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Monday, December 03, 2007

Why isn't this study about the pill and breast cancer heeded?

By Dennis Byrne
Chicago Tribune

Not wanting to become known as the town quack, I am reluctant to write another politically incorrect column about breast cancer.

Four weeks ago, when I reported a study that found a statistical link between abortion and breast cancer, the hate e-mail poured in, denouncing me for being an ignorant, stupid, anti-science, anti-choice and anti-woman lunatic. But it also brought a message alerting me to yet another study, suggesting that premenopausal women (younger than 50) who used oral contraceptives prior to having their first child faced a higher risk of breast cancer. Yes, I know, this debate has been going on for years, if not decades, and judging by the last studies given wide exposure a few years ago by the media, the issue seems settled: Oral contraception does not significantly increase the risk of breast cancer.

There's just one problem. According to an analysis in one of the most credible peer-reviewed journals in the country, the Mayo Clinic Proceedings, the risk is real. The study employed an often-used medical research technique called "meta-analysis" that allows researchers to combine data from other studies on the risk to get a larger picture. The result: Premenopausal women who used oral contraceptives prior to having their first child have a 44 percent higher chance of getting cancer than women who didn't use the pill. If they used the pill for more than four years prior to their first full-term pregnancy, the risk increased 52 percent. Chris Kahlenborn, an internist at the Altoona (Pa.) Hospital and the study's lead author, suggests one additional woman in 200 could get breast cancer. Extrapolated throughout the population, that could mean thousands more cases every year. I'd say that's an important story.

The reaction? Nearly total silence. Since it was published more than a year ago, I couldn't find a single reference to it in the archives of the New York Times, Washington Post, Los Angeles Times or this paper. The Associated Press appears not to have covered it. I couldn't find a single mainstream media article about it in a Google search. But stories about other breast cancer risks were plentiful, including one about how sleeping with a night light on can increase your chances of getting breast cancer. The National Institute of Cancer doesn't mention the study on its Web site, but it did detail a 5-year-old study claiming to find no higher risk to pill use. The American Cancer Society also doesn't mention the study and concedes only that "it is still not clear what part" the pill plays in breast cancer. Such guidance, if not deceptive, is certainly incomplete.

"The last word seems to be that the pill is safe," Kahlenborn told me, as he called me with his frustration with being unable to get this important information out to women. "The word basically in the medical community before the study, and it continues to be, is that the pill is quite safe." But the results of his study are disquieting enough that if the pill were just coming out today, the findings would be enough for the Food and Drug Administration to keep it off the market, he said.

Why so little attention? My guess is that the pill has been so widely accepted, that it has become such a key part of feminist ideology and that the pharmaceutical companies make so much from it, that few folks are willing at this stage to talk about its dangers. It's no small irony that those who habitually are quick to criticize big business and government for failing to "do enough" to protect consumers are mostly silent when it comes to talking about this particular risk.

Here, I also should clarify some things to all the folks who are itching to hit the "post comment" button: Kahlenborn is pro-life, but what has that to do with his research? As for me, I am not opposed to contraception, oral or otherwise. I am not plotting to get the pill banned. I am not writing this column for hidden religious reasons. I am not saying that the Kahlenborn study is the last word; I'm not a scientist, so I can't vouch for its methodology or conclusions. Just like the abortion/breast cancer study, I'm writing about it because people have a right to know about the existence of health information, even if it is contradictory to the given wisdom.

The truth is that I'd just as soon not write about it, for all the heat it generates. I just wish that someone else would.

25 comments:

Anonymous said...

Gee, Dennis. I just wish you would do a complete literature review and publish it. By the way, what makes you think that Mayo Clinic Proceedings is "one of the most credible peer-reviewed journals in the country"? Is it the Impact factor of 1.733, well below that of the New England Journal Of Medicine (22.412)? Or is it the name "Mayo"? Numbers like "44 percent" and "52 percent" sure sound like the studies are certain. If only we could all be so certain as you are Dennis.

Brie: standsalone.org said...

I'm so dubious about even responding to this column, but the ease with which you dispense with Khalenborn's pro-life/anti-choice credentials is pretty amazing.

'...but what has that to do with his research?'

