Cancer of the liver and the use of oral contraceptives.

Abstract

with a hepatoma who had been taking hormone replacement therapy and in whom serun markers were absent Though the chances of a woman taking the pill developing a hepatocellular carcinoma are low, the possibility needs to be considered in any woman with a long history of contraceptive use who develops new symptoms of right upper or central abdominal pain or in whom unexplained hepatomegaly is found. Further investigation by the non-invasive technique of ultrasound together with liver function tests should be enough to indicate the likelihood of a tumour of the liver.We thank Professor M Vessey for the data on control women, obtained from his studies on breast cancer, and also for his comments on the manuscript. The results were analysed after adjusting for age at diagnosis and year of birth and showed tha use of oral contraceptives was associated with a significantly (p<005) raised relative risk for hepatocellr carcinoma of 3-8 (95% confidence interval 1-0 to 14-6) and use for eight years or more was associated with a significanly (<0'01) increased relative risk of 20-1 (2-3 to 175-7). There were n6 apparent increases in risk for cholangiocarcinoma. Despite the small number of cases in this study and the methodological problems in assessng use of oral contra- References

Female hormone utilisation and risk of hepatocellular carcinoma

“…The results of this case-control study confirm an increased risk of primary liver cancer in OC users (Henderson et al, 1983;Neuberger et al, 1986;Forman et al, 1986;La Vecchia et al, 1989;Palmer et al, 1989;Yu et al, 1991;Hsing et al, 1992;Trichopoulos, 1992;WHO, 1992), and, more importantly, indicate that the risk persists for 10 or more years after stopping treatment.…”

Role of reproductive factors in hepatocellular carcinoma: Impact on hepatitis B- and C-related risk

“…17 On the other hand, our result of a marginally statistically significant inverse relationship between oral contraceptive use and HCC is not compatible with the results of 6 case-control studies with information on the duration of oral contraceptive use conducted among white women in low and intermediate risk areas, in which the risk of HCC was increased among users of oral contraceptives, particularly for women with duration of oral contraceptive use longer than 5 years. 3,[21][22][23][24][25] However, the sample size in each of these studies was small, containing only 9 to 26 cases. 3,[21][22][23][24][25] Otherwise, these studies did not take additional reproductive factors into account, so distortion of the relative risk estimate is possible.…”

“…3,[21][22][23][24][25] However, the sample size in each of these studies was small, containing only 9 to 26 cases. 3,[21][22][23][24][25] Otherwise, these studies did not take additional reproductive factors into account, so distortion of the relative risk estimate is possible. In fact, 2 studies involving a larger number of cases that included women in regions endemic for HBV infection and HCC found a statistically nonsignificant decreased risk of HCC for use of oral contraceptives.…”

“…Several case reports have described the occurrence of liver adenomas or focal nodular hyperplasia in women taking oral contraceptives, 20 and the possible association between use of oral contraceptives and the risk of HCC has been assessed in several studies. 3,17,[21][22][23][24][25][26][27] However, most of these studies were based on a very limited number of case subjects, and the results have been incon- …”

Tamoxifen prevents induction of hepatic neoplasia by zeranol, an estrogenic food contaminant.

“…However, other organs such as liver also contain a functioning estrogen-receptor (ER) mediator and, accordingly, are targets for control by circulating estrogens (3)(4)(5)(6)(7)(8). Indeed, estrogens taken by women for birth control purposes are implicated as a cause for development of both benign and malignant hepatic neoplasms (9)(10)(11)(12)(13)(14)(15)(16). In addition to endogenous steroidal estrogens, a variety of compounds with estrogenic activity also are found in the environment because a number of drugs, insecticides, and natural food products representing many different structures can act like estrogens after ingestion (17).…”