Answer: as often as they prescribe the hormonal birth control pill.
This little-known fact about the pill was presented by Dr. Angela Lanfranchi, a breast surgical oncologist and co-founder of the Breast Cancer Prevention Institute, who shared her expertise on the drug at the “50 Years of the Pill” conference in Washington, DC on Friday.
“When is it ever right to give a group one carcinogen to a healthy woman?” she asked the audience. “We don’t have to take a group one carcinogen to be liberated.”
Lanfranchi offered a wealth of statistical data from various sources to support a fact that is known by the medical community to be true yet is rarely acknowledged: use of the pill has been strongly linked to an increased risk of breast cancer. Cervical cancer and liver cancer are also linked to use of the pill, although there is evidence that it is protective of endometrial cancer and ovarian cancer.
“This stuff is not new, it’s not magic, it’s in the literature,” she said, linking pill use to the 660 percent rise in non-invasive breast cancer since 1973. “Women want to know, and women have a right to know, what researchers have known for over 20 years.”
She compared media treatment of the pill’s cancer risk to that of hormone replacement therapy (HRT), which was found to be carcinogenic in 2002. Once word got out, 15 out of 30 million women in America taking HRT stopped; by 2007, invasive breast cancer in women over 50 for estrogen-receptive positive tumors dropped 11 percent.
Meanwhile, she noted, hormonal contraception - essentially the same drug as HRT and with a similar cancer risk, about 25-30 percent - continues to be touted as harmless and even healthy. And yet, the International Agency on Research of Cancer, a branch of the World Health Organization, classified hormonal contraceptives in 2005 as a group one carcinogen along with asbestos and radium.
Unlike the HRT discovery, “I don’t remember one six o’clock news report about that information,” said Lanfranchi.
While even medical textbooks attest to the 30 percent increase in cancer risk, Lanfranchi noted a pervasively dismissive attitude: one British medical textbook she cited said that, “Considering the benefits of the pill, this slight increased risk is not considered clinically significant.”
Not clinically significant? “To whom?” Lanfranchi asked, showing a sobering photograph of one of her own cancer patients, Suellen Bennett. While breast cancer caused by the pill is often caught early, she said, the pill’s “benefits” are hardly a reason not to mention its dangers.
“This is what you have to go through when you’re cured. You lose your hair, you lose your breast,” she said. Had Suellen been told of the risk, Lanfranchi said, “she would very well have been one of those women who would have chosen not to take the pill.”
The surgeon explained that the extra estrogen received by taking the pill not only encourages excessive multiplication of breast tissue - usually a normal occurrence in the menstruation cycle - but, when metabolized, can also directly damage breast tissue DNA.
Because breast tissue remains susceptible to cancer until it undergoes a stabilizing transformation in the childbearing process, said Lanfranchi, the pill is particularly dangerous to women who have not yet had their first child: perhaps the most popular demographic among pill users in the U.S.
To show just how much of a threat the pill posed to young women, Lanfranchi pointed to several statistics, including a 2006 Mayo Clinic meta-analysis that concluded that breast cancer risk rises 50 percent for women taking oral contraceptives four or more years before a full-term pregnancy. In 2009, the Fred Hutchinson Cancer Research Center found that women starting the pill before 18 nearly quadruple their risk of triple negative breast cancer. Even more shocking, Swedish oncologist Hakan Olsson concluded that pill use before the age of 20 increases a young woman’s breast cancer risk by more than 1000 percent.
“It’s like you took this molotov cocktail of a group one carcinogen and threw it into that young girls’ breast,” said Lanfranchi. “Is this child abuse?”
In a world where 50 percent of teenagers are on the pill, Lanfranchi lamented that publicly controverting the deep social dependence on the pill has become nearly impossible - even though the message would save countless women’s lives. She sympathized with doctors who would find the information hard to swallow.
“It’s hard to talk about this because you’re changing a culture ... I want to think that I did good, that I helped my patients, that I did better because of what I did,” she said. “25 years down in my career, when I hear that I’ve been handing out a group one carcinogen for the last 25 years, I’m going to be resistant to that.”