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In reply: Menstrual manipulation

In Reply: Thank you for reading our article. Although the focus was geared more toward a comparison of different means of menstrual manipulation, we appreciate your comments on oral contraceptives and the link to premenopausal breast cancer.

As you noted, oral contraceptives have been linked to an increased risk of breast cancer, both in your meta-analysis1 and again more recently in a prospective study of 116,608 female nurses from 25 to 42 years of age.2 Interestingly, data from the latter study suggested that different formulations of oral contraceptives may pose different risks, and specifically that the use of triphasic preparations with levonorgestrel as the progestin had the highest risk. However, there is otherwise a paucity of data regarding the risk of specific formulations. There is currently no evidence of an association between oral contraceptive use and death from breast cancer, nor is there evidence that longer use of an oral contraceptive increases one’s risk of death from breast cancer.3

Oral contraceptives have also been associated with a reduced risk of ovarian cancer,4 and they appear to protect against death from ovarian cancer and uterine cancer.3 Therefore, the clinician must consider the individual patient before making treatment recommendations, taking into account personal risk factors and other health concerns. (For a full list of contraindications to oral contraceptives, please refer to Table 2 in our original article.) Further guidelines may also be obtained from the “US Medical Eligibility Criteria for Contraceptive Use 2010,” issued by the US Centers for Disease Control and Prevention in May 2010,5 which delineates the eligibility criteria for initiating and continuing specific contraceptive methods, including oral contraceptives.

Thank you again for sharing your concerns. We appreciate the opportunity to clarify this important point.

References
  1. Kahlenborn C, Modugno F, Potter DM, et al. Oral contraceptive use as a risk factor for premenopausal breast cancer: a meta-analysis. Mayo Clin Proc 2006; 81:1290–1302.
  2. Hunter DJ, Colditz GA, Hankinson SE, et al. Oral contraceptive use and breast cancer: a prospective study of young women. Cancer Epidemiol Biomarkers Prev 2010; 19:2496–2502.
  3. Vessey M, Yeates D, Flynn S. Factors affecting mortality in a large cohort study with special reference to oral contraceptive use. Contraception 2010; 82:221–229.
  4. Lurie G, Thompson P, McDuffie KE, et al. Association of estrogen and progestin potency of oral contraceptives with ovarian carcinoma risk. Obstet Gynecol 2007; 109:597–607.
  5. Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, US Centers for Disease Control and Prevention (CDC), Farr S, et al. US medical eligibility criteria for contraceptive use, 2010: adapted from the World Health Organization medical eligibility criteria for contraceptive use, 4th edition. MMWR Recomm Rep 2010; 59:1–86.
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Ellen S. Rome, MD, MPH
Head, Section of Adolescent Medicine, Department of General Pediatrics, Cleveland Clinic Children’s Hospital

Caitlin W. Hicks, BA
Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH

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Head, Section of Adolescent Medicine, Department of General Pediatrics, Cleveland Clinic Children’s Hospital

Caitlin W. Hicks, BA
Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH

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Ellen S. Rome, MD, MPH
Head, Section of Adolescent Medicine, Department of General Pediatrics, Cleveland Clinic Children’s Hospital

Caitlin W. Hicks, BA
Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH

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In Reply: Thank you for reading our article. Although the focus was geared more toward a comparison of different means of menstrual manipulation, we appreciate your comments on oral contraceptives and the link to premenopausal breast cancer.

As you noted, oral contraceptives have been linked to an increased risk of breast cancer, both in your meta-analysis1 and again more recently in a prospective study of 116,608 female nurses from 25 to 42 years of age.2 Interestingly, data from the latter study suggested that different formulations of oral contraceptives may pose different risks, and specifically that the use of triphasic preparations with levonorgestrel as the progestin had the highest risk. However, there is otherwise a paucity of data regarding the risk of specific formulations. There is currently no evidence of an association between oral contraceptive use and death from breast cancer, nor is there evidence that longer use of an oral contraceptive increases one’s risk of death from breast cancer.3

Oral contraceptives have also been associated with a reduced risk of ovarian cancer,4 and they appear to protect against death from ovarian cancer and uterine cancer.3 Therefore, the clinician must consider the individual patient before making treatment recommendations, taking into account personal risk factors and other health concerns. (For a full list of contraindications to oral contraceptives, please refer to Table 2 in our original article.) Further guidelines may also be obtained from the “US Medical Eligibility Criteria for Contraceptive Use 2010,” issued by the US Centers for Disease Control and Prevention in May 2010,5 which delineates the eligibility criteria for initiating and continuing specific contraceptive methods, including oral contraceptives.

