I am writing this newsletter during the Labor Day weekend. It’s supposed to be labor free and shopping-full, but I have no intention of joining the crowds at the mall. Although writing is not really labor (more of a labor of love), I’ll keep it brief so I can spend time with my family and do the traditional barbecue of salt laden hot dogs. We also have Rosh Hashanah this week which celebrates the year to come….and this too should be as labor-free as possible (not the year but the actual holiday). I would like to wish all my patients and those who read my newsletters a “Shana Tova”…Happy New Year; may this next year be one of health for all of you (as well, of course, one of peace and prosperity ….here is where I could make some political comments, but won’t.)
On to a somewhat positive article: The latest Journal of Obstetrics and Gynecology featured a review on benign breast disease. One of the questions dealt with in the article (which many of my patients have also posed) is whether there is a correlation between breast cancer and use of the oral contraceptive pill (OCP). Basically, it would seem there is none. The authors pointed out that there are more than 50 epidemiologic studies which have evaluated this and most have NOT demonstrated an association even if birth control pills were used for a long time. They went on to state that “in a study of pooled data from 54 epidemiologic studies containing 150,000 women with and without breast cancer, no consistent association between oral contraceptive pill use and breast cancer was identified. This study did show an increase risk of breast cancer in women who were current or recent users but this affect disappeared within 10 years of discontinuing the pills.” They then hastened to point out that a separate study involving 10,000 women with and without breast cancer showed that there was no increase in risk of breast cancer in oral contraceptive pill users even among current or recent users, those who had a family history of breast cancer, or those who started OCP’s at a young age.
I think this analysis should be very reassuring to all of you who are currently using the Pill but worry that “those hormones” will cause breast cancer, or if you have pill remorse about having used OCP’s in the past.
Unfortunately, one in eight women will get breast cancer in their lifetime. There are known factors that increase risk….but they do no include oral contraceptives. Although I promised a positive article, this newsletter would not be complete without mentioning these risk factors. They are:
- Early puberty and periods
- Late menopause
- Lack childbirth
- First birth after 35 (as compared to having a baby before the age of 20)
- Long term use of hormone therapy (menopausal hormone therapy, not birth control pills!)
- A strong family history of breast cancer (especially known BRCA gene mutation)
- Previous chest radiation, especially before the age of 21,
- Alcohol …which increases breast cancer risk in a dose dependent fashion (the more you drink, the higher the risk).
That “one in eight” statistic is terrifyingly high, but at least I can report that there has been an overall yearly decrease in mortality from breast cancer. The ability to diagnose this cancer with mammogram, ultrasound and, if necessary, MRI, appropriate biopsies and surgeries, the use of hormone receptor tests and genetic tests to evaluate which therapies will work as well as the recognition of risk allow all of us to get better breast care. It would seem that the one thing you don’t have to worry about when it comes to breast cancer risk is the contraceptive birth control pill.