The Oncological Effects of Combined Oral Contraceptives Caitlyn

The Oncological Effects of Combined Oral Contraceptives Caitlyn Skuodas, PA-S 2 University of South Dakota Physician Assistant Studies Program Abstract Discussion & Conclusion Combined oral contraceptives afford many benefits beyond contraception. However, little is mentioned of their effects on female gynecological cancers. The physiological mechanisms utilized in contraception involve female reproductive hormones with cellular targets in female gynecological tissues. This altered physiological state has oncological implications. Combined oral contraceptives reduce the risk for ovarian and endometrial cancers that extend far beyond the duration of contraception use; whereas, combined oral contraceptives increase the risk of breast and cervical cancers. This increased incidence is more closely associated with current oral contraceptive users and women who have stopped using oral contraceptives within the last five years. The implications of combined oral contraceptives and cancer result in the necessity of gynecological screenings and individual patient risk analysis including genetic mutations and family history for optimum patient care. Ovary: • Ovarian epithelial growth is governed primarily by estrogen and is inhibited by progesterone (Rodriguez, 1998). • Each successive ovulation compounds the trauma endured by the ovary (Fathalla, 1971). • Women who do not undergo a period of anovulation, whether pharmacologically induced or through pregnancy, develop ovarian cancer at a higher rate than the general population (Fathalla, 1971). Endometrial Cancer: • The mechanism of action of combined oral contraceptives appears to be a decreased rate of cell proliferation and an increased rate of endometrial cell sloughing (Bahamondes, 2015). Overall, combined oral contraceptives provide a great protective mechanism against endometrial cancer, which should be appreciated. Keywords: oral contraceptives; breast, endometrial, cervical, & ovarian cancer Oral Contraceptive’s Hormonal Effect on Gynecological Target Tissue Breast: • Estrogen and progesterone cause breast growth and maturation. https: //femelife. com/follicular-monitoring/ Results • Increase in exogenous estrogen and progesterone longer per cycle than compared to those not taking combined oral contraceptives Breast Cancer: • There is an elevated risk of breast cancer for current combined oral contraceptive patrons and recent users; however, this elevated risk subsided ten years after discontinuing use. (Beaber, 2014). • When recency of use was excluded as a compounding factor, combined oral contraceptive use was not associated with increased risk for breast cancer in women of any age (Al-Ajmi, 2018). • Combined oral contraceptives were responsible for approximately 1% of breast cancers in 2010 (Parkin, 2011). • Increase in hormonal exposure is postulated to enhance probability of genetic mutations (Jordan, 2015). • Three-quarters of all breast cancers subtypes are ER-positive (Saha, 2019). HTTPS: //SCIENCEBLOG. CANCERRESEARCHUK. ORG/2015/07/08/ SOLVING-A-BREAST-CANCER-MYSTERY-WHY-DO-DOUBLEPOSITIVE-WOMEN-DO-BETTER/ Endometrium: • Development of the endometrial layer of the uterus is the primary responsibility of estrogen, and cell division is inhibited by progesterone (Yuan, 2019). • Unopposed Estrogen Theory - Without adequate progesterone levels, many believe that estrogen may become unregulated and cause hypertrophy of the endometrial layer and may even contribute to adenocarcinoma of the endometrium (Dossus, 2010). Endometrial Cancer: • Combined oral contraceptives, which contain progesterone, seem to impart a protective mechanism against endometrial cancer, which is consistent with the unopposed estrogen theory (Mueck, 2010). • When comparing women who had never used combined oral contraceptives and women who did, the women who used combined oral contraceptives were less likely to develop endometrial cancer (HR= 0. 65) (Dossus, 2010). Cervical Cancer: • With limited evidence, the conclusions about combined oral contraceptive and cervical cancer are not clinically significant. Ovarian Cancer: • The key to the full ovarian protective effect was the early intervention of combined oral contraceptives, as the risk reduction is higher when combined oral contraceptive use was started before the first full-term pregnancy (Cook, 2017). Ultimately, combined oral contraceptives allow women to prevent pregnancy while managing other menstrual symptoms. The exogenous estrogen and progesterone provided in the hormonal profile produce secondary effects on the female body. After examining the literature, the benefits of combined oral contraceptives seem to outweigh the potential elevated risk of incidence in breast and cervical cancers. References Adcock, R. , Cuzick, J. , Hunt, W. C. , Mc. Donald, R. M. , & Wheeler, C. M. (2019). Role of HPV genotype, multiple infections and viral load on the risk of high-grade cervical neoplasia. Cancer Epidemiol Biomarkers Prev. doi: 10. 1158/1055 -9965. EPI-19 -0239 Al-Ajmi, K. , Lophatananon, A. , Ollier, W. , & Muir, K. R. (2018). Risk of breast cancer in the UK biobank female cohort and its relationship to anthropometric and reproductive factors. PLo. S One, 13(7), e 0201097. doi: 10. 1371/journal. pone. 0201097 Bahamondes, L. , Valeria Bahamondes, M. , & Shulman, L. P. (2015). Non-contraceptive benefits of hormonal and intrauterine reversible contraceptive methods. Hum Reprod Update, 21(5), 640 -651. doi: 10. 1093/humupd/dmv 023 Cervical Cancer: • The immediate use of combined oral contraceptives and the increasing duration of use are positively associated with the increased risk of developing cervical cancer (Roura, 2016). • The risk increased of cervical cancer is only by a factor of one, and combined oral contraceptives were cited as responsible for just under 10% of cervical cancer cases in young women (Parkin, 2011). https: //viosfertility. com/blog/the-menstrual-cycle/ Cervix: • Human Papilloma Virus infections are the principal cause of cervical cancer (Roura, 2016). There are 13 genotypes of HPV that appear highly associated with cervical cancer (Adcock, 2019). 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