Using the pill to prevent pregnancy

[Rau]

Interesting question and interesting thread.

The closest example that comes to mind, is that radiation therapy can cause lymphoma in 1% of the cases. Imagine someone suffering from a deadly form of cancer (let’s take head and neck cancer, for an example). Without treatment, there’s a 100% chance that the person will die. With surgery and radiation therapy, there’s perhaps a 20-50-80% chance (depending on the case) of saving the individual’s life. So, the doctor will take a calculated risk, and apply a radiation therapy that may cause lymphoma in 1% of the cases, however it will not cause lymphoma and also save the patient from certain death in a larger percentage of the cases.

But with the Pill, either as a contraceptive, or for treating legitimate medical conditions (endometriosis, polycystic ovary syndrome, etc), it’s much harder to justify. Combined hormonal contraceptives cause a 4.2-fold increase in the occurrence of TNBC (triple negative breast cancer), which is a particularly aggressive and deadly form of breast cancer that cannot be treated with the usual drugs (drugs targeting the estrogen, progestin, HER2 receptors).

A “4.2 fold increase” does not quantify the absolute risk, so as a statement, it cannot be persuasive to a rational person. Can you give the absolute risk factors?

 

[_Abyssinia]

I keep seeing that claim and I’m not buying it. I’ve looked extensively for any WHO source that says that. The only places I find that claim are religious sites against birth control. Unless you have a reliable citation…?

I’m also inclined to disbelieve it because “the pill” is not one standard thing. It can refer to hundreds of drugs with many different active ingredients. The idea that the WHO rolled them all in to one and classified them as a class one carcinogen is suspect.

monographs.iarc.fr/ENG/Preamble/Preamble-IntReport.pdf

apps.who.int/bookorders/anglais/detart1.jsp?sesslan=1&codlan=1&codcol=75&codcch=405

Twenty-one of 23 studies that followed women who took oral birth control before having their first child showed an increased risk of early breast cancer.

Measuring Risk

Based on these studies, the researchers concluded that taking oral contraceptives before a first full-term pregnancy increases premenopausal breast cancer risk by 44%, compared with women who have never used oral contraceptives.

The increase in risk was 52% among women who took the pill for four years or more before having their first child.

---

“I think women should know about this risk, and they are not being told,” researcher Chris Kahlenborn, MD, of Altoona Hospital in Altoona, Pa., tells WebMD.

“Anyone who is prescribing oral contraceptives has a duty to tell women that 21 out of 23 studies showed an increased risk.”

webmd.com/sex/birth-control/news/20061031/pill-may-raise-breast-cancer-risk

If women were told that their risk of developing breast cancer could increase so dramatically would so many women take the oral contraceptive pill?

 

[Rau]

If women were told that their risk of developing breast cancer could increase so dramatically would so many women take the oral contraceptive pill?

They would, if the absolute risk level remains acceptable. The extent of “increase” is irrelevant if the base risk is low enough.

 

[BlueEyedLady]

They would, if the absolute risk level remains acceptable. The extent of “increase” is irrelevant if the base risk is low enough.

Precisely. And when it comes to cancer risk that’s a discussion to have with a doctor anyway. Lifestyle, diet, exercise, environmental factors, genetics, etc all come into play and only a doctor can tell you what your risk-benefit ratio looks like.

I am on birth control both for medical and contraceptive purposes. Even if the medical issues went away I would still be on it for birth control, and if I were suddenly against contraception I would still use it for my health issues. I was told about the risks, including cancer and blood clots (actually the increased risk is the most dramatic in smokers, and that was my impetus to quit), and I still choose to take it.

 

[OurLadyPray4US]

A “4.2 fold increase” does not quantify the absolute risk, so as a statement, it cannot be persuasive to a rational person. Can you give the absolute risk factors?

I can try to be more specific, but quantifying things gets very complex. In the USA, about 12.8% of women (1 in 8) will get diagnosed with breast cancer, during their lifetime. Roughly 10% of all breast cancer cases fall into the category of TNBC (triple negative breast cancer) in the USA.

The pill increases the risk of “overall breast cancer” 1.5-2.0-fold, and the risk of TNBC 4.2-fold, compared to non-users. Also, on a whole population level, women with BRCA1/BRCA2 gene mutations have a 60% lifetime risk of developing breast cancer, but a study showed that in a small group of COC (combined oral hormonal contraceptive) users with BRCA1/BRCA2 mutations, every single woman got breast cancer before they reached the age of 30.

