An update of the central Netherlands registry, 1997
1997 Study Abstract
The objective of this study was to update the registry of women in the Netherlands with clear cell adenocarcinoma (CCAC) of the cervix or vagina with or without intrauterine exposure to diethylstilbestrol (DES).
From a nationwide search in PALGA, the automated pathology registry in the Netherlands, data were gathered on women with CCAC born after 1947. Information obtained from the clinical files of the patients included reported exposure to DES, patterns of complaints previous to diagnosis, the current status of the patients, and the results of cytopathologic examinations previous to histopathologic diagnosis. After review of the histopathologic slides, the specific pathologic characteristics of CCAC were determined. The age distribution of women born after 1947 was compared with that of women born before 1947.
Information about possible exposure to DES during pregnancy was available for 73 of 88 women with CCAC born after 1947. Exposure to DES was reported for 47 (64%) of these women. The DES medication was most often reported as having started before the 18th week of pregnancy. Cytopathologic examination was informative in 81% of the cases of CCAC of the cervix, but only in 41% of the cases of CCAC of the vagina. Most patients had Stage I or II tumors at diagnosis. Tumor Stage III and IV and a high grade of nuclear atypia were related to unfavorable outcome. The age distribution of all patients with CCAC showed two distinct peaks; one at young age, (a mean age of 26 years), and one at older age (a mean age of 71 years). This bimodal age distribution still applied when the cases in which DES exposure was reported had been excluded.
CONCLUSIONS: Despite the fact that DES has not been prescribed to pregnant women in the Netherlands in the last 20 years, CCAC is still relevant in our times. It is important to stay alert and periodically to update and evaluate the data of this registry, including data on women born outside the DES exposure period. The bimodal age distribution in this study of women without intrauterine exposure to DES suggests a carcinogenesis-promoting role of menarche and menopause and/ or the existence of a subpopulation with genetic risk factors or exogenous risk factors other than exposure to DES. Postmenopausal observation of women exposed to DES must be encouraged for clinical reasons and may help facilitate differentiation between these two hypotheses. If these risk factors of CCAC were better documented and their interrelationships better defined, CCAC could become an important model of multistep carcinogenesis in tissues sensitive to sex hormones.
Sources and more information
Clear cell adenocarcinoma of the vagina and cervix. An update of the central Netherlands registry showing twin age incidence peaks, Cancer. 1997 Jun 1;79(11):2229-36., NCBI PMID: 9179071.
International Ob-Gyn group urges greater efforts to stop exposure to toxic chemicals
Dramatic increases in exposure to toxic chemicals in the last four decades are threatening human reproduction and health, according to the International Federation of Gynecology and Obstetrics (FIGO), the first global reproductive health organization to take a stand on human exposure to toxic chemicals.
The opinion was written by obstetrician-gynecologists and scientists from the major global, US, UK and Canadian reproductive health professional societies, the World Health Organization and the University of California, San Francisco (UCSF).
FIGO, which represents obstetricians from 125 countries and territories, published the opinion in theInternational Journal of Gynecology and Obstetrics on Oct. 1, just prior to its Oct. 4 to 9 world congress in Vancouver, BC, where more than 7,000 clinicians and scientists will explore global trends in women’s health issues.
“We are drowning our world in untested and unsafe chemicals, and the price we are paying in terms of our reproductive health is of serious concern,” said Gian Carlo Di Renzo, MD, PhD, Honorary Secretary of FIGO and lead author of the FIGO opinion. According to Di Renzo, reproductive health professionals “witness first-hand the increasing numbers of health problems facing their patients, and preventing exposure to toxic chemicals can reduce this burden on women, children and families around the world.”
Miscarriage and still birth, impaired fetal growth, congenital malformations, impaired or reduced neurodevelopment and cognitive function, and an increase in cancer, attention problems, ADHD behaviors and hyperactivity are among the list of poor health outcomes linked to chemicals such as pesticides, air pollutants, plastics, solvents and more, according to the FIGO opinion.
“What FIGO is saying is that physicians need to do more than simply advise patients about the health risks of chemical exposure,” said Jeanne A. Conry, MD, PhD, a co-author of the FIGO opinion and past president of the American College of Obstetricians and Gynecologists, which issued an opinion on chemicals and reproductive health in 2013. “We need to advocate for policies that will protect our patients and communities from the dangers of involuntary exposure to toxic chemicals.”
Chemical manufacturing is expected to grow fastest in developing countries in the next five years, according to FIGO. In the U.S. alone, more than 30,000 pounds of chemicals per person are manufactured or imported, and yet the vast majority of these chemicals have not been tested. Chemicals travel the globe via international trade agreements, such as the Transatlantic Trade and Investment Partnership, which is being negotiated between the European Union and the United States. Environmental and health groups have criticized the proposed agreement for weakening controls and regulations designed to protect communities from toxic chemicals.
“Exposure to chemicals in the air, food and water supplies disproportionately affect poor people,” said Linda Giudice, MD, PhD, MSc, a FIGO opinion co-author, past president of the American Society for Reproductive Medicine (ASRM) and chair of the UCSF department of obstetrics, gynecology and reproductive sciences. “In developing countries, lower respiratory infections are more than twice as likely to be caused by chemical exposures than in developed countries.”
Exposure to toxic environmental chemicals is linked to millions of deaths and costs billions of dollars every year, according to the FIGO opinion, which cites the following examples:
Nearly 4 million people die each year because of exposure to indoor and outdoor air pollution as well as to lead.
