Oral contraceptive hormones, folate metabolism, and the cervical epithelium.

The currently available evidence concerning disorders of folate metabolism in women taking oral contraceptives has been reviewed. A disturbance in folate balance serious enough to cause symptoms (i.e., megaloblastic anemia) occurs very rarely. In some series, but not in others, serum and/or red cell folate concentrations have been reduced in oral contraceptive users. It is doubtful whether sex steroids affect polyglutamate folate absorption. About 20 percent of women taking contraceptive hormones manifest mild megaloblastic changes on Papanicolaou smears of the cervicovaginal epithelium which disappear after folic acid therapy. The current evidence, however, would not indicate that any significant benefit would ensue from routine folate supplementation in women on oral contraceptives.

A long-term study of regression of precancerous lesions under oral progestin medication: observations on the prevalence of carcinoma in situ and dysplasia in private versus planned parenthood groups.

PIP: This study is concerned with the relationship of the oral progestins to cancer of the cervix and endometrium and to establish the effect of long-term use of the pill on lesions of carcinoma in situ or dysplasia. A screening study was made of 1696 women attending the Nassau County Planned Parenthood Clinic. Patients with negative cytology were advised to have a routine check in 6 to 12 months. Those with positive cytology who were also found to have advanced or progressive lesions were referred for surgical treatment. Patients showing cells of moderate dysplasia or carcinoma in situ were referred to the Cancer Prevention Clinic where they could elect immediate surgical treatment or experimental treatment with an oral contraceptive. Almost all, 68 in number, chose to defer surgery. They visited the clinic at 4 to 6 week intervals when an examination, a Paanicolaou smear and fluorescent microscopic DNA of nuclear patterna were done. While under study no premalignant lesion progressed to a stage of infiltration. Clinically none showed lesions suggestive of early cancer. Of this group 45 showed no alteration in growth, of cells while 21 had signs of regression, some to a normal morphology. Progression occurred in 2 patients. Of these 1 followed a 4 month interval without oral progestin medication. The greater prevalence of positive findings in patients attending Planned Parenthood Clinics as compared with those being treated by private practitioners is attributed to the types of patients being tested. The clinics see mostly patients of lower socioeconomic status, those who have been more sexually active and those who have begun sexual activities at an early age with more sexual partners. These findings are consistent with the theory of viral transmission of cancer of the cervix by sexual intercourse. After over 8 years of study the authors conclude that the pill does not initiate or accelerate precancerous growth but that the oral progestins at high dose levels show some cancer-inhibiting or regressive influences, often dramatic. Al so they think that the existence of dysplasia or cancer in situ in women attending clinics antedates the taking of the pill, perhaps by several years.^ieng