Cancer Institute). The committee recommends that, three years hence, and at regular intervals thereafter, an NIH consensus conference reassess recommendations for oral contraceptive use based on reevaluation of up-to-date information about the relationship between oral contraceptives and breast cancer. Two institutes in particular, the National Institute of Child Health and Human Development and the National Cancer Institute, would be appropriate lead institutes to judge when consensus conferences should be held.

Research results should be periodically assessed for new evidence of short- and long-term safety and carefully analyzed to provide clinicians with current information on the safest oral contraceptive use for younger and older women. There is also a need for continuous improvement of the dissemination of new and existing information about oral contraceptives and breast cancer among health care providers and women who use oral contraceptives. Multiple channels, through which providers and women can receive up-to-date information, must be opened and maintained. These channels include continuing medical education courses, the technical bulletins and other activities of the American College of Obstetricians and Gynecologists and other professional organizations, the activities of state and local health departments, services delivered by the health units of colleges and high schools, and the “one-on-one” contacts so common to the health profession. The committee emphasizes the obligation of health care providers to offer adequate, accurate information to women seeking contraception and to counsel them regarding the current state of ambiguity with respect to the relationship between oral contraceptives and breast cancer. Only then can fully informed choices be made in clinical practice.

FILLING GAPS IN BIOLOGICAL AND EPIDEMIOLOGICAL KNOWLEDGE

The committee believes that a multidisciplinary research approach is necessary to resolve the relationship between oral contraceptives and breast cancer. Research on a broad front could well produce insights that would lead to some reduction in the incidence of breast cancer, in the same way that research throughout the past three decades has led to insights and changes of lifestyle that are today believed to be reducing the incidence of heart disease in America. With no single, “magic bullet” likely to prevent or cure breast cancer, the committee recommends a broad program of expanded studies on breast function and pathophysiology from the perspectives of endocrinology, biochemistry, molecular genetics, nutrition, cytology, and tissue culture.



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