The National Academies Press

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1. Introduction and Overview
Pages 9-24

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From page 9... ... Such shifts complicate analytic epidemiological studies of the short- and long-term effects of oral contraceptives. Younger women who have not yet started or have not yet completed their planned childbearing increasingly rely on oral contraceptives and other reversible methods of contraception, and women who do not plan further pregnancies rely more and more on irreversible sterilization procedures for themselves or their partners. Read the entire page →
From page 10... ... A Dawson, "Trends in Use of Oral Contraceptives Data from the 1987 National Health Interview Survey," Family Planning Perspectives 22(1990) Read the entire page →
From page 11... ... 11 Thus, the introduction and dissemination of the use of oral contraceptives in the United States were superimposed on steadily rising breast cancer incidence rates (Devesa et al., 1987~. In the United States, the years since the introduction of oral contraceptives have also been years in which hysterectomy and oophorectomy rates were increasing, and the prescription of replacement hormones (estrogens and progestins) Read the entire page →
From page 12... ... postmenopausal breast cancer incidence rate, which has been more marked in women in their later 60s and 70s than in the earlier postmenopausal years. This is also the cohort of women who were too old ever to have taken oral contraceptives. Read the entire page →
From page 13... ... The United States has one of the world's highest annual rates of breast cancer incidence, a rate that was already increasing steadily when oral contraceptives were introduced. Whether susceptible women had already fulfilled their carcinogenesis potential (see Appendix B) Read the entire page →
From page 14... ... A.Dawson, "Trends in Use of Oral Contraceptives Data from the 1987 National Health Interview Survey," Family Planning Perspectives 22(1990) Read the entire page →
From page 15... ... A Dawson, "Trends in Use of Oral Contraceptives Data from the 1987 National Health Interview Survey," Family Planning Perspectives 22(1990) Read the entire page →
From page 16... ... Although some information has been collected about the influence on breast cancer rates of relatively short-term exposures to oral contraceptives, whether long-term use beginning at any age increases pre-, pert-, or postmenopausal breast cancer risk has yet to be determined. And, the possibility has been raised that oral contraceptive use may increase breast cancer risk in relatively underdeveloped countries with low background breast cancer rates. Read the entire page →
From page 17... ... The cohort of women with prolonged oral contraceptive use is just now entering the menopausal years when HRT is prescribed. This affords both the opportunity for and the necessity of studying breast cancer risk in relation to the use of oral contraceptives followed sequentially by HRT. Read the entire page →
From page 18... ... In the case of oral contraceptives, a prudent alternative to waiting for the occurrence of unexpected disease is a well-planned cohort approach to detect all forms of unexpected side effects and possible benefits, as well. Some such studies have been conducted in the United States Read the entire page →
From page 19... ... The chapter also discusses the need to plan a fresh cohort study as soon as a new oral contraceptive preparation is brought into general use, as well as the opportunity to capture essential new information that arises in countries that have relatively low background rates of breast cancer and that decide to introduce the pill as a generally available contraceptive. The potential contributions of existing animal and in vitro human tissue models to questions of oral contraceptives and breast cancer have not been fully exploited, perhaps because they are mostly being used by investigators who are working within their own disciplines to answer other specific questions. Read the entire page →
From page 20... ... For example, although new progestins that are still making their way through the approval process in the United States have been widely used in Europe for a decade, there is no published body of epidemiological evidence on their influence on overall cardiovascular and cancer disease profiles. In addition, no postmenopausal women used oral contraceptives earlier in their reproductive lives for a period long enough to yield any information about systematic oral contraceptive influence on disease profiles. Read the entire page →
From page 21... ... Most of the relatively few unplanned pregnancies that do occur during pill use are due to inconsistent or incorrect use, including contemporaneous use of other drugs that compromise the effectiveness of oral contraceptives (Mattison, 1984~. It is important to remember that users have not only fewer deliveries but fewer abortions and ectopic pregnancies, each of which carries its own risk of mortality and morbidity. Read the entire page →
From page 22... ... Oral contraceptives are associated with a marked increase in the relative risk of benign and malignant liver tumors, but these tumors are so exceedingly rare among U.S. women that a pill user's absolute risk of getting one remains low. Read the entire page →
From page 23... ... Oral contraceptives have proved popular not only in America but in diverse cultures ranging from China to Indonesia to Tunisia to Colombia, and their use is likely to continue to grow rapidly in the coming decade. Globally, one woman a minute dies from pregnancy, childbirth, or abortion, and there is no doubt that oral contraceptives have saved and will continue to save a great many lives. Read the entire page →
From page 24... ... It is imperative to fill in what is possibly the last substantial gap in knowledge of oral contraceptive side effects namely, the effect, if any, on breast cancer. More than 80 percent of American women now in their 20s and 30s who have ever had intercourse have used the pill at some time or other in their fertile lives. Read the entire page →

From page 9...

... Such shifts complicate analytic epidemiological studies of the short- and long-term effects of oral contraceptives. Younger women who have not yet started or have not yet completed their planned childbearing increasingly rely on oral contraceptives and other reversible methods of contraception, and women who do not plan further pregnancies rely more and more on irreversible sterilization procedures for themselves or their partners.

1. Introduction and Overview Pages 9-24

1. Introduction and Overview
Pages 9-24