Well, his previous research was published by One More Soul, a, I'd say, fairly radical anti-contraception/anti-choice group. In addition to supporting Kahlenborn's work, they also purport that condoms have tiny holes that allow HIV to pass through. Their hard, scientific evidence for that is a 1992 letter to the editor.

Early mistakes, right? Post-Mayo, Kahlenborn has arrived at scientific legitimacy. Yet, he's updated his pamphlet for the group in Sept. 2007.

Now, I know from your column that you did a search on Kahlenborn, so it seems likely that you came across this information. How concerned can you be with your readers' 'right to know' when you casually dismiss evidence that the researcher is clearly highly ideological and motivated - if by nothing else sales of his pamphlet at 35c a pop!

Maybe that's why none of the newspapers picked up his research. Good thing we have your column.

Karen Malec said...

The U.S. National Cancer Institute's statements on the pill (also called oral contraceptives) are both contradictory and deceptive.

The World Health Organization classified combined (estrogen and progestin) oral contraceptives (OCs) and combined hormone replacement therapy (HRT) as "Group 1" carcinogens in 2005. [1]

Combined OCs and combined HRT contain the same drugs, but OCs contain a higher dose. If combined HRT raises risk, then so do combined OCs. The drugs in combined OCs can be delivered to women through various means, i.e. the pill, the patch, vaginal ring, injection and IUD.

In 2002, the Women's Health Initiative found a 26% risk increase for women who use combined HRT. [2] Scientists call this a "small increase in risk," but it means thousands more women will develop the disease every year if they use OCs.

It took the World Health Organization 3 years after the above WHI study was published before it assigned the highest level of carcinogenicity to combined OCs and combined HRT.

The U.S. National Cancer Institute (NCI) dragged its feet for 4 years after the WHI study was published before it acknowledged that: "The risk of endometrial and ovarian cancers is reduced with the use of OCs, while the risk of breast and cervical cancers is increased." [3]

(Someone should ask why health experts recommend the use of a carcinogen to prevent cancer, especially when more American women die of the cancers that OCs cause - breast, liver and cervical cancers - than the cancers that OCs prevent - ovarian and endometrial cancers.)

The NCI's statements on OC risk contradict one another. Its statements vary, depending on whether the agency is addressing health professionals or patients.

The NCI's web pages discussing Breast Cancer Prevention include different versions for patients and health professionals.

The web page entitled "Patient Version" says, "Taking oral contraceptives ("the pill") may slightly increase the risk of breast cancer in current users. This risk decreases over time. The most commonly used oral contraceptive contains estrogen." [4]

The web page entitled "Health Professional Version" omits OCs in its list of risk factors for breast cancer. [5]

But both versions identify combined HRT as a risk factor for breast cancer.

OCs are wrongly excluded from the NCI's risk assessment tool, which is used by medical professionals to assess a patient's risk for invasive breast cancer. [6]

The NCI's experts know that estrogen causes cancer. David Longfellow, Ph.D., chief of the Chemical and Physical Carcinogenesis Branch at the NCI was quoted in the Journal of the National Cancer Institute in 2003 as having said, "It has been an uphill battle to convince the mainstream that estrogen initiates cancer by damaging the DNA." [7]

The New England Journal of Medicine and Mayo Clinic Proceedings published reviews of the medical research that examined the link between OCs and breast cancer risk. Both reviews report an increase in risk for women who use OCs. [8,9] The NCI does not mention either of these reviews on its website.

Physician-Senator Tom Coburn accused the agency in 1999 of "having a bias for lack of what the facts are." He was speaking of the abortion-breast cancer link.

It's clear that the NCI's bureaucrats have a bias in favor of feminist ideology.

References:

1. Press Release No. 167, "IARC Monographs Programme Finds Combined Estrogen-Progestogen Contraceptives (the "pill") and Menopausal Therapy Are Carcinogenic to Humans," World Health Organization International Agency for Research on Cancer, July 29, 2005.

2. Writing group for the Women’s Health Initiative Investigators. Risks and benefits of estrogen plus progestin in healthy postmenopausal women. JAMA 2002;288:321-33.

