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Combined estrogen-progestogen for contraception and menopausal therapy: is there a cancer risk?

 

Glossary over Combined estrogen-progestogen for contraception and menopausal therapy: is there a cancer risk?

Cancer

Any one of a group of diseases that occur when cells in the body become abnormal and have the potential to spread and establish growth in nearby tissues and other parts of the body (malignancy). (Source: GreenFacts )

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Cancer risk

A theoretical risk for getting cancer if exposed to a substance every day for 70 years (a lifetime exposure). The true risk might be lower. (Source: ATSDR Glossary of Terms  )

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Carcinogen

A substance, factor or situation that causes or induces cancer. (Source: GreenFacts )

Cervix

The cervix is the lower, narrow end of the uterus that opens up into the vagina. It is often called the neck of the uterus.

Please note that "cervical" can mean either pertaining to the cervix of the uterus or pertaining to the neck region of the spine containing the first seven vertebrae. (Source: GreenFacts)

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Colorectal

Relating to or affecting the colon and the rectum. (Source: GreenFacts)

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Diabetes

Diabetes is a disease that develops when the body is unable to produce or respond to insulin hormone in the normal way. (Source: GreenFacts)

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Endometrial tissue

The layer of tissue that lines the uterus. (Source: NCI Dictionary of Cancer Terms  )

Estrogen

Primary female sex hormone produced mainly by the ovaries. Estrogens are also produced in smaller amounts in the testes of men.

In women, estrogens are primarily involved with the development of female sexual characteristics and the maintenance of the reproductive system and menstrual cycle.

Estrogens are also thought to be important in the development of nerve cells and in the maintenance of a healthy heart.

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Hepatitis

Inflammation of the liver caused by viruses (viral hepatitis) or by chronic exposure to medicines or toxins such as alcohol.

Symptoms include jaundice (yellowing of the skin caused by the buildup of bile pigments in the body), fever, appetite loss and gastrointestinal upset. (Source: GreenFacts)

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Hormone(s)

Chemical messengers that help our body do different tasks. Hormones are produced by the endocrine glands and then sent all over the body to stimulate certain activities. For example, insulin is a well-known hormone that helps our body digest food. Hormones regulate our growth, digestion, reproduction and sexual function. (Source: EMCOM Endocrine disruptors glossary  )

Infection

It is the growth of a parasite within the human body that causes illness. It can be a virus, a bacteria, a fungus or a protozoa. (Source: GreenFacts )

Insulin

A hormone made by [certain] cells of the pancreas. Insulin controls the amount of sugar in the blood by moving it into the cells, where it can be used by the body for energy. (Source: St Jude's Children's Hospital: Medical Terminology & Drug Database  )

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International Agency for Research on Cancer

"The International Agency for Research on Cancer (IARC) is part of the World Health Organization (WHO).

IARC's mission is to coordinate and conduct research on the causes of human cancer, the mechanisms of carcinogenesis, and to develop scientific strategies for cancer control. The Agency is involved in both epidemiological and laboratory research and disseminates scientific information through publications, meetings, courses, and fellowships."

It has collaborated to and published many highly recognized scientific publications.

Most publications are availaible from the webpage IARC Monographs Programme on the Evaluation of Carcinogenic Risks to humans , "The IARC Monographs series publishes authoritative independent assessments by international experts of the carcinogenic risks posed to humans by a variety of agents, mixtures and exposures."

IARC distinguishes between four groups of compounds or physical factors based on the existing scientific evidence for carcinogenicity: Standard IARC classification (Source: IARC website  )

Liver

The liver is a big reddish-brow organ lying beneath the diaphragm on the right side. The liver is made up for a great part of liver cells which absorb nutrients and detoxify and remove harmful substances from the blood such as drugs and alcohol. The liver has many other vital functions and there is currently no way to compensate for the absence of liver.

