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Cancer and the pill--comments and criticisms.


 The author refutes Pike et al.'s conclusions that oral contraceptive (OC) use before the 1st pregnancy is a risk factor for breast cancer. 1st, it is argued that OC use does not increase breast epithelial activity; despite 3 weeks of exposure to progestagen, epithelial activity remains at a fairly low level. In contrast, DNA synthesis in breast epithelium decreases during the 1st half of the normal menstrual cycle and rises markedly when progesterone appears. The risk of breast cancer is greatest among women who reach menarche early and menopause late. In addition, there is little evidence for Pike's hypothesis that progesterone is the risk factor for breast cancer. Although he suggests that breast aging is faster between menarche and the 1st term pregnancy, slower from the 1st pregnancy to menopause, and slower still after menopause, the only study of breast aging showed no fifference after the 1st pregnancy. Next, whereas Pike originally claimed that OC use before the 1st term pregnancy was a risk factor for breast cancer, a later paper based on the same data concluded that the risk factor was OC use under 25 years of age. The basis for this change in conclusion is not given. Finally, despite the fact that other studies have found a substantial error rate when patients' recall of OC brand used is compared against medical records, Pike accepted all 470 of his subject's OC history of face value. Moreover, the progestagen potency values Pike used to identify the high risk preparations have been revealed to be inaccurate, raising questions about the validity of his conclusions.