Thank you again for sharing your concerns. We appreciate the opportunity to clarify this important point.

In Reply: Thank you for reading our article. Although the focus was geared more toward a comparison of different means of menstrual manipulation, we appreciate your comments on oral contraceptives and the link to premenopausal breast cancer.

As you noted, oral contraceptives have been linked to an increased risk of breast cancer, both in your meta-analysis1 and again more recently in a prospective study of 116,608 female nurses from 25 to 42 years of age.2 Interestingly, data from the latter study suggested that different formulations of oral contraceptives may pose different risks, and specifically that the use of triphasic preparations with levonorgestrel as the progestin had the highest risk. However, there is otherwise a paucity of data regarding the risk of specific formulations. There is currently no evidence of an association between oral contraceptive use and death from breast cancer, nor is there evidence that longer use of an oral contraceptive increases one’s risk of death from breast cancer.3

Oral contraceptives have also been associated with a reduced risk of ovarian cancer,4 and they appear to protect against death from ovarian cancer and uterine cancer.3 Therefore, the clinician must consider the individual patient before making treatment recommendations, taking into account personal risk factors and other health concerns. (For a full list of contraindications to oral contraceptives, please refer to Table 2 in our original article.) Further guidelines may also be obtained from the “US Medical Eligibility Criteria for Contraceptive Use 2010,” issued by the US Centers for Disease Control and Prevention in May 2010,5 which delineates the eligibility criteria for initiating and continuing specific contraceptive methods, including oral contraceptives.

Thank you again for sharing your concerns. We appreciate the opportunity to clarify this important point.

References
  1. Kahlenborn C, Modugno F, Potter DM, et al. Oral contraceptive use as a risk factor for premenopausal breast cancer: a meta-analysis. Mayo Clin Proc 2006; 81:1290–1302.
  2. Hunter DJ, Colditz GA, Hankinson SE, et al. Oral contraceptive use and breast cancer: a prospective study of young women. Cancer Epidemiol Biomarkers Prev 2010; 19:2496–2502.
  3. Vessey M, Yeates D, Flynn S. Factors affecting mortality in a large cohort study with special reference to oral contraceptive use. Contraception 2010; 82:221–229.
  4. Lurie G, Thompson P, McDuffie KE, et al. Association of estrogen and progestin potency of oral contraceptives with ovarian carcinoma risk. Obstet Gynecol 2007; 109:597–607.
  5. Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, US Centers for Disease Control and Prevention (CDC), Farr S, et al. US medical eligibility criteria for contraceptive use, 2010: adapted from the World Health Organization medical eligibility criteria for contraceptive use, 4th edition. MMWR Recomm Rep 2010; 59:1–86.
References
  1. Kahlenborn C, Modugno F, Potter DM, et al. Oral contraceptive use as a risk factor for premenopausal breast cancer: a meta-analysis. Mayo Clin Proc 2006; 81:1290–1302.
  2. Hunter DJ, Colditz GA, Hankinson SE, et al. Oral contraceptive use and breast cancer: a prospective study of young women. Cancer Epidemiol Biomarkers Prev 2010; 19:2496–2502.
  3. Vessey M, Yeates D, Flynn S. Factors affecting mortality in a large cohort study with special reference to oral contraceptive use. Contraception 2010; 82:221–229.
  4. Lurie G, Thompson P, McDuffie KE, et al. Association of estrogen and progestin potency of oral contraceptives with ovarian carcinoma risk. Obstet Gynecol 2007; 109:597–607.
  5. Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, US Centers for Disease Control and Prevention (CDC), Farr S, et al. US medical eligibility criteria for contraceptive use, 2010: adapted from the World Health Organization medical eligibility criteria for contraceptive use, 4th edition. MMWR Recomm Rep 2010; 59:1–86.
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Cleveland Clinic Journal of Medicine - 78(3)
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