In certain poor African countries, breast cancer is 9-10 times less frequent than in the USA. The same African cultures do not believe in birth control, and do not use the Pill. I wonder whether that’s an important factor (among other factors) explaining their lower risks of breast cancer. It would be interesting to see whether TNBC makes up less then 10% of total breast cancer cases in those African countries.

Breast cancer is more important than, say, ovarian cancer, because breast cancer is the number 1 cancer in women, both in terms of morbidity and mortality (morbidity = number of people diagnosed with breast cancer; mortality = number of people who die with the disease). A 1.5-2.0-fold increase in breast cancer will ultimately sicken and kill more people than a 30 to 80% decrease in ovarian cancer will save from sickness and death, on a whole population level. Also, cervical cancer outweighs ovarian cancer in the developing world, thus the fact that the Pill increases breast and cervical cancer (in addition to hepatic and colorectal), may cause more damage than the Pill’s beneficial effect in reducing other cancers (ovarian, endometrial).

The following link has a good table - see Table 4 on Page 7 at cancer.org/acs/groups/content/@epidemiologysurveilance/documents/document/acspc-027766.pdf .

The incidence and mortality of breast cancer are as follows, per 100,000 women:
The Pill increases this:

Developed countries: 66.4 (incidence) 15.3 (mortality)
Developing countries 27.3 (incidence) 10.8 (mortality)

Let’s see now cervical cancer:
The Pill increases this:

Developed countries: 9.0 (incidence) 3.2 (mortality)
Developing countries 17.8 (incidence) 9.8 (mortality)

Here’s ovarian cancer:
The Pill decreases this:

Developed countries: 9.4 (incidence) 5.1 (mortality)
Developing countries 5.0 (incidence) 3.1 (mortality)

Here’s hepatic cancer:
The Pill increases this:

Developed countries: 2.7 (incidence) 2.5 (mortality)
Developing countries 7.6 (incidence) 7.2 (mortality)

Here’s colorectal cancer, and this is a big one, because it’s the number 2. or 3. cancer in women (number 1 is breast, number 2 and 3 are colorectal and lung) - according to some studies the Pill increases the risk of colorectal cancer, but we need more studies:

Developed countries: 24.2 (incidence) 9.7 (mortality)
Developing countries 9.4 (incidence) 5.4 (mortality)

 

[manualman]

They would, if the absolute risk level remains acceptable. The extent of “increase” is irrelevant if the base risk is low enough.

You’d think so, but it really depends on the scenario. People are weird. Cars with the worst IIHS crash ratings these days have real world injury and death rates indistinguishable from those with the best test ratings. And yet I meet all sorts of people who wanted “the safest minivan for their kids.” I can only imagine how the market share of a car that had a real world crash fatality rate 4.2 times higher than that of other cars in its class would get hammered, even if those actual fatality rates were quite low.

But I will agree that the physical health risks of the pill shouldn’t be a Catholic’s main point against it. We have a far better argument, even if it is not popular. Contraception fundamentally changes what sex IS and cheapens it. It changes the mindset of the couple and turns the encounter inward rather than outward. It’s not a quirk that EVERY nation on earth with legal and ‘respectable’ contraception has a below replacement total fertility rate. In the most fundamentally important sense, contraception has proven to be harmful to human flourishing. It co-opts something that God intended to make us more loving and selfless into something that tends to make people more selfish. We don’t need the extra help in that area!

 

[_Abyssinia]

I wonder whether doctors tell their patients about the risk of cancer in regards to oral contraceptive. This is not a few percent higher risk by taking oral contraceptives, that would be bad enough, the percentages in the study I posted are startling. Are women told about the percentages? I question whether most women on oral contraceptives even know of a cancer risk.

 

[BlueEyedLady]

I wonder whether doctors tell their patients about the risk of cancer in regards to oral contraceptive. This is not a few percent higher risk by taking oral contraceptives, that would be bad enough, the percentages in the study I posted are startling. Are women told about the percentages? I question whether most women on oral contraceptives even know of a cancer risk.

You aren’t getting it. A 54% increased risk doesn’t say much unless you know what the original risk is. If I have a 1 in 100 chance of getting breast cancer I don’t much care if my risk goes up by 50%. Especially with the decreased risk for uterine cancers.

I was told about the increased cancer risk. We didn’t talk numbers because 1. Every study comes back different, and some studies are much lower than others. There is no consensus on what the risk is. And 2. Saying that there is a ___% increase doesn’t give much information.

