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A comprehensive study of 176,601 women reveals significant associations between various contraceptive methods and cancer risks, offering important insights for clinical decision-making. The research, published in the Journal of the National Cancer Institute, examined four types of contraceptives – levonorgestrel intrauterine system, etonogestrel implants, depot-medroxyprogesterone acetate, and oral contraceptive pills – comparing their relationships with multiple cancer types through a case-control study with 882,999 controls.
Key Points:
- The levonorgestrel intrauterine system demonstrated the highest overall cancer risk (OR 1.25, 95% CI 1.21-1.28) among all contraceptive methods studied, with notable increases in breast cancer risk (OR 1.26) and endometrial cancer risk (OR 3.58). This method also showed significant associations with increased risks of colorectal cancer, melanoma, and thyroid cancer.
- Etonogestrel implants and oral contraceptive pills shared similar breast cancer risk profiles (OR 1.24 for both), while showing protective effects against endometrial cancer (OR 0.21 and 0.44 respectively). Both methods demonstrated reduced risks for epithelial ovarian cancer.
- Depot-medroxyprogesterone acetate exhibited unique risk patterns, showing increased risks for cervical cancer (OR 1.38), colorectal cancer (OR 1.34), and lung cancer (OR 1.36), while maintaining a neutral association with breast cancer risk (OR 1.01).
- All contraceptive methods demonstrated protective effects against endometrial cancer, with the notable exception of the levonorgestrel intrauterine system, which showed a significantly increased risk (OR 3.58).
- The study revealed distinctive cancer risk profiles for each contraceptive method, suggesting the need for individualized contraceptive counseling based on patient-specific risk factors and medical history.
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In a Lancet study reported in 2012, they estimated that 342,203 women died of maternal causes in 2008, but that contraceptive use averted 272,040 maternal deaths (44% reduction), so without contraceptive use, the number of maternal deaths would have been 1-8 times higher than the 2008 total. Also, satisfying unmet need for contraception could prevent another 104,000 maternal deaths per year (29% reduction).
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