According to the statistics from the Japan foundation of Promotion for Cancer Research, the incidence of breast cancer increased by five-fold in the past thirty years, since 1980, reaching to more than seventy-two thousand diagnosed cases in 2011; the fact equates one in twelve may develop breast cancer sometime in her life.

Why this happened? :the onset of breast cancer. Why does it continue to increase? What are the underlying causes? These questions are on the attention attracted in the public domain.

As a member of  obstetrics-gynecology specialists, we all experience how important are the estrogen and progesterone, collectively named female hormones, for maintaining human physiology.

Female hormones are tightly connected to women’s physiology such as pregnancy and delivery, as well as menarche, menopause, and benign tumor such as myoma uteri or menstrual disturbances in reproductive ages. Female hormone preparations are frequently prescribed and crucial medications in obstetrics and gynecology specialty.

In my blog No.63, I mentioned that there is no scientific rationale in the overflowed information that, the pill causes cancer or thrombosis. How could it be true that female hormones (or pills), that energize pro-female physiology as a primary source of life, possess any health-related risks? I should assertively say that these kind of health information have none of scientific bases, just disseminating nonsense messages.

If OC(low dose contraceptive pills),possesses risks of cancer or thrombosis, it means that female hormones, primarily pro-female substances, increase risks of cancer or thromboses: that is essentially in contradiction. A pill means a small tablet medicine.

Such a high incidence of cancer -as to one in twelve affected in lifetime- cannot be caused by female hormone use, it is a woman’s self contradiction of being woman otherwise.

Then how should we understand this? Japan Society of Obstetrics and Gynecology produced a clinical guideline, a reference for standard treatments mainly for young trainee physicians. You can get a hint for solution if you carefully go through the pages of OC guideline 2015 version.

In the pages explaining OC and a risk of breast cancer, it reads; from the analysis of large number of cases published in 1996, an increase of incidence in breast cancer can be recognized with OC use, but only shortly after starting OC and is no longer found after ten years of discontinuation of OC.

More to the reference literatures in the guideline finds, just precise and eye-opening one, which opposed to fallacious information saying pills make cancer and thrombi. One of these reported the results of the survey conducted between 2007 and 2010 by British family physicians in BMJ (British Medical Journal).

It says, prescriptions for pills started in 1968 (Showa  43rd year),and during 39 years after, two groups; who ever used pills and who never use pills were surveyed in the study. Both groups recruited about twenty three thousand women and a total follow up period was eight hundred and thirteen thousand woman-year and three hundred and seventy eight thousand and six woman-year respectively.

The result. There was no difference in the incidence of breast cancer between two groups. In fact, mortality was lowered by 12 percent in the pill users. Reduction of the incidence in the gynecological cancers such as, colon cancer, rectal cancer, cancers of uterine corpus and ovaries; cardiovascular diseases; ischemic heart diseases; others such as respiratory and infectious diseases, were also found.

The authors also concluded that there was no relationship between mortality and the duration of pill use.

Based on this analysis, BMJ literature drew the conclusion that said, prognosis of pill use as long as 39 years does not increase mortality, and the use even contributes to the maintenance of health.

Another study investigating use of pills and health outcomes conducted by British midwives was also published  in the same journal in 2014. Again, the results were similar. This health survey followed 121,701 individuals over 36 years (1976-2012), of those, pill users were 57,951 and non-users were 63,626. Having compared these two groups, it concluded as follows.

No difference between the groups regarding every cause of death was found. Overall, breast cancer death in users did not increase, and death cases from ovarian cancer were decreased in pill users.

In the introduction of 2015 OC guideline in Japan, it says, after analyzed a large number of cases of breast cancer and pill use since 1996,incidence of cancer increases immediately after starting OC. Which indicates the risk of onset may be slightly increased with OC.

I have introduced another story in my blog. Japan Society of Obstetricians and Gynecologists, a domestic specialty body of general practitioners, dispatched a warning letter regarding health risk of HRT (Hormone Replacement Therapy) to the members in 2002. Because, one American literature was published which concluded that menopausal hormone replacement therapy is accompanied by the elevated risks of cardiovascular diseases, stroke and invasive breast cancer, following to the results of NIH trials.

However, we now know that there has been a lot of limitations in this NHI’s report –on menopausal HRT and associated health risks. Female hormones are also used in HRT for postmenopausal women, principally the same as of OC. Around the time in 2002, prescriptions for female hormone preparations were markedly held back in Japan as well as in overseas after NIH report.

On the other hand, according to the literature published in 2003 in JAMA (Journal of American Medical Association), an increased incidence of invasive breast cancer (advanced) in postmenopausal women who have been prescribed with female hormones was observed compared to non-prescribed; a sign manifested in around 4 years after initial prescription. Contrast to this, with early stage breast cancer (in-situ), there was no difference found.

What has been the consequence of global hesitation in the use of female hormone since NIH report? A study results published in Annals of Oncology –a specialty journal in cancer- clearly answered the question. The study was to analyze breast cancer patients registered in two institutions in France between 1990 and 2010. Incidence of breast cancer increased after 1990, in which both cases of invasive and early stage showed upward trend since 2003. In contrast to this, after 2003 towards 2010, invasive cases (advanced cancer) curved toward a decreasing trend, while the early stage cases kept increasing.

We can draw a clear message out behind this fact. That is, the female hormone is a causal factor of increased incidence of invasive breast cancer, but not of one-in-twelve type. I dare say in a perverse way, use of HRT or OC have a side effect (beneficial effect) for early detection of life-threatening type of breast cancer. These regimens  actually promote early detection against breast cancer risks, don’t they?

In my previous blog, I referred to the New York Times news, famous American actress Miss. Angelina Jolie (39 years old) accepted to receive not only resection of normal breast, but also bilateral ovaries after examination of breast cancer genes. According to the US health statistics, hereditary breast-ovarian cancer may be seen in about only 5% of total breast cancer patients.

Lastly, I would tach to some odd statements found in the 2015 OC guideline. It says, the use of OC in Japanese women is as short as 14 years. True? I should give my comments on this statement.

In 1954, American physiologist doctor Gregory Goodwin Pincus (1903-1967) developed a combined pill using estrogen and progesterone and carried out the first clinical trials.

At that time of the era, population growth was on the explosion in the Mid-South America, Latin countries. America provided these countries with pills free of charge, which was an innovative birth control method on people’s eye.

In 1966, I was into a obstetrics-gynecology physicians’ office in Nagoya University (professor Naotaka Ishizuka). Late doctor Masaaki Iida, who was a hoped candidate for a professor seat, devoted himself into the basic scientific research on the pill. We all remember clearly about his enthusiastic works.

Before long, the drug was launched under the brand name Anovlar, ever since the pill has been extensively prescribed among practitioners. The component of estrogen and progesterone in modern pills has been lowered to 20 but it was 50 of estrogen at that time (this type still used presently). A core members of the medical office in Nagoya University was steroid research group and post graduate research theme was the pill. Back in late 1963, basic research for pills had already been underway in this country.