 

[OurLadyPray4US]

Cars with the worst IIHS crash ratings these days have real world injury and death rates indistinguishable from those with the best test ratings. And yet I meet all sorts of people who wanted “the safest minivan for their kids.” I can only imagine how the market share of a car that had a real world crash fatality rate 4.2 times higher than that of other cars in its class would get hammered, even if those actual fatality rates were quite low.

Exactly.

Edit:
On a more sober note, 1 in 8 women will get diagnosed with breast cancer in the USA, during their lifetimes. 10% of those cases are the aggressive type of TNBC (triple negative breast cancer) with a poor prognosis.

The base level of risk is quite high.

Certain African countries have 9-10 times lower breast cancer rates than the USA. And we (Gates foundation, etc) are trying to export our problems to Africa.

 

[manualman]

Certain African countries have 9-10 times lower breast cancer rates than the USA. And we (Gates foundation, etc) are trying to export our problems to Africa.

In fairness, are we sure the difference is pinnable on the pill or is it perhaps even more likely that African women tend to use their breasts to feed their multiple babies while developed country women tend to switch to Enfamil after a couples weeks to a month of trying nursing and not liking it?

Back to an example referred to earlier, I would think they could see if nuns (presumably not pill users) have breast cancer rates similar to the developed world women as a whole or more like the third world women. Maybe there is just something about lactation that reduces breast cancer risk? Stranger things have happened! Maybe it’s Abbott Labs exporting breast cancer as much or more than the Gates.

 

[BlueEyedLady]

In fairness, are we sure the difference is pinnable on the pill or is it perhaps even more likely that African women tend to use their breasts to feed their multiple babies while developed country women tend to switch to Enfamil after a couples weeks to a month of trying nursing and not liking it?

Back to an example referred to earlier, I would think they could see if nuns (presumably not pill users) have breast cancer rates similar to the developed world women as a whole or more like the third world women. Maybe there is just something about lactation that reduces breast cancer risk? Stranger things have happened! Maybe it’s Abbott Labs exporting breast cancer as much or more than the Gates.

Quick google shows that women in Africa do have lower rates of breast cancer primarily because of having multiple babies and extended nursing. One of the biggest risk factors is obesity, which is also less common in Africa.

I would really doubt that the pill accounts for more than a small amount of the discrepancy.

 

[BlueEyedLady]

Ultimately though, trying to argue against the pill on breast cancer grounds isn’t smart. What happens when medical technology advances to the point where that’s a non issue?

 

[OurLadyPray4US]

In fairness, are we sure the difference is pinnable on the pill or is it perhaps even more likely that African women tend to use their breasts to feed their multiple babies while developed country women tend to switch to Enfamil after a couples weeks to a month of trying nursing and not liking it?

Back to an example referred to earlier, I would think they could see if nuns (presumably not pill users) have breast cancer rates similar to the developed world women as a whole or more like the third world women. Maybe there is just something about lactation that reduces breast cancer risk? Stranger things have happened! Maybe it’s Abbott Labs exporting breast cancer as much or more than the Gates.

Yes, the Pill is just one factor. Pregnancy, and at the earlier age a first pregnancy occurs the better, protects against breast cancer. Multiple pregnancies are good against breast cancer. An interrupted pregnancy (surgical abortion, miscarriage) raises the risk. I will look up lactation, whether that could play a role. More red meats in the diet raise the risk of various cancers (notably colorectal, but probably breast as well), and African as well as traditional Asian nations eat less red meat.

Postmenopausal estrogen replacement therapy (ERT) also raises the risk of breast cancer, and that’s something that Western women used to do. More recently, thankfully, the American Endocrine Society warned against ERT on the basis of its carcinogenic effect, and a lot of women stopped using ERT in the USA and in the West.

One would think it’s logical to warn against the carcinogenic effect of estrogens, not only in estrogen replacement therapy, but also in the birth control pills. However, this is that hornet’s nest that most people will rather not mess with. The politicians and the feminists love the Pill, and warning against the Pill is a sensitive issue. How would that go, professional bodies speaking out against the Pill, now when the Obama administration’s birth control mandate tries to make the Pill more accessible to everyone?

 

[OurLadyPray4US]

Ultimately though, trying to argue against the pill on breast cancer grounds isn’t smart. What happens when medical technology advances to the point where that’s a non issue?

For me, this is still an interesting issue because of the non-contraceptive applications of the Pill.

Regarding contraception, I would steer clear of the Pill, even if it was healthier than Vitamin C and green tea antioxidants, combined.

