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AMERICAN JOURNAL OF PUBLIC HEALTH. 1999 Jan; 89(1):92-4.The prevalence of vasectomy increased in the US from protecting approximately 5% of contracepting married women to about 19% by the early 1990s. However, 2 studies published in 1993 noting a potential link between vasectomy and prostate cancer, publications refuting the association and the US National Institutes of Health's recommendation to not change vasectomy practice, subsequent debate in the professional literature, and negative publicity in the national media may have influenced the acceptance and practice of vasectomy in the US. The authors conducted national probability surveys of urology, general surgery, and family practices in 1992 and 1996 to assess the effect of the controversy upon the acceptance and practice of vasectomy in the US. 10.3 vasectomies per 1000 men aged 25-49 years were performed in 1991, compared to 9.9/1000 in 1995. Neither the estimated total number of vasectomies performed nor the population rate changed significantly between 1991 and 1995. 31% and 28% of all physician practices provided vasectomy in 1991 and 1995, respectively, a nonstatistically significant change over the 4 years.
Perceptions and realities: How safe is the pill? The role of the media, healthcare providers, and the pharmaceutical industry in shaping American women's perceptions about birth control. Q and A.
New York, New York, AGI, 1996 Jan 31. 4 p. (Emerging Issues in Reproductive Health: A Briefing Series for Journalists)Contraceptive choice and usage is affected by various factors at different stages of reproductive life including childbearing hopes, sexual behavior, health history, exposure to sexually transmitted diseases (STDs), ability to use a method consistently and correctly, the side effects and/or health benefits of various methods, and the degree of risk associated with unplanned pregnancy. Survey data indicate that most adults in the US gain family planning information from health professionals as well as from friends and family and the mass media. Perceptions about various methods can influence contraceptive usage in general and method choice in particular. While a majority of US adults find oral contraceptives (OCs) "very" or "somewhat" safe, 21% think OCs are somewhat unsafe, and 11% find them very unsafe. Most safety concerns center on the inability of the OC to protect from STDs and ignore specific health effects that vary for individual women. The fact is that failure to use a contraceptive poses greater risk than any method and that OCs are effective contraceptives that do not hinder future fertility. While the relationship of OC use and breast cancer remains uncertain, OCs are known to protect against ovarian and endometrial cancers. OC use is associated with a relatively small increased risk of cardiovascular disease, and the risk increases in older women and women who smoke. Pregnancy also increases the risk of cardiovascular disease. Recent studies reporting 1) an increased risk of venous thrombosis and 2) a decreased risk of myocardial infarction with new formulations of the OC underscore the importance of taking individual circumstances into account when prescribing OCs. The new studies also indicate a need for additional research on the effects of OC use.
Family Planning Perspectives. 1993 May-Jun; 25(3):133-5.As many as 500,000 US men are believed to have had a vasectomy in 1991, and at least four million US couples of reproductive age depend upon the method. About 42 million couples worldwide also rely upon vasectomy for contraception. Concern arose in the family planning community in February 1993 when two studies published in the Journal of the American Medical Association reported that vasectomized men are at higher risk of developing prostate cancer compared to nonvasectomized men. Prostate cancer is the second most common cause of cancer death among American men. Vasectomy, however, is among the safest, most effective, and most acceptable of contraceptive methods. A link between vasectomy and prostate cancer could therefore have a serious negative impact upon vasectomy practice and upon overall contraceptive practice in the US. The National Institutes of Health convened a panel of experts in March 1993 to assess the likelihood of a relationship between vasectomy and prostate cancer and to make recommendations about any changes in vasectomy practice which may be needed. The panel concluded that there was insufficient basis for recommending a change in clinical and public health practice at that time, but that the debate must be resolved. To that end, epidemiologic and basic biological research are needed. The author reviews the background of the debate, early questions, and recent developments, and discusses future research.
FAMILY PLANNING WORLD. 1993 Sep-Oct; 3(5):12-3.Vasectomy has a shaky reputation in the US, but 500,000 men nonetheless undergo the procedure annually in the country. 15% of US men over age 40 are vasectomized. Dr. Edward Giovannucci of the Harvard School of Public Health in a study of 10,000 vasectomized men and 38,000 nonvasectomized men found the rate of prostate cancer in vasectomized men to be 113 per 22,000 compared to 70 per 22,000 among men who were not vasectomized. Controversy ensued its publication in the Journal of the American Medical Association and an expert panel at the National Institutes of Health was quick to pronounce that the new findings warranted no change in vasectomy procedures or counseling. The controversy continues. Giovannucci's detractors argue that the study is simply a dangerous attack on an already underused contraceptive method and that the report is fueled more by hunger for media attention than by sound science. Supporters counter that the findings are being carelessly dismissed to protect vasectomy in the US.