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Sex hormones and gynaecological cancer.

1982; BMJ; Volume: 284; Issue: 6330 Linguagem: Inglês

10.1136/bmj.284.6330.1657

0959-8138

J S Scott,

Testicular diseases and treatments

The opportunities for preventing cancer of the sex organs in women tend to differ greatly from those arising with other cancers. For example avoidance of sexual intercourse would probably almost eliminate carcinoma of the cervix. With cancers of the breast ovary and endometrium sexual activity (in so far as it is measured by numbers of pregnancies) appears to be protective. The action may be hormonally mediated and of these cancers endometrial carcinoma has the clearest endocrine relation: estrogens unopposed by progestogens predispose to it while progestogens can inhibit established tumors and may also act prophylactically. A recent report suggests that the progestogen in oral contraceptives (OCs) may have such a protective effect. The numbers were small and analysis of the total data gave results that did not reach statistical significance but the calculated relative risk of 0.44 is in keeping with other estimates. Apart from comparison with controls the pattern of the data is persuasive: protection appears greater with use over 5 years with recent use and with more progestogenic preparations. Minor modifications of OC regimens should be examined in the hope of enhancing any cancer-inhibiting effect without increasing their adverse effects. The sequential regimen seems not to protect against endometrial cancer while combined estrogen and progestogen for 21 out of 28 days may give some protection. So daily progestogen alone may be more protective. In regard to hormonal replacement for postmenopausal women unopposed estrogen has been found to increase the risk of endometrial cancer but adding progestogen may counteract the effect. Cancer of the ovary seems to be less frequent in users of OCs. An inevitable consequence of OC is more coitus without barrier contraception so that cervical cancer would be expected to be more common in women taking the pill. In practice no evidence has emerged of a substantial increase in invasive tumors in OC users although intraepithelial lesions are more common. Far from disposing to gynecological cancer OCs (or at least their progestogen component) seem to be having an overall favorable influence on the incidence of neoplasms. Such a balance of risks and benefits is more difficult to assess for cardiovascular effects. Inevitably any longterm change in the physiological state such as that pronounced with OCs and postmenopausal hormone replacement will result in a change in disease pattern.