Dr Rick

Most of the off-topic comments on this thread have been inconsequential, but this particular drivel warrants additional commentary to mitigate any unneccessary alarm it could cause.

The connection between estrogen, a naturally occuring hormone present in all menstruating women, has been know for over 100 years since the first report that ovarian excision from premenopausal women improves some breast cancer outcomes, and has since never been seriously refuted. This correlation has engendered literally over a thousand articles, studies, reviews and editorials. This extensive and ongoing evalutation has shown that there is no correlation between breast cancer and oral contraceptives (often used to treat PMS); despite some studies suggesting a possible link, the overwhelming preponderance of evidence shows otherwise. [Fertility drugs are a completely different issue, but I know of no evidence showing a link between them and breast cancer, either]

NEJM Volume 346:2025-2032 June 27, 2002 Number 26
Oral Contraceptives and the Risk of Breast Cancer

Polly A. Marchbanks, Ph.D., Jill A. McDonald, Ph.D., Hoyt G. Wilson, Ph.D., Suzanne G. Folger, Ph.D., Michele G. Mandel, B.A., Janet R. Daling, Ph.D., Leslie Bernstein, Ph.D., Kathleen E. Malone, Ph.D., Giske Ursin, M.D., Ph.D., Brian L. Strom, M.D., M.P.H., Sandra A. Norman, Ph.D., Phyllis A. Wingo, Ph.D., Ronald T. Burkman, M.D., Jesse A. Berlin, Sc.D., Michael S. Simon, M.D., M.P.H., Robert Spirtas, Dr.P.H., and Linda K. Weiss, Ph.D.

"We conducted a population-based, case–control study to determine the risk of breast cancer among former and current users of oral contraceptives...[evaluating] a total of 4575 women with breast cancer and 4682 controls...The relative risk was 1.0... Among women from 35 to 64 years of age, current or former oral-contraceptive use was not associated with a significantly increased risk of breast cancer."

Here's the accompanying editorial summarizing all the available data:

NEJM Volume 346:2078-2079 June 27, 2002 Number 26
Good News about Oral Contraceptives "...Oral-contraceptive [OC] use, even for a long period, is not associated with an increased risk of breast cancer. Thus, our attention should shift from concern about the possible adverse effects of current oral contraceptives to the identification of an ideal oral contraceptive, one that would reduce the risk of breast, ovarian, and uterine cancer without cardiovascular complications...The validity of these results is supported by the finding that recognized risk factors for breast cancer, such as a family history of such cancer and a first pregnancy at an older age, were more common in women with breast cancer than in controls...Concern about the risks of oral-contraceptive use had also initially extended to other types of endocrine-responsive ancers. The news in this respect is even better. Several studies have shown that the use of oral contraceptives reduces the risk of both endometrial and ovarian cancer. For example, in the CASH study, there was a 40 percent reduction in the risk of endometrial cancer...Oral contraceptives are not a panacea, however. Adverse events, although rare, include deep venous thrombosis, pulmonary embolism, ischemic stroke, liver cancer, and among women over 35 years of age who smoke, myocardial infarction. Long-term use of oral contraceptives may also increase the risk of cervical cancer among women with a positive test for the human papillomavirus. But for most women, the benefits of avoiding pregnancy, with its attendant health risks, clearly outweigh these side effects. In addition, the quality of life may be enhanced by benefits such as greater regularity of the menstrual cycle, reduced menstrual blood loss and improvement of associated iron-deficiency anemia, and amelioration of dysmenorrhea [PMS]."

Premenopausal women on oral contraceptives are not the same has postmenopausal women Hormonal replacement therapy for COLOR=orangered]postmenopausal women[/COLOR] has been recently found to be associated with a slightly increased risk of all-cause morbidity in the the Women’s Health Initiative study published in 2002: it was a randomised double-blind placebo-controlled clinical trial in more than 16 000 women with an average age of 63 years at enrollment reporting data on the long-term adverse effects of combined equine estrogen-progestin hormone replacement therapy (HRT) taken for 5 years. (2) On average, a yearly excess of 19 severe adverse events per 10 000 women occurred in the estrogen-progestin group. Relative to the placebo group, there were an extra 8 pulmonary embolisms, 7 coronary events, 8 strokes and 8 cases of invasive breast cancer. In contrast, there were 6 fewer colorectal cancers and 5 fewer hip fractures in the active treatment group.

