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  • Title: Oral contraception and cancer of the female reproductive system.
    Author: Woods KL.
    Journal: J Clin Hosp Pharm; 1985 Jun; 10(2):123-35. PubMed ID: 3894428.
    Abstract:
    This paper reviews epidemiologic evidence regarding the association between exposure to oral contraceptives (OCs) and the development of 4 cancers involving the reproductive system: breast, ovarian, endometrial, and cervical. Most knowledge in this area has been derived from cohort or case-control studies. Currently available evidence suggests that OC use does not influence breast cancer risk either adversely or favorably, although there may be a favorable influence on tumor growth. In view of the long latency of effect seen with known risk factors such as radiation exposure, age at menarche, and age at 1st full-term pregnancy, further studies are needed in this area. The epidemiologic evidence consistently supports the prediction that OC use makes the ovaries less susceptible to malignant change, perhaps by a mechanism similar to the protective effect of pregnancies. The magnitude of the effect is considerable, and should have a significant impact on the future incidence of ovarian cancer. In terms of endometrial cancer, there is evidence that sustained estrogenic stimulation unopposed or inadequately opposed by progestogen leads to endometrial hyperplasia and an increased longterm risk of malignancy. In currently used OC formulations, however, the progestogenic component has the predominant effect on the endometrium, and this effect is protective. It remains unknown whether OCs increase cervical cancer risk directly, or whether the association is an indirect one linked to some aspect of sexual behavior that is not being controlled. On the other hand, it seems reasonable to conclude that longterm OC users have an above average risk of cervical cancer and should have regular screening by cervical cytology. It should be kept in mind that recent changes in OC formulations and use patterns render epidemiologic data now available obsolete. It will be many years before sound data will be available on the low-dose estrogen OCs now in almost universal use.
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