Oral contraceptives and hepatocellular carcinoma

A series of 26 white women aged under 50 who developed hepatocellular carcinoma in a non-cirrhotic liver were studied for the possible role of oral contraceptives. Eighteen of the women had used the "pill" for a median of eight years. Over 1300 women whose use of the pill had been determined in another study served as controls. Patients and controls were divided into five age and four calendar groups and the relative risks associated with oral contraceptives calculated by multivariate analysis. Short term use of the pill was not associated with an increased risk of tumour development; nevertheless, use for eight years or more was associated with a 4.4-fold increased risk (p less than 0.01). When patients with markers of hepatitis B virus infection were excluded the relative risk was 7.2 (p less than 0.01). In both instances the absolute risk for developing hepatoma remained low.     

Oral contraceptives use and liver tumours: a review

Of the nine epidemiologic controlled studies reporting on the relationship between oral contraceptives use and hepatic tumours, three have findings specifically on the association of oral contraceptives use and hepatocellular adenomas. The strength of this association is reported to be dependent more on long-term oral contraceptive use. Three other studies have reported similar relationships of oral contraceptives use with hepatocellular carcinoma, whereas the remaining three other studies have reported no association between oral contraceptives use and hepatocellular carcinoma. There is however, an increased risk of hepatocellular carcinoma as the duration of oral contraceptives use increases. The risk of developing hepatocellular adenomas is higher in oral contraceptives users over 30 years of age than in the younger age groups. These tumours occur more often in oral contraceptive users taking pills with high doses of estrogens and progestogens; while they are not only associated with oral contraceptives containing mestranol, but also those containing ethinylestradiol.     

Oral contraceptives and breast cancer: a national study

In a population based case-control study 433 New Zealand women aged 25-54 with newly diagnosed breast cancer were compared with 897 women selected at random from the electoral rolls. The relative risk of breast cancer in women who had ever used oral contraceptives was 0.94 (95% confidence interval 0.70 to 1.25). The relative risk in women aged 25-34 at diagnosis was estimated to be 2.2 (95% confidence interval 0.47 to 9.9) and in older women less than 1. Analyses of risk by duration of use of oral contraceptives, age at first use, and time since first use showed no adverse effect of the pill. In particular, there was no increased risk in women who had used oral contraceptives before the age of 25 or before their first pregnancy, even for prolonged periods. Given the high prevalence of use in New Zealand, this study provides strong evidence against the hypothesis that use of oral contraceptives at young ages increases the risk of breast cancer.     

Oral contraceptives, pregnancy, and endogenous oestrogen in gall stone disease--a case-control study

A case-control study of gall stone disease in women in relation to use of contraceptives, reproductive history, and concentrations of endogenous hormones was undertaken. The study population comprised 200 hospital patients with newly diagnosed gall stone disease, 182 individually matched controls selected from the community, and 234 controls who were patients in hospital. Use of oral contraceptives was associated with an increased risk of developing gall stones among young subjects but a decreased risk among older subjects. The risk of developing gall stone disease increased in association with increasing parity, particularly among younger women. The risk fell with increasing age at first pregnancy, independent of parity. Mean urinary excretion over 24 hours of oestrone, but not of pregnanediol, was significantly (p less than 0.05) greater for postmenopausal patients than controls. The age dependence of the relative risk associated with exposure to oral contraceptives and pregnancy suggests that there are subpopulations of women susceptible to early formation of gall stones after exposure to either oral contraceptives or pregnancy.     

Breast cancer and oral contraceptives: findings in Oxford-Family Planning Association contraceptive study

Among the 17 032 women taking part in the Oxford-Family Planning Association contraceptive study, 72 were first diagnosed as having breast cancer between the date they were admitted to the study and 1 September 1980. The relative risk of developing the disease in women who had used oral contraceptives in comparison with those who had never used them was estimated to be 0.96 (95% confidence limits 0.59 to 1.63). Among women aged under 35 years, the corresponding relative risk (based on only 14 women with breast cancer) was estimated to be 0.61. No relation was apparent between the risk of developing breast cancer and duration of oral-contraceptive use or interval since first oral-contraceptive use in any age group. The data in this study are thus reassuring; but observations based on women with long-term use of oral contraceptives, especially those starting to use the preparations at an early age, are few.     

