RISK FACTORS FOR UTERINE LEIOMYOMA

子宫平滑肌瘤（UL）发生在20-40%的妇女，主要是在他们的晚期 生殖年;它被广泛引用，UL频率要高得多， 在黑人中。 有症状的病例占总数的50%; 异常阴道出血、盆腔疼痛、不孕症和不良妊娠 事件可能发生。 据估计，其中一部分病例的比例不详， 恶性转化为平滑肌瘤。 虽然 保守的管理现在更普遍，UL仍然是主要原因 子宫切除术的案例 临床观察结果支持 认为子宫肌层的无对抗性雌激素刺激 与UL有关。 然而，只有三项流行病学研究 发表;一致的结果是积极的关联， 未生育，与绝经和吸烟呈负相关。 关于口服避孕药的作用， 替代雌激素、肥胖和月经期。 这些 研究可能会受到选择偏倚的影响，因为它们是基于 仅在主要无症状或轻度 有症状的情况 一项基于实践的病例对照研究将在巴尔的摩 该地区的妇女在一组妇科医生的照顾下， 约翰霍普金斯医疗机构。 主要目的是确定 UL是否与子宫内膜增生的几种标志物有关 暴露于无抵抗的内源性和外源性雌激素。 其他因素 包括种族和社会经济地位;动脉粥样硬化风险 因素（自我报告的肥胖、高血压、糖尿病和吸烟） 病史）; UL家族史;以及子宫内膜异位症的可能来源 刺激（盆腔炎，使用子宫内 避孕装置、阴道冲洗和会阴使用滑石粉）。 例 这些从业者诊断的UL，组织学或 超声波检查证实，将被确定。 符合条件的案件将 地区居民，绝经前，无侵入性病史或存在 乳腺癌或妇科癌症。 对照品的频率将与 年龄在5岁以内的病例，从来访的妇女中随机挑选 日历期间由同一名医生进行常规妇科评估 该病例的肿瘤首次被临床怀疑时的一个月。 控制 如果他们是绝经后、子宫切除、 临床UL，或浸润性乳腺或妇科病史或存在 癌的 预计将确定约350例病例和350例对照 九个月后 受过培训的女性面试官将利用结构化的 电话访谈问卷;此外， 将从医疗记录中提取 医疗监测数据和 还将收集健康行为指标，以控制 真让人困惑 将进行双变量和分层分析， 将拟合逻辑回归模型;访谈之间的一致性 和医疗记录数据进行研究。 研究结果预期 提供目前未定义的人口统计学和流行病学信息 制定预防策略，并确定高危人群， 需要监测。

Uterine leiomyoma (UL) occurs in 20-40% of women, mainly in their late reproductive years; it is widely quoted that UL frequency is much higher among blacks. Symptomatic cases comprise up to 50% of the total; abnormal vaginal bleeding, pelvic pain, infertility and adverse pregnancy events may occur. An unknown proportion of the cases is estimated to undergo malignant transformation into leiomyosarcomas. Although conservative management is now more common, UL is still the leading cause of hysterectomy in the United States. Clinical observations support the idea that unopposed estrogenic stimulation of the myometrium is associated with UL. However, only three epidemiologic studies have been published; consistent findings were a positive association with nulliparity, and a negative association with menopause and smoking. Conflicting data emerged regarding the role of oral contraceptives, replacement estrogens, obesity, and duration of menstrual life. These studies were potentially subject to selection bias, as they were based only on surgical cases of a predominantly asymptomatic or mildly symptomatic condition. A practice-based case-control study will be conducted among Baltimore area women under the care of a group of gynecologists affiliated with The Johns Hopkins Medical Institutions. The primary aim is to determine whether UL is associated with several markers of increased uterine exposure to unopposed endogenous and exogenous estrogens. Other factors to be studied include race and socioeconomic status; atherogenic risk factors (self-reported obesity, hypertension, and diabetes, and smoking history); family history of UL; and possible sources of uterine irritation (pelvic inflammatory disease, use of intrauterine contraceptive device, vaginal douching, and perineal use of talc). Cases of UL diagnosed by these practitioners, and histologically or sonographically confirmed, will be ascertained. Eligible cases will be area residents, premenopausal, with no history or presence of invasive breast or gynecologic cancers. Controls will be frequency matched to cases on age within 5-year groups, randomly selected among women visiting the same physician for routine gynecologic evaluation during the calendar month when the case's tumor was first clinically suspected. Controls will be excluded if they are postmenopausal, hysterectomized, have clinical UL, or history or presence of invasive breast or gynecologic cancers. About 350 cases and 350 controls are expected to be ascertained in nine months. Trained female interviewers will utilize a structured questionnaire in telephone interviews; in addition, selected information will be abstracted from medical records. Data on medical monitoring and health behavior indicators will also be collected, to allow control for confounding. Bivariate and stratified analyses will be conducted, and logistic regression models will be fitted; agreement between interview and medical records data will be studied. Study findings are expected to provide currently undefined demographic and epidemiologic information for preventive strategies, and for identification of high risk groups in need of monitoring.