Oral contraceptives and skin neoplasia

Risks and benefits of oral contraceptive pills

In the more than 40 years since the combined oral contraceptive pill was first marketed, much information has been obtained as to its risks. Considerably less publicity has been given to the balancing benefits that have also emerged. There has been an increasing realization that the risks are focused in those women with recognised risk factors, meaning that the remainder can use the product with increasing reassurance. The doses of both hormones have also been lowered considerably since the early years. Thus, it can be a rational decision by a fully informed woman to use this form of contraception.

Treatments for menopausal and post-menopausal problems: present and future

Probable developments in HRT and non-HRT treatments for menopausal and post-menopausal problems have been reviewed. More information is required on potential benefits and side-effects of HRT. The major potential benefit is prevention against stroke amelioration of Alzheimer's disease: the major potential side-effect discussed in this chapter is ovarian cancer. At present, techniques for delivering oestrogens are more varied and advanced than those for progestogens. Non-oral delivery systems for progestogens which minimize side-effects will be introduced during the next decade. It is not clear whether benefits expected with new progestational agents will be realized. Preliminary data suggest that SERMs and phytoestrogens are worthy of further evaluation. Their development will provoke intense interest over the next 10 years.

Does pregnancy influence the prognosis of malignant melanoma?

The effect of pregnancy on the clinical course of malignant melanoma (MM) is unclear. Early clinical and laboratory evidence suggested a relation between hormones and MM and subsequently between pregnancy and MM. We reviewed the literature on MM and pregnancy to address three questions: What is the effect on prognosis if an MM is diagnosed during pregnancy? What is the effect of previous pregnancies on the prognosis of MM? What effect does a subsequent pregnancy have on the prognosis of MM? On the basis of a limited number of controlled studies, it does not appear that being pregnant before, after, or at the time of diagnosis of stage I MM influences the 5-year survival rate. However, caution in interpreting these data must be taken because it is possible that the duration of follow-up and size of the study populations are not sufficient to observe a true effect.

Melanoma and pregnancy. A review

In the last half-century the incidence of cutaneous malignant melanoma has increased all over the world according to available reports. No association between risk of melanoma and age at menarche, first birth, menopause or duration of reproductive period has been proven so far. Studies on the effect of parity on relative risk and survival have given divergent results with multiparous women possibly having a better prognosis than nullipara. Women with melanoma diagnosed during pregnancy tend to have thicker tumours, shorter disease-free interval and, maybe, lower 10-year survival rate than non-pregnant matched controls. There is no conclusive evidence that therapeutic abortion improves the cure rate. Multivariate analysis has failed to unveil impaired prognosis in women who become pregnant subsequent to diagnosis.

The prevention of cutaneous malignant melanoma: high-risk groups, chemoprevention, education, and screening

Melanoma is a disease that need not be deadly. Advances in our understanding of the etiology and biology of melanoma over the past 20 years have brought us to the brink of a new era in which the twin goals of primary and secondary prevention may be within our grasp. There is ample reason to be optimistic that this can and will be accomplished.

Oral contraceptive use and risk of cutaneous malignant melanoma

The relation between cutaneous malignant melanoma (MM) and the use of oral contraceptives (OC) was investigated in a case-control study carried out from 1979 to 1991 among patients in hospitals and clinics in the Philadelphia (PA) and New York City (NY) metropolitan areas (United States). Cases were 615 women under age 70 who recently had been diagnosed with invasive melanoma; controls were 2,107 women of the same ages who had been treated for other conditions unrelated either to OC use or to skin diseases. The cases were categorized as severe or nonsevere based on the depth of invasion of the tumor or the presence or absence of metastases. Among the severe cases, OC use was not associated with MM: the relative risk (RR) estimate for ever-use was 1.1 (95 percent confidence interval [CI] = 0.8-1.5) and the estimate for 10 or more years of use was 1.1 (CI = 0.6-2.1). Nor was risk associated with recent use, long latency, or young age at first use. Among the nonsevere cases, ever-use of oral contraceptives was associated positively with MM (RR = 1.5, CI = 1.1-2.4) but there was no trend with increased duration of use. The findings provide evidence against the hypothesis that OC use increases the risk of malignant melanoma. The elevated estimates among the nonsevere cases most likely reflect selection bias rather than a causal relation.