The risk associated with HRT was small but significant. These finding are important for any postmenopausal women contemplating HRT, but the increase in breast cancer incidence was so small that it could not possibly account for the reported increase in the general population. The individual risks from these agents to an individual woman are likewise so small that they can still be prescribed if a woman and her physican belief it is warranted to decrease the risk of osteoporosis or diminish post-menopausal symptoms.

Most importantly, none of this has anything to do with OC, PMS, or infertility treatments: that’s why this statement:

…is so stupid; HRT is by definition used only in postmenopausal women; the hormone combinations and dosages used to treat PMS and infertility, both conditions only treated in premenopausal women are different. PMS hormonal therapy usually utilizes OC, not HRT, and the treatment of infertility usually involves neither of these. Equine-derived estrogen is the primary agent used in HRT regimens, but it is almost never used in OC or to treat PMS.

Why the difference? Because the conditions being treated are so completely different. HRT aims to replace deficient hormones, OC are used to suppress ovulation, fertilization and embryo implantation, and to regulate menstrual flow, and fertility drugs are used to augment what OC usually suppresses.

They all have varying purposes and actions, so blanket comparisons amongst the three are totally unwarranted and invalid.

Cancer rates began declining in the nineties after years of increase. We’re seeing these shifts in cancer data due to the effects of earlier detection upon an aging population that smokes less:


J Natl Cancer Inst 1995 Feb 1;87(3):175-82
Recent cancer trends in the United States.
Devesa SS, Blot WJ, Stone BJ, Miller BA, Tarone RE, Fraumeni JF Jr.
“…Age-adjusted incidence rates for all cancers combined increased by 18.6% among males and 12.4% among females from 1975-1979 to 1987-1991, due largely to rising rates for prostate cancer among men and for breast and lung cancers among women…Much of the recent increase in cancer incidence can be explained by known factors. Improved detection appears to account for most of the increases in breast cancer among women and prostate cancer among men. On the other hand, cigarette smoking is the major determinant of the rise in lung cancer among women…

J Natl Cancer Inst 2001 Jun 6;93(11):824-42
Annual report to the nation on the status of cancer (1973 through 1998), featuring cancers with recent increasing trends.
Howe HL, Wingo PA, Thun MJ, Ries LA, Rosenberg HM, Feigal EG, Edwards BK.
“From 1992 through 1998, total cancer death rates declined in males and females, while cancer incidence rates declined only in males. Incidence rates in females increased slightly, largely because of breast cancer increases that occurred in some older age groups, possibly as a result of increased early detection.”

These figures had nothing to do with oral-contraceptives, hormone-replacement therapy, or abortion; the first and the third do not cause cancer, and the second slightly increases the risk, but not nearly enough to impact overall cancer statistics. The risk of breast cancer from HRT is so slight that it could not possibly account for the increased incidence observed in the US population, and multiple excellent studies have confirmed that neither abortion nor OC cause breast cancer.

Of course, this also has nothing to do the lies some pro-lifers try to foist upon us about abortion, but the other misinformation warranted debunking.

dk

dk: That’s very interesting, and I think you just made my point,

dk: Dr. Rick that’s what happens when politics and science collide.

Bumble Bee Tuna

Well, as long as you admit that you're just looking at the hits and ignoring the misses, that's fine.

So by your line of reasoning...

Let's say you were a famous person actually capable of making public statements, and an interviewer asked you if you were lying about something, how would you respond?

If you say that you were lying, you're being dishonest.

If you say that you weren't lying, though, by your logic you have just publicly claimed not to be lying and thuswe can conclude that you were lying. That is of course ridiculous.

-B

dk

Bumble Bee Tuna: Well, as long as you admit that you're just looking at the hits and ignoring the misses, that's fine.
So by your line of reasoning...
Let's say you were a famous person actually capable of making public statements, and an interviewer asked you if you were lying about something, how would you respond?
dk: The people and circumstances I mentioned got tagged as liars, not because they lied, but because the public mask they projected became a lie.

Bumble Bee Tuna: If you say that you were lying, you're being dishonest.
dk: When a politician compromises he doesn’t automatically become a liar. When a scientific organization becomes politically correct what happens?

Bumble Bee Tuna: If you say that you weren't lying, though, by your logic you have just publicly claimed not to be lying and thus we can conclude that you were lying. That is of course ridiculous.
dk: I have no idea what “If you say that you weren’t lying” means or implies. sounds like a riddle. Suppose you want to enter a building with two doors. Each door guarded by a sentry. One door leads to certain death, and the other door leads to happiness. One sentry always tells the truth, and the other sentry always lies. You can ask one question…What question do you ask, how do you proceed, and why?