3. See the National Cancer Institute's Fact Sheet, "Oral Contraceptives and Cancer Risk: Questions and Answers," updated 5/4/06. Available at: http://www.cancer.gov/cancertopics/factsheet/Risk/oral-contraceptives

4. See the NCI's web page, "Breast Cancer Prevention, Patient Version." Updated 10/5/07. Available at: http://www.cancer.gov/cancertopics/pdq/prevention/breast/Patient/page3

5. See the NCI's web page, "Breast Cancer Prevention, Health Professional Version." Updated 9/13/07. Available at: http://www.cancer.gov/cancertopics/pdq/prevention/breast/HealthProfessional

6. See the NCI's "Breast Cancer Risk Assessment Tool," Available at: http://www.cancer.gov/bcrisktool/

7. Miller K. Estrogen and DNA Damage: The Silent Source of Breast Cancer? Journal of the National Cancer Institute, Vol. 95, No. 2, 100-102, January 15, 2003.

8. Kahlenborn C, Modugno F. Potter D, Severs W. Oral contraceptive use as a risk factor for premenopausal breast cancer: A meta-analysis. Mayo Clinic Proceedings 2006;81(10):1290-1302.

9. Yager JD et al. Estrogen Carcinogenesis in Breast Cancer. N Engl J Med 2006;354:270-82.

Dennis Byrne said...

Here are some objections to the column: http://standsalone.org/blog/2007/12/04/dennis-byrne-and-the-pill/#comment-914

Anonymous said...

Good for you and thank you!!!!

Science reporting in the media is horrible and biased. It's important to have this information so we can make an educated decision.

In order to make an educated decision, one must also know who the author of the study is. I recall The Tribune running a front-page, above-the-fold article about a "study" that said fetuses don't feel pain when aborted. What the article failed to mention was that one of the authors of the "study" used to run an abortion clinic. I don't recall pro-choice people being upset about that study.

As you said,"people have a right to know". That goes for both sides of any issue.

Anonymous said...

Dennis: Finally something in your column that makes sense. You are "an ignorant, stupid, anti-science, anti-choice and anti-woman lunatic." And I read it in the world renowned, prestigious newspaper, the Chicago Tribune.

patricia said...

I am a breast cancer survivor and I want to thank you for exposing the truth about the lack of coverage on hormonal contraception and breast cancer.

I hope you will not be discouraged by the verbal attacks from the radical feminists. Those of us who are authentic feminists recognize that hormonal contraceptives are not good for women.

Dr. Ellen Grant has written extensively on the harmful effects of “the Pill.” Her book, “The Bitter Pill,” is a classic. Barbara Seaman’s book, “The Doctors’ Case Against The Pill,” also chronicles the dangers of the pill. Sadly, neither of these women are pro-life but their contributions to the truth about contraceptives is very enlightening.

For women who need to avoid  or want to achieve,pregnancy,  various modern methods of Natural Family Planning (not the old rhythm method) are more effective than hormonal contraception, have no side effects, are free (after a small charge for initial training), and are associated with a very low divorce rate.

In addition to asking why more journalists are not reporting the truth about hormonal contraception, I wonder why more are also not telling women about the benefits of Natural Family Planning.

Dennis Byrne said...

I am posting this response from Monica K. Martin, M.D., with her permission:

I am replying to your editorial "Why isn't this study on the pill
needed?". First, this is not a feminist tirade, it's a science
tirade. In decades gone by, the lay press largely ignored science
and medicine journals. These studies were assumed to be the
purview of the professions themselves. Indeed, most studies are
designed to analyze a particular hypothesis, and present the data
to the scientific community at large for analysis and further
study. As such they are not usually appropriate for a headline in
the newspaper.
However, the disturbing recent trend is that every abstract of
every paper in every journal that has shock value is headlined
somewhere in a newspaper.

An example of this trend is the treatment in the press of The
Women's Health Initiative Study of 2002 on hormone replacement
therapy. The papers virtually told every woman taking hormone
replacement therapy that she would die because of it. These press
reports emphasized the relative risk of taking a drug, rather than
the absolute risk. For instance, if the risk of death in a group
is one in a million and a drug increases that risk to 2 in a
million, the relative risk is increased by 100%, while the absolute
risk is still 2 in a million or 0.00002%, an enormous numerical
difference.