Pesticide poisonings of farmworkers in sub-Saharan Africa is estimated to cost $66 billion between 2005-2020.
Health care and other costs from exposure to endocrine disrupting chemicals in Europe are estimated to be at a minimum of 157 billion Euros a year.
The cost of childhood diseases related to environmental toxins and pollutants in air, food, water, soil and in homes and neighborhoods was calculated to be $76.6 billion in 2008 in the United States.
“Given accumulating evidence of adverse health impacts related to toxic chemicals, including the potential for inter-generational harm, FIGO has wisely proposed a series of recommendations that health professionals can adopt to reduce the burden of unsafe chemicals on patients and communities,” said FIGO President Sabaratnam Arulkumaran, MBBS, who is also past president of the British Medical Association.
FIGO proposes that physicians, midwives, and other reproductive health professionals advocate for policies to prevent exposure to toxic environmental chemicals; work to ensure a healthy food system for all; make environmental health part of health care; and champion environmental justice.
The FIGO opinion was authored by representatives from the American College of Obstetricians and Gynecologists, American Society for Reproductive Medicine, International Federation of Gynecology and Obstetrics, Royal College of Obstetricians and Gynaecologists, Society of Obstetricians and Gynaecologists of Canada, UCSF’s Program on Reproductive Health and the Environment, and the World Health Organization. These and numerous other reproductive health organizations have either endorsed or formally supported FIGO’s opinion.
The FIGO opinion has also been applauded by health and advocacy groups, including the Health and Environment Alliance (HEAL), Women in Europe for a Common Future (WECF), Healthcare Without Harm, and Physicians for Social Responsibility.
The International Federation of Gynecology and Obstetrics (FIGO) is a non-profit organization that brings together obstetrical and gynecological associations from 125 countries/territories worldwide. It is dedicated to the improvement of women’s health and rights and to the reduction of disparities in healthcare available to women and newborns, as well as to advancing the science and practice of obstetrics and gynecology. Based in London, the organization hosts a triennial World Congress that draws more than 7,000 women’s health scientists, clinicians, and other allied health professionals to present the latest science and best clinical practice in obstetrics and gynecology. This year’s XXI World Congress will be held in Vancouver.
Sources and more information
Global Ob-Gyn Group Urges Greater Efforts to Prevent Toxic Chemical Exposure, figo press release, 01.10.2015.
International Federation of Gynecology and Obstetrics opinion on reproductive health impacts of exposure to toxic environmental chemicals, figo opinion papers, 01.10.2015.
Téléchargez une brochure indépendante, délivrant une information claire.
Le contenu de ce post est publié par Cancer Rose, site né de la rencontre de cinq médecins indépendants, d’horizons différents.
Dépistage du cancer du sein
Une brochure permet de donner le choix aux femmes
Le dépistage organisé du cancer du sein, généralisé en France depuis 2004 et proposé aux femmes de 50 à 74 ans, fait l’objet de controverses. Celles-ci, publiées dans des revues scientifiques de premier plan, ont été longtemps minimisées auprès du grand public.
Les doutes portent sur un faible bénéfice et des risques avérés. Ces derniers sont essentiellement les fausses alertes, c’est à dire l’annonce d’une lésion mammographique qui ne s’avère pas réelle, et le surdiagnostic. Le surdiagnostic est la découverte d’un cancer qui n’aurait pas affecté la santé de la femme de son vivant, s’il n’avait pas été détecté. Le bénéfice s’avère beaucoup plus faible que présenté officiellement, en raison notamment du faible risque en valeur absolue de mourir de ce cancer, et de la faible efficacité du dépistage.
De ce constat est née une brochure indépendante, délivrant une information claire, qui se veut loyale, aussi complète que possible et facilement accessible. Elle est téléchargeable gratuitement directement sur la page d’accueil de cancer-rose.
Seize auteurs l’ont élaborée. Destinée à la lectrice concernée par le dépistage, elle est aussi pensée comme aide au praticien démuni face aux interrogations d’une patiente.
L’objectif de cette brochure, (unique en langue française alors qu’il en existe p.ex. en Allemagne pour les femmes) est de donner aux femmes le pouvoir de décider de façon rationnelle et sans être culpabilisées. Chacune se fera ainsi son opinion au travers des meilleures sources scientifiques disponibles. Même si le dépistage du cancer du sein est un programme dit de santé publique, il n’en reste pas moins que la participation est une décision individuelle qui ne peut être prise qu’en connaissance de cause, ni imposée ni subie.
A l’origine cinq médecins, Dr Pabion, Dr Nicot, Dr Gourmelon, médecins généralistes, Dr Yver, anatomo-patologiste, Dr Bour , radiologue, se sont rencontrés dans le cadre du Formindep et ont décidé de créer un site internet d’information sur le dépistage du cancer du sein, puis cette brochure, initiative inédite puisqu’il n’en existe aucune sous cette forme en langue française.
L’objectif du groupe est d’expliquer aux femmes que ne pas se soumettre au dépistage organisé du cancer du sein par mammographie n’est pas une “faute” contre leur santé. Ces médecins ont voulu ce site et cette brochure pour informer les femmes sur la réalité de la mammographie de dépistage, et parce qu’il n’existe actuellement aucune information indépendante sur les sites officiels pouvant aider les médecins dans leur pratique quotidienne au service de leurs patients.