Good News About Endometriosis and Preterm Delivery

Non peer reviewe

Deep infiltrating endometriosis affecting the urinary tract-surgical treatment and fertility outcomes in 2004-2013

Peer reviewe

Incidence of extraovarian clear cell cancers in women with surgically diagnosed endometriosis : A cohort study

Background Endometriosis is associated with increased risk of clear cell ovarian cancer and has even suggested being an etiological factor for this cancer. Association between endometriosis and extraovarian clear cell cancers is unclear. This study aimed to assess the association between surgically diagnosed endometriosis and risk of extraovarian clear cell cancers according to the type of endometriosis (i.e., ovarian, peritoneal, and other endometriosis) and the site of clear cell cancer. Methods In this register-based historic cohort study we identified all women with surgically diagnosed endometriosis from the Finnish Hospital Discharge Registry 1987-2012. Data on extraovarian clear cell cancers of these women were obtained from the Finnish Cancer Registry. The follow-up started January 1(st), 2007 or at endometriosis diagnosis (if later), and ended at emigration, death or on the December 31(st), 2014. Standardized incidence ratios were calculated for each site of clear cell carcinoma (intestine, kidney, urinary tract, gynecological organs other than ovary), using the Finnish female population as reference. Results The endometriosis cohort consisted of 48,996 women, including 22,745 women with ovarian and 19,809 women with peritoneal endometriosis. Altogether 23 extraovarian clear cell cancers were observed during 367,386 person-years of follow-up. The risk of extraovarian clear cell cancer was not increased among all women with surgically diagnosed endometriosis (standardized incidence ratio 0.89, 95% confidence interval 0.56-1.33) nor in different types of endometriosis. The incidence of clear cell cancer in any specific site was not increased either. Conclusions The risk of extraovarian clear cell cancers in women with surgically diagnosed endometriosis is similar to that in the general population in Finland.Peer reviewe

Trends in the incidence rate, type and treatment of surgically verified endometriosis - a nationwide cohort study

Introduction. To study the trends in incidence rate, type and surgical treatment, and patient characteristics of surgically verified endometriosis during 1987-2012. Material and methods. This is a register-based cohort study. We identified women receiving their first diagnosis of endometriosis in surgery from the Finnish Hospital Discharge Register (FHDR). Quality of the FHDR records was assessed bidirectionally. The age-standardized incidence rates of the first surgically verified endometriosis was assessed by calendar year. Results. The cohort comprises 49956 women. The quality assessment suggested the FHDR data to be of good quality. The most common diagnosis, ovarian endometriosis (46%), was associated with highest median age 38.5years (interquartile range 31.0-44.8) and the second most common diagnosis, peritoneal endometriosis (40%), with median age 34.9years (28.6-41.7). Between 1987 and 2012, a decrease was observed in the median age, from 38.8 (32.3-43.6) to 34.0 (28.9-41.0) years, and in the age-standardized incidence rate from 116 [95% confidence interval (CI) 112-121] to 45 (42-48) per 100000 women. The proportion of hysterectomy as a first surgical treatment decreased from 38 to 19%, whereas that of laparoscopy increased from 42 to 73% when comparing 1987-1995 with 1996-2012. Conclusions. This nationwide cohort of surgically verified endometriosis showed a decrease in the incidence rate and in the patient age at the time of first diagnosis, even though the proportion of laparoscopy has increased. The number of hysterectomies has decreased. These changes are likely to reflect the evolving diagnostics, increasing awareness of endometriosis, and effective use of medical treatment before surgery.Peer reviewe

A cohort study of 49 933 women with surgically verified endometriosis : Increased incidence of breast cancer below the age of 40

Introduction The association between endometriosis and breast cancer is unclear. We assessed the risk of breast cancer in women with surgically verified endometriosis, with special focus on the age at cancer diagnosis, time from endometriosis diagnosis and breast cancer histology. Material and methods All women with first endometriosis-associated diagnoses occurring concomitantly with relevant surgical codes during 1987-2012 were retrieved from the Finnish Hospital Discharge Register in Finland. Breast cancers diagnosed after the endometriosis diagnosis were identified from the Finnish Cancer Registry. The Finnish female population served as the reference. The endometriosis cohort consisted of 49 933 women (23 210 cases of ovarian, 20 187 peritoneal and 2372 deep infiltrating endometriosis). The outcome measure was the standardized incidence ratio (SIR) with 95% confidence interval (95% CI) of breast cancer calculated for the whole cohort and for the subtypes of endometriosis, stratified by the age at breast cancer diagnosis, histology and time from endometriosis diagnosis. Results The overall risk of breast cancer (1555 cases) was similar to the reference population (SIR 0.99; 95% CI 0.94-1.03), did not differ in types of endometriosis, and was similar for ductal and lobular breast cancer. However, the SIR of breast cancer was increased in the age group of 20-29 years (SIR 4.44; 95% CI 2.22-7.94) and in the age group of 30-39 years (SIR 1.28; 95% CI 1.03-1.57). The risk of in situ breast cancer (170 cases) was increased in the entire endometriosis cohort (SIR 1.25; 95% CI 1.07-1.44). Conclusions The overall risk of breast cancer in women with surgically verified endometriosis was similar to that of general population. However, the risk of breast cancer at young age was increased. Young women with surgically verified endometriosis represent highly symptomatic patients with more frequent surgeries and additional therapies that might also contribute to the risk of breast cancer.Peer reviewe

