Animal tests suggest no cancer risk for the pill

Tests carried out over several years on rats and mice for the possible carcinogenicity of the constituents of oral contraceptives have satisfied the British Committee on Safety of Medicines that there is no carcinogenic hazard to women. The experiments are discussed in a recent publication of the Committee and were continued at varying dosages for most of the lives of the animals involved (both male and female). Progestagens and estrogens were tested both separately and together at a low dose (2-5 times the human dose), a medium dose (50-150 times the human dose), and a high dose (200-400 times the human dose). Only at the medium and high doses were any benign or malignant tumors found in any organs, and these were not always seen in both species of animal tested. While the results are complex, and it is difficult to transfer the experience gained with 1 species to another, the Committee concluded: "Although a carcinogenic effect can be produced when some of the preparations are used in high doses throughout the life-span in certain strains of rat and mouse, this evidence cannot be interpreted as constituting a carcinogenic hazard to women when these preparations are used as oral contraceptives." Long-term experiments on dogs and primates are continuing in the US, and their results will be carefully s crutinized by the Committee when they become available. On present evid ence, however, based on the results of the rat and mice experiments and the added clinical experience and physiological knowledge of the last few years, the Committee has opened the way for a number of new Pills to be licensed for the British market. 10 new preparations are expected to appear - 5 "minipills" or progestagen-only preparations, of which 3 have already been registered, 4 combined oral contraceptives, and 1 sequential preparation.

Is the pill getting safer?

The Office of Population Census and Surveys in London maintains a constant observation of possible drug-related mortality in the United Kingdom. In 1969 there were 28 deaths in England where on the certificate of registration the doctor had implicated oral contraceptives as a possible cause of death. The number of deaths in which therapeutic drugs have been implicated, in selected categories, for the years 1967, 1968, 1969, and 1970, respectively, are: contraceptives, 2, 17, 28, and l3; for analgesics, 17, 20, 19, and 24; for anticoagulants, 18, 30, 32, and 28; for antirheumatics, 21, 35, 31, and 27; for corticosteroids and similar drugs, 31, 62, 59, and 57; and psychiatric, 9, 11, 15, and 7. In 21 cases of death from oral contraceptives this was due to venous thrombosis and embolism, in 1 case to coronary thrombosis, and the remaining 6 were ascribed to other adverse effects of estrogen. In 1970 there were 13 such deaths reported: 7 cases of venous thrombosis and embolism, 2 of coronary thrombosis, and 4 resulting from other adverse effects of estrogen. Death certification is not necessarily totally accurate, and in some cases the pill may have been wrongly implicated and in other cases its possible causal relationship may not have been reported on the death certificate. However, Adelstein, reviewing these data, writes: "Although these comparisons are based on relatively few cases, they afford highly suggestive evidence that mortality related to the pill has decreased materially. Hopefully, one could speculate that any morbidity that may be related to the pill should have diminished, roughly speaking, in parallel." The number of oral contraceptive users in England has now returned to the level reported before the adverse publicity which oral contraceptives received early in 1969.

Abortion in Britain

Last month saw the end of the first year of operation of the Abortion Act in Britian, and statistics are now available for the first 10 months, from April 1968, to February 1969. In that time, legal, notified abortions totalled 28,849, of which 20,746 were on the grounds of risk of injury to the physical or mental health of the women. A further 1350 were carried out because of risk to the life of the woman, 1137 because of risk to the physical or mental health of existing children, 965 because of the risk of the woman bearing a physically or mentally handicapped child, and 52 as emergencies to save the life of the woman or prevent grace injury to her health. Another 4599 abortions were carried out for more than 1 of these reasons. An earlier set of statistics, covering the period up to December 1968, showed that 22,256 abortions legally carried out up to then, 13,609 were in National Health Service hospitals and 8601 in other approved hospitals. It is likely that the total number of legal abortions in Britain for the first full year of the Act will be about 34,000. In the years leading up to the introduction of the Abortion Act, the number of abortions carried out in Britain for reasons then legal had been growing steadily, and had reached 7600 in National Health Service hospitals in 1967. An unknown further number of legal abortions had been done in private nursing homes - these cannot be computed because they were not notifiable before the Abortion Act came into force. There are 4 legal abortions for every 100 live births in Britain; this is about 1/2 the figure for Denmark and one tenth that of Czechoslovakia.

Health beliefs and promotion of HIV-preventive intentions among teenagers: a Scottish perspective

Beliefs concerning the spread of the human immunodeficiency virus (HIV) and preventive behaviors were examined in a sample of 351 sexually active Scottish teenagers. A postal questionnaire, including measures of variables specified by the health belief model (HBM) and preventive intentions, was employed. The relation between HBM measures and reported endorsement of HIV-preventive intentions was investigated. Results indicated that, in general, respondents intended to use condoms with new sexual partners. The majority also intended to carry condoms if they thought they might have sex with a new partner and to ask potential partners about their previous sexual history. Multiple-regression analyses showed that measures of health beliefs, gender, age, sexual experience, and previous condom use accounted for 17.8% to 24.3% of the variance in reported preventive intentions. Perceived barriers to preventive behaviors were found to be important predictors. However, the overall pattern of results raised questions concerning the adequacy of the HBM as a model of the determinants of HIV-preventive intentions, and the need for an extended model is discussed. Separate analyses were conducted for men and women and for 16- and 18-year-olds, and the implications for modeling intention formation in these subgroups are considered. The relevance of these findings to HIV-preventive campaigns is also discussed.