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It’s still a man’s world

Once again the month of October is upon us with the full press of breast cancer awareness coming from nearly every angle one can imagine.  Personally, NFL players wearing pink shoes and gloves is a bit much for me.  And again, the contribution oral contraceptives make to increase breast cancer among younger women goes unstated, unspoken, and unnoticed.

The widespread cultural refusal to recognize this inconvenient truth about hormonal contraceptives was underscored once again for me as I opened the latest issue of JAMA online. In the October 12 issue a new large study indicates men who took large doses of vitamin E during a 3-year randomized trial had a 17% increased risk of developing prostate cancer compared to men who took a placebo. The authors conclude that “[men who took 400IU/day] have a significantly increased risk of prostate cancer.”  The study also concluded the use of vitamin D would add 16 more cases of prostate cancer for every 10,000 men.

What I find interesting is that this single study made national TV news, and will be picked up on many websites, blogs, etc. No doubt lots of men are conversing about this today. Remember that “16 per 10,000” and read on about how breast cancer risk is presented.

First, the data.  Kahlenborn and others published a large meta-analysis in 2005 and found that among premenopausal women who took oral contraceptives the overall risk of breast cancer increased 19%, basically the same as our men consuming vitamin E. (Meta-analysis is a technique that pools several clinical studies focused on a common outcome to reach a more accurate estimate of risk or benefit.)  Among women who started using oral contraceptives before their first full-term pregnancy (a very common habit in today’s world) Kahlenborn’s study found premenopausal breast cancer risk is increased to 44%. In the same year the World Health Organization’s International Agency for Research on Cancer concluded from a review of over 70 studies on 60,000 women with breast cancer, that the combined oral contraceptive is a human carcinogen.

So what does a resource on contraceptives referenced by FDA and other government agencies with links to Planned Parenthood say about this?

Quoting from page 224 of Contraceptive Technology (19th edition):

Subsequent meta-analyses and subgroup analyses (reference: Kahlenborn’s work) have caught media attention but add little to change our counseling of women using modern low dose combined oral contraceptives (COC).  Even if there were a slight increase in risk of women under age 35, breast cancer is so rare in women in that age group that these are very reassuring findings about the safety of low dose COC’s.

To put the statement “so rare” in perspective, data from the National Cancer Institute’s SEER database show the incidence of breast cancer in American women aged 20-49 is 7 cases per 10,000 women.

So for men, 16 cases of prostate cancer for every 10,000 is a “significant increase in risk,” but for women, some fraction of 7 breast cancer cases per 10,000 is called “reassuring about the safety” of oral contraceptives.

I guess we should conclude that a few more women with breast cancer under the age of 35 are less important in the grand scheme of things than a few more men with prostate cancer over the age of 60.

Sadly, it still really is a man’s world.

– Mike Manhart