Environmental risk factors for uterine fibroids: a prospective ultrasound study(Supplement)

子宫肌瘤的环境危险因素：一项前瞻性超声研究（补充）

• 批准号: 9907405
• 负责人: LAUREN A WISE
• 金额: $ 21.81万
• 依托单位: HENRY FORD HEALTH SYSTEM
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-01 至 2020-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9907405
• 关键词: Address; Administrative Supplement; Adult; Adverse event; Affect; African American; Age; Age of Onset; Automobile Driving; Blood; Caucasians; Characteristics; Chemical Exposure; Chemicals; Childhood; Cohort Studies; Communities; Data; Data Collection; Deterioration; Diagnosis; Disadvantaged; Discrimination; Disease susceptibility; Early-life trauma; Economically Deprived Population; Elderly; Endocrine Disruptors; Enrollment; Environment; Environmental Exposure; Environmental Hazards; Environmental Risk Factor; Etiology; Exposure to; Family; Fibroid Tumor; Financial Hardship; Funding; Goals; Gonadal Steroid Hormones; Growth; Gynecologic; Gynecology; Health; Health Care Costs; Health Promotion; Hemorrhage; Hormones; Human; In Vitro; Incidence; Influentials; Laboratories; Life; Life Cycle Stages; Life Style; Literature; Measurement; Measures; Medical; Menarche; Mental Depression; Morbidity - disease rate; National Institute of Environmental Health Sciences; Operative Surgical Procedures; Outcome; Pain; Pathway interactions; Persons; Phenols; Physical activity; Policy Maker; Politics; Polychlorinated Biphenyls; Prevalence; Procedures; Prospective Studies; Prospective cohort study; Proxy; Puberty; Quality of life; Questionnaires; Religion and Spirituality; Reporting; Reproductive Process; Research; Research Design; Resources; Risk; Risk Factors; Role; Sample Size; Serum; Severity of illness; Shapes; Social support; Socioeconomic Status; Spirituality; Standardization; Statistical Data Interpretation; Strategic Planning; Stress; Structure; Symptoms; Teenagers; Testing; Time; Training; Ultrasonography; United States National Institutes of Health; Urine; Uterine Fibroids; Weather; Woman; Women' s Health; Work; age effect; aged; animal data; base; biopsychosocial; bisphenol A; chemical association; cost effective; depressive symptoms; design; early experience; early onset; experience; follow-up; food insecurity; high risk population; human data; innovation; neighborhood safety; parent grant; phthalates; pollutant; pressure; prospective; psychosocial; racial disparity; reproductive; reproductive hormone; screening; symptomatology; tumor; urinary

Abstract of Funded Parent Grant (R01-ES024749) Uterine leiomyomata (UL) are diagnosed in 25-30% of reproductive-aged women, resulting in considerable gynecologic morbidity and billions in U.S. health care costs annually. African Americans have 2-3 times the UL incidence of Whites and greater disease severity. Sex steroid hormones are involved in the etiology of UL. Given that endocrine disrupting chemicals (EDCs) can alter the functioning of hormones, we propose to evaluate UL risk in relation to 3 classes of EDCs: phthalates, polychlorinated biphenyls (PCBs), and phenols, specifically bisphenol A (BPA). Our choice of chemicals is informed by their high exposure prevalence in humans and by in vitro, animal, and human data documenting their effects on reproductive hormones and processes that could influence UL risk. Existing studies of EDCs and UL are limited by small sample size, uncertain temporality due to retrospective design, and suboptimal measurement of EDCs and UL. This study will use data and biospecimens from the Study of Environment Lifestyle and Fibroids (SELF), a NIEHS prospective cohort study of 1,300 African American women aged 23-34 and free of UL at baseline (2010-2012). Questionnaire data were collected at baseline and subjects are being followed for 5 years. Every 20 months, blood and urine are collected, and ultrasounds are performed by trained sonographers to detect UL. We request support for the laboratory and statistical analysis of EDCs in relation to UL incidence. We propose a cost-effective case-cohort study design that includes 400 incident UL cases and 400 controls. We will measure urinary phthalate metabolites, serum PCBs, and urinary BPA, characterize exposures according to UL risk factors, and determine the associations of these chemicals with UL incidence and tumor characteristics. Non-persistent chemicals (phthalates, BPA) will be measured at baseline, 20 months, and 40 months. Persistent chemicals (PCBs) will be measured at baseline only. SELF provides a unique opportunity to assess the association of common EDCs with UL risk. This project has many strengths that overcome the limitations of prior studies: large sample size, prospective data collection, state-of-the-art EDC measurement, serial ultrasound screening for UL, analysis of repeated EDC measures, innovative statistical approaches for evaluating EDC mixtures, and control for multiple confounders. Pilot data show large exposure variability, providing excellent power to test the proposed hypotheses. This study of African Americans, a high-risk population for EDC exposure and UL, will provide informative data on the effects of widespread pollutants on UL, seek explanations for the racial disparity in UL incidence, and provide critical data to the public, scientific community, and policy makers.

资助家长补助金摘要（R01-ES024749） 25-30% 的育龄女性被诊断出子宫平滑肌瘤 (UL)，导致 美国每年有相当高的妇科发病率和数十亿美元的医疗费用。非洲人 美国人的 UL 发病率是白人的 2-3 倍，且疾病严重程度更高。性类固醇 激素与 UL 的病因有关。鉴于内分泌干扰化学物质 (EDC) 可以改变激素的功能，我们建议评估与 3 类相关的 UL 风险 EDC：邻苯二甲酸盐、多氯联苯 (PCB) 和苯酚，特别是双酚 A (BPA)。 我们对化学品的选择是基于其在人类和体外的高暴露率， 动物和人类数据记录了它们对生殖激素和过程的影响 可能会影响 UL 风险。现有的 EDC 和 UL 研究受到样本量较小的限制， 由于回顾性设计以及 EDC 和 UL 的次优测量而导致不确定的时间性。 这项研究将使用环境生活方式和肌瘤研究的数据和生物样本 (SELF)，一项 NIEHS 前瞻性队列研究，对象为 1,300 名 23-34 岁的非洲裔美国女性， 基线（2010-2012 年）不含 UL。收集基线和受试者的问卷数据 已被跟踪 5 年。每 20 个月收集一次血液和尿液，并进行超声波检查 由训练有素的超声技师执行以检测 UL。我们请求对实验室的支持 EDC 与 UL 发生率相关的统计分析。我们提出一个具有成本效益的案例队列 研究设计包括 400 个 UL 事件案例和 400 个对照。我们会测量尿 邻苯二甲酸盐代谢物、血清 PCB 和尿液 BPA，根据 UL 表征暴露情况 危险因素，并确定这些化学物质与 UL 发生率和肿瘤的关联 特征。非持久性化学品（邻苯二甲酸盐、BPA）将在基线 20 进行测量 个月、40 个月。持久性化学品 (PCB) 将仅在基线处进行测量。自己 提供了一个独特的机会来评估常见 EDC 与 UL 风险之间的关联。这 该项目有许多优点克服了先前研究的局限性：样本量大， 前瞻性数据收集、最先进的 EDC 测量、连续超声筛查 UL，重复 EDC 测量分析，评估 EDC 的创新统计方法 混合物，并控制多个混杂因素。试点数据显示暴露变化很大， 为检验所提出的假设提供了极好的能力。这项针对非裔美国人的研究 EDC 暴露和 UL 的高风险人群，将提供有关影响的信息数据 UL 上广泛存在的污染物，寻求 UL 发病率种族差异的解释，以及 向公众、科学界和政策制定者提供关键数据。