CONSTANT USED OF ORAL CONTRACEPTIVES RAISES HIGH RISK OF (BREAST, OVARIAN AND CERVICAL CANCER) M. Saidu
INTRODUCTION Cancers of different types have been a serious and global pandemic and resulted in million deaths of people worldwide. Its estimated that about 20% of all deaths are cancer related. there have been changing patterns in incidence of cancers in both sexes and in different geographic locations, where in developed countries there are cases of lungs, breast, prostate and colerectal while in developing countries most common are liver, cervical and oesophageal cancers. Therefore, I took interest in enlighten couples and families about the dangers and outcomes of constant use of oral contraceptives. General classification DRUG CLASS AND MECHANISM: Oral contraceptives (birth control pills) are medications that prevent pregnancy. They are one method of birth control Oral contraceptives are hormonal preparations that may contain combinations of the hormones estrogen and progestin or progestin alone. Combinations of estrogen and progestin prevent pregnancy by inhibiting the release of the hormones leuteinizing hormone(LH) and follicle stimulating hormone (FSH) from the pituitary gland in the brain. LH and FSH play key roles in the development of the egg and preparation of the lining of the uterus for implantation of the embryo. Progestin also makes the uterine mucus that surrounds the egg more difficult for sperm to penetrate and, therefore, for fertilization to take place. In some women, progestin inhibits ovulation (release of the egg). There are different types of combination birth control pills that contain estrogen and progestin that are referred to as "monophasic," "biphasic," or "triphasic." Monophasic birth control pills deliver the same amount of estrogen and progestin every day. Biphasic birth control pills deliver the same amount of estrogen every day for the first 21 days of the cycle. During the first half of the cycle, the progestin/estrogen ratio is lower to allow the lining of the uterus (endometrium) to thicken as it normally does during the menstrual cycle. During the second half of the cycle, the progestin/estrogen ratio is higher to allow the normal shedding of the lining of the uterus to occur.
Triphasic birth control pills have constant or changing estrogen concentrations and varying progestin concentrations throughout the cycle. There is no evidence that bi- or triphasic oral contraceptives are safer or superior to monophasic oral contraceptives, or vice versa, in their effectiveness for the prevention of pregnancy. INTERACTIONS: estrogen can inhibit the metabolism (elimination) of cyclosporine, resulting in increased cyclosporine blood levels. Such increased blood levels can result in kidney and/or liver damage. If this combination cannot be avoided, cyclosporine concentrations can be monitored, and the dose of cyclosporine can be adjusted to assure that its blood levels do not become elevated. Estrogens appear to increase the risk of liver disease in patients receiving dantroline (Dantrium) through an unknown mechanism. Women over 35 years of age and those with a history of liver disease are especially at risk. Estrogens increase the liver's ability to manufacture clotting factors. Because of this, patients receiving warfarin (Coumadin) need to be monitored for loss of anticoagulant (blood thinning) effect if an estrogen is begun. A number of medications, including some antibiotics and anti seizure medications, can decrease the blood levels of oral contraceptive hormones, but an actual decrease in the effectiveness of the oral contraceptive has not been convincingly proven.because of this theoretical possibility, some physicians recommend backup contraceptive methods during antibiotic use. Examples of medications that increase the elimination of estrogens include carbamazepine(Tegretol),phenobarbital, phenytoin(Dilantin), primidone(Mysoline),rifampin(Rifadin),rifabutin(Mycobutin), and ritonavir(Norvir). SIDE EFFECTS: The most common side effects of the birth control pills include nausea, headache, breast tenderness, weight gain, irregular bleeding, and mood changes. These side effects often subside after a few months' use. Scanty menstrual periods or breakthrough bleeding may occur but are often temporary, and neither side effect is serious. Women with a history of migraines may notice an increase in migraine frequency. On the other hand, women whose migraines are triggered by fluctuations in their own hormone levels may notice improvement in migraines with oral contraceptive use because of the more uniform hormone levels during oral contraceptive use. Uncommonly, oral contraceptives may contribute to increased, blood clots, heart attack, and stroke. Women who smoke, especially those over 35, and women with certain medical conditions, such as a history of blood clots or breast or endometrial cancer, may be advised against taking oral contraceptives, as these conditions can increase the adverse risks of oral contraceptives. PRECAUTIONS: Before you take this medication, tell your doctor your entire medical history, including family medical history, especially: asthma, high blood pressure, kidney disease, liver disease, heart disease, stroke, history of jaundice (yellowing skin/eyes) or high blood pressure
