 Welcome back it's still the breakfast and plus TV Africa after a first conversation this morning a new research published yesterday or this week earlier this week in the United Kingdom's Guardian confirmed that all types of hormonal contraceptives carry a small increased risk of breast cancer yes you had it right breast cancer the research establishing a link with progesterogen pills for the first time was published in the plus medicine publication a data analysis by the University of Oxford Research has established that the use of progesterogen is associated with a 20 to 30% higher risk of breast cancer now this builds on previous work showing that the use of a combined contraceptive pill which contains oestrogen and progesterogen is associated with a small increase in the risk of developing breast cancer that declines after its stoppage joining us to provide some insight into this is Dr. Nesochie who is a New York City area based physician health expert media contributor health writer she's not only a practicing internist and civil surgeon designated by the United States Department of Homeland Security and the US citizenship and immigration services but she's also a medical advisor Dr. Nesochie is a CEO of the internal medicine private practice Dr. Nesochie LLC and health media consulting company Supermodel MD LLC USA I don't Americans may call you Nesochie I'm sure what is Nesochie welcome nice to have you again and albeit on for a very very chilling topic now hormone pills hormone contraceptives are used by women in a lot of cases I mean recently I was talking to a lady who was recommended to use some hormonal pills to stop or reduce her menstrual flow this is quite worrying and Dr. Nesochie tell us a bit of the background to this Dr. Nesochie are you there please can hear us all right since we have a problem with the network connection I will try to get across to her in a bit message a quite a worrying worrying sign you know quite a worrying information rather than this you know report has come out and we'll get to get some context you know but women use use these pills in contraceptives from time to time and I have many you know female friends who you know confide in me from time to time and there's a friend of mine who had a situation and they said they had to get some contraceptives to control her and I mean if you hear that there's a risk of breast cancer that's worrying very worrying and we're hoping that you know we have this connection I think that for us here in Nigeria and in most part of Africa the culture of you know paying attention to the health and you know our bodies not quite you know a priority not necessarily because it's not that what we should do well over time it's not just the culture it's not the practice because what you practice becomes a lifestyle but I mean we're being prompted to take you know a short break in this and as we return we're able you know to resolve all of the connectivity issues and have you know our doctor join us to give us you know more insight to the issue please stay with us we'll be right all right we glad to have back with us Dr. Nesochie who is of course a guest on the first segment of our conversation this morning we had a bit of a connection issue with Dr. Nesochie but she is back and we're looking at of course some research that has come through indicating that there's a risk of the users of hormonal contraceptives getting or being infected with the affected by breast cancer. Dr. Nesochie forgive me for mixing it up but you're the expert here so just give us some some background to all of this so just unbonded it for us I know I gave an introduction but that is nothing compared to what you can you can you can so shed some light on what this research is talking about. First thing so this research basically filled some knowledge gaps some looming questions that we had before on the scientific community in regards to oral contraceptive use and the risk of breast cancer so just to lay the framework in the past there have been studies done linking breast cancer or increasing the risk of breast cancer with the use of combined oral contraceptives combined meaning that these oral contraceptives include both the hormone estrogen and progestogen. Now they wanted to really look at what the effect or impact would be when we're focusing on just the oral contraceptive containing progestogen just one hormone within the oral contraceptive that did not have estrogen included what that have that's would that still have that same impact and have that small increased risk of breast cancer when we're analyzing and looking at data of those just using this kind of oral contraceptive so what do these researchers do they analyze data from about 10,000 women who are under the age of 50 who are diagnosed with an invasive breast cancer and about 18,000 women who did not have it and they found that 44% of women with breast cancer and 39% of those who did not have it had been prescribed an oral contraceptive pill in about three years prior so they did some analysis of the data and really looked at two things what would the absolute risk of breast cancer be and what would the relative risk of breast cancer be in these individuals absolute risk looks at really an actual probability of an outcome in a specific group so what we found was that the absolute risk of breast cancer with oral contraceptive use in those ages of 16 to 20 years of age was one in 12,500 in the age range of 35 to 39 years of age they found that absolute risk was 33 in about 12,500 so they then looked at the relative risk of