Oral contraceptives and breast cancer: review and meta-analysis

Article Abstract:

Oral contraceptives use hormones to regulate the female reproductive cycle. As breast cancer is known to be dependent on a hormonal component, there has always been some concern that the use of oral contraceptives would increase the risk of breast cancer for some women. Even if the increased risk is relatively low, oral contraceptives are in such widespread use that only a small increase in risk would have significant impact upon the public health. The relationship between oral contraceptives and breast cancer is difficult to define reliably on the basis of studies published in the medical literature. Some studies have found an association, others have seen no link. To elucidate any increased risk of breast cancer resulting from oral contraceptive use, researchers pooled and analyzed the published results from 27 separate studies. Called a 'meta-analysis', such a study demands statistical sophistication, since the published studies are not directly comparable, and often published reports do not contain all the data that have been collected. The results of the meta-analysis indicated that, overall, there was no increased risk of breast cancer resulting from oral contraceptive use. However, the same was not true when particular sub-groups of women were considered separately. Long-term use of oral contraceptives was found to be a statistically significant risk factor in breast cancer among premenopausal women. The risk of premenopausal breast cancer associated with 10 years of contraceptive use was 46 percent greater than that of women in general. While this observation is consistent with the opinion of some researchers that premenopausal breast cancer is more hormonally sensitive than postmenopausal breast cancer, interpretation of the finding is complicated by the fact that women with long-term contraceptive use are only now beginning to reach menopausal age. The data also indicate that a increased risk is associated with long-term oral contraceptive use prior to the first pregnancy. This result, which did not reach significance, may be due to the known correlation of breast cancer with a delay in the first pregnancy; it is not clear that contraceptive hormones contribute directly to this association. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Complications and side effects, Oral contraceptives, Meta-analysis

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The effect of age on treatment choice and survival in elderly breast cancer patients

Article Abstract:

The chances of having breast cancer rise rapidly with age. Since the number of elderly people in most developed countries is rising, the number of elderly breast cancer patients is rising as well. In The Netherlands, where the present study took place, breast cancer accounts for 26 percent of all female cancer patients over the age of 65, and is the number one cause of death for women between 65 and 80 years. Many studies on the treatment of cancer do not include patients who are 70 years and older. For this reason, a study was undertaken to evaluate cancer treatment for patients beyond this age. Data from 611 breast cancer patients were compared for women in three age groups: 55 to 64, 65 to 74, and 75 years and older. The review showed that physicians were less likely to employ radiotherapy (radiation treatment) after breast cancer surgery among patients who are 75 and older. In addition, physicians were less likely to suggest mastectomy for early-stage breast cancer in these women; instead, they recommended hormonal therapy. There was no evidence, however, that very elderly women were more likely to be diagnosed at a more advanced stage of the disease. The 7-year survival of the patients in the eldest group was 50 percent, in contrast with the significantly better 65 percent survival of the 65 to 74 age group. This difference, however, does not seem to be attributable to differences in treatment, indeed, it does not seem to be attributable to breast cancer at all. The difference seems to be due to other physical disorders and to the more general overall weakness of the patients in the 75 and older group. It is worth noting that the youngest group in the present study, the 55- to 64-year-old women, had a 55 percent 7-year survival, which was also significantly worse than the survival of the 65 to 74 age group. Among these younger patients, however, decreased survival seems to be the result of more aggressive disease. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Aged, Elderly, Medical protocols

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