ELLAS: Environment, Leiomyomas, Latinas and Adiposity Study

ELLAS seeks to address the significant gap in our knowledge of leiomyomas in the fastest growing group of women in the United States-Latinas. Uterine leiomyomas or "fibroids" are well-defined, benign smooth muscle tumors of the uterus that represent a significant healthcare burden in women. For the populations on which we have data, largely Caucasian and African-American women, fibroids are present in 30%-50% of reproductive-age women and have an overall cumulative incidence of >70% by the age of 50 years. Fibroids are associated with menorrhagia, anemia, infertility, pelvic pain, and recurrent pregnancy loss. The physiological and psychological sequelae of these symptoms, and the lack of effective medical treatment options, explain why these benign tumors remain the leading cause of hysterectomy in the United States. Recent analyses estimate the cost of fibroids in the U.S. to be as high as $34 billion annually. While we know that fibroids disproportionately affect African-American women, there are very few data on either their prevalence amongst Latinas or whether there are risk factors for fibroids that are unique to Latinas. The Latina population has high rates of obesity and diabetes, both of which have been implicated as risk factors for fibroids. The overall objective of this proposal is to determine the prevalence and growth patterns of leiomyomas amongst Latinas and to examine metabolic dysregulation as a risk factor for leiomyomas in this population. We will recruit 600 premenopausal Latinas between the ages of 25- 45 for evaluation. Pelvic ultrasound will be performed to determine prevalence and survey data, saliva, and blood samples will be collected (Aim 1). Subjects who have fibroids at this initial visit will return for a follow-up visit in 18-24 months to determine fibroid growth ovr that time and to identify factors related to growth (Aim 1). We will also measure adiposity and various biomarkers of metabolism and glucose regulation, and determine th