Oral Contraceptives and Breast Cancer (1991) / Chapter Skim
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Appendix E: Risks and Benefits of Oral Contraceptives: Will Breast Cancer Tip the Balance?
Appendix E: Risks and Benefits of Oral Contraceptives: Will Breast Cancer Tip the Balance?
Pages 165-174
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From page 165... ...
The recognition that oral contraceptives reduced the risk of benign breast disease fueled the hope that they would also protect against breast cancer. The great majority of studies, however, have shown no alteration of risk; indeed, several recent investigations have suggested that oral contraceptives may increase the risk of breast cancer in certain groups of women (Schlesselman, 1989; Thomas, 1989; Mann, 1990~.
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From page 166... ...
The noncontraceptive benefits of combined oral contraceptives include reductions in the incidence of menstrual problems (such as dysmenorrhea and menorrhagia) , irondeficiency anemia, pelvic inflammatory disease, functional ovarian cysts, benign breast disease, epithelial ovarian cancer, and endometrial cancer (Prentice and Thomas, 1987; Population Information Program, 1988; Nlessey, 1990~.
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From page 167... ...
that modern low-dose oral contraceptives carry lower risks. Long-term use of the pill increases the risk of hepatocellular adenoma (Rooks et al., 1979)
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From page 168... ...
Vessey recently described a simplified model of mortality that compares users of oral contraceptives and of condoms in the United Kingdom (Vessey, 1990~. He assumes that a cohort of one million women start to use combined oral contraceptives at age 16 and that another cohort of one million women decide to rely on the condom from the same age.
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From page 169... ...
But not only were the relative risk estimates much closer to 1.0 than in the previous studies; there was now no greater effect of use before the first pregnancy than after the first pregnancy. The results were presented clearly, but many readers apparently did not appreciate that the authors' previous hypothesis (about a risk confined to use at a specific time in early reproductive life)
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From page 170... ...
Doll concluded that use of oral contraceptives produces no material increase in the risk of developing breast cancer after the age of about 45. With regard to the 35- to 44-year-old age group, he thought that it is "reasonable to postulate that there is some tailing off of the effect" occurring at younger ages.
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From page 171... ...
La Vecchia proposed that oral contraceptives might have an effect similar to that of pregnancy, although the evidence supporting this hypothesis is limited (La Vecchia, 1990~. Third, there could be an effect of use early in reproductive life, which has become common only among the most recent cohorts of women.
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From page 172... ...
The relationship between the pill and breast cancer appears complex and will not be clarified by a focus only on positive subgroups. If future studies are not to produce results that may be misleading from a public health viewpoint, they should cover the full range of ages of women who have used oral contraceptives (including women who have passed the menopause)
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From page 173... ...
1986. Oral contraceptives and hepatocellular carcinoma.
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From page 174... ...
1990. An overview of the benefits and risks of combined oral contraceptives.
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