December 7th, 2011
06:50 PM ET
Catholic nuns take a vow of chastity, so you might not think that any sister would need to be on birth control.
But oral contraceptive pills have other uses besides preventing pregnancy; in fact, Catholic bioethicists say there is no inherent conflict in nuns (or any other Catholic) taking these very same substances for prescribed, therapeutic reasons, such as for treating heavy menstrual bleeding or endometriosis.
A new article in the journal The Lancet goes one step further. It argues that nuns "should be free to use the contraceptive pill to protect against the hazards of nulliparity” – that is, heightened cancer risk among women who do not bear children.
According to the authors, Australian researchers Kara Britt and Roger Short, there are about 95,000 nuns in the world, and they are paying "a terrible price for their chastity": increased risks of breast, ovarian and uterine cancer.
Women who don't ever get pregnant have more ovulatory menstrual cycles, which have been linked to cancer risk, than those who do get pregnant. Research has shown that women who give birth to a first child at a young age, have more children and breastfeed, lower their risk of breast cancer, as well as endometrial and ovarian cancer. The Lancet piece cites a 1969 study of about 32,000 nuns in the United States from 1900 to 1954, which found that nuns had a higher likelihood of dying from these kinds of cancers than the general population.
But, broken down by age, the death rate for uterine cancer isn’t higher among nuns than females generally until age 70; for ovarian cancer it’s age 80. For ovarian cancer, nuns age 80 and above had a rate of 3 out of 10,000 deaths reported; for uterine cancer, about 13 out of 10,000.
“So the question has to be asked, is it worth the expense (and these drugs are expensive) to treat all at risk populations (in this case nuns) with preventative hormone replacement in order to prevent 13 cancers?” says Sr. Beatrice Hernandez, a Franciscan sister who is also a retired oncologist.
Britt and Short cite two large studies, published in 2010, on the health effects of the oral contraceptive pill, showing it reduces the risk of ovarian and uterine cancers, and does not up the risk of breast cancer. Women who had never taken the pill had a 12% higher mortality rate than those who used it regularly.
Dr. Lisa Flowers, of the department of obstetrics and gynecology at Emory University School of Medicine, says this information in the Lancet piece bears further consideration. Women – nuns included – should talk to their doctors about this in relation to their family history of cancer and their medical profile, she said.
“All women should have this conversation with their physicians to see if they would be potential candidates, and if it would be a benefit for them,” she said.
She noted that the population of nuns may not be screened as often for cancers by physicians. If nuns are already at higher risk, they especially may wish to consider the potential benefits of oral contraception – not only for cancer prevention, but also for alleviating premenstrual and menstrual discomforts.
Hernandez doesn't think the data is convincing enough to recommend that all nuns take the pill preventatively. Neither does John Brehany, executive director and ethicist at the Catholic Medical Association. He called the pill “a powerful hormone that tricks a woman’s body into thinking that it’s pregnant,” with side effects that include nausea, breast tenderness, change in appetite and headaches.
Flowers wouldn't go as far as to say that all women (or all nuns) should be on the pill, either. Some women can’t tolerate the side effects, and there are certain medical conditions, such as high blood pressure, that would make use of oral contraception inappropriate.
Patients typically have a three-month trial of oral contraception to see if it’s right for them, she said.
“We probably need to change our mindset of the oral contraceptive pill, not to think of it only as an effective tool to prevent pregnancy, but also in its ability to protect from cancers and to protect women from some of the discomforts and medical problems that they have associated with menstruation,” she said.
However, there are certain cancer risks with the pill, too. According to the National Cancer Institute, there has been conflicting evidence about whether the pill increases the risk of breast cancer. Several studies found that it raises the risk of liver cancer in low-risk populations; a 2003 study found an increased risk of cervical cancer in women who took the pill for longer periods of time.
And the U.S. Food and Drug Administration will be hearing evidence Thursday about concerns about a possible increased risk of blood clots in the birth control pill YAZ, compared to other oral contraception.
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