Sometimes I read or hear about some part of history and I just have to breathe a sigh of relief that people no longer hold such misguided beliefs. Such times are often accompanied with a smug chuckle as I ponder how people could have possibly believed as they did. For example, as early as 1843 Dr. Oliver Wendell Holmes knew that hand-washing prevented infection, and he advocated it to reduce the rates of women dying from childbed fever in hospitals.1 In the late 1840s, Dr. Ignaz Semmelweis observed that laboring women who were attended by medical students had three times the infection rate (as high as 25%) as those attended by midwives. Horrifying to today's ears, medical students would go from dissecting cadavers in the autopsy room to examining women in the maternity wards without washing their hands in between. Semmelweis mandated that doctors and medical students wash their hands in a chlorinated solution prior to examining patients. With this simple practice, he was able to reduce the rate of childbed fever to less than 1%.1 With such amazing results one would think that he would have been hailed as a hero for saving the lives of so many women and that the practice of hand-washing would have spread rapidly as other hospitals sought to reproduce his successes. On the contrary, despite such striking results, his ideas were met with ridicule and hostility.
Decades later, others who believed in the germ theory of disease were ridiculed as well by their colleagues. Even as late as 1910, over half a century after Semmelweis's discovery, hand-washing was still not a widespread practice among healthcare workers. Today thankfully, the Centers for Disease Control advocate hand-washing as the number one way to prevent the spread of communicable diseases.
Today we wonder how those physicians could have refused to wash their hands even when presented with such striking results. Maybe washing their hands between patients was too inconvenient and they didn't want to change how they did things. I'm sure most were decent people, doctors who went into the profession in order to help others. Maybe they didn't want to face that they, themselves, had been the cause of so many deaths. Whatever their reasons, they would cause the deaths of many more women who would die of childbed fever in the decades to come.
Unfortunately, there is much truth to the ancient writings, "What has been, that will be [again]; what has been done, that will be done. Nothing is new under the sun." (Ecc 1:9)2 Today's medical debates are not about the importance of handwashing of course, but it seems that many people, including the medical establishment, are reticent to let go of long-held beliefs about how some things are done.
More recently, in 2002, preliminary findings of the Women's Health Initiative were published about hormone replacement therapy (HRT) among post-menopausal women. The results showed an increased risk of breast cancer for women on HRT.3 This study made the news and made it into magazines and although only around 2% of women were on HRT at the time, this translated into millions of women. After hearing about their increased risk of breast cancer, millions of women stopped this therapy. By the following year, this dramatic decrease in the number of women on HRT translated to an 11% reduction of breast cancer rates.4
It's important to know that women who have gone through (or are going through menopause) only needed a small amount of estrogen-progestin combination to experience relief of menopause symptoms. Birth control pills, used by young women, are the exact same hormones, except in much higher doses. A young woman whose body is already producing the full amount of estrogen and progesterone in her cycle, needs even higher doses if the aim is to completely shut her natural cycle down to prevent ovulation and pregnancy. Why would the medical community think that a known carcinogen in older women would be perfectly safe in much higher doses given to younger women?
In 2005 the World Health Organization classified Oral Contraceptives as a Group One carcinogen, placing it in the same league as asbestos and cigarettes. 5 Even though only 2-3% of women were on HRT in 2002 and presently about 28% of women of childbearing age are using the pill6, higher for women in the lower age-range than the higher, there has been very little media coverage. If 2% used HRT and millions stopping it caused an 11% reduction in breast cancer rates the following year, imagine the impact if millions of women stopped using the pill.
A woman has a 40% increased risk of breast cancer if she uses the pill prior to her first full-term pregnancy, at least a 72% increased risk if she used it for four or more years prior. For Depo-Provera, the effects are even worse. A woman who uses Depo-Provera for two or more years prior to the age of 25, has a 190% increased risk of breast cancer7.