A few women taking the pill found to have benign liver tumors

At least 50 proven cases of liver tumors following use of oral contraceptives have been reported. The authors reports 12 in his practice but thinks may have gone unrecognized elsewhere. The 11 cases reported to the surgical meeting in Miami Beach were solitary primary tumors in nonalcoholic and otherwise healthy women with an average of 32 years. Of these 6 had been taking oral contraceptives for 5 or more years, 3 for 2 years or less, and 2 for 1 year or less. Several had catastrophic hemorrhage, abdominal pain, and shock. Hemoperitoneum was found at laparotomy. In 2 cases the tumors were malignant. In 5 cases the tumors had not bled but were found incidentally at laparotomy. No particular type of contraceptive was correlated. sometimes the patient had detected a lump in the right upper part of the abdomen. All tumors were hepatocellular. The tumors were hamartoma, focal nodular hyperplasia, and adenoma or hepatocellular carcinoma.     

原发性肝癌病理类型与乙肝病毒感染模式和血清AFP含量的相关性研究

目的 探讨原发性肝癌病理类型与乙肝病毒感染模式和血清AFP含量的相关性.方法 回顾性分析2003年1月-2013年12月广东省省内的三家医院的肝胆外科收治的原发性肝癌肝切除术患者的临床资料.按照病理类型将肝癌患者分为肝细胞癌组、胆管癌组、其他类型肝癌组3种病理类型并与乙肝病毒感染模式和血清AFP含量进行相关性分析.结果 原发性肝癌患者病理类型与患者的性别、年龄无明显的相关性(X2=1.034,P=0.596;X2=1.360,P=0.507);但不同病理类型的原发性肝癌患者血清AFP含量具有明显差异,且肝细胞癌患者血清AFP含量明显高于其他病理类型的肝癌患者,并且差异有统计学意义(X2=99.65,P =0.000);原发性肝癌的病理类型与乙肝病毒感染模式具有显著的相关性,且小三阳(HBsAg+HBcAb+HBeAb阳性)与肝细胞癌高度关联,大三阳(HBsAg+HBeAg+HBcAb阳性)与肝细胞癌也有一定的关联,HBsAb阳性和胆管癌也具有一定的关联性(P=0.000).结论 原发性肝癌的组织病理类型与乙肝病毒感染模式及血清AFP含量存在明显的相关性,医疗工作者及患者应重视血清AFP水平的检测以及乙肝病毒感染防治,特别是对于小三阳和大三阳患者.     

Oral contraceptives may tend to protect against benign breast cancer

A retrospective epidemiological study was made of all women of reproductive age admitted to 5 London hospitals for primary treatment of breast cancer or biopsy of a mass in the breast. The only significant difference was that the benign disease group had used oral contraceptives about half as long as the controls. 12% of the women with benign breast lesions used oral contraceptives the month immediately preceding discovery of the breast mass. 22% of the Controls used the contraceptives during the corresponding month.     

Liver tumours associated with oral contraceptives.

Five young women have been encountered with unusual forms of hepatic neoplasms in a ten year period. Each had been taking an oral contraceptive. Two of the four women with benign lesions noted the presence of their tumours, and another woman presented with abdominal pain. Each of these tumours was resected successfully. The fourth patient had the diagnosis made at laparotomy following the development of haemoperitoneum after an attempt at percutaneous liver biopsy. A fifth patient developed jaundice and investigation revealed a hepatocellular carcinoma which was invading the biliary tree. This experience illustrates the need for periodic physical examination of young women who are taking oral contraceptives.     

