Racial and Ethnic Differences in the Pathogenesis and Clinical Manifestations of Uterine Leiomyoma

Abstract

Uterine leiomyomas are the most common benign gynecologic condition. The prevalence is three times more common among women of African ethnicity. Disparity in this disease is evidenced by earlier age of onset, greater severity of symptoms, and different response to treatment. Although the pathogenesis of disease development is not completely known, growing evidence focuses on investigating the molecular mechanisms in disease development and the influence of ethnicity. Variation in the expression levels or function of estrogen and progesterone receptors, polymorphism of genes involved in estrogen synthesis and/or metabolism (COMT, CYP17), retinoic acid nuclear receptors (retinoid acid receptor-α, retinoid X receptor-α), and aberrant expression of micro-RNAs (miRNAs) are some of the molecular mechanisms that may be involved. Nutritional factors, such as vitamin D deficiency, might also contribute to the higher incidence in dark skinned populations who are also commonly suffer from hypovitaminosis D. Culture and environmental difference might have a role in disease development. Further analysis and better understanding of these mechanisms will provide insight into the molecular basis of racial disparities in leiomyoma formation and will help to develop new innovations in leiomyoma treatment.

Signaling Pathways in Leiomyoma: Understanding Pathobiology and Implications for Therapy

“…This was followed by two other major studies including a cohort of women from the eastern United States in 2013 by Baird and colleagues (140) and another cohort of Italian women in 2013 by Paffoni and colleagues (141). The high prevalence of vitamin D deficiency in African Americans may explain, at least in part, the high prevalence of uterine fibroids in this patient population (142).…”

Gonadotropin-releasing hormone analogues inhibit leiomyoma extracellular matrix despite presence of gonadal hormones

“…The high prevalence (70%-80%) and presence of accompanying morbid symptoms that affect women with this disease justify the need for improved therapeutic intervention (3). African American women are particularly affected by this disease and experience more severe symptomatology when compared with other women in the population (4)(5)(6)(7). Common symptoms that may afflict these patients and affect their quality of life may include heavy and prolonged menstrual bleeding resulting in anemia, infertility, and pelvic and leg pain (2,4,6).…”

“…African American women are particularly affected by this disease and experience more severe symptomatology when compared with other women in the population (4)(5)(6)(7). Common symptoms that may afflict these patients and affect their quality of life may include heavy and prolonged menstrual bleeding resulting in anemia, infertility, and pelvic and leg pain (2,4,6). Although hysterectomy is curative, it is associated with short-term and long-term morbidity and precludes future childbirth.…”

Diet-induced vitamin D deficiency triggers inflammation and DNA damage profile in murine myometrium

“…Although there are many factors associated with an increased risk of UF development, such as nulliparity, early menarche, obesity and genetics, the race is considered to be one of the most important among them. We have reported that the estimated prevalence of UFs remains significantly higher in African-American women even after controlling for potential confounders such as parity and body mass index 1. These minority women also commonly suffer from vitamin D deficiency 2.…”