 

[manualman]

How would that go, professional bodies speaking out against the Pill, now when the Obama administration’s birth control mandate tries to make the Pill more accessible to everyone?

You mean “FREE” to everyone (in propaganda talk). In reality, “free” means those who don’t want it or need it are now forced to pay for it for those who do. Good con if you can pull it off.

 

[OurLadyPray4US]

You mean “FREE” to everyone (in propaganda talk). In reality, “free” means those who don’t want it or need it are now forced to pay for it for those who do. Good con if you can pull it off.

Thanks for the correction.

In addition, Gov. Rod Blagojevich of Illinois, and Christine Gregoire of Washington state, tried to pass legislation forcing all pharmacists to fill prescriptions for contraceptives, or else lose their licenses. Currently, both states suspended those laws due to lawsuits from the pharmacists.

Imagine when women get breast cancers and when they start suing the companies, as well as possibly the pharmacists, for giving them carcinogenic drugs. Ditto with the deadly pulmonary embolisms. That’s why France recently banned Diane-35, and that’s why there’s a movement to ban Yaz and Yasmin in the USA and Canada. Many girls and young women died because of these drugs, in an arguably even more dramatic way than with cancer. 18-year old perfectly healthy women started to take the drugs, and suddenly died of pulmonary embolism, typically within a few weeks of going on those drugs. With cancer, the effect is not so immediate and not so dramatic. With the embolisms however, the cause-effect relationship is more difficult to deny. When a healthy 18-year old starts taking the drug, and she collapses and dies 5 weeks later, just like that, it’s very difficult to deny that it was the Pill that killed her.

The pharmacists (still) have the opportunity not to carry and fill prescriptions of those drugs that are dangerous or immoral, however the Democrats tried to change that in Illinois and Washington states. I wonder how long before Obama passes a federal law that does the same on a federal level.

 

[His_helpmeet]

A physician colleague of mine (I’m a nurse) pointed out a very interesting argument. He’s Catholic and refuses to prescribe the Pill. However, he does so not for medical reasons but because, as he states, fertility is not a disease. Why would you recommend a potentially dangerous treatment for something that’s not even a disease in the first place?

I recognize that there are women who take the Pill for medical reasons, usually to treat ovarian cysts, decrease pain from endometriosis, and regularize menstruation. However, in most cases, the Pill will only treat the signs and symptoms; it will do NOTHING to diagnose or treat the underlying cause of the problem. The Pope Paul VI Institute has developed NaPro Technology (Natural Procreative Technology) that has been shown to be very helpful in diagnosing and managing these kinds of problems WITHOUT the need to use the Pill.

As an aside, I have polycystic ovary syndrome (PCOS), a metabolic disorder that causes my ovaries to produce too much testosterone due to insulin resistance. I was on the Pill for awhile but stopped it due to my then-impending marriage and the severe side effects I experienced on it. I started taking metformin, a drug originally used to treat diabetes, that has been shown to aid in conception in women with PCOS. My husband and I had initially intended to have a baby right away. However, when that didn’t happen, and we decided to wait, I decided to keep taking metformin - because my menstrual cycle had largely normalized. I’m not saying that metformin is the best treatment for EVERY woman who has PCOS, but it worked for me. The side effect profile is safer than the Pill, and it will help to protect me against developing diabetes in the future, so I have stayed on it.

 

[_Abyssinia]

You aren’t getting it. A 54% increased risk doesn’t say much unless you know what the original risk is. If I have a 1 in 100 chance of getting breast cancer I don’t much care if my risk goes up by 50%. Especially with the decreased risk for uterine cancers.

I was told about the increased cancer risk. We didn’t talk numbers because 1. Every study comes back different, and some studies are much lower than others. There is no consensus on what the risk is. And 2. Saying that there is a ___% increase doesn’t give much information.

Risk of getting breast cancer because of oral contraceptives is higher than the decreased risk that you may get in a reduced ovarian cancer rate. Following article claims 27% reduced risk but the article I posted shows a much higher percentage for risk of breast cancer. Reduced risk of ovarian cancer has not been proven as the following article details

nbcnews.com/id/52124987/ns/health-cancer/t/pill-tied-lower-ovarian-cancer-risk

 

[Rau]

Risk of getting breast cancer because of oral contraceptives is higher than the decreased risk that you may get in a reduced ovarian cancer rate. Following article claims 27% reduced risk but the article I posted shows a much higher percentage for risk of breast cancer. Reduced risk of ovarian cancer has not been proven as the following article details

nbcnews.com/id/52124987/ns/health-cancer/t/pill-tied-lower-ovarian-cancer-risk

You are not following the argument I think. Let’s say that the chance of a disease ordinarily is 1 in 10 million. But, if you take drug X, the chance is 100 times higher! Well, that probably is not a concern, because the chance now (ie, taking the drug) of getting the disease is still only 1 in 100,000. The factor of 100 sounds really, really bad, but its actually irrelevant because the base chance was so low anyway.

