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June 1, 2009
WHO DECLARES ORAL CONTRACEPTIVES "HIGHLY CARCINOGENIC"
 The above headline from the World Health Organization (WHO) is almost four years old now, but so few women are aware of it that it bears repeating: the International Agency for Research on Cancer (IARC), a division of WHO, reported in a monograph released on July 29, 2005 that oral contraceptives were highly carcinogenic, thus placing them into the category of Group I carcinogens (like lead and benzene), known to cause cancer in humans.
The story of how the WHO finally came to its conclusion began in 2003 when epidemiologic evidence of the carcinogenicity of oral contraceptives began to mount. Members of the WHO became concerned about new and worrisome reports of an increase in the number of cancers in users of oral contraceptives. They suspected that prior assessments of the carcinogenic potential of these drugs had been significantly underestimated. As a result, they requested that the WHO conduct a formal review, with the "highest priority," of all of the scientific evidence related to oral contraceptives and hormone replacement therapy.
The WHO assigned the review to the IARC, who then convened a panel of experts from around the world. The experts spent the next two years reviewing all of the epidemiologic data, and in 2005 they submitted their report to WHO declaring that, upon further consideration of all of the available scientific evidence, oral contraceptives and hormone replacement therapy were, indeed, Group I carcinogens. In particular, the IARC Advisory Group reported that oral contraceptives increased the risk for three specific cancers: breast, cervix and liver.
In July 2005 the WHO published a monograph of the findings of the Advisory Group, "IARC Monograph on the Evaluation of Carcinogenic Risks to Humans, Volume 91, Combined Estrogen-Progestogen Contraceptives and Combined Estrogen-Progestogen Menopausal Therapy" labeling oral contraceptives and hormone replacement therapy highly carcinogenic.
Though a bold statement by WHO standards, this "news" did not surprise many who had long suspected that drug companies, who were making a fortune from the sale of synthetic female hormones, had systematically minimized their carcinogenic potential. In fact, in 2003, two years prior to the WHO report, worried scientists at the National Cancer Institute (NCI) published a paper in which they stated that there was "a significantly increased risk of breast cancer" in women who used oral contraceptives. Unfortunately, neither the NCI (in 2003) nor the WHO (in 2005) took steps to curb their use. Rather, they suggested that users should be followed more closely by their doctors and screened more aggressively for early signs of cancer, a predictably vague and somewhat cynical prescription that appears to have been largely ignored by all.
Today, as ever, the challenge for public health advocates is to get past all of the bureaucratic and marketing obstacles thrown in the way of unsuspecting women by the many stakeholders who stand to loose if enough women discover the alarming risks associated with oral contraceptives and toss them in the garbage where they belong. The hurdles are high, but the stakes higher.
The number of women at risk for developing a breast, cervical or liver cancer from oral contraceptives is substantial. In 2000, the United Nations estimated that over 100 million women worldwide use oral contraceptives every day - a staggering 61% of all women of reproductive age living in developed countries that are married or partnered in a consensual relationship.
Sadly, the vast majority of these women have no idea of their increased risk for cancer; and neither do their doctors. As a matter of fact, in many countries women can purchase oral contraceptives over the counter, as if they were no more harmful than aspirin.
As President of the Breast Health & Healing Foundation, an organization whose explicit mission is to prevent breast cancer, the risks associated with the use of oral contraceptives is of special interest to me. Women who use oral contraceptives before their first full-term delivery increase their risk of breast cancer by 44%. Though the absolute number of women diagnosed with pre-menopausal breast cancer is relatively small (25% of the total) compared to the number of women diagnosed with post-menopausal breast cancer (75% of the total), no one can say for sure who of these women will or will not derive their breast cancers as a result of oral contraceptives. Whether a risk is worth taking is related not only to the level of risk but also to the consequences of that risk. Unfortunately, the risk for breast cancer lingers long after women have stopped taking the pill, up to ten years in most studies.
Furthermore, I am afraid that the carcinogenicity of oral contraceptives is not limited only to those who use them. You see, the 100 million women who daily ingest oral contraceptives excrete, in their urine, a portion of these pills that are still metabolically active. Yes, every day about 30% of the active ingredients in 100 million oral contraceptive pills are flushed back into our shared environment.
In part, the dramatic rise in the incidence of breast cancer in developed countries over the past forty years may be related to the widespread use of oral contraceptives following their introduction in the 1960’s. Clearly, oral contraceptives are everyone’s first choice for the prevention of an unwanted pregnancy, but with 1.3 million new cases of breast cancer diagnosed worldwide in 2008, and another half-million breast cancer deaths on top of that, we can no longer wait for the FDA, or Congress, or the pharmaceutical industry to forcefully break the cone of silence and properly inform women of their carcinogenic potential.
Women are already aware of the increased risk for breast cancer associated with hormone replacement therapy, and many have stopped taking these drugs already. As a result of this grass roots movement the number of new cases of breast cancer has finally begun to decline. The next step on the path toward primary prevention of breast cancer, the "pure cure," involves spreading the word about the hazards of oral contraceptives. We can no longer tolerate the social silence surrounding the carcinogenicity of oral contraceptives. If content and information are the keystones for our new civilization, then we must get the message out, fast and furiously: oral contraceptives are Group I carcinogens, known to cause cancer in humans.
Regards,
Kathleen T. Ruddy, MD
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