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Old 12-01-2011
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Drug Decreasing the risk of disease with OCPs

A 29-year-old woman comes to the office for a periodic health maintenance examination. She has no complaints. Her past medical history is significant for irritable bowel syndrome. She has never had any surgery. She has been taking the oral contraceptive pill for the past 12 years, ever since she became sexually active. She has no known drug allergies. Physical examination, including pelvic examination, is unremarkable. By taking the oral contraceptive pill, this patient is decreasing her risk most significantly for which of the following?

A. Breast cancer
B. Cerebrovascular disease
C. Cervical cancer
D. Liver cancer
E. Ovarian cancer
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Old 12-01-2011
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Old 12-02-2011
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E. Ovarian cancer
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Old 12-02-2011
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Ovarian cancer
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Old 12-02-2011
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The correct answer is E. Ovarian cancer represents the most common cause of death from gynecologic malignancy in the United States. Several studies have shown that oral contraceptive use decreases the risk for malignant and borderline epithelial ovarian cancer. The estimated risk reduction is approximately 40%. The amount of protection that the pill provides against the development of ovarian cancer seems to depend on the duration of use, with longer uses having increased protection. One study has shown that women who use oral contraceptive pills for a decade or longer have an 80% risk reduction for the development of ovarian cancer. The exact mechanism for how the oral contraceptive pill provides this protection is unknown, but there is some evidence that ovulation inhibition may play a central role.
The evidence concerning the oral contraceptive pill and breast cancer (choice A) does not show a significant protective effect. In fact, several studies have shown an increased risk for breast cancer associated with recent or current oral contraceptive use. Other studies, however, have not revealed this finding.
There is an increased risk for cerebrovascular disease (choice B) in patients who use the oral contraceptive pill. This risk is believed to be highest in women with hypertension, women who smoke cigarettes, and women who are older than 35 years of age.
It is also unclear whether oral contraceptive use increases or decreases a woman’s risk for developing cervical cancer (choice C). Women on the oral contraceptive pill should have annual cervical cytologic screening.
Several reports in the 1980s raised concerns about a possible link between oral contraceptive pills and liver cancer (choice D). More recent reports have not confirmed those concerns.
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