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Sunday, March 05, 2006

NAQs* on MAPs and OC and BC

NAQs* on MAPs and OC and BC**

* (Never Asked Questions) on Morning-After Pills and Oral Contraceptives and Breast Cancer


(continued from original post


NOTE: Seven world-renowned, peer-reviewed, medical journals all can't be wrong: Journal of the Natl Cancer Inst (JNCI) ... Cancer ... Anticancer Research ...Archives of Internal Medicine ... The Lancet Oncology / World Health Organization's International Agency for Research on Cancer (IARC) ... Cancer Causes and Control ... 3rd European Breast Cancer Conference.

Of the sources below for eleven (11) published research studies from 1986-2005, there isn't a single one from an anti-abortion, anti-morning-after-pill site. They are all from the National Cancer Institute, National Institutes of Health (NIH), official IARC press releases, WebMD or other unbiased, objective science periodicals.

All eleven found increased risks of breast cancer from using birth control pills (oral contraceptives or OC).

And since Morning After Pills (MAPs) are typically "10-20 times the progesterone" and "5 times" the estrogen as in the standard daily Pill, according to Pharmacists for Life, it is possible that "a very high dose" of the same hormones can as well.

It's never been studied. Don't you think it should be?

There is also a twelfth source--a published letter--by a CDC cancer research head, however, that refuted the birth control/breast cancer link, by saying that, instead, "Induced abortion before first term pregnancy increases the risk of breast cancer."

Lastly, we'll show how easy it was to find NCI's prominent "No-BC/BC-Link" links from the 1980s (and one from 2002 with possibly misstated results) but how hard--or impossible--it was to find on NCI's site the 1990s-2000s studies that showed there are BC/BC links.


THE OC's ELEVEN

It is possible that the order of magnitude of MAPs could parallel the increased dosage: 5, 10 or 20 times the increased risks of:
  1. -CERVICAL CANCER: 2003: The Lancet, Vol 361, 4 April: Women using birth control pills for 10 or more years double our risk of cervical cancer. If taken for 5-9 years, the risk is increased 60%.
  2. -BLOOD CLOTS: 2003: Arch Intern Med. 2003;163:2771-2774: Women taking birth control pills are 14 times more likely to develop blood clots from airplane travel.

    -BREAST CANCER: (9 research studies in 6 major cancer journals)
  3. 1995: Brinton LA, Daling JR, Liff JM, Schoenberg JB, Malone KE, Stanford JL, Coates RJ, Gammon MD, Hanson L, Hoover RN. Oral contraceptives and breast cancer risk among younger women. J Natl Cancer Inst 1995;87;827-835: "...recent use of OCs, especially long-term use, increased the risk of very early breast cancers, namely those that develop prior to the age of 35. Notably, recent OC users who had been exposed for 10 or more years were at approximately a twofold increased risk compared with nonusers." They said the results "provided support for the notion that the elevated risks may have been due to the higher formulations that were used in early years." Which is exactly what the Morning After Pill is: a much higher formulation of the standard birth control pill.
  4. 2005: Cogliano, V., The Lancet Oncology; August 2005; vol 6: pp 552-553: "An IARC Monographs Working Group has concluded that combined estrogen-progestogen oral contraceptives and combined estrogen-progestogen menopausal therapy are carcinogenic to humans (Group 1), after a thorough review of the published scientific evidence." [quote from July 29, 2005 press release found here: ) Vincent Cogliano, PhD, is with the World Health Organization's International Agency for Research on Cancer (IARC). Also found on WebMD and here.
  5. 2003: (presumably Althuis MD, Brogan DD, Coates RJ, et al. Breast cancers among very young premenopausal women (United States). Cancer Causes and Control 2003; 14(2):151–160): "In an NCI-sponsored study published in 2003, researchers examined risk factors for breast cancer among women ages 20 to 34 compared with women ages 35 to 54. Researchers analyzed data from 2,202 women who were diagnosed with breast cancer between 1990 and 1992, and 2,209 women who did not have breast cancer. The results indicated that the risk of breast cancer was significantly increased for women ages 20 to 34 who had used OCs for at least 6 months. The risk associated with OC use was strongest for women who had used OCs within 5 years of breast cancer diagnosis. Although also elevated, the risk was weaker for women over age 35 and those who used OCs for longer periods of time."
  6. 2002: Presented at the 3rd European Breast Cancer Conference, 19-23 March 2002, Barcelona, Spain, Source: http://www.fecs.be , Federation Of European Cancer Societies: "Women who have taken the contraceptive Pill at any stage in their lives have a slightly increased chance of developing breast cancer, research shows. Their risk rose by just over a quarter (26%), compared with women who had never used the Pill…Dr Merethe Kumle, who carried out the research, said: 'It is clear that oral contraceptives increase a woman's risk of developing breast cancer, particularly when they are used in the later period of reproductive life.' The study, presented at the third European Breast Cancer Conference in Barcelona, used data collected from 103,000 women aged between 30 and 49. Dr Kumle from the Institute of Community Medicine in Tromso, Norway, collaborated with researchers in Sweden and France to assess data from the Women's Lifestyle and Health study carried out in Norway and Sweden. [T]hose who had taken the Pill over longer periods increased their risk of breast cancer by 58% compared with those who never used it. However, the highest increased risk (144%) was among women aged over 45 who were still using the Pill."
  7. 1999: "[S]ome recent studies suggest a possible increase in breast cancer at an early age (before age 45) among long-term oral contraceptive users, and those who started taking oral contraceptives at a young age."