Endometrioosi ja syöpä : Lisääkö endometrioosi syövän myöhemmän kehittymisen riskiä vai suojaako se siltä?

Vertaisarvioitu.Aiempien tutkimusten mukaan endometrioosia sairastavien naisten kokonaissyöpäriski ei poikkea muista samanikäisistä naisista. Munasarjasyöpää, kilpirauhassyöpää ja ihomelanoomaa on todettu hieman useammin ja kohdunkaulasyöpää esiastemuutoksineen hieman harvemmin kuin muilla naisilla. Uuden suomalaistutkimuksen perusteella näyttää siltä, että suurentunut munasarjasyöpäriski liittyy vain munasarjan endometrioosiin.Peer reviewe

The genetic basis of endometriosis and comorbidity with other pain and inflammatory conditions

Endometriosis is a common condition associated with debilitating pelvic pain and infertility. A genome-wide association study meta-analysis, including 60,674 cases and 701,926 controls of European and East Asian descent, identified 42 genome-wide significant loci comprising 49 distinct association signals. Effect sizes were largest for stage 3/4 disease, driven by ovarian endometriosis. Identified signals explained up to 5.01% of disease variance and regulated expression or methylation of genes in endometrium and blood, many of which were associated with pain perception/maintenance (SRP14/BMF, GDAP1, MLLT10, BSN and NGF). We observed significant genetic correlations between endometriosis and 11 pain conditions, including migraine, back and multisite chronic pain (MCP), as well as inflammatory conditions, including asthma and osteoarthritis. Multitrait genetic analyses identified substantial sharing of variants associated with endometriosis and MCP/migraine. Targeted investigations of genetically regulated mechanisms shared between endometriosis and other pain conditions are needed to aid the development of new treatments and facilitate early symptomatic intervention

The genetic basis of endometriosis and comorbidity with other pain and inflammatory conditions

Endometriosis is a common condition associated with debilitating pelvic pain and infertility. A genome-wide association study meta-analysis, including 60,674 cases and 701,926 controls of European and East Asian descent, identified 42 genome-wide significant loci comprising 49 distinct association signals. Effect sizes were largest for stage 3/4 disease, driven by ovarian endometriosis. Identified signals explained up to 5.01% of disease variance and regulated expression or methylation of genes in endometrium and blood, many of which were associated with pain perception/maintenance (SRP14/BMF, GDAP1, MLLT10, BSN and NGF). We observed significant genetic correlations between endometriosis and 11 pain conditions, including migraine, back and multisite chronic pain (MCP), as well as inflammatory conditions, including asthma and osteoarthritis. Multitrait genetic analyses identified substantial sharing of variants associated with endometriosis and MCP/migraine. Targeted investigations of genetically regulated mechanisms shared between endometriosis and other pain conditions are needed to aid the development of new treatments and facilitate early symptomatic intervention

Lehmänmaitoallergian kliininen kuva ja diagnostiikka.

Syventävä työ ei kirjastoss

Women with surgically diagnosed endometriosis : Incidence, risk of cancer and death

