'The Pill' Saves Lives!
Abstract & Commentary
By Alison Edelman, MD, MPH, Assistant Professor, Assistant Director of the Family Planning Fellowship Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, is Associate Editor for OB/GYN Clinical Alert
Dr. Edelman reports no financial relationship to this field of study
Synopsis: Ever-use of oral contraception not only prevents but provides long-term protection against ovarian cancer.
Source: Collaborative group on epidemiological studies of ovarian cancer. "Ovarian cancer and oral contraceptives: collaborative reanalysis of data from 45 epidemiological studies including 23,257 women with ovarian cancer and 87,303 controls." Lancet. 2008;371:303-314.
This publication is a reanalysis of 45 epidemiological studies to determine the impact of ever-use of oral contraceptives on the long-term prevention of ovarian cancer.1 Women with epithelial and non-epithelial cancers (cases) were compared to women without ovarian cancer who had not undergone bilateral oophorectomy (controls). Information regarding pill use was obtained (cumulative duration of use, age at first and last use, and calendar year of first and last use). Of note, the year of pill use highly correlates to the level of estrogen contained in the pill. Potential confounders were also gathered including demographics, age at first birth, parity, family history of breast cancer, age at menarche, menopausal status, use of hormone replacement therapy, height, weight, body-mass index, alcohol use, and smoking. The greater duration of oral contraceptive use, the greater reduction in ovarian cancer risk (1.2 cancers/100 women decreased to 0.8/100 women, p < 0.001) and in mortality from ovarian cancer. This risk reduction persisted for more than 30 years after cessation of the oral contraceptive but became slightly attenuated with time (risk reduction of 29% with cessation of use less than 10 years ago vs 15% for use less than 20-29 years ago). Use of high vs low-dose oral contraceptives appeared to have no differences in their beneficial effect.
Commentary
We have long known that oral contraceptives are highly effective at preventing ovarian cancer.2 This study not only confirms this protective effect but also demonstrates that this effect persists long after medication cessation.1 This study estimates that oral contraceptives have prevented 200,000 ovarian cancers and 100,000 deaths from the disease. Additionally, it puts to rest the growing concern that modern oral contraceptive formulations containing lower estrogen levels might not offer the same protective effect. This study shows that these lower dose products are just as protective.
Although this study did not specifically look at high risk patients (women with BRCA genes), we also know that even these women benefit from oral contraceptive use.3
Unfortunately, the tremendous number of non-contraceptive benefits of hormonal contraception are rarely celebrated or even discussed. Studies have shown that few patients are aware of these beneficial effects.4 We as providers need to be more proactive about educating our patients. I can hear the groaning from the reader as I write this—I am fully aware that no remaining time exists after educating about immunizations, diet, exercise, sunscreen, smoking cessation, domestic violence and fire-arm safety (did I miss anything?) so it's no wonder that our patients are unaware of these fabulous non-contraceptive benefits. But let's not be shy—this kind of information deserves sky-writing, bumper stickers, or even a spot on Oprah! Or easier yet, how about a patient-information sheet:
References
- Collaborative group on epidemiological studies of ovarian cancer. "Ovarian cancer and oral contraceptives: collaborative reanalysis of data from 45 epidemiological studies including 23,257 women with ovarian cancer and 87,303 controls." Lancet. 2008;371:303-314.
- The cancer and steroid hormone study of the Centers for Disease Control and the National Institutes of Child Health and Human Development. The reduction in risk of ovarian cancer associated with oral contraceptive use. NEJM. 1987;316:650-6555.
- Whittemore AS, et al. Oral contraceptive use and ovarian cancer risk among carriers of BRCA1 or BRCA2 mutations. Br J Cancer. 2004;91(11):1911-1915.
- Picardo CM, et al. Women's knowledge and sources of information on the risks and benefits of oral contraception. JAMA. 2003;58(2):112-116.
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