The birth control pill--which, starting 10 years ago, fell from grace among women concerned that it could cause everything from heart attacks to cancer--today takes what many doctors believe ought to be a last major step toward its deserved vindication.
Involved is a report in which a team of federal government researchers, expanding on an earlier conclusion, has reiterated findings that--contrary to scary reports first published in the early 1970s--the Pill poses no significant breast cancer risk.
And looking at the Pill's past with something of the perspective of a revisionist historian, Dr. David Grimes, professor of obstetrics and gynecology at the USC School of Medicine, said the Pill suffered from overly enthusiastic reporting of its alleged possible dangers in American news media. The stories were based on what turned out to be preliminary or incomplete studies.
Dramatic Drop in Use
Both the initial research findings and their reporting led, Grimes and other experts noted, to a dramatic decline in Pill use, from 14 to 15 million women in the early 1970s to about 9 million at present.
Now, however, Grimes and other observers believe the Pill may be poised for a deserved comeback--both because new, long-term research has found much of the early criticism to be little more than a bad rap and because the nation's love affair with product liability litigation has led to sharp curtailment in availability of the intrauterine device and threatens even such pedestrian forms of birth control as the diaphragm and contraceptive gel.
Today, agreed Grimes and Dr. Louise Tyrer, medical director of the Planned Parenthood Federation of America, the Pill represents the best and most effective form of readily reversible birth control. Both Grimes and Tyrer predicted a greater role for the Pill as its exoneration is more widely recognized.
The new report, by a division of the National Institutes of Health, does little more than add detail and depth to findings first published in 1983. In the study in question, government researchers examined the cases of 4,711 female breast cancer victims from ages 20 to 54 and another 4,754 women who did not have the disease, looking for some association between Pill use and incidence of breast cancer. Results of the study are being published in the New England Journal of Medicine.
Rearranging the data again and again in an attempt to establish a correlation between the formulation of the Pill a woman took, the length of time she took it (even women on the Pill for 15 years or more) and the age at which she started using it, the new study found nothing to suggest that the Pill plays any causative role in breast cancer at all.
The research team, headquartered at the government's Centers for Disease Control but which drew support from the National Institute of Child Health and Human Development and National Cancer Institute, found that:
- The relative risk of contracting breast cancer was the same for women who had never taken the Pill and those who had, irrespective of the length of time users had taken it, with the same equal risk recorded for women who had used the Pill from less than 12 months to more than 15 years.
- Contrary to what some researchers suspected, the brand and formulation of Pill a woman used had no relationship to breast cancer risk. Pills come with different mixes of birth control estrogens and researchers elsewhere have concluded that formulations relying on higher estrogen doses are possibly associated with an increased risk of heart disease among Pill users, but that lower-dose varieties lack that disadvantage. One earlier study had suggested a similar cancer risk for women using high-dose formulas, but the new study specifically ruled that out.
- The age at which a woman began using the pill and whether she had been pregnant or had a child before starting the Pill was equally irrelevant to breast cancer risk.
"These findings provide evidence that, overall, oral contraceptive use does not increase the risk of breast cancer," the NIH group's report concluded. "These findings . . . offer some further reassurance about the safety of oral contraceptives."
In an editorial accompanying the newly published study, Dr. Samuel Shapiro of the Boston University School of Medicine noted that, although there are still risks in the Pill for some women--notably women who smoke and are 35 or older, other doctors agreed--the fundamental conclusion is that the Pill is far safer than many women have believed and represents apparently the best practical, reversible birth control option available today.
Several doctors interviewed by The Times cautioned that there remains a small but established risk for women taking the Pill that they may unexpectedly have a stroke or other cardiovascular episode. However, three experts agreed that the risks of such side effects are, by even the most cautious estimate, slight.