Study Sees the Pill as Victim of Bad Press : Data Notes No Link With Breast Cancer
The birth control pill--which, starting 10 years ago, fell from grace among women concerned that it could cause everything from heart attacks to cancer--today takes what many doctors believe ought to be a last major step toward its deserved vindication.
Involved is a report in which a team of federal government researchers, expanding on an earlier conclusion, has reiterated findings that--contrary to scary reports first published in the early 1970s--the Pill poses no significant breast cancer risk.
And looking at the Pill’s past with something of the perspective of a revisionist historian, Dr. David Grimes, professor of obstetrics and gynecology at the USC School of Medicine, said the Pill suffered from overly enthusiastic reporting of its alleged possible dangers in American news media. The stories were based on what turned out to be preliminary or incomplete studies.
Dramatic Drop in Use
Both the initial research findings and their reporting led, Grimes and other experts noted, to a dramatic decline in Pill use, from 14 to 15 million women in the early 1970s to about 9 million at present.
Now, however, Grimes and other observers believe the Pill may be poised for a deserved comeback--both because new, long-term research has found much of the early criticism to be little more than a bad rap and because the nation’s love affair with product liability litigation has led to sharp curtailment in availability of the intrauterine device and threatens even such pedestrian forms of birth control as the diaphragm and contraceptive gel.
Today, agreed Grimes and Dr. Louise Tyrer, medical director of the Planned Parenthood Federation of America, the Pill represents the best and most effective form of readily reversible birth control. Both Grimes and Tyrer predicted a greater role for the Pill as its exoneration is more widely recognized.
The new report, by a division of the National Institutes of Health, does little more than add detail and depth to findings first published in 1983. In the study in question, government researchers examined the cases of 4,711 female breast cancer victims from ages 20 to 54 and another 4,754 women who did not have the disease, looking for some association between Pill use and incidence of breast cancer. Results of the study are being published in the New England Journal of Medicine.
Rearranging the data again and again in an attempt to establish a correlation between the formulation of the Pill a woman took, the length of time she took it (even women on the Pill for 15 years or more) and the age at which she started using it, the new study found nothing to suggest that the Pill plays any causative role in breast cancer at all.
The research team, headquartered at the government’s Centers for Disease Control but which drew support from the National Institute of Child Health and Human Development and National Cancer Institute, found that:
- The relative risk of contracting breast cancer was the same for women who had never taken the Pill and those who had, irrespective of the length of time users had taken it, with the same equal risk recorded for women who had used the Pill from less than 12 months to more than 15 years.
- Contrary to what some researchers suspected, the brand and formulation of Pill a woman used had no relationship to breast cancer risk. Pills come with different mixes of birth control estrogens and researchers elsewhere have concluded that formulations relying on higher estrogen doses are possibly associated with an increased risk of heart disease among Pill users, but that lower-dose varieties lack that disadvantage. One earlier study had suggested a similar cancer risk for women using high-dose formulas, but the new study specifically ruled that out.
- The age at which a woman began using the pill and whether she had been pregnant or had a child before starting the Pill was equally irrelevant to breast cancer risk.
“These findings provide evidence that, overall, oral contraceptive use does not increase the risk of breast cancer,” the NIH group’s report concluded. “These findings . . . offer some further reassurance about the safety of oral contraceptives.”
In an editorial accompanying the newly published study, Dr. Samuel Shapiro of the Boston University School of Medicine noted that, although there are still risks in the Pill for some women--notably women who smoke and are 35 or older, other doctors agreed--the fundamental conclusion is that the Pill is far safer than many women have believed and represents apparently the best practical, reversible birth control option available today.
Several doctors interviewed by The Times cautioned that there remains a small but established risk for women taking the Pill that they may unexpectedly have a stroke or other cardiovascular episode. However, three experts agreed that the risks of such side effects are, by even the most cautious estimate, slight.
“Oral contraceptives have given women unprecedented control over their reproductive function, but at a cost,” Shapiro wrote in his editorial. “From a public health viewpoint, as best we can judge on the present evidence, that cost is acceptable.
“We should recognize . . . that our thinking can be subject to a subtle bias: We tend selectively to notice and remember the victims (of alleged Pill side effects) and not the beneficiaries. If we overcome that bias, we can recommend oral contraceptives with the reassurance that the vast majority of users will experience only the benefits.”
Problem of Bad Press
USC’s Grimes, who is an expert on oral contraceptives, said that while the use of any drug is predicated on a balance of risks and benefits, the evidence in the case of the Pill has increasingly mounted on the side of safety. He said it is ironic that the last remaining, clear high-risk group in terms of Pill use involves women who smoke tobacco.
“From a public health view, one could make a strong case for making the Pill available over the counter and cigarettes by prescription only,” Grimes said. “Largely, the problem the Pill has had is due to bad press.
“Each time the news media covered one of these major studies in the 1970s, Pill use would decline in the U.S. (The decline) peaked about five years after (the initial reports in mass media of possible risks to the Pill) never to recover.
“Many times, the truism was that bad news sells more newspapers than good news and frightening news certainly sells newspapers and women’s magazines.”
Grimes noted that as research has increasingly focused on the Pill, what earlier seemed like risks have largely failed to materialize and the Pill has even proven to have a number of clear if unanticipated benefits in terms of disease prevention. He noted that recent studies have shown the Pill to play a role in preventing pelvic inflammatory disease and tubal pregnancy. The ectopic pregnancy risk, he said, is cut by 90% among Pill users.
Grimes said the Pill has also proven to cut down the risk of contracting cancer of the endometrium--by perhaps 40% to 50%. “This advantage lasts longer than 10 years,” he said. “It is literally a 10-year insurance policy against (this form of) cancer.”
Dr. Barbara Hulka, a contraceptive expert at the University of North Carolina, noted that both the growing incidence of new research studies exonerating the Pill and legal problems that have afflicted other forms of birth control make oral contraceptives an especially important component of the nation’s birth control and family planning strategy. With research money for birth control scarce, she noted, the Pill may retain its prominence for many years to come.
“The pill has become more and more important,” she said. “I would certainly hope that women realize this.”
Planned Parenthood’s Tyrer noted that the Pill has established itself as the second most prevalent form of birth control after sterilization. For a younger woman uncertain whether she eventually wants to have children, Tyrer said, the Pill and recent verifications of its safety are especially important.
“The Pill has always been the most important method of reversible birth control,” she said. “I think that (beginning now) there will likely be more Pill use not only among women who have traditionally chosen the IUD, but among all age groups, too.”