it's kind of oral contraceptive use and what they found was that this oral contraceptive use may increase the chance of developing breast cancer by 70 to 30 percent compared to the risk you already started with so when they're saying that all hormone contraceptives may increase the risk by a small amount all meaning that we've now in the past we studied the dual contraceptives meaning the combined oral contraceptive estrogen progestogen and now we're only focusing on progestogen which is basically a key hormone that is used to regulate menstruation and pregnancy and when we have this hormonal contraceptive it's usually in the form when we're doing the progestogen only of an IUD and intrauterine device contraceptive injections and what is sometimes popularly known as the mini pill so now this gap in our knowledge has really been filled but with that said there is still more room for further investigation because there was some limitation to the data that they studied the ricks is universal I mean if it's a universal concept or issue and we're looking at Nigerian on an Africa especially when you look at you know the health practice and behavior over time do you think that Nigerians are also will be disadvantaged higher ricks you have to look and take a full picture into perspective as there are various factors that we know about that can increase one's risk of breast cancer and there are other risk factors that no one has any control of so factors that we can't control include your eight the older you are the higher your risk is certain genetic mutations your family history a personal history you've had breast cancer before chances of having another breast cancer in the future increase the risk factors that you can control and we have to put this in the context of those living in Nigeria would be one certain hormones taking certain hormones so depending on the hormonal contraceptive treatment that is used by women in Nigeria that needs to be taking into perspective not being physically active that's another risk factor that you can control that could increase one's risk the more sedentary that you are your risk is increased and also drinking alcohol smoking cigarettes that's another risk factor as well so we're looking really at the big picture the big picture being what may one's individual risk in Nigeria that would be a question that's best answered by having a conversation with your health care provider and discussing what your individual risk is this family history comes to play for a patient here those do genetic mutations come to come into play is there an issue with what we call lifestyle modifications the choices that we make on a day-to-day basis like cigarette smoking or ingesting and drinking a lot of alcohol so what typically will happen is that you're going to have a discussion about risk benefit analysis basically your doctor will take a look at what are the risks and what are the benefits of potential oral contraceptive use given the big picture given your overall risk for breast cancer does this because we see here in the 30 percent to 40 percent increase in the risk i'm also seeing the study that had was conducted in 2018 where those who took the combined pill had a about a 50 percent risk increase um are we are we therefore saying now based on these studies that the women need not take any of these pills either the progesterone or the combined pill are we seeing that women shouldn't take the pills at all have hormonal treatment are we saying uh you know it shouldn't be taken on a prolonged basis or what exactly is this research and report going to help us do now yeah dr. Nesochie are you there okay if if you can hear me dr. Nesochie based on this research what is it um suggesting women do is it saying that women should see sticking these uh hormonal pills uh contraceptives or is it saying that um it shouldn't be taking over a long period of time um i didn't hear the whole question but from what i heard you're asking um whether or not the study is saying that women should stop taking oral contraceptive pills that have progestogen only so if that's the question um that's not what this study is saying i think the study is really stating that we now understand that all kinds of oral contraceptives come with some level of minimal increased risk for breast cancer now you have to be aware that um oral contraceptive use um is not only used to uh prevent pregnancy they're also used for various treatments of various convictions so a woman may be using um an oral contraceptive for treatment of endometriosis or heavy menstrual bleeding so example picture what is the context of the use of um the oral contraceptive use do the risks outweigh the benefit um is it someone's advantage to continue using that and again that is only a discussion that can be had with the patient and doctor to determine if it is of the best interest of the patient to continue on using the oral contraceptive um um i have an example of a drug called tranaxomic acid um which is is also something recommended to women um you know especially if they experience a heavy flow you know so are we talking about things like that i've also heard like i said um some some some you know uh medication that was recommended to a friend of mine who um they said they had to really like slow down even seize totally uh the flow ahead of some sort of procedure so you look at things like maybe tranaxomic acid which some women take very irregularly because of the the amount of the flow is are we looking at things like that yeah so we're really looking at the um the uh