What has been the reaction of the medical community to all this? To inform their patients of these risks? To change the way they view and treat women's bodies? Unfortunately, the reaction of the mainstream medical community has been quite disappointing, similar to their reaction to the implementation of hand-washing in the 1800s. Some ridicule physicians who refuse to prescribe birth control because they feel it is bad medicine. Secondly, they downplay the risks. They gloss over the alarming evidence and emphasize that after 10 years of discontinued use of oral contraceptives, the risk goes away, as if a whole decade of increased cancer risk were not that big of a deal.
Unfortunately many women in their 20s, 30s, and 40s are being diagnosed with breast cancer. It is the leading cancer death in women aged 20-59 7. Some women might not have a decade available to sit around and wait until this risk goes away. Unlike post-menopausal breast cancer, premenopausal breast cancer is especially aggressive and often unresponsive to typical cancer therapies.
Why do so many still deny or downplay the very real risks of hormonal contraceptives? Maybe because it would be inconvenient to change the way they currently practice gynecology. Maybe because they don't want to admit they have been causing the deaths of young wives, daughters, and mothers. Maybe because the myth still persists that Natural Family Planning is difficult to learn or is ineffective. [Though a study of over 16,000 poor women in India (some of whom were illiterate) showed a birth rate of less than 1% for those using the method in order to avoid pregnancy8 - showing that NFP is both effective and easy to learn.] How long before the medical establishment begins to change the way they currently practice gynecology? Another decade? Half a century? More? I don't know the answer to these questions, but I know that I don't want to wait around for them to change their ways before I choose health for myself now.
Addendum: (added January 28,2012 11:30am)
I have been asked about the claims that the pill lowers the risk of ovarian and endometrial cancers, and so I feel I should address this. It is true that while the pill increases the risk of liver, cervical, and breast cancer, it lowers the risk of ovarian and endometrial cancers. However, as Dr. Angela Lanfranchi has pointed out, it is not an either/or equation. A woman's risk of getting ovarian and endometrial cancers are low, whereas if she takes the pill for any length of time, her risk of getting the other cancers that the pill causes is higher than her original risk of ovarian and endometrial cancer. Furthermore, even if in special cases a woman is at a high risk for ovarian cancer, such as if she has a family history of it, I still feel it is a poor solution to offer her breast cancer instead. If a particular woman is at high risk for these cancers then I feel being diligent about cancer screening would be a better solution, as well as steps to reduce any other risk factors if possible.
1. Christine L. Case. Ed.D, "Handwashing." National Health Museum, 27 Jan 2012, http://www.accessexcellence.org/AE/AEC/CC/hand_background.php
2. Ecc 1:9 NAB
3. Jacques E Roussouw MBChB MD, Garnet L. Anderson PhD, Ross L. Prentice PhD, et al., "Risks and Benefits of Estrogen Plus Progestin in Healthy Postmenopausal Women," The Journal of the American Medical Association, 288 no. 3 (2002): 321-333 http://jama.ama-assn.org/content/288/3/321.full
4. Angela Lanfranchi, M.D., (lecture, Women Deserve the Truth, St. Norbert College, De Pere, WI, 24 September 2011).
5. Department of Reproductive Health and Research, "Carcinogenicity of Combined Hormonal Contraceptives and Combined Menopausal Treatment," World Health Organization, (September 2005) http://www.who.int/reproductivehealth/topics/ageing/cocs_hrt_statement.pdf
6. "Facts on Contraceptive Use in the United States," Guttmacher Institute, June 2010, http://www.guttmacher.org/pubs/fb_contr_use.html
7. Chris Khalenborn, MD., "Breast Cancer, Abortion, and the Pill," One More Soul, 7 Dec 2009, http://onemoresoul.com/contraception/risks-consequences/breast-cancer-abortion-and-the-pill.html
8. R.E. Ryder, "'Natural Family Planning': Effective Birth Control Supported by the Catholic Church," British Medical Journal, 307 no.6906 (18 Sep 1993): 723-6 http://www.ncbi.nlm.nih.gov/pubmed/8401097