during pregnancy, excessive weight gain or fluid retention during menstrual cycle, blood clots, heart, seizures, migraine headaches, breast cancer high blood level of cholesterol or lipids (fats), diabetes, depression. Depending on strength, this drug may cause a patchy, darkening of the skin on the face (melasma). Higher strengths are more likely to cause melasma. Sunlight may A number of studies suggest that current use of oral contraceptives (birth control pills) appears to slightly increase the risk of breast cancer, especially among younger women. However, the risk level goes back to normal 10 years or more after discontinuing oral contraceptive use. Women who use oral contraceptives have reduced risks of ovarian and endometrial cancer. This protective effect increases with the length of time oral contraceptives are used. Oral contraceptive use is associated with an increased risk of cervical cancer; however, this increased risk may be because sexually active women have a higher risk of becoming infected with human papillomavirus, which causes virtually all cervical cancers. Women who take oral contraceptives have an increased risk of benign liver tumors, but the relationship between oral contraceptive use and malignant liver tumors is less clear. Two types of oral contraceptives (birth control pills) that are most commonly prescribed are man-made versions of the natural female hormone estrogen and progesterone. This type of birth control pill is often called a “combined oral contraceptive.� The second type is called the mini pill. It contains only progestin, which is the man-made version of progesterone that is used in oral contraceptives. How could oral contraceptives influence cancer risk? Naturally occurring estrogen and progesterone have been found to influence the development and growth of some. Because birth control pills contain female hormones, researchers have been interested in determining whether there is any link between these widely used contraceptives and cancer risk. The results of population studies to examine associations between oral contraceptive use and cancer risk have not always been consistent. Overall, however, the risks of endometrial and ovarian appear to be reduced with the use of oral contraceptives, whereas the risks of breast, cervical and liver cancer appear to be increased. A summary of research results for each type of cancer is given below. How do oral contraceptives affect breast cancer risk? A woman’s risk of developing breast cancer depends on several factors, some of which are related to her natural hormones. Hormonal and reproductive history factors that increase the risk
of breast cancer include factors that may allow breast tissue to be exposed to high levels of hormones for longer periods of time, such as the following: Beginning menstruation at an early age Experiencing menopause at a late age Later age at first pregnancy Not having children at all A 1996 analysis of epidemiological data from more than 50 studies worldwide 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 higher risk of developing breast cancer than women who had never used the pill. The risk was highest for women who started using oral contraceptives as teenagers. However, 10 or more years after women stopped using oral contraceptives, their risk of developing breast cancer had returned to the same level as if they had never used birth control pills, regardless of family history of breast cancer, reproductive history, geographic area of residence, ethnic background, differences in study design, dose and type of hormone(s) used, or duration of use. In addition, breast cancers diagnosed in women who had stopped using oral contraceptives for 10 or more years were less advanced than breast cancers diagnosed in women who had never used oral contraceptives. A recent analysis of data from the Nurses’ Health Study, which has been following more than 116,000 female nurses who were 24 to 43 years old when they enrolled in the study in 1989, found that the participants who used oral contraceptives had a slight increase in breast cancer risk. However, nearly all of the increased risk was seen among women who took a specific type of oral contraceptive, a “triphasic” pill, in which the dose of hormones is changed in three stages over the course of a woman’s monthly cycle. Because the association with the triphasic formulation was unexpected, more research will be needed to confirm the findings from the Nurses’ Health Study. A more recent analysis of data from the CASH study, however, indicated that oral contraceptive formulations with high levels of progestin were associated with a lower risk of ovarian cancer than formulations with low progestin levels. In another study, the Steroid Hormones and Reproductions (SHARE) Study, researchers investigated new, lower-dose progestin’s that have varying androgenic (testosterone-like) effects. They found no difference in ovarian cancer risk between androgenic and no androgenic pills. Oral contraceptive use by women at increased risk of ovarian cancer due to a genetic mutation in the BRCA1or BRCA2gene has been studied. One study showed a reduction in risk among
