Re­duce can­cer risk by tak­ing the Pill? Re­ally?

The Irish Times - Tuesday - Health - - Health - Muiris Hous­ton mhous­ton@irish­times.com @muirishous­ton

For many younger women the oral con­tra­cep­tive pill (OCP) is the “go-to” method to con­trol fer­til­ity. It’s a re­li­able method of con­tra­cep­tion, with an es­ti­mated 100 to 150 mil­lion women world­wide us­ing the Pill at present.

While the short-term risks of tak­ing a com­bined oe­stro­gen and pro­ges­terone prod­uct, such as the chances of an in­di­vid­ual de­vel­op­ing a blood clot, will be the main fo­cus of an ini­tial con­sul­ta­tion when de­cid­ing on the safest and most suit­able form of con­tra­cep­tion, there are other long-term health is­sues worth con­sid­er­ing.

A re­cent study has looked at the very long-term can­cer risks and ben­e­fits as­so­ci­ated with the OCP. Re­searchers in the UK en­rolled some 23,000 women us­ing OCPs and 23,000 women with no past or cur­rent use of OCP in the study be­tween 1968 and 1969. They were fol­lowed up for an av­er­age of 40 years and the in­ci­dence of dif­fer­ent can­cers in each group was cal­cu­lated. The av­er­age du­ra­tion women used the Pill for was 3.7 years.

Of the women who had ever used the OCP, some 4,661 were di­ag­nosed with at least one can­cer over the fol­low-up pe­riod. Among the never-users, 2,341 were di­ag­nosed with can­cer. Cur­rent or re­cent (within the past five years) users of the OCP were at an in­creased risk for can­cer in gen­eral as well as for breast can­cer and for can­cer of the cervix. This sig­nif­i­cantly in­creased risk of breast and cer­vi­cal can­cer ap­peared to wane within about five years of stop­ping the Pill; nor was there any ev­i­dence of ei­ther can­cer re­cur­ring at in­creased risk over time in “ever users”. And there was noth­ing to sug­gest that new can­cer risks ap­peared later in life among women who had used the OCP.

The study, pub­lished in the Amer­i­can Jour­nal of Ob­stet­rics and Gy­nae­col­ogy, sug­gested some strik­ing long-term ben­e­fits: use of the OCP was as­so­ci­ated with a re­duced risk of bowel can­cer, ovar­ian can­cer, can­cer of the womb and blood can­cers. This as­so­ci­a­tion lasted for many years af­ter stop­ping the Pill.

Oe­stro­gen and pro­ges­terone may in­flu­ence can­cer devel­op­ment and growth; this has been a con­cern ever since the in­tro­duc­tion of hor­monal con­tra­cep­tion. But clearly the com­bi­na­tion also has some ben­e­fits: we know the risk for ovar­ian can­cer is re­duced when the num­ber of ovu­la­tions is fewer and when trans­port of po­ten­tially car­cino­genic agents is re­duced through the gen­i­tal tract-mech­a­nisms on which the OCP has a ben­e­fi­cial ef­fect.

The OCP is as­so­ci­ated with many non-con­tra­cep­tive ben­e­fits. Be­cause of the pre­cise and con­stant cycli­cal dosage of fe­male hor­mones, it reg­u­lates pe­ri­ods and makes them less heavy. In pre­menopausal women with anaemia due to heavy pe­ri­ods, pre­scrib­ing the Pill is a use­ful way to re­verse the trend of ex­ces­sive blood loss.

Se­vere pre­men­strual syn­drome (PMS) can be hugely dis­abling. For some women the in­tense anx­i­ety and ir­ri­tabil­ity is sim­i­lar to a brief bout of clin­i­cal de­pres­sion; add bloat­ing, fa­tigue and breast ten­der­ness and it be­comes quite dif­fi­cult to func­tion. Again the Pill can help by smooth­ing out hor­monal highs and lows.

A less ob­vi­ous role for the Pill is the treat­ment of acne in women. One par­tic­u­lar Pill for­mu­la­tion is renowned for its abil­ity to re­duce oily

Use of the OCP was as­so­ci­ated with a re­duced risk of bowel can­cer, ovar­ian can­cer, can­cer of the womb and blood can­cers. This as­so­ci­a­tion lasted for many years af­ter stop­ping the Pill

skin which, com­bined with its anti-an­dro­gen prop­er­ties, make it a good treat­ment for acne. Re­search sug­gests the com­bined pill is as ef­fec­tive at treat­ing the skin con­di­tion as are oral an­tibi­otics.

The OCP is a highly ef­fec­tive con­tra­cep­tive method when used prop­erly. In ad­di­tion it is as­so­ci­ated with many non-con­tra­cep­tive ben­e­fits. There has been an un­der­stand­able fear of can­cer as­so­ci­ated with the use of hor­monal treat­ments. Yes, there is some in­creased risk with cur­rent or re­cent use of the Pill but the find­ings of this lat­est study are largely re­as­sur­ing.

While any long-term ben­e­fits of the OCP are un­likely to be the main fac­tor for a young wo­man choos­ing con­tra­cep­tion, they of­fer an ad­di­tional di­men­sion to that choice.

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