Depo medroxyprogesterone acetate (DMPA) and combined oral contraceptives and cervical carcinoma in-situ in women aged 50 years and under

Most low-resource settings depend on hormonal contraceptives for their family planning programmes and cervical cancer occurs in higher frequency in these populations. To determine whether hormonal contraception use increases cervical carcinoma in-situ (CIS) risk, a case-control study was conducted in the Kingston and St Andrew Corporate area of Jamaica, using 119 cases from the Jamaica Tumour Registry and 304 population controls matched on year of Papanicolaou (Pap) smear and clinic where Pap smear was obtained. While CIS cases were more likely to have 'ever used' combined oral contraceptives (COC) (OR = 1.4, 95% CI: 0.8, 2.5), depo-medroxyprogesterone acetate (DMPA) use was similar. Compared to women who never used hormonal contraceptives, the risk of CIS was elevated in: women who had used COCs five years or more (OR = 2.1, 95% CI: 1.0, 4.6), women who first used COC for less than 10 years prior to the interview (OR = 1.8, 95% CI: 0.9, 3.7) and women who were 18 to 24 years old when they first used COCs (OR = 1.8, 95% CI: 0.9, 3.4). Similarly, compared to women who never used DMPA, the risk of CIS was elevated in: women using DMPA five years or more (OR = 1.9, 95% CI: 0.7, 4.8), women reporting use within a year prior to interview (OR = 2.8, 95% CI: 0.7, 10.7) and women who initiated use of DMPA when they were 20 and 24 years old (OR = 1.4, 95% CI: 0.7, 3.1). These results suggest that if hormonal contraceptive use confers any risk of CIS, it is confined to long-term users. Increased risk in some groups, however, warrant further study.     

Epidemiology of hepatocellular adenoma. The role of oral contraceptive use.

A case-control study of hepatocellular adenoma (HCA), a serious though nonmalignant liver tumor, was conducted by the Center for Disease Control and the Armed Forces Institute of Pathology (AFIP). Interviews with 79 women with HCA and with 220 age- and neighborhood-matched controls were completed. Limited information was obtained on nine additional patients who had died. Women with HCA and hemorrhage have a greater risk of morbidity and death than those with other symptoms. Increasing duration of OC use increases the risk of HCA. Use of OCs with high hormonal potency and age over 30 years may further increase a woman's risk of HCA. Long-term users of OCs have an estimated annual incidence of HCA of 3 to 4 per 100,000.     

Do oral contraceptives prevent rheumatoid arthritis?

Two studies have suggested that the risk of rheumatoid arthritis in women using oral contraceptives is less than half that of nonusers. When a third study from the Mayo Clinic failed to confirm these findings, it was criticized for inclusion of ineligible subjects, misclassification of oral contraceptive use, and inadequate statistical power. Recent expansion of the Mayo Clinic's data resources provided a unique opportunity to resolve the controversy, and a new population-based case-control study was undertaken. In comparison with the previous study, the new investigation had 2.2 times as many eligible cases and more complete ascertainment of oral contraceptive use via access to the records of Planned Parenthood of Minnesota. Comparing any prior use of oral contraceptives with never having used them, the relative risk of rheumatoid arthritis estimated from 182 cases and their 182 matched controls was 1.1 (95% confidence interval 0.7 to 1.7). The relative risk for current use was 1.3 (95% confidence interval, 0.7 to 2.4). The lack of a protective effect was independent of age, disease severity, and disease end point (date of confirmed diagnosis or symptom onset).     

Epidemiology of cancer of the cervix: global and national perspective

Cancer of the uterine cervix is one of the leading causes of cancer death among women worldwide. The estimated new cancer cervix cases per year is 500,000 of which 79% occur in the developing countries. Cancer cervix occupies either the top rank or second among cancers in women in the developing countries, whereas in the affluent countries cancer cervix does not even find a place in the top 5 leading cancers in women. The truncated rate (TR) in the age group 35-64 years in Chennai, India, is even higher (99.1/100,000; 1982-95) than rate reported from Cali, Colombia (77.4/100,000, 1987-91). The cervical cancer burden in India alone is estimated as 100,000 in 2001 AD. The differential pattern of cervical cancer and the wide variation in incidence are possibly related to environmental differences. Aetiologic association and possible risk factors for cervical carcinoma have been extensively studied. The factors are: Sexual and reproductive factors, socio-economic factors (education and income), viruses e.g., herpes simplex virus (HSV), human papillomavirus (HPV), human immunodeficiency virus (HIV) in cervical carcinogenesis and other factors like smoking, diet, oral contraceptives, hormones, etc. The accumulated evidence suggests that cervical cancer is preventable and is highly suitable for primary prevention. Sexual hygiene, use of barrier contraceptives and ritual circumcision can undoubtedly reduce cervical cancer incidence. Education, cervical cancer screening of high risk groups and improvement in socio-economic status can reduce cervical cancer morbidity and mortality significantly.     