Other liver functions include:

  • controlling levels of fats, amino acids and glucose in the blood
  • fighting infections in the body, particularly infections arising in the bowel.
  • manufacturing bile, a kind of digestive juice which aids in the digestion of fats
  • storing iron, certain vitamins and other essential chemicals
  • breaking down food and turning it into energy
  • manufacturing, breaking down and regulating numerous hormones
  • making enzymes and proteins which are responsible for most chemical reactions in the body, for example those involved in blood clotting and repair of damaged tissues.
Osteoporosis

Disease characterized by low bone mass and deterioration of bone tissue, which leads to fragile bones and a greater risk of fracture, particularly in older people. (Source: GreenFacts Digest on Diet and Nutrition)

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Population

A group or number of people living within a specified area or sharing similar characteristics (such as occupation or age). (Source: ATSDR Glossary of Terms  )

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Prevalence

The frequency of a disease may be measured in two (standard) ways:

  • Prevalence is the total number of persons known to have had the disease at any time during a specific period. It gives an idea of the importance/burden of disease at a given time, and it is widely used in public health monitoring and planning.
  • Incidence
Standard IARC degrees of evidence of carcinogenicity

which are the basis for the Standard IARC Classification

Carcinogenicity in humans

Sufficient evidence of carcinogenicity:

The Working Group considers that a causal relationship has been established between exposure to the agent, mixture or exposure circumstance and human cancer. That is, a positive relationship has been observed between the exposure and cancer in studies in which chance, bias and confounding could be ruled out with reasonable confidence.

Limited evidence of carcinogenicity:

A positive association has been observed between exposure to the agent, mixture or exposure circumstance and cancer for which a causal interpretation is considered by the Working Group to be credible, but chance, bias or confounding could not be ruled out with reasonable confidence.

Inadequate evidence of carcinogenicity:

The available studies are of insufficient quality, consistency or statistical power to permit a conclusion regarding the presence or absence of a causal association between exposure and cancer, or no data on cancer in humans are available.

Evidence suggesting lack of carcinogenicity:

There are several adequate studies covering the full range of levels of exposure that human beings are known to encounter, which are mutually consistent in not showing a positive association between exposure to the agent, mixture or exposure circumstance and any studied cancer at any observed level of exposure. A conclusion of 'evidence suggesting lack of carcinogenicity' is inevitably limited to the cancer sites, conditions and levels of exposure and length of observation covered by the available studies. In addition, the possibility of a very small risk at the levels of exposure studied can never be excluded.

In some instances, the above categories may be used to classify the degree of evidence related to carcinogenicity in specific organs or tissues.

Carcinogenicity in experimental animals

Sufficient evidence of carcinogenicity:

The Working Group considers that a causal relationship has been established between the agent or mixture and an increased incidence of malignant neoplasms or of an appropriate combination of benign and malignant neoplasms in (a) two or more species of animals or (b) in two or more independent studies in one species carried out at different times or in different laboratories or under different protocols.

Exceptionally, a single study in one species might be considered to provide sufficient evidence of carcinogenicity when malignant neoplasms occur to an unusual degree with regard to incidence, site, type of tumour or age at onset.

Limited evidence of carcinogenicity:

The data suggest a carcinogenic effect but are limited for making a definitive evaluation because, e.g. (a) the evidence of carcinogenicity is restricted to a single experiment; or (b) there are unresolved questions regarding the adequacy of the design, conduct or interpretation of the study; or (c) the agent or mixture increases the incidence only of benign neoplasms or lesions of uncertain neoplastic potential, or of certain neoplasms which may occur spontaneously in high incidences in certain strains.

Inadequate evidence of carcinogenicity:

The studies cannot be interpreted as showing either the presence or absence of a carcinogenic effect because of major qualitative or quantitative limitations, or no data on cancer in experimental animals are available.

Evidence suggesting lack of carcinogenicity:

Adequate studies involving at least two species are available which show that, within the limits of the tests used, the agent or mixture is not carcinogenic. A conclusion of evidence suggesting lack of carcinogenicity is inevitably limited to the species, tumour sites and levels of exposure studied. (Source: IARC Preamble to the IARC Monographs  )

Therapy

Measures taken to treat a physical or mental disease.

First-line therapy is the first type of therapy given for a condition or disease.

Second-line therapy is the treatment that is given when initial treatment (first-line therapy) doesn't work, or stops working. (Source: based on St Jude Hospital Medical Terminology & Drug Database )

Tumour

An abnormal mass of tissue resulting from uncontrolled and excessive cell division.

Tumours can be either benign (localised, without the invasion of other tissues) or malignant (showing progressive invasion of other tissues). (Source: GreenFacts)

Virus

A virus is a small organism which can infect other biological organisms.

Viruses can only reproduce by invading and taking over cells as they lack the cellular machinery for self reproduction.

They cause diseases in human beings, animals, plants and bacteria.

Examples of human diseases caused by viruses include the common cold, influenza, small pox, AIDS, and cold sores. (Source: GreenFacts)

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