Saliva samples were taken previously from women in Bolivia, the Democratic Republic of Congo, Nepal, Poland, and the United States.2
Samples were collected daily during at least one menstrual cycle from women 25 to 35 years old, and progesterone concentrations were analysed by radioimmunoassay.2
Mean concentrations were calculated for the fifth to ninth days preceding the start of the next cycle (mid-luteal phase); these are the days with the highest progesterone concentrations.2
The relation between these concentrations and the incidence of breast cancer in each country was investigated. The data on cancer incidence were obtained from the Globocan database of the International Agency for Research on Cancer (www-dep.iarc.fr/dataava/globocan/globoJava.html
). The populations studied in this analysis are the only ones for which reliable values of ovarian progesterone are available. All variables used in this study were transformed to natural logarithms before the correlation analyses were performed.
Higher concentrations of ovarian progesterone in the mid-luteal phase were strongly associated with an increasing incidence of breast cancer (r2
=0.968, P=0.0025) (figure): an increase in progesterone concentration of <70% coincided with a more than 8-fold rise in cancer rate. This pattern confirms the expected positive relation between concentrations of ovarian progesterone and incidence of breast cancer in these populations.1
Mean total energy intake was used as a crude indicator of the relative energy status of a population and its relation with progesterone concentrations was examined. The mean values used in this analysis came from the food balance sheets of the Food and Agriculture Organisation (http://apps.fao.org/page/collections
); values used were 7.6 MJ/day for the Congo, 9.2 MJ/day for Bolivia, 9.6MJ/day for Nepal, 14.0 MJ/day for Poland, and 15.3 MJ/day for the United States. These values were positively and significantly correlated with concentrations of ovarian progesterone (r2
=0.818, P=0.035). Thus, poor energy status in a population is associated with impaired ovarian function in women.
Clinical studies have shown that restricting energy intake frequently leads to recurring suppression of reproductive function. Such suppression ranges from reduced steroid production and anovulatory cycles to total amenorrhoea when conditions become severe. In these circumstances the lifetime production of ovarian steroid hormones is curtailed. In contrast, when the available energy is virtually unlimited women have frequent ovulatory menstrual cycles characterised by high hormone concentrations.