    Posted on the Internet Feb. 21, 1999 and still available today, by the National Institutes of Health/National Cancer Institute, specifically one Celia Byrne, Ph.D. with the Environmental Epidemiology Branch, Division of Cancer Etiology, National Cancer Institute, Bethesda, Maryland.

    Her references are here.

    NCI's Byrne gives no titles, authors, citations or even year of publication--not even in her references--for the "some recent studies" suggesting a possible BC/BC link, unlike the other eleven studies she references.
  8. 1996: (presumably Collaborative Group on Hormonal Factors in Breast Cancer. Breast cancer and hormonal contraceptives: Collaborative reanalysis of individual data on 53,297 women with breast cancer and 100,239 women without breast cancer from 54 epidemiological studies. Lancet 1996; 347:1713–1727): "A 1996 analysis of worldwide epidemiologic data conducted by the Collaborative Group on Hormonal Factors in Breast Cancer found that women who were current or recent users of birth control pills had a slightly elevated risk of developing breast cancer. However, 10 years or more after they stopped using OCs, their risk of developing breast cancer returned to the same level as if they had never used birth control pills." [my question: What Pill user stops using it for very long (unless for health or planning a pregnancy), never mind for 10 years?]
  9. 1991: Olsson H, Ranstam J, et al. Proliferation and DNA ploidy in malignant breast tumors in relation to early contraceptive use and early abortions. Cancer. 1991; 11: 2043-2046: Young women with breast cancer who used oral contraceptives "before 20 years of age" were found to have "significantly... 43% higher …tumor cell proliferative activity,… a higher fraction of DNA aneuploid tumors" (which is an "abnormal balance of chromosomes…(i) ubiquitous in cancer, [and] (ii) proportional to the degree of malignancy of cancer"), "larger tumors"
and "a worse survival" rate. All these findings were "in line with previously reported findings…in early users of OC compared with other young women with breast cancer." Those earlier findings were not listed in the abstract of course.


  • 1990: Romieu I, Berlin J, et al. Oral contraceptives and breast cancer, Review and meta-analysis. Cancer. 1990; 66: 2253-2263: Of 21 studies on the birth control/breast cancer connection between 1980 and 1990, 18 showed there was increased risk in using The Pill. This review of all research available up till 1990 showed that "This risk was predominant among women who used oral contraceptives for at least 4 years before their first term pregnancy (relative risk = 1.72; 95% confidence interval = 1.36 to 2.19)." That means they had a 72% increased risk of developing breast cancer.
  • 1988: Olsson H, Moller TR, Ranstam J, Borg A, Ferno M. Department of Oncology, University Hospital, Lund, Sweden. Early oral contraceptive use as a prognostic factor in breast cancer, Anticancer Res. 1988 Jan-Feb;8(1):29-32: "Women, who had started their oral contraceptive use (OC-use) before 20 years of age had a significantly lower survival rate as compared with those who had never used OC and late users (p = 0.02 and = 0.04 respectively, generalized Wilcoxon test). For women who started OC-use between 20 to 25 years of age, a tendency for a shorter survival was seen in comparison with women who had never used OC (p = 0.18)."
  • THE OC's TWELFTH: CDC's Phyllis Wingo's Flip-Flop

    Phyllis Wingo is often a major co-author on research finding that it is "not possible" to conclude there is an abortion/breast cancer link.

    She is (now back) at the Centers for Disease Control and Prevention as Chief, Cancer Surveillance Branch. At the time she co-wrote a letter published in the UK's Lancet on Feb. 22, 1986, she represented the Centers for Disease Control and Prevention as either a statistician or an epidemiologist (her bio doesn't contain exact dates or titles at the CDC).

    By 1986, she'd had 11 years with the CDC as a PhD in Statistics. It appears she does not have an M.D. or any degree in medical treatment, biostatistics or epidemiology per se.

    Much like David Reardon, who is often dismissed for not being "a doctor in psychology, psychiatry or in any kind of medicine or health field," either.

    I guess it's only fine for someone to be without a medical-treatment doctorate when one is pro-choice.

