VIEWPOINT:A LITTLE MASSAGE

The latest example of medical double speak concerns the contraceptive pill.

A recent study in the Lancet finally confirmed what Dr Ellen Grant and a few other brave souls have been shouting loudly about for years: that the Pill causes breast cancer.

A Dutch study of 918 women aged 20-54 with breast cancer, matched against a similar group of healthy women, compared Pill use in both groups. Their conclusion: younger (teenaged to 25) and women older than 39 had an increased risk of developing breast cancer.

“Our results strongly suggest that oral contraceptive use during the early and late fertile years is associated with an increased risk of breast cancer,” wrote the Dutch researchers.

Having reached that irrefutable conclusion, the authors, two doctors at the Netherlands Cancer Institute in Amsterdam, began backpedalling like crazy.

They stressed the risk was small; Pill use for more than four years might account for one of the two breast cancers that develop in every 1000 women before they reach 36.

In the study, those aged between 25-39 on the Pill didn’t show up with an increased risk. By grouping their results together with those of the younger and older women at increased risks, the Dutch doctors were able to statistically flatten out the risk factor and produce their astonishing conclusion, which agrees with many other studies of the Pill: overall, women who have taken the Pill have no higher incidence of breast cancer than those who have never taken it.

Organizations like the Family Planning Association were quick to dismiss the results. Karin Pappenheim of the FPA was quoted as saying this study should be seen in context with some of the others, which had found no risk, although others had found a slightly increased risk of breast cancer. Even though she thought that young women considering taking the Pill ought to be warned that there is a slight risk of breast cancer, this ought to be weighed against the “evidence that the Pill protects against endometrial and ovarian cancer” (the Daily Telegraph, 23 September 1994).

Does anybody out there speak English? This may be the first time I’ve ever heard of a 50 per cent increase in cancer described as “small”. Or a study concluding that its results demonstrate an increased risk but, on balance, no risk.

Miss Pappenheim’s comments are also typical of the kind of torturous turn medical reasoning takes when faced with an unsavory conclusion. This drug is beneficial because it may “protect” you against one kind of fatal cancer (another highly questionable medical conclusion), even though it may give you another potentially fatal cancer.

Medicine always has difficulty retrenching after expressing uncritical enthusiasm over a discovery. For 20 years, doctors have been touting the Pill as the safest drug ever developed, and there are many moves afoot to make it available over the counter. The Dutch study is a colossal embarrassment to an entire industry devoted to contraception at all costs.

But all it takes is a little massaging of statistics and an uncritical press, and, presto, the problem goes away.

!ALynne McTaggart