Are doctors disclosing cancer risks with The Pill?

Perhaps no pharmaceutical innovation has the cultural baggage carried by The Pill.  The birth-control therapy either gets blamed for demolishing sexual ethics and the family structure or celebrated for liberating women by disconnecting procreation from sexual activity.  What usually gets lost in the culture wars is that the drug has side effects and risks, just like every other drug, which need to be carefully managed and disclosed to those who use it.  A new study funded by a pro-life organization suggests that women are not informed in most cases about those potential risks, some of which are life-threatening if relatively rare:

According to the poll, conducted by the polling company™, inc./Women’s Trend, of “the Pill’s” side effects, only 19 percent of respondents said they had been warned about the increased risk of breast cancer. Forty-nine percent said they were warned of weight gain, 23 percent of headaches, and 40 percent were told of blood clots and the risk of stroke.

“It’s long been known that estrogen/progestogen combination drugs such as the pill does cause breast cancer. In fact, in 2005 the International Agency for Research on Cancer, which is part of the World Health Organization, put it as a Group I carcinogen,”  said Dr. Angela Lanfranchi, breast cancer surgeon and co-director of Sanofi Aventis Breast Cancer Center Steeplechase Cancer Center.

The majority of women (53 percent) who take or have taken the Pill began at the age of 18 or younger. Fewer than 20 percent of women had never taken the Pill. 60 percent said that they began taking the Pill in order to prevent pregnancy and more than 66 percent said that is the reason they continue to take it. Regulation of menstruation cycle was the second most popular answer to why they began (21 percent) and continue to take (19 percent) the Pill.

“It is clear through these data that women believe it is a positive thing,” Kellyanne Conway, the president and CEO of the polling company™, inc./Women’s Trend. “But it is also clear in this data that they lack fundamental knowledge about the liabilities and the health risks associated with sustained use of the Pill by some of its users.”

Before going much further, we should look to see whether the poll’s assumptions are correct.  Does the Pill increase the risk of certain cancers in women?  Even this question gets fraught with politics, as a search of news sites will quickly prove.  However, the National Cancer Institute (part of HHS) does concur that use of the Pill increases risks of breast cancer with longer-term use, especially by younger women, cervical cancer, and liver cancer.  It also reduces risk of endometrial cancer, and may or may not have impact in either direction on ovarian cancer, although most studies show a slight decrease in risk among Pill users.

Given those risks, women should be informed before taking the Pill in order to make an intelligent and responsible decision.  Most who take the pill would probably still take it, as a balance against the risks of sexual activity and pregnancy.  However, since more than half of all women who take or have taken the Pill begin at age 18 or younger, they seem particularly at risk for breast cancer, and yet only 19% of those who are taking or have taken the Pill had been warned of that particular risk.  Less than half were warned about weight gain, and that is the one risk most discussed according to the survey.  Just over a third had been warned about the increased risks of depression, and that risk can easily be moderated by dosage adjustments — but only if the patient is aware enough to link the depression to the Pill.

The use of this contraceptive strategy may or may not fit within the viewpoint of everyone, but it is a choice that should be left to a woman and her own conscience.  However, if this study reflects reality, those women have not been well-served by physicians who should be ensuring that their patients have all of the information at hand to make a rational, informed decision.

Note: One should always proceed cautiously with polls conducted by stakeholders in issues.  The questions in this survey seem to be properly formed to avoid push polling, but there is one problem in this particular poll.  The first three questions focus on whether the Pill has had a positive, negative, or neutral impact on society.  The questions themselves are properly formed, but leading with them rather than gathering information on personal use of the Pill and whether the respondents were informed of the risks could have had some impact on later questions in the survey, or more importantly, the decision by potential respondents to refuse to complete the poll.  This particular topic will be difficult to poll anyway, and those subjective response questions should have gone to the end of the survey.  Still, the respondents were overwhelmingly positive about the Pill on those questions, which indicates that it probably had no more than an insignificant impact on the results.