Is oral contraceptive therapy advisable in woman with family history of breast cancer?

A 20-year-old single woman suffers from severe dysmenorrhea, unresponsive to analgesic medication. Findings for gynecological examination were normal. Her mother died of mammary cancer at the age of 47. This cancer was diagnosed at age 42 while she was taking oral contraceptives. The patient in question, and her 3 sisters, had been warned against taking oral contraceptives. Now it is suggested that her dysmenorrhea might respond to contraceptive therapy. The question is asked regarding the use of oral contraceptives. In response, a diagnostic laparoscopy is recommended to determine if endometriosis is present. If endometriosis is found, medroxyprogesterone acetate may be used for suppression of ovulation, but ovulation may continue to be suppressed for 12-18 months after discontinuing this medication. Danazol is also effective in treating endometriosis and dysmenorrhea but has no estrogenic effect. Available data do not show an increased incidence of mammary cancer in users of oral contraceptives.     

能谱CT在肝细胞癌与肝内肿块型胆管细胞癌鉴别诊断中的应用价值

目的 探讨能谱CT在肝细胞癌与肝内肿块型胆管细胞癌鉴别诊断中的应用价值。方法 行能谱CT扫描并经病理证实的肝癌患者34例(肝细胞癌20例、肝内肿块型胆管细胞癌14例),通过能谱分析软件,获取肿块内感兴趣区的碘基图、水基图及101组单能量图像,分析单能量55 Kev下对应的碘含量、水含量、能谱曲线及标准化后碘含量。用独立样本t检验分析上述参数。结果 肝细胞癌的碘含量、能谱曲线斜率、标准化后碘含量分别为(12.84±2.38)、(1.58±0.24)、(0.15±0.05)μg/cm³,肝内肿块型胆管细胞癌分别为(10.71±3.01)、(1.34±0.32)、(0.12±0.34)μg/cm³。肝细胞癌与肝内肿块型胆管细胞癌的碘含量、能谱曲线斜率、标准化后碘含量差异均有统计学意义(P<0.05)。肝细胞癌与肝内肿块型胆管细胞癌的水含量分别为(1041.05±6.47)、(1 038.74±8.54)mg/cm³,差异无统计学意义(P>0.05)。结论 能谱CT成像及多参数分析,对肝细胞癌与肝内肿块型胆管细胞癌鉴别诊断中有一定价值。     

Serum zinc status of rural women taking combined OC

This prospective case-control study was undertaken on 78 women between 15 to 45 years of age from rural area to see alteration of serum zinc due to oral contraceptive (OC) use. Of the subjects, 34 women was taken as controls having no history of taking any form of hormonal contraceptives neither during the time of selection nor during one-year period prior to the study. All of the women in the control group were advised to start consuming oral pill (Sukhi) for 3 consecutive cycles and at the 3(rd) month, 25 women were taken as cases on longitudinal basis. Another 44 women were randomly selected as cases on the basis of using combined oral contraceptives (Sukhi) for 4 months onwards. Subjects were classified as follows on the basis of duration of oral contraceptive use: Group I (n=34) -- controls, Group II (n=25) -- 3 months, Group III (n=17) -- 4 months -- 2 years and Group IV (n=27) -- >2 years. Finally, 103 samples of blood (34 from controls and 69 from oral contraceptives users) were collected for estimation of Serum Zinc (microg/dl) by Atomic Absorption Spectrometry using UNICAM - AA Spectrometer. MeanSD of Serum Zinc significantly reduced in all 3 contraceptive groups in comparison to controls (p<0.001). It was recommended to carry out further study including larger population from rural area to elucidate alteration in serum zinc and other trace elements to correlate with side effects caused by hormonal contraceptive so that attempt could be made to mitigate those.     

