Therefore, aggressive management of pain and bleeding may be effective in reducing the need for surgical intervention.

Growth of uterine leiomyomata among premenopausal black and white women.

Uterine leiomyomata (fibroids) are the leading cause of hysterectomy in the United States. Black women have a greater fibroid burden than whites, yet no study has systematically evaluated the growth of fibroids in blacks and whites. We prospectively tracked growth for 262 fibroids (size range: 1-13 cm in diameter) from 72 premenopausal participants (38 blacks and 34 whites). Fibroid volume was measured by computerized analysis of up to four MRI scans over 12 months. We used mixed effects models to identify factors that are associated with growth, and results were converted to percent change per 6 months for clinical relevance. The median growth rate was 9% (range: -89% to +138%). Seven percent of fibroids regressed (>20% shrinkage). Tumors from the same woman grew at different rates (within-woman component of variation was twice the component among women; both were significant, P < 0.001). Black and white women less than 35 years of age had similar fibroid growth rates. However, growth rates declined with age for whites but not for blacks (P = 0.05). The odds of a tumor growing more than 20% in 6 months also decreased with age for whites but not for blacks (P < 0.01). Growth rates were not influenced by tumor size, location, body mass index, or parity. We conclude that (i) spontaneous regression of fibroids occurs; (ii) fibroids from the same woman grow at different rates, despite a uniform hormonal milieu; (iii) fibroid size does not predict growth rate; and (iv) age-related differences in fibroid growth between blacks and whites may contribute to the higher symptom burden for black women.

Cyclooxygenase-1 and 2 in normal and malignant human ovarian epithelium.

OBJECTIVES: Cyclooxygenase-1 and 2 (COX-1 and COX-2) play important roles in normal physiology and are often dysregulated in neoplastic tissues. The present study determines whether COX-1 and COX-2 are expressed in ovarian cancers and whether the pattern of expression of these enzymes reveals clues to their roles in this cancer. METHODS: The expression of COX-1 and COX-2 proteins in 9 normal human ovaries, in 137 cases of ovarian cancers of epithelial origin (83 primary and 54 metastatic), and in 7 ovarian cancer cell lines was examined by immunohistochemistry and western analysis. RESULTS: COX-1 protein was present in 95/137 (69.3%) of the total cancers studied, with 55/83 (66.3%) of the primary cancers and 40/54 (74.1%) of the metastatic cancers positive for protein. COX-2 was present in 97/137 (70.8%) of all cancers studied, with 53/83 (63.9%) of the primary cancers and 44/54 (81.5%) of the metastatic cancers positive for protein. Notably, the quickscores for COX-2-positive staining were significantly higher in metastatic cancers. Moreover, COX-2 immunostaining was frequently found at the advancing margin of tumor invasion or in new metastatic loci. COX-1 protein expression was observed in the ovarian surface epithelial cells, especially that of the inclusion cysts. COX-1 was also detected by western blot in seven of nine ovarian cancer cell lines. However, no COX-2 was detected in either normal epithelium or cancer cell lines. CONCLUSION: COX-1 and COX-2 were expressed in every type of ovarian epithelial cancer, suggesting that each may contribute to the cancer development or progression.