benefit of what these hormonal treatments um can give to an individual can give to a woman so if you are using the oral contraceptive to help slow down heavy menstrual flow again you're looking at the patient you're looking at the individual to determine is it of benefit to her to continue using this um for decreasing the heaviness of the menstrual flow that she has in the context of what the risk would be for her putting in perspective the younger a patient is the lower their risk is going to be so for most patients who are on any of these um uh progestigent only pills or oral contraceptive pills um the doctor is really going to look at what the um overall risk is going to be based on the patient's um set of family history um her social history and other factors to deem if it is of the greatest benefit for her to continue but to answer your question these oral contraceptive treatments again they have a wide range of um what it can um allow in regards to treatment for various um gynecological uh problems and conditions the progestigent only pills but um the combined pills I was asking about earlier with the estrogen and the progestigent uh together what about that so the combined pills um these have been the more popular forms of um oral contraceptives um over the course of many many years um with estrogen and progestigent again oral contraceptives in general can be used whether it's the progestigent only or the combined pills for um treatment of various gynecological uh conditions so what we really need to know is that we've had an abundance of research on the combined for many years what we're looking at now really is what the progestigent pills um you know for everyone in regards to um risk and we're seeing that the risk is pretty much at the same level um whether or not it's the combined or it is the um individual pill just the progestigent okay um we hear that they uh it's been noted that you know the study because he talked about family history did not consider family history of breast cancer to determine what it affected the those um patients who were sampled in the research um so just I want you to talk about that again if this study did not take that into account is it possible that maybe they may not have gotten it right because those people may have had a family history of breast cancer and not necessarily uh have had have had breast cancer because of the increased use or high use of these um these uh hormonal contraceptives so the researchers um did make note of that that was one major limitation of the study not um putting into account family history again um there are those risk factors like family history that one just cannot control so if you do have a very significant family history that can um significantly increase one's risk of breast cancer so if that is not accounted for in the study um it doesn't mean that we're just dumping the study and we're not taking some um learning points away from it it just means that there's room for further investigation there is um more room for more studies to basically determine if um one can actually um look for uh confounding factors um like family history and account for that in another study so it's really um just a call for more research to make sure that there are no more limitations when we're looking at um studies such as this one I think this this presents as an opportunity to um educate ourselves uh again about the the issue of breast cancer so just just to go over the the risk factors and what we may need to do to test themselves are the initial steps and measures they have to take to you know check themselves for those who are watching so for those who are watching I think the um takeaway is to have the routine preventive health evaluations um when it comes to breast health and that is really in the form of mammography so typically um the recommendations are that starting from the age of 40 a woman should have a mammogram um that is essentially an x-ray of the breasts and these uh routine tests will really allow for one to determine if there are any um concerns or issues with a potential breast cancer but that said um every woman should also be aware of some of the potential signs and symptoms of breast cancer so that they could bring it to their doctor's attention if they ever um recognize any of these um signs or symptoms so some of the red flags to be aware of if you notice a breast lump or lesion um if you notice some kind of uh lump in the underarm area and the axillary area um if you notice um basically um any kind of um expression of fluid um from the nipple area outside of one lactating when one is not breastfeeding that is not um a normal finding if you notice certain changes to the texture of the skin of the breast something um typically known as po-de-hong which is just um the skin on the breast looking like the skin of an orange certain changes like this should be a red flag for one to um have an evaluation of their doctor sooner than later with that said the key really is prevention and prevention really comes um by means of mammography and the routine screenings Dr Nesochie thank you so much for your time and for giving us a real real uh a deep insight into this research and also into the general issue of breast cancer we look forward to having you again pretty soon on the breakfast thank you for having me all right we have more conversations ahead of course we'll look at the international table tennis federation rankings also a review of the upcoming qualifiers for the african couple of nations involving nigeria supra gills please stay with us