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  • Title: Results of oral contraceptive epidemiologic studies regarding neoplastic and cardiovascular effects.
    Author: Grimes DA.
    Journal: Int J Fertil; 1989; 34 Suppl():27-33. PubMed ID: 2576254.
    Abstract:
    Over the past three decades, much of the research on oral contraceptives has focused on cardiovascular and neoplastic effects. Results of recent United States studies have shown no increased risk of death among users of oral contraceptives, although an increased risk of idiopathic venous thromboembolism has been a consistent finding. There is compelling evidence that oral contraceptive use provides significant protection against endometrial and ovarian cancer, and that this protection lasts at least 15 years. In addition, no clear association has been found between oral contraceptive use and breast cancer or cervical cancer. Data on hepatocellular carcinoma and malignant melanoma are inconclusive. The objectives of this article on epidemiological studies of health risks from oral contraceptives (OCs) is to review major studies of the association between OCs and circulatory disease and cancer. It is also to emphasize methodologic limitations of the existing data, and to identify unresolved and important questions. A brief discourse on the nature and imputation of relative risk is provided. Cardiovascular diseases covered include ischemic heart disease, stroke, and thromboembolism. Current studies on low dose pills from 3 large US populations reveal that there is no impact of death from use of OCs. A Great Britain and the Walnut Creek study from the US found a slight but not statistically significant increase in ischemic heart disease. These studies also found a statistically significant 3-fold increase in stroke among OC users and, from another study, a 2-fold increase. These studies were based on high levels of ethinyl estradiol where the risk becomes apparent. The risk for idiopathic venous thromboembolism was 3- 8 fold for current OC users. The accuracy of these findings is questioned when the data reflect such heterogeneity. Cancer is differentiated as breast cancer, endometrial cancer, ovarian cancer, cervical cancer, malignant melanoma, and hepatocellular adenoma. For breast cancer, both case control studies as well as cohort studies found no increase in breast cancer. Future additional research will continue to explore unanswered questions about this association. Beneficial effects of OCs occur for endometrial cancer for as long as 15 years after taking the pill. Only 1 year's use resulted in a 50% reduction in risk of endometrial cancer regardless of pill dose and particularly for nulliparous women, who have an increased risk. The longer duration of use of the OCs results in a protective effect against ovarian cancer, i.e., 5 years of use yields as relative risk of below 0.5 and the results of a protective effect can be seen as early as 3 months after pill use. There is about 40% protection against ovarian cancer even with low dose pills; the effect lasts 15 years after cessation of OC use. Cervical cancer studies have shown mixed results. The human papilloma viruses 16 and 18 have been shown to be related to cervical cancer but further research is needed to identify the association with OCs. Data are inconclusive but lean in the direction of no association with malignant melanoma. Hepatocellular adenoma has not been identified in large vital statistics studies, although several small studies have suggested an increased risk. It has been shown by Fortney et al. that with a 50% increase in cervical cancer risk and a 3-4 fold increase in cardiovascular disease risk that OC use for 5 years before the age of 30 years adds 4 days to a health women's life.
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