New Perils of the Pill?

By Anastasia Toufexis

When oral contraceptives were introduced in 1960, women embraced them as a dream drug: an easy, reliable and safe way to prevent pregnancy. But fears spread in the 1970s, after researchers found that users of the Pill, particularly smokers, were somewhat more vulnerable than other women to heart attacks and strokes. In the '80s the Pill became attractive again after scientists showed that it helps protect against ovarian and endometrial cancer.

Now women are confused -- even panicked -- once more, this time by reports suggesting that the use of birth-control pills increases the risk of breast cancer. After newspaper and TV stories on the possible link appeared last week, doctors were besieged by calls from many of the 13.2 million American women who take the Pill. And no wonder: breast cancer is the third leading cause of death among U.S. women, killing 42,000 a year.

The concern stemmed from two U.S. studies and one from Britain. Among the findings:

-- Childless women who started menstruating before age 13 and had been on the Pill for eight to eleven years were nearly three times as likely to develop breast cancer as comparable women who had not used oral contraceptives.

-- Women who took the Pill for more than ten years tripled their risk of developing breast cancer by age 45.

-- The rate of breast cancer in women 30 to 34 who were former pill users was three times as high as in those who had not taken the drug.

Though unsettling, these studies are far from conclusive. They contradict about 30 previous surveys, nearly all of which indicated that the Pill is safe. Last week an advisory committee of the Food and Drug Administration met to review the handful of studies suggesting otherwise. The panel's conclusion: the evidence is too weak to warrant a change in pill use or a new warning label. But the group admitted that the issue is not settled and called for further research.

Some consumer advocates think women should be warned that the safety of oral contraceptives is in question. "It's not clear the Pill is not associated with breast cancer," contended Judy Norsigian of Boston's Women's Health Book Collective. But most scientists, including those who conducted the disturbing studies, backed the FDA's stance. Said Bruce Stadel, an agency epidemiologist: "The findings are inconsistent and difficult to reconcile with biological plausibility."

Researchers believe the latest findings could be due to errors in study design or interpretation. Moreover, the surveys may not be relevant to current pills. The reports contain data on women who took older formulations of oral contraceptives; today's tablets contain lower levels of sex hormones and are considered much safer. Most doctors remain convinced that the Pill's documented benefits far outweigh unproven risks. Women will have to decide for themselves whether they agree.

With reporting by Georgia Harbison/New York and Dick Thompson/Washington