The increased risk of heart attack in the group taking combination
hormone replacement therapy was 7/10,000 per year, less than a
tenth of a percent. Yet the newspapers reported only the relative
risk . Why do I have those numbers at my fingertips? Because I
discuss them with one of my patients almost every day. I don't
have those numbers memorized for birth control pills, except that I
can tell you that the death rate for all causes in every age group
up to 35 years old is less in women who are taking birth control
pills than those who are not. I will leave it for you to figure
out why this is, but it has something to do with the risk of death
from childbirth. The numbers are available in the product
information in every package of birth control pills.

So I hope to leave you with a better understanding of why a meta-
analysis that comes up with an increased relative risk of breast
cancer in women taking birth control (under any circumstances) may
not be newsworthy. Look up the product information for any birth
control pill, find the cardiovascular risk for an age group and
multiply the increased relative risk by the absolute number of
events. I think you will find that the risk remains very small in
non-smokers. If I can convince one news "writer and consultant" to
be more responsible and less sensational about science and
medicine, I willl have done a service.

Monica K. Martin, MD
Internal Medicine
Downers Grove

Karen Malec said...

Regarding comments from Monica Martin, MD:

I would agree that the debate on the pill is about science, not ideology. At the same time, it's important to recognize that, according to research reported by Rivkin et al. last year at the San Antonio Breast Cancer Conference, U.S. breast cancer rates declined by 14,000 cases between 2002 and 2003 - the year after the press (not the cancer establishment) educated the public about the risks of using combined hormone replacement therapy.

Remember - the scientific community calls the use of combined HRT a "small risk."

Evidence of a link between combined HRT and breast cancer dates from the 1980s. The scientific community knew about the risk for many years before the press reported it in 2002. The press only learned of the breast cancer risk accidentally - after the Women's Health Initiative was stopped midway because women were dying of heart attacks and strokes.

Warning women about all of the risk factors for the disease is bad for business.

It is true that mortality rates are declining, but most women would prefer not to have to deal with the nightmare of breast cancer treatment in the first place.

Anonymous said...

Thank You for exposing the truth about the Pill. The Pill is not good for women, it ruins their health, and causes damage in the long run. I've seen it happen to way too many women. Don't let negative comments discourage you from your honest work.

Rebound said...

Dennis,
Thank you for this article and thank you for the article on the abortion-breast cancer link.

The hate mail is unfortunate but the truth is critical and you should be commended for writing about the truth.

As it has been pointed out by others, when an insurance industry magazine publishes an article discussing the abortion-breast cancer link and advising its readers that this epidemic will be costly for the insurance industry and consumers, this is incredibly significant.

As Karen Malec pointed out in her comments about the study, "Insurance companies, after all, are in the business of making money and pleasing their stock-holders, not in dealing with politically motivated issues."

"For people who don't know who to believe, when the insurance industry starts talking about the issue then we know its a serious problem," Malec concluded.

I AM writing about it Dennis, locally, and I am asking repeated questions of the Susan G. Komen Foundation. I expect the hate mail to come at some point but what I am finding out initially is that people are astounded that this link (between abortion-breast cancer - due to estrogen overexposure) is SO physiologically fact-based! Why on earth are women not demanding an explanation as to why they were never advised of this physiological aspect of breast changes during pregnancy and the cancer vulnerable state they are left in after an abortion!

The abortion industry is evil and a threat to the welfare of women everywhere. There is absolutely NO CONCERN for the overall welfare of women by those in the abortion industry and I fear that the some of the cancer-fundraising organizations may be going down the same path.

Debbie Bloomfield said...

I heard about your article in the December 3 Chicago Tribune from the Coalition on Abortion Breast Cancer.

Thank you for boldly telling the truth and opening the conversation about the links between contraception, abortion, and breast cancer.

Now that you readers are wondering what to do if they must avoid a pregnancy and are concerned about their health and safety, I suggest that you write an article about Natural Family Planning. I am a volunteer promoter for the Couple to Couple League (www.ccli.org) with husbands and wives teaching the symptom thermal method of NFP. The teaching program has just been revised and updated. It is truly good news and is safe, healthy, effective, and morally acceptable.