The aim of this thesis was to assess the risk of cancer according to the types of endometriosis and the risk of death among women with surgically verified endometriosis. In first register-based cohort study, all women with an initial endometriosis diagnosis (49 956 women) undergoing a relevant surgical procedure were identified from the Finnish Hospital Discharge Register from 1987 to 2012. The cohort was divided into sub-cohorts of ovarian (n=23 222), peritoneal (n=20 197), and deep infiltrating endometriosis (n=2372) according to the procedural diagnosis. Between 1987 and 2012 the median age at index surgery decreased 38.8-34.0 years (interquartile range 32.3–43.6; 28.9–41.0) and the age-standardized incidence rate decreased from 116-45 (95% confidence interval [CI] 112–120; 43-48) per 100 000 women. In second and third study, all female cancer cases were identified from the Finnish Cancer Registry until the end of 2014 (840 000 person-years). The overall risk of cancer mirrored that of the Finnish general female population (standardized incidence ratio 0.98; 95%CI 0.95–1.01). Of all gynecological cancers, the risk of ovarian cancer increased (1.76; 1.47–2.08). It was highest among women with ovarian endometriosis and especially for endometrioid and clear-cell ovarian cancer. In contrast, the incidence of precancerous lesions of the uterine cervix (0.81; 0.71–0.92) and that of invasive squamous cell cervical cancer (0.46; 0.20–0.91) decreased. Of all non-gynecological cancers, the risk of thyroid cancer (1.43; 1.23–1.64) and that of basal cell carcinoma increased (1.18; 1.10–1.25). In comparison, the risk of mouth and pharynx cancers (0.60; 0.41–0.80) and of pancreatic cancer (0.76; 0.58–0.96) decreased. In fourth study, the data on the deaths was obtained from Statistics Finland until the end of 2014. The reference cohort (n=98 824) included two age- and municipality-matched women for each woman in the endometriosis cohort. The risk of death from any cause decreased (adjusted mortality rate ratio [MRR] 0.73; 0.69–0.77) in the endometriosis cohort. Furthermore, the adjusted MRR difference remained significant during 24 years of follow-up. Mortality was lower due to cardiovascular diseases (0.57; 0.50–0.65), including ischemic heart and cerebrovascular diseases, as well as due to accidents and violence, diseases of the respiratory and digestive systems, alcohol-related causes, and other causes. In conclusion, only a few types of cancer carry an increased or decreased risk with mid-life women among surgically diagnosed endometriosis. Ovarian endometriosis was most strongly associated with increased risk of ovarian cancer. The overall mortality and cardiovascular mortality were decreased among these women.Endometrioosi eli kohdun limakalvon sirottumatauti on pitkäaikainen tulehduksellinen sairaus, jota esiintyy 4–10 %:lla hedelmällisessä iässä olevista naisista. Endometrioosiin liittyy lisääntynyt riski sairastua muun muassa tiettyihin syöpiin sekä sydän- ja verisuonitauteihin. Tämän väitöskirjatutkimuksen tarkoitus oli selvittää, vaikuttaako endometrioosi riskiin sairastua syöpään, poikkeaako riski eri endometrioosin ilmenemismuotojen osalta ja vaikuttaako endometrioosi kuolemanriskiin keski-iässä. Terveyden ja hyvinvoinnin laitoksen hoitoilmoitusrekisteristä haettiin ne 49 956 naista, joille oli tehty endometrioosidiagnoosi ensimmäisen kerran leikkauksessa Suomessa vuosina 1987–2012. Munasarjaendometriooseja oli 23 222, vatsakalvoendometriooseja 20 197 ja syviä endometriooseja 2 372. Seuranta-aikana naisten keski-ikä ensimmäisen leikkauksen aikaan nuorentui (38,8-34,0 vuoteen) samalla kun ikävakioitu ilmaantuvuussuhde pieneni (116-45 tapausta sataatuhatta naista kohti). Kaikki endometrioosidiagnoosin jälkeiset syöpädiagnoosit haettiin Syöpärekisteristä vuoden 2014 loppuun saakka (840 000 henkilövuotta). Riski sairastua mihin tahansa syöpään ei ollut suurentunut verrattuna Suomen naisväestöön (vakioitu ilmaantuvuussuhde 0,98; 95 %:n luottamusväli 0,95–1,01). Munasarjasyövän ilmaantuvuus oli suurentunut (1,76; 1,47–2,08) - riski oli suurin munasarjaendometrioosiryhmässä. Kohdunkaulan levyepiteelisyövän ilmaantuvuus oli vähentynyt. Muista syövistä kilpirauhassyövän riski oli suurentunut, toisaalta suu- ja nielusyöpä- sekä haimasyöpäriskit olivat pienentyneet verrattuna muuhun naisväestöön. Tiedot kuolemista ja kuolemansyistä haettiin Tilastokeskukselta seurannan alusta vuoden 2014 loppuun saakka. Vertailukohortti muodostettiin valikoimalla kullekin tutkittavalle kaksi iän ja asuinpaikan mukaan kaltaistettua naista (98 824). Endometrioosikohorttilaisten kokonaiskuolleisuus oli pienentynyt (vakioitu kuolleisuussuhde 0,73; 95 %:n luottamusväli 0,69–0,77). Havaittu kokonaiskuolleisuusero säilyi tilastollisesti merkitsevästi pienentyneenä 24 vuoden ajan. Tautikohtaisista kuolleisuusluvuista pienentyivät sydän- ja verisuonitautikuolleisuus, kuolleisuus alkoholista riippuviin syihin, onnettomuuksiin ja väkivaltaan sekä hengitystie- ja ruoansulatustautikuolleisuus. Leikkauksessa todetun endometrioosidiagnoosin jälkeen pienentynyt tai suurentunut sairastumisriski liittyi siis vain muutamaan syöpätyyppiin. Munasarjasyöpäriski liittyi nimenomaan munasarjaendometrioosiin. Kokonaiskuolleisuus sekä sydän- ja verisuonitautikuolleisuus olivat pienentyneet vertailuryhmään nähden