Dr Rick

Clearly a tacit admission that dk is trying to mislead people and can't make his point.

dk

I don't follow...How exactly does one go about tacitly misleading someone?

Bumble Bee Tuna

Clearly I erred when I assumed you could understand simple sentences. Allow me to try again.

Imagine, just for a moment, that you are a famous person. One day, someone asks you in an interview whether you ever visited Talahassee (arbitrary [iece of information). You say yes, you visited Talahassee. (Imagine that you have been there, if you haven't)

Now imagine that the reporter comes back the next week. He asks you in another interview, "Were you lying when you told me you had visited Talahassee?".

You have a choice now.

The honest answer is that you weren't lying. But if you say that you weren't lying, by your logical standards you outlined that you are holding the ACS to, your public denial of any lying wouls allow an audience to logically deduce that you must in fact have lied. This is absurd, of course. This is what's known as an argumentum ad absurdum, I believe. The purpose of the hypothetical situation is to demonstrate that your logical standard from which you are concluding that ACS is lying is absurd, and if you are rational you will no longer use it and stop saying the ACS is lying.

Do you understand, or should I give up trying to explain complex sentences to you?

-B

Dr Rick

You are not alone, it appears.

I carefully explained the differences between oral contraceptives and hormone replacement therapy including the simple medical studies and editorials with some further explanation; I was confident that even the scientifically illiterate could understand it.

One cannot draw inferences on oral contraceptives, which are used in premenopausal women, with data from hormone replacement therapy, which is used in postmenopausal women. They are different medications with different dosages used in different populations for different indications. See my long post above on this page for more details and a simple explanation of the data, though for most of you the point is probably easy enough to understand.

I initially thought dk was joking when he made his response, but now, unbelievable as it may be, it looks like he really doesn't understand the difference between premenopausal women on oral contraceptives and post menopausal women on hormone replacement therapy:

...and I'll wager he still doesn't see the delicious irony in that last sentence.

[edited to highlight]

dk

The fact is… the ASC errantly blessed HRT treatments to healthy menopausal women for over 20 years, only to discovered HRT treatments increased the risk of in invasive breast cancer, along with coronary heart disease, stroke, and pulmonary embolisms. I’m sure the ASC regrets the imprudent recommendation. This was a blunder of great scope and magnitude that caused many people to suffer greatly, especially women and doctors that have received and prescribed HRT treatments for the last 30 years. The focus of the ASC needs to be on the health of women, not personal reputations and agenda. Many women have needlessly died, are dying and suffer needlessly from breast cancer, coronary heart disease, stroke, and pulmonary embolisms. The ASC has an obligation to help women get back on their feet, not push them back on rounded heels. We have an opportunity to educate through a healthy public debate, an effort impeded by the ACS response at damage control and cover up to protect personal political agendas.

This raises three essential questions, First: What wrong minded assumptions lead the ACS to make the imprudent recommendation in the first place?… Second: Why did the ACS stand by the recommendation for so long?… Third: What other recommendations has the ACS made that need to be re-evaluated.

• Bumble Bee Tuna

• mistakes the “cover up/damage control” PR campaign employed by the ACS as a justification for past sins.
  
• Dr. Rick enters into the debate to defend the moral rectitude of the ACS.
• dk has laid the blame at the clay feet of political hacks and bureaucrats that hide behind scientific authority to advance a personal agenda, when politics and science collide.

In an effort to put this discussion back on track can we at least agree the ACS made a mistake to recommend HRT treatments for the last 20 years, to discuss the implications, wrong minded assumptions and other impacts of which abortion may be one.

Dr Rick

What recommendation is that? When did the ACS ever recommend post-menopausal women to take HRT?

When did the ASC issue a recommendation about HRT? The ACS Recommendations, published before 2002 are still in place; the only change since then is that the ACS no longer recommends monthly self-breast examinations.

Their home site also has some recommendations about tobacco and diet, but where's this big blunder you're blabbering about?

Seriously, what are you ranting about?

What recommendations have got you in such a lather? Is it the ones about breast cancer screening or the ones about prostate cancer?

Actually, I was just trying to address this nonsense about a link between abortion and breast cancer, then you came along with some wild accusations against the ACS, and started going on about all sorts of stuff like political agendas and hrt.

Notice the title of the thread (hint: it's not about the ACS or alcohol).