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  1. 1
    782141

    Steroid contraception and the risk of neoplasia.

    World Health Organization [WHO]. Scientific Group

    Geneva, Switzerland, WHO, 1978. (World Health Organization Technical Report Series No. 619) 54 p

    Studies on steroid contraception (SC) and risk of neoplasia are reviewed. Methodological issues in neoplasia etiology studies include: 1) possibility of a latent period between exposure to cause and disease development; 2) cumulative effects of prolonged or repeated SC exposure; 3) discontinued drugs or dosage schedules; 4) time of exposure (adolescence or prenatal, e.g.); 5) isolation of specific causes among multiple risks; and 6) variations in neoplasma diagnoses. The 4 epidemiological approaches to SC-associated neoplasia studies have inherent shortcomings, but cohorts yield significant associations. Relative risk (ratio of disease incidence among exposed vs. nonexposed persons) is an index of association only, not evidence of cause and effect. Benign breast neoplasia risk was reduced by current SC use of >2 years, and weak evidence points to a residual protective effect, apparently associated with progestogen dose. Aggregated breast cancer data show no clear adverse or beneficial effect of SC use; however, evidence suggests SCs may increase breast cancer risk in population subgroups (e.g., young women). Only short-term evidence is available; hence, no inference of long-term SC breast cancer effects is possible. No beneficial effect of SCs on uterine fibroids is evident, but sequential SCs, no longer marketed, may have increased risk to endometrial carcinoma. Inconclusive data suggest SCs may decrease ovarian cancer risk. Increased risk of cervical dysplasia and carcinoma in situ is associated with SC use, especially long-term use by women with predisposing factors. Risk of hepatocellular adenoma of the liver increases with prolonged SC exposure, especially high dose. Relevance of existing data from more developed countries to disease risk in less developed ones is discussed, and recommendations made.
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  2. 2
    780644

    Depo-Provera: controversy grows, hearings scheduled.

    Intercom 6(8):2-3. August 1978.

    The injectable contraceptive Depo-Provera was discussed by the U.S. House of Representatives Select Committee on Population. In March 1978 the FDA denied approval of Depo-Provera for U.S. use. Depo-Provera is thought, but not proved, to be responsible for increased risk of breast tumor, delayed return to fertility, irregular bleeding, and birth defects. Observations and studies held in Thailand and Mexico do not show any serious side effects or unwanted pregnancies in women who were injected with Depo-Provera. It must be recognized, however, that benefit-risk considerations differ in developing countries.
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