Your Health Matters
June Tavenor Brake, RN, BN
August 6th, 2006
Birth Control and Cancer Risk: A Connection?
With escalating controversy in the media regarding cancer and prevention, why is it that Canadian women still have relatively no idea how to lower their cancer risks? There is a lot of advise on what can increase cancer rates (some legit, and some not) circulating our world: on TV, in the newspapers, and all over the Internet. Quitting smoking is a no-brainer when it comes to lowering your risk of cancer. As a matter of fact, there is a growing market for products to help you overcome this addiction.
One main area that still remains a mystery to many Canadian women is birth control. Many women would be surprised to learn that some birth-control methods increase their rate of cancer. So what options are there for women in this day and age who may be more career-oriented, or who simply do not wish to have children, to prevent pregnancy, and not expose themselves to an increased risk of cancer?
The birth control pill is a pill taken daily which contains hormones designed to work in a couple of different ways. The most common, combination pills, contain estrogen and progestin. When a woman is pregnant, estrogen is released naturally in her body, a system that prevents her ovaries from releasing any more eggs during the pregnancy. The level of estrogen created by taking the Pill is comparable to the levels that circulate during pregnancy, tricking the body into thinking you are already pregnant. Therefore, when taking the birth control pill, a woman’s cycle does not include the vital component of ovulation; there is no egg to fertilize.
Progestin, a synthetic form of the hormone progesterone,
thickens the mucous of the cervix which impedes the
advancement of sperm past the cervix. It also prevents the lining of the uterus from developing properly, which the body interprets as a sign it is not ready to hold a viable pregnancy, so that even if an egg was fertilized, it would not implant on the uterus and would be expelled with menstruation.
So, obviously the Pill affects hormone levels. The way the Pill works is comparable to estrogen levels of hormone replacement therapy in post-menopausal women. How much are women willing to interfere with your hormones? As part of the recent and widely-viewed Marketplace piece involving Wendy Mesley, cancer expert Dr. Sam Epstein referred to the birth control pill as “the largest unregulated human trial that’s ever been conducted.” In 2005, a division of the World Health Organization reclassified some oral contraceptives due to their causing an increased risk of cervical, liver, and breast cancer. The Canadian Cancer Society is currently revisiting their position on birth control pills, which was expected to be released this past spring.
Why, then, are so many women still taking the birth control pill? During my research, I noticed that most websites focused on the positives of the Pill such as the decreased incidence of ovarian cancer. I find it interesting (not to mention frightening) that more women are not taking this information seriously and demanding more studies and research about the cancer links to hormone replacement. While the Canadian Cancer Society’s website includes information pertaining to hormone replacement therapy for menopausal women, there is little information regarding birth control pills. And while various independent websites do state the connection, many Canadians still look to national organizations (such as the Canadian Cancer Society) to announce a uniform policy.
Until more information is released, women may not think to change their birth control methods. However, if the pill is doing all of these negative things to women’s bodies, what other options do working women have for contraception?
Condoms
Male Condoms
Male latex condoms have been around since the 1930s, and are still used today for good reason. They provide excellent contraception -- 97% effective rate of preventing pregnancy when used properly; 99% when used with spermicidal lubricant. The biggest advantage of a latex condom is its effectiveness in preventing the spread of STIs (formally known as “STDs”). Considering that Human Papiloma Virus (HPV), the most common and readily contagious STI is implicated in almost all cases of cervical cancer, using condoms would be a great bet for a woman’s contraceptive of choice, especially for those women not in committed relationships who are more likely to be concerned about contracting an STI. Male condoms are easy to use, inexpensive, small and easy to conceal in a purse, and readily available in stores and pharmacies. The downside to condoms include the interruption of the sex act, and some decrease in sensitivity of sex. Also, a few people have sensitivities to latex and can develop allergic reactions including rash and itching.
Female Condoms
The female condom is a relatively new product that allows women to be more proactive with their own sexual protection. It is made from latex, larger than the male condom, and inserted into the vagina. It can be inserted ahead of time, therefore being less disruptive to the sex act. Unfortunately, some women have reported that it shifts around during sex and can be noisy and distracting. The female condom provides an excellent barrier to protect against STIs and pregnancy, but actual statistics regarding effectiveness have not yet been published.