BRCA1- or BRCA2-mutation carriers who took oral contraceptives, whereas another study showed no effect. A third study, published in 2009, found that women with BRCA1mutations who took oral contraceptives had about half the risk of ovarian cancer as those who did not. In another view by the American cancer society textbook on clinical oncology outlined use of oral-contraceptives as one of the risks factors for developing Breast cancer. Other factors includes, age, hereditary factors, benign breast diseases, endogenous and exogenous endocrine factors, environmental factors(diet, region of birth, alcohol intake etc. How do oral contraceptives affect cervical cancer risk? Long-term use of oral contraceptives (5 or more years) is associated with an increased risk of cervical cancer. An analysis of 24 epidemiologic studies found that the longer a woman used oral contraceptives, the higher her risk of cervical cancer. However, among women who stopped taking oral contraceptives, the risk tended to decline over time, regardless of how long they had used oral contraceptives before stopping. In a 2002 report by the International Agency for Research on Cancer, which is part of the World Health Organization, data from eight studies were combined to assess the association between oral contraceptive used and cervical cancer risk among women infected with the human papillomavirus (HPV). Researchers found a nearly threefold increase in risk among women who had used oral contraceptives for 5 to 9 years compared with women who had never used oral contraceptives. Among women who had used oral contraceptives for 10 years or longer, the risk of cervical cancer was four times higher. Virtually, all cervical cancers are caused by persistent infection with high-risk, or oncogenic types of HPV, and the association of cervical cancer with oral contraceptive use is likely to be indirect. The hormones in oral contraceptives may change the susceptibility of cervical cells to HPV infection, affect their ability to clear the infection, or make it easier for HPV infection to cause changes that progress to cervical cancer. Questions about how oral contraceptives may increase the risk of cervical cancer will be addressed through ongoing research. How do oral contraceptives affect liver cancer risk? Oral contraceptive use is associated with an increase in the risk of benign liver tumors, such as hepatocellular adenomas. Benign tumors can form as lumps in different areas of the liver, and they have a high risk of bleeding or rupturing. However, these tumors rarely become malignant. Whether oral contraceptive use increases the risk of malignant liver tumors, also known as hepatocellular carcinomas, is less clear. Some studies have found that women who take oral contraceptives for more than 5 years have an increased risk of hepatocellular carcinoma, but others have not.
What are the Alternatives? I'm very aware that women (and their partners) want to avoid unplanned pregnancies. I concede that birth control pills have provided an easy but not safe for the health. Therefore, the way to accomplish this goal can not be only using oral contraceptives but there are numerous safe and effective ways to prevent unwanted/ unplanned pregnancies, those ways are as follows: Male condoms: Most of us are familiar with male condoms, which, at a 98 percent effectiveness rate when used correctly, are nearly as effective as birth control pills. However, be sure to purchase lubricated condoms or use water-based lubricants like K-Y jelly or spermicidal creams to increase your protection. Many couples are unaware that lubricants like petroleum jelly actually cause the latex in the condoms to break down and increase the risk of pregnancy. An added bonus of condoms: They help protect against sexually transmitted diseases. Female condoms: Most of us are unfamiliar with female condoms, but these thin, soft polyurethane pouches fitted inside the vagina before sex are 95 percent effective. Again, the rate of effectiveness is increased if a spermicidal jelly is used. The female condom has an inner ring that goes into the upper part of the vagina and an outer one, which should be visible outside the vagina. Female condoms are less likely to tear than male condoms. Diaphragm: Diaphragms, which must be fitted by a doctor, are thin soft rubber mounted on a ring. When inserted into the upper part of the vagina to cover the cervix, they act as a barrier to sperm. If used correctly with spermicidal jellies, they are 92 to 98 percent effective in preventing pregnancy. Cervical cap: This effective (91 percent), but underutilized, form of birth control has been available in the U.S. for decades. The heavy rubber cap fits tightly against the cervix and can be left in place for 48 hours. Like the diaphragm, a doctor must fit the cap. Proper fitting enhances the effectiveness above 91 percent. Spermicides: Creams, jellies and suppositories contain chemicals that kill sperm. While they can increase the effectiveness of other forms of contraception, I don't recommend using them alone. Finally, I will like to draw the attention of all oral contraceptives users to know the serious and dangerous outcomes associated in their use. Also to advise them to look on to and try practicing other several safe ways of avoiding unwanted/ unplanned pregnancies.
Thank you
Pharmtech, M.saidu
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