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  • Title: Review: oral contraceptives and menopausal estrogens in relation to breast neoplasia.
    Author: Brzezinski A, Schenker JG.
    Journal: Isr J Med Sci; 1982 Apr; 18(4):433-8. PubMed ID: 7045033.
    Abstract:
    An estimated 40-50 million women worldwide are currently using oral contraceptives (OCs) and the high incidence of breast cancer concurrent with extensive OC-exogenous estrogen usage has created concern as to the possibility of a relationship between OC use and breast cancer. The following conditions are conducive to high risk of breast cancer: 1) being a woman, 2) long menstrual life, 3) nulliparity, and 4) high incidence of anovulatory cycles. Conditions associated with low risk are: 1) early 1st full-term pregnancy, 2) early castration, and 3) multiparity. The following theories of hormonal etiology of breast cancer have been suggested: 1) estriol might normally serve to modulate the effects of the more potent estrogens on breast tissue, 2) progesterone theory - conditions conducive to low progesterone/estrogen ratios are considered risk factors for breast cancer, 3) androgen theory; decrease in the level of urinary 17-ketosteroids has been associated with poor response to endocrine therapy and increased risk of breast cancer, 4) prolactin theory, and 5) pineal gland theory. Most studies show a significantly decreased risk of benign breast disease in women using OCs; it is possible that the progestational component of OCs is responsible for their protective effort against benign breast disease. Research on the role of OCs in causing breast cancer has shown that specific subgroups run a greater risk such as: 1) women with a previous biopsy of benign breast disease, and 2) young women on longterm use of OCs. There is also evidence that estrogen treatment for postmenopausal women is associated with increased risk of endometrial cancer which also links estrogens with breast cancer, since both the breast and the endometrium are target organs for estrogens; there may be a relationship between exogenous estrogen therapy and breast cancer. Other observations have been that relative risk was greater among women with intact ovaries who used estrogens of a dose in excess of 1.5 g/day and that risk increased with prolonged use of estrogen. Although some of these results are not statistically significant, they warrant continued monitoring of large numbers of women for more years. Young women should be advised to avoid prolonged use of OCs and to have frequent screening tests. It is recommended that continuous use of menopausal estrogens for more than 10 years should be reconsidered.
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