title: European Code against Cancer 4th Edition: Medical exposures, including hormone therapy, and cancer.
abstract: The 4th edition of the European Code against Cancer recommends limiting - or avoiding when possible - the use of hormone replacement therapy (HRT) because of the increased risk of cancer, nevertheless acknowledging that prescription of HRT may be indicated under certain medical conditions. Current evidence shows that HRT, generally prescribed as menopausal hormone therapy, is associated with an increased risk of cancers of the breast, endometrium, and ovary, with the risk pattern depending on factors such as the type of therapy (oestrogen-only or combined oestrogen-progestogen), duration of treatment, and initiation according to the time of menopause. Carcinogenicity has also been established for anti-neoplastic agents used in cancer therapy, immunosuppressants, oestrogen-progestogen contraceptives, and tamoxifen. Medical use of ionising radiation, an established carcinogen, can provide major health benefits; however, prudent practices need to be in place, with procedures and techniques providing the needed diagnostic information or therapeutic gain with the lowest possible radiation exposure. For pharmaceutical drugs and medical radiation exposure with convincing evidence on their carcinogenicity, health benefits have to be balanced against the risks; potential increases in long-term cancer risk should be considered in the context of the often substantial and immediate health benefits from diagnosis and/or treatment. Thus, apart from HRT, no general recommendations on reducing cancer risk were given for carcinogenic drugs and medical radiation in the 4th edition of European Code against Cancer. It is crucial that the application of these measures relies on medical expertise and thorough benefit-risk evaluation. This also pertains to cancer-preventive drugs, and self-medication with aspirin or other potential chemopreventive drugs is strongly discouraged because of the possibility of serious, potentially lethal, adverse events.
authors.affiliation: Danish Cancer Society Research Center, Danish Cancer Society, Strandboulevarden 49, 2100 Copenhagen, Denmark; Department of Public Health, University of Copenhagen, 2100 Copenhagen, and Department of Clinical Epidemiology, Faculty of Health, Aarhus University Hospital, 8200 Aarhus N, Denmark.
authors.forename: Søren
authors.initials: S
authors.lastname: Friis
authors.affiliation: International Agency for Research on Cancer (IARC), 150 Cours Albert Thomas, 69372 Lyon, France.
authors.forename: Ausrele
authors.initials: A
authors.lastname: Kesminiene
authors.affiliation: International Agency for Research on Cancer (IARC), 150 Cours Albert Thomas, 69372 Lyon, France.
authors.forename: Carolina
authors.initials: C
authors.lastname: Espina
authors.affiliation: School of Health Sciences, University of Tampere, FI-33014 Tampere, Finland; STUK-Radiation and Nuclear Safety Authority, Research and Environmental Surveillance, FI-00881 Helsinki, Finland.
authors.forename: Anssi
authors.initials: A
authors.lastname: Auvinen
authors.affiliation: International Agency for Research on Cancer (IARC), 150 Cours Albert Thomas, 69372 Lyon, France.
authors.forename: Kurt
authors.initials: K
authors.lastname: Straif
authors.affiliation: International Agency for Research on Cancer (IARC), 150 Cours Albert Thomas, 69372 Lyon, France. Electronic address: secretariat-cancer-code-europe@iarc.fr.
authors.forename: Joachim
authors.initials: J
authors.lastname: Schüz
mesh_terms: D005062:European Union; D020249:Hormone Replacement Therapy / Q000009:adverse effects*; D006801:Humans; D009369:Neoplasms / Q000209:etiology* / Q000517:prevention & control*; D017410:Practice Guidelines as Topic / Q000592:standards*; D012307:Risk Factors
keywords: Breast cancer; Cancer, radiation-induced; Chemoprevention; Diagnostic X-rays; Europe; Hormone replacement therapy; Ionising radiation; Pharmaceuticals; Prevention and control