Why do I recommend NFP?
I used birth control pills when first married (1974). Then I realized that I didn’t want to add chemicals to my body; after all, I belonged to a food co-op and bought mostly organic foods!

We wanted to insure some space between our children, so I used an IUD. Then I found out that it worked by causing early abortions when the baby couldn’t implant in the irritated womb.

Then we found out about ecological breast feeding and natural family planning. It really improved our marriage communication as well as helped us to space our children.

NFP knowledge about reading my body’s fertility signs allowed me to easily transition into menopause.

I know other people who were having difficulty conceiving a child and NFP helped them to maximize their fertility.

And yes, the Catholic Church recommends NFP for couples who need to avoid a pregnancy.

Another benefit is that with less estrogen polluting the environment (i.e. the story about estrogen polluted streams in Colorado) the healthier we all will be!

THANK YOU again!
Debbie Bloomfield

Joe Rutkowski said...

Dear Dennis, It took a backbone to write this article. The negative comments are to be expected. A "reasonable" person would at least look into these matters sincerely before responding. My wife used the pill with my consent. It wasn't until years later and a tumor removed that I read anything that could possibly explain the breast tumor. It is too late now, but had I known about the information you wrote in your article then, I may have investigated further -- at least suggested to stop the the pill until I educated myself better - for my wife's health. For us the news was not fatal - for now.

Eventually this truth will get out. In large part because there are writers with backbones like yourself. I am sure you will inspire others. Thanks!

Anonymous said...

Thanks Dennis for reporting the truth - I have always been amazed at how gullible women are - look at a graph showing when breast cancer really took off and compare it to a graph showing when the pill and abortion became the "standard" forms of birth control - it is amazing and you do not have to be "rocket scientist" or a medical professional to see that once the effects of abortion and the pill took hold, so did breast cancer.

Naughton said...

Mr. Byrne,

Thank you for your excellent columns on the increased risk of breast cancer from abortion and the combined pill. Your columns are an excellent service as women have a right to have this information, yet it is being hidden from them by those who profit from abortion and contraceptives.

I hope you will continue to inform women about these breast cancer risks.

Another aspect of the pill denied to women is that at times it will act as an abortifacient and we have none other than the former president of Planned Parenthood as a refernce for this information.

In her testimony against the confirmation of Attorney General Ashcroft (Jan. 2001) to the U.S. Senate Judiciary Committee, Gloria Feldt, President of Planned Parenthood Federation of America, said, "… the birth control pill, which frequently acts to prevent implantation of the fertilized ovum …", thus confirming that oral contraceptives frequently abort a woman without her even knowing it. Bogomir M. Kuhar, Pharm. D., in his book, Infant Homicide Through Contraception, claims there are many more contraceptive abortions than there are surgical abortions.

Women are used as bozo's by the profiteers. Their magnificent and necessary function of reproduction is degraded,used and abused by the pill and abortion.

Anne Marie said...

Thank you for this post.

Patrick McKay said...

Thank you once again Dennis, for your courage and conviction.

I earn my 'daily bread' as a designer of electrical services in buildings. As any engineer worth his salt knows, we simply can't interfere with nature with impunity. So it has turned out to be, with the 'pill' and abortion.

Truth is truth, even if nobody believes it - and error is error, even if EVERYBODY believes it.

7kidchaos said...

On Dennis Byrne's bravery... Kudos for Dennis Byrne for having the guts to release compelling scientific evidence of the birth control pill-breast cancer link.
It's pathetic that the government and the mainstream media talks about breast cancer as much as it does, but then won't mention these key links.

SueW said...

