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This review aims to summarize and assess key studies investigating the relationship between hormonal contraception and breast cancer risk. Approximately two-thirds of breast cancers express the estrogen receptor, and long-term exposure to estrogen is a debated risk factor for breast cancer development. This hypothesis is based on prior studies looking at reproductive risk factors (endogenous estrogen exposure) along with hormone replacement therapy (exogenous hormone exposure). Historically accepted reproductive risk factors include age at menarche, age at first delivery, and parity. Exogenous hormone exposure encompasses both receipt of hormonal contraception and menopausal hormone replacement therapy. This review highlights the reported risks associated with the most common hormonal contraception methods including oral, transdermal, and transvaginal routes. Large observational studies of the past and more recent works are summarized highlighting gaps in knowledge. Several themes emerge: difficulty accounting for well-established risk factors in analyses of epidemiologic studies, challenges determining whether associations between hormonal contraception and breast cancer are due to the exogenous hormones themselves or to increased engagement with the medical system, and discrepancies between statistically significant and clinically significant risk, odds, and hazard ratios. Understanding the strengths and limitations of these studies will help providers in and outside of oncology support women making decisions regarding both cancer risk-reduction and family planning.
RESUMO
INTRODUCTION: Cannabis is the most common illegal substance used in the world. The psychoactive nature of cannabis is primarily due to delta-9-tetrahydrocannabinol (THC). Some research suggests that prolonged cannabinoid use increases its half-life and fat solubility in the body, slowing gastric emptying, leading towards feelings of nausea and vomiting. We describe a case where a 32 year old male has excessive nausea and vomiting after prolonged use of daily cannabis. CASE REPORT: A 32 year old Hispanic male with no significant past medical history presented to the emergency department with five days history of nausea and vomiting associated with abdominal pain. The vomitus is associated with diffuse abdominal pain and is alleviated by taking hot showers. Vital signs were normal and physical exam showed some abdominal tenderness. CBC and CMP were normal, and urine toxin screen revealed positivity for THC. The patient was admitted with possible diagnoses of cannabis induced hyperemesis. He was placed on Lorazepam and he took multiple hot showers, which improved his nausea. The next day he was discharged home in stable condition. CONCLUSION: Our patient reported the vomiting episodes were associated with the regular usage of cannabis over 19 years. One theory on the effectiveness of hot showers states that it may correct the disequilibrium of the thermoregulatory system in the hypothalamus. Another theory suggests that the concept of peripheral vasodilation and redistribution of blood flow from the splanchnic circulation to peripheral musculature helps decrease vomiting. This research gap shows that further studying of cannabis and its effects are still needed.
