RESUMO
A hospital-based case-control study was conducted in two hospitals in Bangkok, Thailand, and in one hospital each in Chiang Mai, Thailand, Mexico City, Mexico and Nairobi, Kenya. One purpose of this study was to determine whether the long-acting progestational contraceptive, depot-medroxyprogesterone acetate (DMPA), alters risk of invasive cervical carcinomas with adenomatous histological features. Information on prior use of DMPA, screening for cervical cancer, and the suspected risk factors for this disease was ascertained from interviews of 239 women with adenocarcinomas and 85 women with adenosquamous carcinomas, as well of from a large pool of controls, 2534 of whom were matched to the cases included in this report. For selected subsets of these women, a smoking history was also elicited, blood specimens were collected for measurement of antibodies against herpes simplex and cytomegalovirus, and information on sexual behavior was obtained from interviews of their husbands. The relative risk (and 95% confidence interval) of adenomatous cervical carcinomas in women who ever used DMPA was estimated to be 0.75 (0.51, 1.11). No trends in risk were observed with duration of DMPA use, times since first or last use, or age at first use. The results provide reassurance that use of DMPA for over four years does not enhance risk of adenomatous cervical carcinomas, and risk is not increased after a potential latent period of over 12 years since initial exposure.
Assuntos
Adenocarcinoma/induzido quimicamente , Carcinoma Adenoescamoso/induzido quimicamente , Anticoncepcionais Femininos/efeitos adversos , Acetato de Medroxiprogesterona/efeitos adversos , Neoplasias do Colo do Útero/induzido quimicamente , Adenocarcinoma/epidemiologia , Adenocarcinoma/patologia , Adulto , Carcinoma Adenoescamoso/epidemiologia , Carcinoma Adenoescamoso/patologia , Estudos de Casos e Controles , China/epidemiologia , Feminino , Humanos , Cooperação Internacional , Quênia/epidemiologia , México/epidemiologia , Pessoa de Meia-Idade , Fatores de Risco , Inquéritos e Questionários , Tailândia/epidemiologia , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/patologia , Organização Mundial da SaúdeRESUMO
BACKGROUND: Although the possible influence of oral contraceptives on risk of cervical carcinoma in situ has been the subject of multiple prior investigations, the results have been inconsistent. METHODS: Data from a multinational, collaborative case-control study were analysed to investigate further this possible relationship. To assess potential screening bias, some statistical analyses were restricted to subgroups of cases with and without symptoms at the time of their diagnosis. RESULTS: Relative risk estimates in relation to various features of oral contraceptive use tended to be highest for asymptomatic disease, lowest for disease presenting with vaginal bleeding, and intermediate for disease presenting with other symptoms, suggesting the presence of a screening bias. In women with vaginal bleeding, who are least likely to have been detected by routine screening, no elevated risk of cervical carcinoma in situ was observed in relation to ever having used combined oral contraceptives, but there was an increased risk in users of over 60 months' duration. An increasing trend in risk with duration of use was most pronounced in these women who first used oral contraceptives in the past 5-10 years; and in women who used oral contraceptives for more than 60 months, risk declined with time since last use. CONCLUSION: These findings could reflect a reversible effect of long-term use of oral contraceptives at an intermediate stage in the carcinogenic process, or a non-causal relationship due to unidentified sources of bias or confounding.
Assuntos
Carcinoma in Situ/induzido quimicamente , Anticoncepcionais Orais Combinados/efeitos adversos , Neoplasias do Colo do Útero/induzido quimicamente , Adulto , Viés , Carcinoma in Situ/diagnóstico , Estudos de Casos e Controles , Chile , Fatores de Confusão Epidemiológicos , Anticoncepcionais Orais Combinados/administração & dosagem , Interpretação Estatística de Dados , Feminino , Humanos , México , Pessoa de Meia-Idade , Fatores de Risco , Tailândia , Fatores de Tempo , Neoplasias do Colo do Útero/diagnósticoRESUMO
The relationship of depot-medroxyprogesterone acetate (D-MPA) use to risk of cervical carcinoma in situ was investigated using data from a large multi-national, hospital-based case-control study. To avoid possible detection bias from Pap smear screening, final analyses were restricted to a subset of cases with symptoms at the time of their diagnosis of cervical carcinoma in situ. Relative to nonusers, the risk was elevated in women who had ever used DMPA and increased with duration of use. Decreasing trends in relative risk with times since first and last uses were observed in long-term users. Results from another portion of this same study did not show a relationship of invasive cervical cancer to DMPA use. These findings suggested that if DMPA increases the risk of cervical carcinoma in situ then either this is a reversible effect, or the cervical lesions induced by DMPA tend not to progress to invasive disease.
