CORRESPONDENCE
AIDS turnaround: first remedy the
adverse effects of the condom policy
With
reference to the recent Eleventh AIDS Conference in Vancouver, Canada,
July 9-12, 1996, it was a good news indeed to hear that the heterosexual
AIDS epidemic did not materialize among the mainstream American population,
as well as somewhere else. The information of the main new development
at the Conference, however, seems to have been missed in the reporting:
the change of the condom-use policy.
The
real turn-around at the Vancouver Conference was the fact that the condom
use became virtually a non-issue in the strategy for prevention against
the AIDS transmission. Since the promotion of an indiscriminate and persistent
condom use for prevention of the AIDS/HIV infection in the general population
has been attributed to as the main single factor responsible for the dramatic
rise of breast cancer in the country and elsewhere,1 the practical
abolition of the condom-use policy at the Vancouver AIDS Conference opened
a real opportunity for prevention of breast cancer, the other deadly epidemic
disease, in the community.2 For prevention of AIDS infection,
"condoms cannot be used," said explicitly Dr. Donna E. Shalala, the U.S.
Secretary of Health and Human Services, on the CNN International
from the Conference, but for that purpose, only the "vaginal creams and
foams with antiviral effects." The virus-killing creams and foams, still
under development, would mean "a freedom for women to use them anytime,"
the Secretary added. A CDC Officer in charge of AIDS prevention and detection,
Dr. Helene Gayle, justified her enthusiastic statement on the CNN
that "prevention (against AIDS) is no longer necessary" because of the
new, promising "cocktail therapy" against the disease. "The condom is ineffective
for," and vaccine against the AIDS infection is needed, the other participants
asserted. The condom was hardly mentioned, if at all, in the ensuing mass
media and newspaper reports during and after the Conference anymore. Such
a radical change in the absolutist condom-use policy, at least in the U.S.
and the other developed countries, even in the given situation when the
alternatives for prevention of AIDS transmission still seem remote, could
not be made without a compelling reason and external strain against the
device, such as the hard evidence of an etiologic condom-breast cancer
association and the potential for a primary prevention of breast cancer
and other related phenomena.
What
is needed now, I believe, is an open information about and a straightforward
discussion and push for raising the awareness of women and married couples
in the community, of all ages, about the hazards and danger they are exposed
to the carcinogenic effects of a long-term condom use,3 and
about the related potential for a natural (non-chemical) prevention of
breast cancer as an epidemic disease, and possibly for prevention of tumors
of other organs of female reproductive system,4 by eliminating
the condom use for fertility-control purposes.
References:
1 Gjorgov
AN. Emerging worldwide trends of breast cancer incidence in the 1970s and
1980s: Data from 23 cancer registration centres. European J of Cancer
Prevention 1993; 2: 423-440.
2
Gjorgov AN. Stop the natural experimental trial in breast cancer because
of the increasing incidence: Summarizing the evidence. European J of
Cancer Prevention 1995; 4:
97-103.
3 Gjorgov
AN. History of the condom: The overlooked adverse effects. J Royal Society
of Medicine 1994; 97: 570.
4
Gjorgov AN. Barrier Contraception and Breast Cancer. S. Karger,
Basel-New York, 1980: x + 164.
A N Gjorgov
MEDICS Group
G. Hadzi-Panzov St., No. 2,
Skopje
Republic of Macedonia
Fax: (+389) 91 127 361
Editor’s note: I showed the above
letter from Dr. Gjorgov to
Dr. Irwin, who has written on
this subject below.
Drs. Irwin et al comment:
The above letter critically mis-states several facts and opinions of the
Public Health Service (PHS). Contrary to Dr Gjorgov’s assertions, Drs Shalala
and Gayle have strongly and repeatedly supported the PHS recommendation
on barrier methods for HIV prevention, most recently in July 1996 during
the 11th International Conference on AIDS in Vancouver and in related interviews
(Transcripts of CNN International-TV World News, 1996). This recommendation
states that consistent and correct use of latex condoms provides a high
level of protection against HI infection (Centers for Disease Control and
Prevention, 1993). Indeed, this level of protection is close to that provided
by vaccines for some other diseases. Based on extensive data, this policy
was further supported in numerous presentations at the Vancouver conference
that described increasing levels of condom use and associated reductions
in HIV transmission in many communities. More than 800 conference abstracts
noted condoms as a component of HIV risk-reduction activities (Proceedings
of the 11th International Conference on AIDS, 1996).
Despite
the recent success of some condom promotion efforts, many couples at risk
for HIV infection do not use condoms for various reasons. As Dr Shalala
stressed in her Vancouver speech, to address the HIV prevention needs of
these couples, other prevention needs such as topical microbicides must
be developed. The data from large, controlled, clinical trials are as yet
inadequate to provide (evidence) that any commercially available vaginal
or rectal product reduces the risk of HIV transmissions in humans. However,
laboratory studies on several products provide some preliminary evidence
that a biological basis for anti-HIV activity is plausible.
Also
unfounded is Gjorgov’s assertion that this "practical abolition of the
condom-use policy" is "good news" because of "hard" evidence that condom
use increases the risk of breast cancer. Gjorgov cites the only data suggesting
an aetiological relationship, his own small case-control study from the
1970s in which the final risk estimate was probably spuriously elevated
because of inadequate control for confounding factors and biased selection
of control patients (Gjorgov, 1980; Irwin and Peterson, 1995). No other
studies have demonstrated a relationship between condom use and breast
cancer risk. The Cancer and Steroid Hormone Study, one of the world’s largest,
best controlled studies of risk factors for breast cancer, found that condom
users had the same risk of breast cancer as non-users (Irwin and Peterson,
1995).