Spermacides
Spermacides are foams, creams, or jells that contain chemicals which make the sperm unable to function. They are a less effective contraceptive when used alone, about a 5-7% chance of pregnancy when used perfectly every time (typical failure rate more like 18-22%). However, when used with a condom, there is an almost 100% guaranteed against pregnancy. Spermacides allow women to again be in control of the contraception, and they can be inserted ahead of time. However, it is less effective unless used perfectly every time, and provide next to no protection against STIs.
Contraceptive sponge
The contraceptive sponge is a barrier contraceptive device with spermacide. It is inserted into the vagina and can remain there for up to 24 hours with no need to remove or add additional spermacide. With practice, the insertion and removal can be quite simple. The sponge is relatively comfortable for both individuals, the woman is in control, and they are readily available in pharmacies. It is small and can be concealed in a purse, perhaps less conspicuous than condoms. The effectiveness of the sponge as a contraceptive is 88-91%. However, there is almost no protection against STIs, and they cannot be used during a woman’s period due to the risk of toxic shock syndrome.
Diaphragm
A diaphragm is a rubber dome-shaped device that is made to fit over a woman’s cervix to prevent sperm from entering your uterus. It is always used with a spermacide. It needs to be custom-fitted to a woman’s cervix, so these must be obtained from a physician. When properly cared, a diaphragm can last a long time. When used perfectly each time, it has a 2% failure rate. The typical failure rate is more like 18%. Again the woman is in control of contraception, and it is comfortable for both individuals. A diaphragm can be inserted up to two hours before sex. It is a little more time consuming to obtain, and if a woman’s weight fluctuates either way by 10lbs, she will have to revisit her doctor to have the diaphragm refitted. Again, there is no protection against STIs!
Copper Intrauterine device (IUD)
An IUD is a device that is inserted into the uterus to prevent pregnancy. It is a T-shaped device that rests in a uterus with two strings that remain outside the cervix for removal and checking of placement. IUDs can work in a couple of different ways. One theory is that they prevent the egg from joining with the sperm. Another is that they prevent an impregnated egg from attaching to the uterus wall, which is the first vital step in the egg developing into a fetus. IUDs can be left in place for 2 to 5 years, provided there are no complications. They are 96-98% effective in preventing pregnancy. IUDs are inserted by a physician, and need to be checked for accuracy of placement every 6 months. Women using IUDs also need to check placement of the strings after every period and visit their doctor if they cannot feel them. The IUD is very effective and inexpensive and very low maintenance. They can also be easily removed should a woman decide to have children. IUDs have been known to cause heavier periods with worse cramping due to the copper, a risk of pelvic infection related to the insertion procedure, and if the contraception fails, a higher risk of ectopic pregnancy.
Emergency Contraception
An emergency contraception is available should one of the previous methods fails. A medication known as Plan B has recently become available over-the-counter at pharmacies. It is, however, a hormonal method, very similar to the birth control pill and holds all the same side effects as the Pill, potentially including increased cancer risks if used regularly. Plan B is meant to be used as a backup within 72 hours when contraception fails. It will only work for women who are not already pregnant from a previous sexual interaction. It works by using the hormones to prevent the release of the egg, and also from preventing a fertilized egg from attaching to the uterus wall. It is 89% effective in preventing pregnancy. Side effects include nausea, vomiting, abdominal pain and cramping, headache, and dizziness. Also, there is absolutely no defense against STI’s with this method.
The Choice is Yours
The most effective birth control and STI prevention method is abstinence. But for women who are sexually active, it is so important to protect against STIs, even though pregnancy is the forefront of most working women’s priorities. A stable, open and committed relationship lowers the chances for an STI. Many of the contraceptive methods mentioned here are great options for women who wish to steer away from the hormonal methods, and very possibly lower the risk of cancer.
References and For More Information:
- "Chasing the Cancer Answer" (CBC Marketplace)
- "Birth control pill FAQ: From menstruation to menopause — and everything in between" (MayoClinic)
- The Canadian Cancer Society
- "Birth Control" (Cool Nurse)
- "Birth Control: Sexual Health Centre" (Women's Health Matters)
- Plan B
Other Articles By June:
- Good Day Sunshine (June 2006)
- (April 2006)
- An Apple A Day (March 2006)
- "I’ve been waiting for 3 hours!” -- Wait times in Canadian hospitals (February 2006)
- Private Parts: The implications for women’s health in the federal election (December 2006)
June welcomes comments from her readers. You can contact her by writing to june@edwardsmagazine.ca
