Re: Reversal of Relation Between Body Mass and Endogenous Estrogen Concentrations With Menopausal Status (original) (raw)

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Imperial Cancer Research Fund Cancer Epidemiology Unit

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oxford, U.K.

Correspondence to: Hollie V. Thomas, Imperial Cancer Research Fund Epidemiology Unit, Gibson Bldg., Radcliffe Infirmary, Oxford, OX2 6 HE,U.K.

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Imperial Cancer Research Fund Cancer Epidemiology Unit

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oxford, U.K.

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Imperial Cancer Research Fund

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London, U.K.

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Imperial Cancer Research Fund

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London, U.K.

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Department of Academic Biochemistry, Royal Marsden Hospital

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London

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Imperial Cancer Research Fund Oncology Unit, Guy's Hospital

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London

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Unit of Metabolic Medicine, St. Mary's Hospital Medical School

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London

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Hollie V. Thomas, Timothy J. Key, Diane S. Allen, John W. Moore, Mitchell Dowsett, Ian S. Fentiman, Dennis Y. Wang, Re: Reversal of Relation Between Body Mass and Endogenous Estrogen Concentrations With Menopausal Status, JNCI: Journal of the National Cancer Institute, Volume 89, Issue 5, 5 March 1997, Pages 396–397, https://doi.org/10.1093/jnci/89.5.396
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The risk of breast cancer may be decreased in obese premenopausal women but increased in obese postmenopausal women. Potischman et al. ( 1 ) recently evaluated the relation of body mass index (BMI, kg/m 2 ) and hormonal profiles in 88 premenopausal and 210 postmenopausal control subjects from a study of endometrial cancer. They reported a significant decrease in sex hormone binding globulin (SHBG) concentrationas BMI increased in both menopausal groups. As BMI increased, total estradiol increased significantly in postmenopausal women but decreased in premenopausal women, significantly so during the follicular phase. We have repeated these analyses in another dataset.

We used serum hormone concentrations for 182 premenopausal and 178 postmenopausal control subjects from a prospective study of endogenous hormone concentrations and breast cancer on the island of Guernsey, U.K. ( 2 ). Written informed consent was obtained from all study participants, and procedures were approved by institutional review. Height and weight were measured at interview, a blood sample was collected, and serum was stored at −20°C. Serum concentrations of SHBG were measured by liquid-phase immunoradiometric assay while estradiol and progester one were measured by radioimmuno assay. All premenopausal women reported menstruating in their usual pattern and their next menstrual period within 42 days of the interview date. All postmenopausal women reported having had no menstrual periods in the last 12 months. Women were excluded if they were using exogenous sex hormones at the time of blood collection.

Analysis of covariance was used to calculate the geometric mean values within the menopausal groups, and multiple regression was used to test the trend of BMI with hormone concentration. For comparability with the results of Potischman et al., we grouped BMI according to their tertiles. All analyses were adjusted for age and duration of blood storage; analyses involving premenopausal women were also adjusted for day of menstrual cycle (0–2, 3–11, 12–15, 16–21, and 22+ days prior to the next menstrual period for SHBG; 0–2, 3–5, 6–8, 9–11, 12–15, 16–18, 19–21, 22–24, and 25+ days prior to the next menstrual period for estradiol and progesterone). Two-sided P values are quoted.

Potischman et al. that SHBG concentrations decreased as BMI increased in both premenopausal and postmenopausal women and that estradiol concentration increased with BMI in postmenopausal women ( Table 1 ). These relationships have been well established in many previous studies. Potischman et al. reported a 45% lower mean follicular phase estradiol concentration in premenopausal women with high BMI,whereas we found a nonsignificant 20% lower concentration. In serum collected between 0 and 15 days prior to the next menstrual period, we observed a 6% higher mean estradiol concentration and a 12% lower mean progesterone concentration in women with relatively high BMI. Westhoff et al. ( 3 ) recently reported a 14% higher mean urinary estradiol ( P = .16) and an 18% lower mean serum progesterone concentration ( P =.003) during the luteal phase in 84 women in the upper half of the distribution of body weight compared with 83 women in the lower half of the distribution.

Severe obesity, associated with anovulation, is probably associated with reduced production of both estradiol and progesterone in the second half of the menstrual cycle ( 4 ). However, in contrast to the unequivocal relationship of BMI with SHBG and with postmenopausal estradiol concentration, any association between BMI and estradiol concentration in premenopausal women with regular menstrual cycles is more subtle.

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