Dennis, thank you for the courage to stand up and tell it like it is. When I started investigating HRT (which is low dose birth control) back in 1999 when it was being prescribed like candy, I first was alerted to the breast cancer link when a nursing magazine mentioned "THE HRT-BREAST CANCER LINK". Not suspected link ... just THE link. So I started digging and found a study in the 1930's where synthetic estrogen was given to rats, male and female and they all came down with breast cancer. This study, mentioned in, (of all things) one of the bodybuilder magazines, was not available for citing on the web but I found a study done in Canada in 1960 which repeated the exact same results! That one WAS quotable. And this was when the Merck Manual was saying that HRT and b/c raises the risk for stroke,thrombosis and heart attack and "maybe breast cancer but this hasn't been yet proven". hmmm. So I elected to go another way with my own peri menopause treatment. In 2004, synthetic estrogen was put on the FDA list of carcinogenic (cancer causing) chemicals. That was a non news item also (of course). As was the Janet Daling study which suggested as high as a 250 times greater risk of breast cancer in aborted women (Janet, as a pro choice scientist, tried to suppress the results of her study because she felt the pro life movement would do something nefarious like warn women about this risk). Since then, more than 30 world wide studies have suggested a strong link between breast cancer and induced abortion and two double blind NIH studies testing both low dose estrogen and low dose estrogen and progestin necessitated being halted midway because the experimental group was getting too many heart attacks, strokes and thrombosis... and cancer. The Melbye study of Denmark is often quoted as "proving" no link between induced abortion and breast cancer, however, Dr Melbye admitted that a large group of women who were aborted before things were computerized had not been in the computer (approx 60,000) so had been counted as NON aborted. And if these were added to the aborted group, the Melbye study actually shows a STRONGER link between induced abortion and breast cancer than some other studies! And since most folks get most of their information from the media, I feel the media SHOULD report on these studies accurately. So I thank you for being the first mainstream media person who I know about to really frankly report this and know that even though it must have been difficult for you, others will speak up and your courageous move and articles ARE being indexed on the internet, just like CNN and the others (the beauty of the cyber highway) and perhaps through your efforts and others who will stand up and tell, many women could be saved from breast cancer (which is as we speak, killing thousands annually). Thanks so much... you are truly a good guy. We need more "you's" in this world!

Arundel said...

Dennis -

Your column is a good example of the current trend of people going off about "political correctness" as a smokescreen for their own politically motivated diatribes.

Your writings supporting dubious and unfounded links between abortion and the Pill and breast cancer are elegantly dissected here:

http://scienceblogs.com/insolence/2007/12/the_other_chicago_tribune_village_quack.php#more

Also, I suggest that you learn to distinguish between "hate mail" and "Your columns are poorly researched and idiotic" mail.

Jesse said...

I agree with everything Arundel said. Not only are you not 'brave' for 'exposing' this, you are nothing but a biased, anti-science, religious zealot.

It is cowards and intellectually bankrupt people like you that are slowly destroying our country. The anti-vaccination lobby. The creationists. The hypocrites. You are all leading the charge towards ruining our country in order to push a thinly veiled religious agenda. Shame on you for your deceit and willful disregard for the truth.

Anonymous said...

Thank you, Dennis, for having the courage to report the truth. As a previous blogger pointed out, the truth is the truth even if no one else believes it. The increasing numbers of breast cancer diagnoses
since the advent of the oral contraceptive pill back you up. Good job in reporting the facts. Thanks again.
Anonymous

Anonymous said...

The media does report science poorly. Women may be underinformed of the risks of oral contraceptives. But I don't think you're making some bold, martyred move in telling us all about this supposedly dire-but-underreported public health issue.

Look at the number of women (and men, for that matter) who smoke, sunbathe, don't exercise, eat too little fiber, drive too fast, skip checkups... the list goes on. Each of these behaviors increases risk of serious health problems or death. And these dangers are well-established and well-publicized.

You think the only thing keeping women from revolting against the pill is a little knowledge about cancer risk? It's not. You might feel noble by "bravely" writing about this, but I think betrays a lack of realism--and an excess of hubris. I don't undertand what kind of change you think your heroic stand here is going to bring about.

Steve said...

As JN said in A Few Good Men, some people can't handle the truth! That apparently includes many members of medical community. As a previous poster indicated, check the breast cancer incidence graph against the abortion numbers and usage of the pill. Maybe the drastic increase in BC is due to "environmental factors" such as global warming. Wake up people! Warn your daughters.

Anonymous said...

Dennis welcome to the neo-flat earth society times. You have to speak about the truth of current medical findings because many have become unpopular, i.e., breast cancer links to abortion and contraception, legitimate questions concerning global warming, radical depopulation in western societies, and I could go on. The University has abandoned the search for truth and elevated the promotion of utopian causes that spell the next generation of great experiments against reality. Keep writing, we need someone or it will be no one.