Oral Contraceptives and Breast Cancer

Éditeur: National Academies Press
ISBN: 9780309044936
eISBN Pdf: 9780309597630
Lieu de publication: United States
Année de publication électronique: 1991
Mois : Janvier
Pages: 196
DDC: 616
Langue: Anglais

Légende

At least 10.7 million American women use oral contraceptives (OCs). The potential connection with breast cancer has caused concern among these OC users and uncertainty among many of their physicians. This new volume offers the most up-to-date information available on this critical topic.

While the best available knowledge does not support any fundamental change in clinical practice with respect to the use of OCs, this book offers specific recommendations for more research to fully resolve the relationship between OCs and breast cancer. Noting consumer confusion, the volume includes a concise summary of benefits, risks, and other practical information for contraceptive users and their doctors.

The volume presents current data on changes in patterns of OC use, differences in risk at different ages, the benefits of OCs, and more.

Oral Contraceptives and Breast Cancer will be important reading for obstetricians/gynecologists and other health professionals, their patients who use OCs, contraceptive manufacturers, women's health advocates, policymakers, and researchers.

Oral Contraceptives & Breast Cancer
Copyright
Preface
Contents
Executive Summary
- MAINTAINING SURVEILLANCE
- DEVELOPING A BROADER ARRAY OF CONTRACEPTIVES
- ASSESSING KNOWLEDGE FOR APPLICATION IN CLINICAL PRACTICE
- FILLING GAPS IN BIOLOGICAL AND EPIDEMIOLOGICAL KNOWLEDGE
1 Introduction and Overview
- BIOLOGICAL PLAUSIBILITY OF A LINK BETWEEN ORAL CONTRACEPTIVES AND BREAST CANCER
- WHAT IS—AND IS NOT—KNOWN
- SEEKING ANSWERS
2 Epidemiology: Information Needs and Data Gaps
- EPIDEMIOLOGICAL RESEARCH
  - Case-Control Method
  - Cohort Studies
  - Comparison Groups
  - Ecological Studies
  - Special Studies
    - Women Exposed to Hormones Other than Oral Contraceptives
    - Women Genetically Susceptible to Breast Cancer
    - Estrogen Metabolism
    - Progestins
  - Changing Oral Contraceptive Formulations
- SUMMARY AND CONCLUSIONS
3 Biology: Information Needs and Data Gaps
- SIGNAL COMPLEXITY IN BREAST REGULATION
- RESEARCH ISSUES
  - Relationships Among Cell Types
  - Receptors
  - Timing
  - Effects of Pregnancy and Lactation
  - Pathological Breast Tissue
  - Oncogenes
  - Molecular Changes Associated with Human Breast Cancer
    - Activated ras Mutations
    - Overexpression of Tyrosine Kinases
    - Amplification of int-2 and myc
    - Deletions of Genes
- RESEARCH MODELS
  - Breast Cancer Cell Lines
  - Short-term Culture of Normal Mammary Epithelium
  - Organ Culture
  - Nude Mouse Model
- SUMMARY AND CONCLUSIONS
4 Information for Users of the Pill and Health Care Providers
- BENEFITS AND RISKS OF ORAL CONTRACEPTIVES
  - Benefits
  - Risks
- CURRENT CONTROVERSY
- PRESCRIBING PROBLEMS
5 Policy Issues and Recommendations
- MAINTAINING SURVEILLANCE
  - Cooperative Research
  - Surveillance Requirements of the Food and Drug Administration
- DEVELOPING A BROADER ARRAY OF CONTRACEPTIVES
- ASSESSING KNOWLEDGE FOR APPLICATION IN CLINICAL PRACTICE
- FILLING GAPS IN BIOLOGICAL AND EPIDEMIOLOGICAL KNOWLEDGE
References
Appendixes
- A Oral Contraceptives and Breast Cancer: A Review of the Epidemiological Evidence with an Emphasis ...
  - Changing Profile Of Oral Contraceptive Use
  - Biological Plausibility
  - Epidemiological Studies Of Breast Cancer and Oral Contraceptives
    - "Ever" Use of Oral Contraceptives
    - Duration of Oral Contraceptive Use
    - Oral Contraceptive Use Before First Full-term Pregnancy or Before Age 25
    - Duration Since First Use of Oral Contraceptives (Latency)
    - Use of Oral Contraceptives in High-Risk Subgroups
    - Steroidal Potency of Various Formulations
  - Issues to Consider in Reviewing the Epidemiological Evidence
  - Discussion
  - The Future
  - References
- B Oral Contraceptives and Breast Cancer: Review of the Epidemiological Literature
  - Methods
  - Results
    - Risk of Oral Contraceptive Users of All Ages in Developed Countries
    - Risk in Oral Contraceptive Users in Developing Countries
    - Risk in Oral Contraceptive Users With and Without Various Risk Factors for Breast Cancer
    - Risk in Relation to Early Use of Oral Contraceptives
    - Screening Bias
    - Risk in Relation to Use of Oral Contraceptives Near the Age of Menopause
    - Individual Formulations and Constituents of Oral Contraceptives
  - Conclusions, Interpretations, and Recommendations for Further Research
  - Acknowledgments
  - References
- C The Evolving Formulations of Oral Contraceptives
  - Implications for Research
  - References
- D Animal Models of Sex Steroid Hormones and Mammary Cancer: Lessons for Understanding Studies in Humans
  - Direct Tests of Carcinogenicity
    - Mice and Rats
    - Beagle Dogs
  - Pharmacokinetics of Various Steroids in Mice, Rats, and Beagles
  - Studies of Mechanisms for Mammary Carcinogenicity of Sex Steroid Hormones in Mice, Rats, and Dogs
  - Conclusions
  - Interesting Questions Raised by Animal Studies
  - References
- E Risks and Benefits of Oral Contraceptives: Will Breast Cancer Tip the Balance?
  - Established Benefits and Risks
  - Balance of Benefits and Risks
  - Oral Contraceptives and Breast Cancer
  - An Effect in Young Women
  - Conclusions
  - References
- F List of Background Documents
Index