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Review
. 2023 Nov 4;24(21):15972.
doi: 10.3390/ijms242115972.

Evidence-Based Approach for Secondary Prevention of Uterine Fibroids (The ESCAPE Approach)

Somayeh Vafaei  1 , Michał Ciebiera  2   3   4 , Mervat M Omran  1 , Mohammad Mousaei Ghasroldasht  1 , Qiwei Yang  1 , Tanya Leake  5 , Rochelle Wolfe  5 , Mohamed Ali  1 , Ayman Al-Hendy  1
Affiliations
Review

Evidence-Based Approach for Secondary Prevention of Uterine Fibroids (The ESCAPE Approach)

Somayeh Vafaei et al. Int J Mol Sci. .

Abstract

Uterine fibroids (UFs) are common tumors in women of reproductive age. It is imperative to comprehend UFs' associated risk factors to facilitate early detection and prevention. Simple relying on surgical/pharmacological treatment of advanced disease is not only highly expensive, but it also deprives patients of good quality of life (QOL). Unfortunately, even if the disease is discovered early, no medical intervention is traditionally initiated until the disease burden becomes high, and only then is surgical intervention performed. Furthermore, after myomectomy, the recurrence rate of UFs is extremely high with the need for additional surgeries and other interventions. This confused approach is invasive and extremely costly with an overall negative impact on women's health. Secondary prevention is the management of early disease to slow down its progression or even halt it completely. The current approach of watchful observation for early disease is considered a major missed opportunity in the literature. The aim of this article is to present an approach named the ESCAPE (Evidence-Based Approach for Secondary Prevention) of UF management. It comprises simple, inexpensive, and safe steps that can arrest the development of UFs, promote overall reproductive health, decrease the number of unnecessary surgeries, and save billions of health care systems' dollars worldwide.

Keywords: EGCG; leiomyoma; reproductive health; secondary prevention; uterine fibroid; vitamin D3.

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Conflict of interest statement

A.A-H declares receiving consulting fees from AbbVie, Bayer, Myovant, Novartis, ObsEva, and Pfizer, outside of the current work. The uthors declare no conflicts of interest.

Figures

Figure 1
Figure 1
The important markers which play roles in vitamin D such as, NF-KB: Nuclear Factor-Kappa B; MAPK: Mitogen-Activated Protein Kinase; TGFB1: Transforming Growth Factor Beta 1; TGFB3: Transforming Growth Factor Beta 3; SMAD: Mothers Against Decapentaplegic (SMAD is a family of proteins); CDK: Cyclin-Dependent Kinase; COMT: Catechol-O-Methyltransferase; PCNA: Proliferating Cell Nuclear Antigen; KI-67: Antigen KI-67 (also known as MKI67); CYCLIN D1: Cyclin D1; MYC: Myelocytomatosis Oncogene; BAX: Bcl-2 Associated X Protein; CASPASE 3: Caspase 3; BAD: Bcl-2 Associated Death Promoter; BCL2: B-Cell Lymphoma 2; MMPS: Matrix Metalloproteinases (MMPS is a family of proteins); PAI-2: Plasminogen Activator Inhibitor-2; TIMP: Tissue Inhibitor of Metalloproteinases (TIMP is a family of proteins); FIBRONECTIN: Fibronectin; COLLAGEN: Collagen; VEGF: Vascular Endothelial Growth Factor; ROS SCAVENGERS: Reactive Oxygen Species Scavengers; ER: Estrogen Receptor and PR: Progesterone Receptor. (Red arrow: decreased expression, black arrow: increased expression.)
Figure 2
Figure 2
The important markers which play roles in EGCG such as, NF-KB: Nuclear Factor-Kappa B; Fas; Fas cell surface death receptor; MAPK: Mitogen-Activated Protein Kinase; TGFB1: Trans-forming Growth Factor Beta 1; TGFB3: Transforming Growth Factor Beta 3; CDK: Cy-clin-Dependent Kinase; PCNA: Proliferating Cell Nuclear Antigen; KI-67: Antigen KI-67 (also known as MKI67); BMP2: Bone Morphogenetic Protein 2; BAX: Bcl-2 Associated X Protein; CASPASE 3: Caspase 3; apoB: Apolipoprotein B; BCL2: B-Cell Lymphoma 2; MMPS: Matrix Metalloproteinases (MMPS is a family of proteins); FIBRONECTIN: Fibronectin; COLLAGEN: Collagen; VEGF: Vascular Endothelial Growth Factor; FGF: Fibroblast Growth Factor; SOD1: Superoxide Dismutase 1; NOX: NADPH Oxidase; ER: Estrogen Receptor and PR: Progesterone Receptor (Red arrow: decreased expression, black arrow: increased expression.).
Figure 3
Figure 3
Utilization of vitamin D (4000 IU/day), and epigallocatechin gallate (EGCG), (800 mg/day) can be considered safe and efficacious for extended usage based on related studies.
Figure 4
Figure 4
Simple but important considerations to avoid endocrine-disrupting chemical (EDC)-containing products, such as using phthalate-free products, reading labels to seek alternatives, reducing the use of plastic containers, avoiding traffics jam, removing shoes before entering the home, reducing the use of beauty and cosmetic products like nail polish, avoiding water plastic bottle and air freshener, staying hydrated with filtered water, wearing mask, including detox foods, adopting a plant-based diet intake, consuming fruits with vitamins and fiber content, dusting and vacuuming often with a high-efficiency particulate absorbing filter (HEPA)-filtered vacuum, choosing fresh whole foods over processed ones.
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