Serum copper in rural women taking combined oral contraceptive

This prospective case-control study included 78 women between 15 to 45 years of age from rural area to see changes in serum copper level as a consequence of oral contraceptive use. Among the subjects, 34 women were included as controls because of not taking any form of hormonal contraceptives neither during the time of selection nor during one-year period prior to the study. Women in the control group were motivated to consume oral pill (Sukhi) for 3 consecutive cycles. At the 3(rd) month, 25 such women became available and henceforth included as cases on longitudinal basis. Another 44 women were randomly selected as cases on the basis of using combined oral contraceptives (Sukhi) for a duration of 4 months onwards. Considering different duration of oral contraceptive (OC) use, subjects were grouped as follows: Group I (n=34)--> controls, Group II (n=25)--> 3 months, Group III (n=17)--> 4 months - 2 years and Group IV (n=27)--> >2 years. Finally, 103 samples of blood (34 from controls and 69 from oral contraceptives users) were collected for estimation of Serum Copper (mgm/dl) by Atomic Absorption Spectrometry using UNICAM-AA Spectrometer. Mean+/-SD of Serum Copper significantly increased in all 3 contraceptive groups in comparison to controls (p<0.001). Further study including larger population from rural area was recommended to see correlation among serum copper and other trace elements with side effects of hormonal contraceptives. This preliminary study tried to explore the possibility of establishing biochemical monitoring of serum trace elements in OC users.     

Contraceptive efficacy of the pill

Some women who use the pill are at a high risk of unplanned pregnancy. Health practitioners must evaluate drug medication data, gastrointestinal disturbances, and determine a patient's ability to use the pill effectively to identify those at high risk. Of the many types of contraceptives, the pill still comes the closest to being the most effective contraceptive. Nevertheless, the expected failure rate is lower than actual user rate due to a variety of reasons, such as forgetfulness in taking the tablets and temporary malabsorption problems. Since combined preparations of the pill such as the triphasic pill effect the hypothalamic-pituitary region, the endometrium, and the cervical mucosa, one would expect a high level of protection. Evidence indicates, however, that the triphasic pill is comparatively less effective than the fixed dose oral contraceptives. Additionally, studies reveal that certain women should not use oral contraceptives (e.g. women who smoke) because of increased risk to their health. Several benefits have been identified, however, in those women who are not considered high risk, such as a reduction in dysmenorrhea and irregular menstrual bleeding. Unfortunately, little is known on how to detect noncompliant users or how to motivate them to use the pill effectively. Yet research into alternative delivery routes, such as dermal patches and implants, has not reached the commercial level. In Australia, 25% of women of reproductive age choose oral contraceptives.     

Hormonal factors and melanoma in women

The effect of exogenous hormones and reproductive factors on the risk of melanoma in women was investigated in a case-control study. Data from 91 women, aged from 15 to 81 years, and 91 matched controls were analysed in relation to use of oral contraceptives (OC), parity, age at the birth of the first child, and calculated length of ovulatory life. When potential confounding factors (including pigmentary characteristics and the lifetime exposure to sunlight were taken into account, there was no increase in risk of melanoma in relation to OC use, parity, or age at the birth of the first child. An unexplained association between melanoma and ovulatory life of greater length than 20 years was observed. The general findings of this study suggest that neither hormonal nor reproductive factors increase the risk of melanoma in women.     

Association between diaphragm use and urinary tract infection

We conducted independent case-control and retrospective cohort investigations to assess the relationship between diaphragm use and urinary tract infection (UTI). In the former, we compared diaphragm use and vaginal flora among 114 women with acute UTI and 85 women with acute urinary tract symptoms and no UTI. In the latter study, we ascertained the incidence of UTI in 192 diaphragm users and 182 women taking oral contraceptives during a mean follow-up of 9.4 months. Both studies demonstrated a significantly increased risk of UTI in diaphragm users: relative odds were 2.0 in the case-control study and the relative risk was 2.5 in the retrospective cohort study. Vaginal colonization with Escherichia coli was significantly greater in diaphragm users. The incidence of UTI in the cohort study was 26.6 per 1,000 patient-months for diaphragm users and 8.9 per 1,000 patient-months for women taking oral contraceptives. The increased risk of UTI in diaphragm users could not be attributed to differences in age, parity, sexual activity, or previous UTI.