What's New in Medicine?

By Luis G. de Jesus, MD

Hormonal Contraceptives and the Small Increased Risk of Breast Cancer

A large prospective study published in the New England Journal of Medicine (NEJM) involving women in Denmark who were younger than 50 years of age showed an association between the use of hormonal contraceptives and the risk of breast cancer. Women who were currently using or had recently used hormonal contraceptives had a 20% higher risk of breast cancer than among those who had never used them. The risk increased with a longer duration of use.

The absolute increase risk, however, remains low (13 per 100,000) particularly for women younger than 35 years of age (2 per 100,000). Most of the breast cancer cases occurred among women older than 40 years of age.

The study also showed a beneficial association between the use of hormone contraceptives and lower risk of ovarian, endometrial, and colorectal cancers.

Patients should discuss with their medical providers  the benefits (e.g. effective means of contraception, relief of dysmenorrhea, lower ovarian/endometrial/colorectal cancer) as well as the risks (e.g. blood clots, heart attack and stroke, breast cancer) of hormonal contraceptives.

  • Women younger than 35 years have lower risk for breast cancer and cardiovascular disease and may benefit from hormonal contraceptives use.
  • For women older than 40 or with higher risk for cardiovascular disease or breast cancer, careful consideration of alternative methods of contraception (e.g. non-hormonal IUDs) should be discussed.
  • Lower risk for breast cancer by maintaining optimal weight, exercising and limiting or abstaining from alcohol.

Mouth HPV Infection & Cancer in Men

According to the Annals of Internal Medicine's recent report, oral Human papillomavirus (HPV) infection is common among U.S. men.

  • The overall prevalence of oral HPV infection was 3.6 times greater in men (11.5%) than women (3.2%). This equates to 11 million men and 3.2 million women in the US.
  • More significantly, high-risk oral HPV infection (HPV associated with risk of developing cancer) was 5 times more prevalent among men (7.3%) than women (1.4%).
  • Among men who reported having same-sex partners, the prevalence of high-risk HPV infection was 12.7% (3.6% for women with same-sex partners).
  • Other associated risk factors for high-risk oral HPV infection include concurrent genital HPV infection, multiple lifetime sexual partners, and cigarette/marijuana smoking.

HPV infection can cause cancer at several anatomical sites (oropharynx, anus, and penis in men and oropharynx, anus, cervix, vagina, and vulva in women). Approximately 40,000 HPV-related cancer cases are diagnosed annually. Among these cases, more than 12,000 men and 3,000 women are diagnosed with oral cancer.

Evidence shows that prophylactic HPV vaccination protects against specific HPV subtypes (e.g. 4 subtypes for Gardasil and 9 subtypes for Gardasil 9). Since vaccination of these subtypes protect against high-risk HPV infections, this is a potential way to reverse the rising oral cancer incidence among men. Unfortunately, uptake rate of the vaccine among boys remain low despite CDC recommendation (it is routinely given at 11 or 12 years of age, but it may be given through age 26 years). Moreover, men older than 26 years do not qualify for HPV vaccination or may have already been exposed to HPV (may be less effective).

The New Hypertension Guidelines from The American Heart Association

A new hypertension guideline was recently published by the American College of Cardiology & American Heart Association Task Force on Clinical Practice Guidelines. These are the highlights of the report:

1. Hypertension is now defined as BP of 130/80 or higher (previous definition was 140/90 or higher). A significant number of people will be classified as having hypertension with this new definition.

  • Most of these newly classified patients can prevent hypertension-related health problems such as heart attacks and strokes through lifestyle changes alone.
  • Some patients, particularly with higher risk or pre-existing cardiovascular conditions may benefit from BP-lowering medications along with lifestyle changes.

2. Accurate measurements of BP (properly calibrated instruments and proper basic BP measurement technique) is important. It also emphasizes having patients monitor their own BP to guide diagnosis, treatment, and management.

3. Lifestyle changes can effectively reduce systolic BP (by 4 to 11mm Hg for patients with hypertension).

  • DASH diet, which is rich in fruits, vegetables, whole grains, and low-fat dairy products
  • Reduce sodium intake and increase dietary potassium intake (except with existing kidney disease)
  • Maintain an ideal body weight
  • Physical activity (e.g. 90 to 150 minutes of aerobic and/or dynamic resistance exercise per week and/or 3 sessions per week of isometric resistance exercises)
  • For patients who drink alcohol, reduce intake to 2 or fewer drinks daily for men and no more than 1 drink daily for women

4. BP-lowering medication, in addition to lifestyle changes, is utilized based on level of BP together with the patient’s risk for cardiovascular disease (e.g. heart attack or stroke).