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Re: Pill and breast cancerFrom: ainsron (ainsron@sbcglobal.net)Tue Apr 24 11:57:51 2007
OCs decrease risk of benign breast disease, as well as benign ovarian cysts, ovarian cancer, endometrial cancer, acne, PID, ectopic pregnancy, osteoporosis, anemia, etc. If your patient wants the pill give it to her. Do yearly breast exams and ultrasound or mammogram if indicated. The idea that OCs increase risk of breast CA is not supported in the literature and is a common misconception of patients and apparently MDs. The Collaborative Group on Hormonal Factors in Breast CA, Contraception, 1996, an international collaborative analysis of 54 epidemiologic studies showed that OC use is not associated with a significantly increased risk of breast CA. Current users had a small increase in RR of being diagnosed with breast CA while on OCs and for 10 years after. Cancers were diagnosed earlier in users and tended to be localized to the breast. When data were adjusted for recency of use, no subgroups were found to be at increased risk, including women with a FH of breast CA, those starting at an early age or those who used them for a long duration of time and there was no evidence that the slightly increased risk of Breast CA persisted for over 10 years after discontinuation. One other review from JAMA points a little different picture, probably related to different formulations in early OCs, but overall, it is reassuring that we aren't doing harm to these women: Risk of Breast Cancer With Oral Contraceptive Use in Women With a Family History of Breast Cancer. Grabrick DM, Hartmann LC, et al. JAMA 2000; 284 (October 11): 1791-1798 Objective: To study the risk of breast cancer as it relates to family history and oral contraceptive use. Design: Retrospective cohort study with follow-up interview. Methods: 544 women identified with a diagnosis of breast cancer between 1944 and 1952 were retrospectively evaluated. Follow-up with the families of these patients was conducted in 1991 and 1996. Of the initial 544 families who were in this study, 40 were excluded because the program had prevalent breast cancer diagnosed before 1940, and 42 more were excluded because no or very few relatives were still alive for follow-up. The primary outcome measure of the study was to determine the relative risk of breast cancer as it is associated with the history of oral contraceptive use by a relative of the initial proband cancer case. Investigators collected data on the cancer history and risk factors for breast cancer through telephone interviews and subsequently confirmed the accuracy of these reports by review of medical records. Patients were questioned regarding the ever or never use of oral contraceptives. Analysis of data was performed by using Cox proportional hazards regression. Results: Among relatives of breast cancer patients who used oral contraceptives, there was a significant increased risk of breast cancer among sisters and daughters (relative risk 3.3 with a 95% CI), but not among granddaughters and nieces of women who have married into the families. After adjusting for parity, age at first birth, age at menarche, age at menopause, oophorectomy, smoking, and education, the results were essentially unchanged. The elevated risks for breast cancer among women who had a first degree relative family history were greatest before 1975 when higher estrogen and progestin formulations of contraception were used. There were only 2 cases of breast cancer that occurred among women with first degree relatives with breast cancer and a history of oral contraceptive use after 1975. This limited number of patients did not allow for statistical analysis. Conclusions: Early formulations of oral contraceptives are associated with increased risk of breast cancer, particularly in patients who have a first degree relative with breast cancer. Reviewer's Comments: This study is a "yellow flag" regarding the relationship of oral contraceptives to breast cancer. Although the results of this study primarily relate to high-dose estrogen-progestin formulations of oral contraceptives, the question of the effect of oral contraceptives in lower doses on breast cancer can only be inferred. Further studies are needed in this area. (Reviewer-John C. Jennings, MD). Ronald E. Ainsworth, MD, FACOG -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of drsavvas Sent: Tuesday, April 24, 2007 8:06 AM To: Multiple recipients of list OB-GYN-L Subject: Pill and breast cancer Patient 22y.o.her mother was recently diagnosed with cancer of the breast HER2 positive but oestrogen negative.Is there any risk if she takes the pill?If she takes the pill what is the follow up. I'll appreciate your help. Dr.S.Savvas
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