Had the base chance of disease been 1 in 1000, - well that’s entirely a different situation, since now, taking the drug raises the chance to 1 in 10, which is getting too close for comfort.

You need to know the absolute risk, not just the relative risk, to make a rational decision.

 

[OurLadyPray4US]

Risk of getting breast cancer because of oral contraceptives is higher than the decreased risk that you may get in a reduced ovarian cancer rate. Following article claims 27% reduced risk but the article I posted shows a much higher percentage for risk of breast cancer. Reduced risk of ovarian cancer has not been proven as the following article details

nbcnews.com/id/52124987/ns/health-cancer/t/pill-tied-lower-ovarian-cancer-risk

To expand a bit on this, let’s see the statistics for breast cancer and ovarian cancer (I posted these statistics already in post #25).

For every 100,000 women, 66.4 women get diagnosed with breast cancer a year in the developed countries. Conversely, 9.4 women get diagnosed with ovarian cancer. This means that the morbidity of breast cancer is more than 7 times greater than that of ovarian cancer - 7 times more women get a new diagnosis of breast cancer, than ovarian cancer.

Even if the Pill would totally abolish ovarian cancer, which it does not, it would only save 9.4 women (per 100,000 women per year), from a new ovarian cancer diagnosis. In the reality, the reduction of ovarian cancer morbidity with newer generations of the Pill (with low-dose combined contraceptives) is not more than 1/4 (25%) to 1/3 (33.3%), which means that about 2 to 4 women (per 100,000 women per year) will be saved from a new case of ovarian cancer by taking the Pill.

Now let’s see breast cancer. The Pill increases the morbidity of breast cancer about 1.5-2.0-fold (although it should be mentioned that there are studies that found even higher, 3-4-fold increases of breast cancer rates among certain subgroups of Pill users, and among certain subgroups of breast cancer). With a baseline morbidity of 66.4 (per 100,000 women per year), a 1.5 to 2.0-fold increase means an additional 33 to 66 women (per 100,000 per year) will get breast cancer if they take the Pill.

OK, now let’s compare the beneficial effect of the Pill in protecting from ovarian cancer, with its harmful effect in causing new breast cancers. For every 100,000 women per year, about 2 to 4 women will be saved from ovarian cancer, and conversely, about 33 to 66 additional women will get breast cancer, if they take the Pill. In other words, for every case of a woman prevented from getting ovarian cancer, we will get 15 (fifteen) additional women sickened with breast cancer, among the Pill users.

I have a rhetorical question:

Is it worth it?

Is it good medicine, to treat women with a carcinogen that, although preventing 2 to 4 women from getting ovarian cancer (per 100,000 women per year), will cause 33 to 66 new cases of breast cancer (per 100,000 women per year)?

I believe the answer to the rhetorical question is generally NO. I believe this is, in most cases, not sound medicine. The Pill is a nasty dangerous drug. I can see a theoretical case being made for using a nasty dangerous carcinogenic drug for treating some even nastier and life-threatening disease, but I’m not even sure there is a practical case in which it would be justified.

Would it be justified to use a nasty dangerous drug that causes breast cancer, to treat acne and hirsutism? Definitely not.

How about using a nasty dangerous drug that causes breast cancer (a group 1 carcinogen, per the World Health Organization!!!), to treat endometriosis, PCOS, and menstrual problems? This is up to discussion between the patient and the physician, but I believe that in most cases, the answer is NO. In most cases, it is simply not worth to take a group 1 carcinogen, and risk getting breast cancer, cervical cancer, hepatic cancer, colorectal cancer (as well as deep vein thrombosis, and blood clots causing often deadly pulmonary embolisms, strokes, and heart attacks), just for the sake of treating a gynecological problem such as PCOS, endometriosis, or heavy menstrual bleeding, especially if the gynecological problem itself is not life-threatening.

Patients should seek out doctors who will look for less dangerous treatment alternatives. It is a form of recklessness to prescribe the Pill for all sorts of medical problems that are not life-threatening themselves, as if the Pill wasn’t a truly dangerous group 1 carcinogen that causes breast cancers and other cancers.