Assuntos
Carcinoma in Situ/induzido quimicamente , Carcinoma in Situ/epidemiologia , Acetato de Medroxiprogesterona/efeitos adversos , Neoplasias do Colo do Útero/induzido quimicamente , Neoplasias do Colo do Útero/epidemiologia , Adulto , Estudos de Casos e Controles , Preparações de Ação Retardada , Feminino , Humanos , Acetato de Medroxiprogesterona/administração & dosagem , México/epidemiologia , Pessoa de Meia-Idade , Fatores de Risco , Tailândia/epidemiologia , Organização Mundial da SaúdeRESUMO
This preliminary report reviews the use of the proximal tibial metaphysis as an alternative to other bone graft donor sites. A series of 21 cancellous grafts were procured from 20 patients using a predictable orthopedic approach. A singular finding was the overall lack of morbidity at the donor site and the apparent favorable quality and quantity of the procured bone. Data describing the use of tibial cancellous bone grafting in a wide range of maxillofacial reconstructive procedures are presented.
Assuntos
Transplante Ósseo/métodos , Ossos Faciais/cirurgia , Tíbia , Adolescente , Adulto , Idoso , Curetagem , Durapatita , Feminino , Seguimentos , Humanos , Hidroxiapatitas , Masculino , Seio Maxilar/cirurgia , Pessoa de Meia-Idade , Osteotomia , Dor Pós-Operatória/prevenção & controle , Próteses e Implantes , Estudos Retrospectivos , Tíbia/fisiologia , Tíbia/cirurgia , Fatores de Tempo , Suporte de CargaRESUMO
The World Health Organization Collaborative Study of Neoplasia and Steroid Contraceptives is a large multinational hospital-based case-control study of steroid contraceptives and gynecologic, hepatobiliary, and mammary neoplasms. Monthly injectable steroid contraceptives which contained the long-acting progestogen dihydroxyprogesterone acetofenide plus a shorter-acting estrogen (usually estradiol enanthate) were used by women in two of the countries (Chile and Mexico) from which data were collected. In preliminary analyses of data from Chile (1979-1983), a strong association was observed between use of these products and invasive cervical cancer. Therefore, three additional data sets from these two countries were analyzed in further detail for this report. Analyses of additional data from Chile on invasive cervical cancer (1983-1985) and cervical carcinoma in situ (1979-1986) and of data on invasive cervical cancer from Mexico (1979-1986) failed to confirm the initially observed association. The original finding was probably due to chance, but a causal interpretation cannot be confidently ruled out, and additional studies are warranted.
Assuntos
Carcinoma/induzido quimicamente , Anticoncepcionais/efeitos adversos , Neoplasias do Colo do Útero/induzido quimicamente , Acetofenida de Algestona/administração & dosagem , Acetofenida de Algestona/efeitos adversos , Carcinoma/diagnóstico , Chile , Ensaios Clínicos como Assunto , Anticoncepcionais/administração & dosagem , Esquema de Medicação , Combinação de Medicamentos , Estrogênios/administração & dosagem , Estrogênios/efeitos adversos , Feminino , Humanos , Injeções , México , Estudos Multicêntricos como Assunto , Inquéritos e Questionários , Fatores de Tempo , Neoplasias do Colo do Útero/diagnósticoRESUMO
A case-control study of cervical carcinoma in situ was conducted in Santiago, Chile, to determine whether risk of this condition is altered by use of oral contraceptives. Responses to a standardized questionnaire were compared in 133 hospitalized cases and 254 age-matched controls selected from the same screening program through which the cases were detected. After controlling for the possible confounding influence of a variety of indices of sexual behavior, socioeconomic status, and prior cytological smears, no increase in risk was found in women who ever used oral contraceptives. No trend of increasing or decreasing risk was seen in relation to duration of use, up to more than 6 years of exposure, or with the passage of time from either initial or most recent exposure. An observed increase in risk in current users of oral contraceptives was not considered likely to represent a causal relationship.
PIP: A case-control study of cervical carcinoma in situ was conducted in Santiago, Chile, to determine whether risk of this condition is altered by the use of oral contraceptives (OCs). Responses to a standardized questionnaire were compared in 133 hospitalized cases and 254 age-matched controls selected from the same screening program through which the cases were detected. After controlling for the possible confounding influence of a variety of indices of sexual behavior, socioeconomic status, and prior cytological smears, no increase in risk was found in women who had ever used OCs. No trend of increasing or decreasing risk was seen in relation to duration of use, up to more than 6 years of exposure. An observed increase in risk in current OC users was not considered likely to represent a causal relationship.