    Wingo's published, co-authored letter stated that abortion was a "more likely" factor in breast cancer increases than birth control pills:
    In 1986, four prominent epidemiologists criticized in The Lancet a study's suggestion that the increasing incidence of breast cancer among Swedish women was due to oral contraceptive use: 'This reasoning overlooks the more likely role of other factors, especially induced abortion. Induced abortion before first term pregnancy increases the risk of breast cancer.'" [my emphasis] [Bruce V. Stadel, National Institutes of Health, et al., Letter, 1986 (I) The Lancet 436., as cited in 1998 Wis. L. Rev. 1595, "The Fit Between The Elements For An Informed Consent Cause Of Action And The Scientific Evidence Linking Induced Abortion With Increased Breast Cancer Risk," Copyright 1998 by The Board of Regents of the University of Wisconsin System; Reprinted by permission of the Wisconsin Law Review]
    It was upon joining the American Cancer Society, where she worked from 1994-2000, that Wingo did her about-face on the abortion/breast cancer link.

    As late as 1997, she had remained "flipped" and as recently as 2000, she was still the American Cancer Society's go-to person (see "Acknowledgements") per their "Breast Cancer Facts and Figures" (PDF) document citing her review Wingo PA, Newsome K, Marks JS, Calle EE, Parker SL, Review: the risk of breast cancer following spontaneous or induced abortion. Cancer Causes and Control, 1997;8:93-108 which concluded: "Definitive conclusions about an association between breast cancer risk and spontaneous or induced abortion are not possible at present because of inconsistent findings across studies."

    This despite dozens of published studies showing there is an association between breast cancer risk and induced abortion.

    Dr. Wingo's bio says she "taught junior high mathematics," then did "computer programming for the Breast Cancer Detection and Demonstration Project at Emory University." Then she earned her MS and PhD in Statistics. She worked for the CDC twenty years (1974-1994), then six at the The American Cancer Society, and presumably rejoined CDC from 2000 through present.

    That's about a minimum of 36 years since her college days. I hope that before she retires, she will find a way to risk getting all the truth out.


    NCI's Prominent "No-BC/BC-Link" Links

    I found that NCI/Celia Byrne "some studies" page quite by accident via Google. The top graphic showed the title "RISK FACTORS" and three buttons: Home, Rates, Next. Looking to learn more about that entire document, I clicked the report's "Home" button. The URL says http://rex.nci.nih.gov/nci_pub_interface/raterisk/index.html but then returns NCI's main home page instead. With some spelunking back inside the report's series I was able to find the Risk Factors Table of Contents, but still no home page.

    NCI's search tools were useless for finding even the page I'd first found. But the Internet Archives' "Wayback Machine" was imminently more helpful. It found both the Home page and the date of first occurrence of the breast cancer pages, Feb. 22, 1999.

    The Home page read "This online publication provides international cancer incidence and mortality rates in a series of charts and graphs. Also included is information on cancer risk factors and risks for major cancers. Choose from 'Rates' or 'Risks' buttons on the left."

    At NCI's site, I tried again, advance-searching all options on "breast cancer" and "oral contraceptive," among other phrases. No luck. I did find--easily--this link to two (or three) studies saying that "current or former OC use did not appear to be associated with a significantly increased risk of breast cancer."

    The most prominently discussed Cancer and Steroid Hormone (CASH) Study appears to have been published in 1983 and 1986 in JAMA and New Engl J Med, respectively.

    1983 and 1986. Yet there's no mention of the eleven sources after 1988 showing there is a link.

    That link also cited the Marchbanks et. al. study, &nbsp Oral Contraceptives and the Risk of Breast Cancer, 346:2025-2032, June 27, 2002, Number 26.

    They stated that "Use of oral contraceptives by women with a family history of breast cancer was not associated with an increased risk of breast cancer, nor was the initiation of oral-contraceptive use at a young age."

    Yet they didn't study women under 35. One can only hope that they studied some significant number of women who had used contraceptive pills before they reached 35. Otherwise, they could not "find" the second part of their result. But the abstract doesn't give those specifics so we can't know for sure.

    This letter-writer in Volume 347:1448-1449, October 31, 2002, Number 18, seemingly cautions another concern:
    To the Editor: In the Women's Contraceptive and Reproductive Experiences (Women's CARE) Study, Marchbanks et al. (June 27 issue)[1] carefully verified previous investigations showing that there is no association between combination oral contraceptives and the risk of breast cancer among women older than 45 years of age.[2] [my emphasis] However, when data from women 35 to 44 years old are combined for analysis, the risk of breast cancer associated with recent use of oral contraceptives may not be fully apparent among the youngest women. The investigators report that they found a higher risk of breast cancer among the women 35. . ." [my emphasis]
    That's the short summary, and not being a NEJM member I cannot see the rest nor learn who wrote this. It seems to say that Marchbanks found higher risks in the youngest cohort--the 35 to 44 year olds--but this was not part of their results summary. It's possible it wasn't a significant increase and thus not worth including in their results summary, but we really don't know.

    So this 2002 study NCI is still somewhat questionable, at least in how it was summarized and reported. Yet, it figures prominently in NCI's easily accessible "Surveillance Epidemiology and End Results (SEER) Landmark Studies."

    Much of the above other information is either extremely difficult to find, requires non-NCI help (Google) to locate, and/or is shunted away by NCI from the public eye when one attempts to read it in its entirety.

    Nice going, NCI.
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