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  • Title: Case control study finds long-term pill use is associated with higher risk of benign liver tumors.
    Journal: Int Fam Plann Dig; 1976 Jun; 2(2):13-5. PubMed ID: 12334249.
    Abstract:
    A recent case-control study by a team of University of Southern California investigators follows published observations on a total of 107 liver tumors among young women. Most of them were, or had been, oral contraceptive users. The importance of duration of use in the etiology of these tumors was shown by data on 58 women reported at the 1976 annual meeting of the American College of Obstetricians and Gynecologists. Of the 58 women who developed these tumors, 85% had used the pill continuously for more than 4 years. An increasing number of such reports has induced the National Cancer Institute to undertake an investigation regarding these tumors. Almost all of the reported tumors have been benign and described as adenomas, hamartomas, or focal nodular hyperplasia. Some have been without symptoms. Others have been associated with severe abdominal pain or sudden bleeding. A case-control study of 34 young women diagnosed as having benign liver tumors in 1955-1976 was made with appropriate controls. Of the 34 tumor cases, 29 had used oral contraceptives but 26 of the controls had done so also. The tumor patients had taken the pills for significantly longer periods than the controls. The risk of developing liver tumors increased with duration of use and was 2.5 times greater than after 3-5 years than for 1 year or less of use. After 5 years of use, the risk increased sharply to 25 times greater after 9 or more years of pill use. A palpable mass was present in 34% of the cases and severe abdominal pain in 29% of 1 series. Pills containing mestranol seemed more likely to cause liver tumors than those containing ethinyl estradiol. Another report was of 44 case histories published within the past 5 years and 27 new cases reported to the Registry for Liver Tumors Associated with Oral Contraceptives. This Registry was established in 1975. Duration and type of pill use was recorded for 58 of them. Of these, 85% had taken the pill for over 4 years. Mestranol-containing pills had been mostly used. Norethindrone was often used. Of these tumors, 18 ruptured resulting in the death of 8 of the 71 women. In Louisville, 9 cases of benign liver tumors were diagnosed between 1968 and 1974 in women who had used oral contraceptives. No similar tumors had been observed in a comparable age group of women in the previous 13 years. In 1 case, a patient had the tumor removed and resumed the pills. After 6 years a 2nd similar tumor developed. It was not removed but regressed somewhat in 5 months when the oral contraceptive was omitted. In Britain and the U.S., 3 prospective studies of pill users are being conducted. The different types of liver tumors involved seem to have different etiologies. Focal nodular hyperplasia is sometimes found in men but liver-cell adenoma is almost exlusively found in women, many of whom have used oral contraceptives. The Central Registry may resolve some questions.
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