1. Use of Oral Contraceptive Pills in Nuns to Prevent Cancer By: Samia B

2. Background Bernadino Ramazzini, an Italian physician, noted in 1713 that nuns had a high incidence of breast cancer A study by Fraumeni and colleagues compiled cancer mortality rates in 31, 658 Catholic nuns in the USA between 1900-1954 K Britt, R Short The plight of nuns: hazards of nulliparity Lancet, 379 (2012), pp. 2322–2323

3. Why Nuns? Take vows of chastity ◦ What this means  Do not give birth  Women who have never given birth are at increased risk of breast cancer, ovarian cancer, and endometrial cancer. Live in secluded monastery, generally covered ◦ What this means  Small closed space, away from sunlight, may lack essential nutrients The Meaning of the Terms Nun, Sister, Monk, Priest, and Brother. N.p., n.d. Web..

4. Rationale of OCP Epidemiological studies of breast cancer have directly linked # of menstrual cycles to cancer risk Two large epidemiological studies show that oral contraceptives do not increase breast cancer risk, and reduces both ovarian and uterine cancer. K Britt, R Short The plight of nuns: hazards of nulliparity Lancet, 379 (2012), pp. 2322–2323

5. Rationale of OCP In both studies ◦ RR Ovarian (RR 0·53 [95% CI 0·38–0·72] and 0·4 [0·3–0·6]) ◦ RR Endometrial (0·43 [0·21–0·88] and 0·3 [0·1–0·8]) ◦ No reduction in RR of Breast Cancer (0·9 [0·74–1·08] and 1·0 [0·8–1·2]). Oral Contraceptives (estrogen progesterone combination) can reduce # of menstrual cycles to 4 a year K Britt, R Short The plight of nuns: hazards of nulliparity Lancet, 379 (2012), pp. 2322–2323

6. Challenges Any form of contraception other than abstinence not allowed by Catholic Church Challenges to the article ◦ Correspondence published in the Lancet (Ivo Brosens,, Giuseppe Benagiano)  Agreed that studying nuns was effective in understanding health in a population  Disagreed nuns should be taking oral contraceptives  “A study in 2000 by the same group (Fraumeni and colleagues) reported that active nuns have similar mortality rates compared with the general population, which the authors ascribed to the “healthy worker effect”.  Risk of cervical cancer low Ivo Brosens, Giuseppe Benagiano, Oral contraceptives, nuns, and cancer, The Lancet, Volume 379, Issue 9834, 23–29 June 2012, Page 2339, ISSN 0140-6736, 10.1016/S0140-6736(12)61014-9. (http://www.sciencedirect.com/science/article/pii/S0140673612610149)

7. Challenges Another correspondence published by Lancet (Ellen CG Grant,, Elizabeth H Price) ◦ Uncertain if lack of nutrients (Vitamin D, etc.) could be reason ◦ Saying oral contraceptives can protect ovarian cancer may be mistaken  Not really a huge difference in taking oral contraceptives in woman diagnosed or not diagnosed with ovarian cancer ◦ HRT is known to increase cancer risk in post- menopausal women  Adding HRT population to women who do not take oral contraceptives may result in a bias ◦ Study specific: loss to follow up, etc. Ellen CG Grant, Elizabeth H Price, Oral contraceptives, nuns, and cancer, The Lancet, Volume 379, Issue 9834, 23–29 June 2012, Pages 2339-2340, ISSN 0140-6736, 10.1016/S0140-6736(12)61015-0. (http://www.sciencedirect.com/science/article/pii/S0140673612610150)

8. National Cancer Institute on Oral Contraceptives and Cancer Risk OCPs and Breast Cancer ◦ Slightly increased risk  1996 analysis of > than 50 studies worldwide by the Collaborative Group on Hormonal Factors in Breast Cancer found women on birth control pills had a slightly higher risk of developing breast cancer than women who had never used the pill  The risk was highest for women who started using oral contraceptives as teenagers.  10+ years after OCs were stopped, risk returned to the same level before using birth control pills "Oral Contraceptives and Cancer Risk." National Cancer Institute, n.d. Web..

9. National Cancer Institute on Oral Contraceptives and Cancer Risk OCPs and Breast Cancer ◦ Nurses’ Health Study,  16,000 female nurses between 24 to 43 years old in 1989  Participants had a slight increase in breast cancer risk.  However, nearly all of the increased risk was seen in women who took a specific type of oral contraceptive "Oral Contraceptives and Cancer Risk." National Cancer Institute, n.d. Web..

10. National Cancer Institute on Oral Contraceptives and Cancer Risk OCPs and Ovarian Cancer ◦ Reduced Risk  1992 analysis of 20 studies  Found that longer a woman used OCs the more her risk of ovarian cancer decreased.  The risk decreased by 10 to 12 percent after 1 year of use and by approximately 50 percent after 5 years of use OCPs and Endometrial Cancer ◦ Reduced risk "Oral Contraceptives and Cancer Risk." National Cancer Institute, n.d. Web..

11. National Cancer Institute on Oral Contraceptives and Cancer Risk OCPs and Cervical Cancer ◦ Increased risk  Analysis of 24 epidemiologic studies found that longer OCs were used, the higher the risk of cervical cancer.  International Agency for Research on Cancer (part of WHO) combined data from eight studies to association between oral contraceptive use and cervical cancer risk among women infected with the human papillomavirus (HPV).  Threefold increase in risk among women who used oral contraceptives for 5 to 9 years compared with women who had never used oral contraceptives.  Women who used oral contraceptives for 10 years or longed demonstrated risk of cervical cancer four times higher Possibly changing hormonal conditions making HPV more favorable to infect "Oral Contraceptives and Cancer Risk." National Cancer Institute, n.d. Web..

12. Conclusion Nuns may have increased risk of cancer due to ◦ No pregnancy & more menstrual cycles ◦ Nutrient deficiency ◦ Lack of rigorous activity No substantial basis yet to suggest OCs should be taken for preventative measures Religious reasons need to be taken into account. Screening and detection should be made more readily accessible to this population