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【drug-news】柳叶刀杂志载文提议: 避孕药应该免去
The pill appears to reduce the risk of ovarian cancer, even long after women stop taking it, concludes an analysis in the Lancet. That’s interesting enough. But what really caught our attention was an accompanying editorial in the medical journal that says the findings support making birth control pills available without a prescription.
While it was already known that the pill reduces the risk of ovarian cancer, the magnitude and duration of the effect has remained unclear. The authors of the analysis crunched data from more than 40 studies that included more than 100,000 people. They found that for every 5,000 women who take the pill for one year, roughly two ovarian cancers and one death from the disease are prevented.
Taking the pill for a longer period of time increases the protective effect, and the authors estimate that during the past 50 years, 100,000 ovarian cancer deaths have been prevented because of oral contraceptives.
An accompanying editorial points out that the pill also carries health risks. It may increase the risk of breast and cervical cancers, and may have short-term cardiovascular risks as well. And there are some women, such as those who have heart disease or migraines, who should not take the pill.
But the cardiovascular risks have declined with new formulations of the pill, and the pill seems to reduce the overall risk of cancer, the editorial argues. (The pill reduces the risk of endometrial as well as ovarian cancer.)
“In translating the evidence from this large systematic review to individual women, oral contraceptives should now be made more widely available,” the editorial says. “Women deserve the choice to obtain oral contraceptives over-the-counter, removing a huge and unnecessary barrier to a potentially powerful cancer-preventing agent.”
Health Blog Poll: Should birth-control pills be available without a prescription?
柳叶刀杂志论文摘要
http://www.thelancet.com/journals/lancet/article/PIIS0140673608601671/abstract
Summary
Background
Oral contraceptives were introduced almost 50 years ago, and over 100 million women currently use them. Oral contraceptives can reduce the risk of ovarian cancer, but the eventual public-health effects of this reduction will depend on how long the prtection lasts after use ceases. We aimed to assess these effects.
Methods
Individual data for 23 257 women with ovarian cancer (cases) and 87 303 without ovarian cancer (controls) from 45 epidemiological studies in 21 countries were checked and analysed centrally. The relative risk of ovarian cancer in relation to oral contraceptive use was estimated, stratifying by study, age, parity, and hysterectomy.
Findings
Overall 7308 (31%) cases and 32 717 (37%) controls had ever used oral contraceptives, for average durations among users of 4·4 and 5·0 years, respectively. The median year of cancer diagnosis was 1993, when cases were aged an average of 56 years. The longer that women had used oral contraceptives, the greater the reduction in ovarian cancer risk (p<0·0001). This reduction in risk persisted for more than 30 years after oral contraceptive use had ceased but became somewhat attenuated over time—the proportional risk reductions per 5 years of use were 29% (95% CI 23–34%) for use that had ceased less than 10 years previously, 19% (14–24%) for use that had ceased 10–19 years previously, and 15% (9–21%) for use that had ceased 20–29 years previously. Use during the 1960s, 1970s, and 1980s was associated with similar proportional risk reductions, although typical oestrogen doses in the 1960s were more than double those in the 1980s. The incidence of mucinous tumours (12% of the total) seemed little affected by oral contraceptives, but otherwise the proportional risk reduction did not vary much between different histological types. In high-income countries, 10 years use of oral contraceptives was estimated to reduce ovarian cancer incidence before age 75 from 1·2 to 0·8 per 100 users and mortality from 0·7 to 0·5 per 100; for every 5000 woman-years of use, about two ovarian cancers and one death from the disease before age 75 are prevented.
Interpretation
Use of oral contraceptives confers long-term protection against ovarian cancer. These findings suggest that oral contraceptives have already prevented some 200 000 ovarian cancers and 100 000 deaths from the disease, and that over the next few decades the number of cancers prevented will rise to at least 30 000 per year.
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作者:admin@医学,生命科学 2011-06-27 05:20
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