TABLE 1-7 Breast Cancer Incidence (per 100,000 women), United States, 1986

Age

Incidence Rate

20-24

1

25-29

7

30-34

30

35-39

65

40-44

131

45-49

186

50-54

217

55-59

263

60-64

331

65-69

402

70-74

424

75-79

450

80-84

443

85+

391

SOURCE: Nine standard Surveillance, Epidemiology, and End Results(SEER) registries. Females only, all races, by five-year age groups.

late postmenopausal years when coronary heart disease and breast and ovarian cancers become more and more common.

Studies in the United States and around the world show that many women—and some health care providers—are both misinformed and unnecessarily pessimistic about the effects of the pill. For example, fewer than a fifth of American women in 1987 (El Shafei et al., 1987) knew that the pill protects against ovarian and uterine cancer; some women considered oral contraceptive use to be more dangerous than childbirth. (In fact, when the full range of proven side effects is considered, childbirth is always more risky than using the pill [Fortney et al., 1986].) In Chapter 4, the committee summarizes the best available information for pill users and health care providers.

Most of the relatively few unplanned pregnancies that do occur during pill use are due to inconsistent or incorrect use, including contemporaneous use of other drugs that compromise the effectiveness of oral contraceptives (Mattison, 1984). It is important to remember that users have not only fewer deliveries but fewer abortions and ectopic pregnancies, each of which carries its own risk of mortality and morbidity. In the short term, most women on the pill have less menstrual loss, risk of anemia, and chance of acne, as well as a reduction in premenstrual symptoms. Fewer pill users are hos-



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