Medical Bulletin 06/ June/ 2024

Some women who experience menopause early—before age 40—have an increased risk for developing breast and ovarian cancer, according to research being presented Monday at ENDO 2024, the Endocrine Society’s annual meeting.

Breast and ovarian cancers are two of the most significant health concerns affecting women globally. Breast cancer originates in the breast tissue, primarily in the ducts or lobules, and is characterized by the uncontrolled growth of malignant cells. It is the most common cancer among women worldwide, with risk factors including genetics, lifestyle choices, and hormonal influences. Ovarian cancer, although less common, is particularly deadly due to its late diagnosis. It begins in the ovaries, which are responsible for producing eggs and hormones, and can spread quickly to other parts of the body.

Recent studies have highlighted that early menopause may increase the risk of developing both breast and ovarian cancers, underscoring the need for awareness and early detection strategies.

Researchers started with the hypothesis that women with primary ovarian insufficiency (POI) and their family members might be predisposed to reproductive or hormone-related cancers. POI occurs when a woman's ovaries stop functioning normally before age 40.

The study involved 613 women with POI and 165 women who experienced early menopause. Researchers reviewed medical records from 1995 to 2021 and used the Population Database to trace genealogy and cancer diagnoses among these women and their relatives. They focused on diagnoses of breast, ovarian, endometrial and colon cancer.

The results revealed that women with early menopause had a twofold increased risk for breast cancer and an almost fourfold increased (borderline) risk for ovarian cancer. Additionally, the risk of breast cancer was 1.3 times higher and colon cancer 1.5 times higher in second-degree relatives.

“Women who have infertility from low egg numbers or experience early menopause should make sure they are regularly screened for breast cancer, especially if they have family members with cancer. Doctors who practice general medicine, gynaecology and fertility treatment should be aware that early menopause increases risk for a number of diseases, and they should now be aware that breast cancer may be one of these diseases to watch for,” said Corrine Welt, chief of the Division of Endocrinology, Metabolism and Diabetes at the University of Utah Health in Salt Lake City.

Reference: Corrine Welt, M.D. et al.; Early menopause linked to greater risk for breast, and possibly ovarian cancer; THE ENDOCRINE SOCIETY; MEETING: ENDO 2024

A recent BMC Public Health study examined data from the National Health and Nutrition Examination Survey (NHANES) database to investigate the association between atherosclerotic cardiovascular disease (ASCVD) and dietary choline.

Choline is an essential nutrient needed for making several important molecules in the body, including acetylcholine, a neurotransmitter involved in memory, mood, and muscle control. It also helps form cell membrane components like phosphatidylcholine and sphingomyelin. Since the body can't produce enough choline on its own, it's important to get it from foods like beef, fish, milk, eggs, cruciferous vegetables, legumes, and nuts.

The connection between choline and heart disease (ASCVD) is not clear. Some studies suggest choline may increase heart disease risk by affecting the TMAO pathway, while others indicate it might help prevent heart issues by regulating metabolism.

Metabolic syndrome (MetS) includes conditions like high cholesterol, high blood sugar, high blood pressure, and obesity, affecting 20-30% of adults worldwide. It raises the risk of heart disease, heart attacks, and strokes.

In the study, researchers examined how choline intake affects the risk of ASCVD in adults and the development of metabolic syndrome. The cross-sectional study included 5,525 individuals from the NHANES database between 2011 and 2018. Out of these, 510 participants were categorised into the non-ASCVD group, while 5,015 individuals were placed in the ASCVD group.

The results showed no significant correlation between choline intake and metabolic syndrome.

The study found that the optimal choline intake for beneficial effects was 244 mg/day for women and 367 mg/day for men, with men experiencing more protective effects from higher choline intake.

Choline is essential for preventing chronic diseases and neurodevelopment issues, as deficiency can lead to muscle damage and fatty liver. The study also indicated that excessive choline intake did not correlate with an increased risk of stroke, possibly because the brain regulates choline absorption, release, and metabolism.

Reference: Lin, H., Zong, Z., Zhang, C., et al. (2024) An inverse association of dietary choline with atherosclerotic cardiovascular disease among US adults: a cross-sectional NHANES analysis. BMC Public Health 24(1460). doi:10.1186/s12889-024-18837-8

Researchers at the University of São Paulo (USP) in Brazil have shown for the first time that SARS-CoV-2, the virus that causes COVID-19, can remain in the sperm of patients for up to 90 days after hospital discharge and up to 110 days after the initial infection, reducing semen quality.

The study was published in the journal Andrology.

More than four years after the start of the pandemic, researchers know that SARS-CoV-2 is able to invade and destroy several types of human cells and tissue, including the reproductive system. Although scientists have noted that the virus is more aggressive than other viruses toward the male genital tract, and autopsies have found it in testicles, it has rarely been detected in semen by polymerase chain reaction (PCR) analysis, which focuses on viral DNA.

To understand this, the study used real-time PCR and transmission electronic microscopy (TEM) to detect viral RNA in semen and spermatozoa donated by men who were recovering from COVID-19.

For the study, semen samples were taken from 13 patients, aged 21 to 50, who had experienced mild, moderate, or severe COVID-19 and had been admitted to Hospitals.

The analysis was conducted up to 90 days after discharge and 110 days after diagnosis. Although PCR test results were negative for SARS-CoV-2 in the semen, the virus was detected in the sperm of eight out of 11 moderate to severe COVID-19 patients (72.7%) within 90 days of discharge, suggesting it could be present for even longer. SARS-CoV-2 was also detected in one patient with mild COVID-19.

Overall, the virus was found in the sperm of nine out of the 13 patients (69.2%). Additionally, two other patients exhibited ultrastructural gamete impairment similar to that seen in COVID-19 patients. The authors concluded that 11 of the patients had the virus in their sperm.

“Moreover, we found that the sperm produced ‘extracellular traps’ based on nuclear DNA. In other words, the genetic material in the nucleus decondensed, the sperms’ cell membranes ruptured, and the DNA was expelled into the extracellular medium, forming networks similar to those described previously in the systemic inflammatory response to SARS-CoV-2,” said Jorge Hallak, corresponding author of the article.

Reference: Hallak J, Caldini EG, Teixeira TA, et al. Transmission electron microscopy reveals the presence of SARS-CoV-2 in human spermatozoa associated with an ETosis-like response. Andrology. 2024; 1-9. https://doi.org/10.1111/andr.13612