geoffrey modest medical blogs

a recent article, highly publicized in the press, found a significant risk of breast cancer in women on contemporary (ie lower dose) hormonal contraception (see DOI: 10.1056/NEJMoa1700732). study was industry-supported. Details: --nation-wide prospective cohort study of all women in Denmark between 15-49 yo, who had not had cancer or venous thromboembolism. --1.8 million  women followed average of 10.8 years --fully adjusted models (below) included: level of education, parity, polycystic ovary syndrome, endometriosis, family history of breast/ovarian cancer; and BMI, smoking status, and age at first delivery when women were parous (these last 3 were available only in women who had a kid) Results: --11,517 cases of breast cancer occurred overall --relative risk of breast cancer:     --current or recent hormonal contraception users: 20% increase, RR 1.20 (1.14-1.26)        ...

2 related articles were recently published by the CDC. 1. In the United State from 1991 to 2014 the birth rate among teens age 15 to 19 has  declined by a dramatic 61%  from 61.8 per 1000 to 24.2 per 1000,  with larger % decreases in ethnic/racial minorities   (see  http://www.cdc.gov/mmwr/volumes/65/wr/mm6516a1.htm?s_cid=mm6516a1_w  ).  However the birth rate remained approximately twice as high for Hispanic and non-Hispanic black teens compared to non-Hispanic white teens.  There are also significant geographic and socioeconomic disparities. See prior blog  http://gmodestmedblogs.blogspot.com/2016/05/dropping-teen-birthrates.html     for the full assessment . In brief: -- from 2006 to 2014, a 41% decline in birthrate overall, to 25.4 per 1000 female teens      -- Hispanic: decreasing to 39.8 per 1000, a 51% decrease from 77.4 per 1000      -- B...

The BMJ just published a large analysis of the relationship between combined oral contraceptives OCPs and the risk of venous thromboembolism VTE  (see  oral contraceptives and vte risk bmj2015  in  dropbox, or BMJ 2015;350:h2135). They analyzed 2 nested case-control studies from 2 different UK  databases, with a combined input from 1340 general practices, assessing the first diagnosis of VTE in women aged 15-49 from 2001-2013, and comparing this group to 5 controls matched for age, practice, and calendar year. results: --10562 cases of VTE. mean age 38, 27% smokers in the VTE cases and 21% in controls, obesity in 27% vs 16% in controls. established risk factors for VTE were 47% vs 26% in controls --odds ratio for incident VTE and use of OCPs in the previous year, adjusted for smoking, alcohol, ethnic group, BMI, comorbidities, and other contraceptives:     ​--current exposure to any OCP was associat...

a disturbing story today that morning-after pills may not be as effective in overweight women (see  http://in.reuters.com/article/2013/11/26/us-fda-morningafter-idINBRE9AP02B20131126  for story). basically, European health regulators found that a French morning after pill marketed as Norlevo had decreasing effectiveness in women over 165 pounds and was not effective at all in those over 176 pounds, prompting the Europeans to order a label change.  turns out that Plan B in the US is basically the same composition. there was a comment in Physician's First Watch that  "According to the CDC, the average American woman weighs 166.2 pounds, which may raise concern about the efficacy of this type of emergency contraception among many U.S. women. The battle to make emergency contraception available has been long and arduous. Hopefully, this recent information will not discourage users, as this may still be the best option available."  a couple of comments: 1. i...