Let
us be clear -- for persons who do not choose abstinence, latex condoms
used consistently and correctly are the most effective method to prevent
the sexual transmission of HIV infection. In the absence of effective vaccines
or microcides that prevent HIV infection, condoms represent one of the
few, effective, widely available tools to interrupt the propagation of
the epidemic. Condoms continue to play a vital role in comprehensive HIV
prevention programmes (Roper et al, 1993). Amidst the human tragedy of
the global HIV epidemic, we cannot afford misunderstandings that undermine
this important prevention strategy.
References
Centers for Disease Control
and Prevention (1993). Update: barrier protection against HIV infection
and other sexually transmitted diseases. MMWR 42: 589-91,97.
Gjorgov AN (1980). Barrier
Contraception and Breast Cancer. Basel, Karger.
Irwin KL, Peterson HB (1995).
Breast cancer and condoms. J R Soc Med 88: 663.
Proceedings of the 11th International
Conference on AIDS, Vancouver, BC, 7-12 July 1996.
Roper WL, Peterson HB, Curran
JW (1993). Commentary: condom and HIV/STD prevention --clarifying the message.
Am J Public Health 83: 501-3.
Transcripts of CNN International-TV
World News (1996). Video Monitoring Services of America Inc. Washington
DC, 8-9 July 1996.
K Irwin
Division of HIV/AIDS Prevention
National Center
for HIV, STD and TB Prevention
Centers for
Disease Control and Prevention
1600 Clifton Road,
NE Atlanta, GA 30333, USA
Fax: (+1) 404 639 6118
H Peterson
Women’s Health and Fertility Branch
Centers for Chronic Disease Prevention
and Health Promotion
H Gayle
National Center for HIV, STD and TB Prevention
Centers for Disease Control and Prevention
1600 Clifton Road,
NE Atlanta, GA 30333, USA
Replies Dr Gjorgov:
The
authors of the above reply asserted that this author "mis-states several
facts and opinions of the Public Health Service (PHS)," rather than of
the statements of Drs. Gayle and Shalala, expressed on CNN International
on July 8 and 10, 1996 (European time),respectively, from the 11th AIDS
Conference in Vancouver. The comments in the reply seem to confirm that
the PHS has considered neither the evidence of the unexplained, dramatic
rise and epidemic extent of the other deadly disease in the United States
(Gjorgov, 1993, 1995A), and worldwide (Gjorgov, 1995B), nor the evidence
of the tested etiologic relationship between a long-term exposure to condom
use and the development of breast cancer in American married women. I still
believe that it is a good news (unfounded?), exposed at the Vancouver Conference,
that the heterosexual AIDS epidemic did not materialize among the mainstream
American population. For, the general population is the main stage for
and source of the breast cancer epidemic in the community, which epidemic
could potentially be controlled and prevented to a great extent by the
elimination of the use of condoms for fertility-control and family-planning
purposes.
The
Cancer and Steroid Hormone Study (CSHS, 1986), as cited by the CDC authors,
was designed for assessing mainly the risk of oral contraceptives on breast
cancer, with a possible "gunshot" approach to other risk-factors, such
as the barrier contraceptive methods, i.e., condom and withdrawal, and
male sterility. An indication in this regard might be the fact that the
diaphragm, which was defined as a non-barrier contraceptive method in my
hypothesis-testing study of 1970s (Gjorgov, 1978 and 1980), has been misclassified
and presented in the CSHS report as a barrier method. As mentioned, among
the most important requirements for a case-control study, large or small,
is the controlling for confounding factors. I believe that my retrospective
breast cancer study was reasonably free of confounding or other biased
factors, and there were no spuriously elevated results. Since it is well
known that breast cancer is not a local but a systemic disease, an ill-defined
condition and unspecified carcinogenic process, with frequent degenerative
and neoplastic manifestations on the breast, uterus and ovaries, my study
was designed to take these conditions under consideration as probable precursors
or equivalents to breast cancer, and to control them as confounding factors
(covariates), with their exclusion from the control subjects (along with
women with hysterectomy and cervical cancer) from the outset of the study.
The condom use, as the postulated main risk factor in breast cancer, was
assessed to be quite robust, more than fivefold greater risk than in users
of non-barrier methods (the pills, diaphragm, IUDs, rhythm, vaginal creams
and foams, and tubal ligation). Despite the inclusion of some risk factors
in the tailored CSHS analysis, indicating unity between condoms and breast
cancer, the exclusion of the nonspecific lesions in the organs of the reproductive
system of the control-group women, that is, controlling for these confounding
factors in the condom-use risk assessment, was not mentioned in the CSHS
report. Two more case-control studies were conducted in France (Lê
et al, 1989) and in the former USSR (Pikhut et al, 1991), in order to specifically
re-test the semen-factor hypothesis in the etiology of breast cancer. The
conclusions of both studies strongly corroborated the condom-breast cancer
association.
The
evidence of the predictive power of my tested hypothesis in breast cancer
etiology of an impending natural experiment of breast cancer upsurge was
confirmed by the sharp rise of the disease and the excess incidence of
breast cancer (and other accompanying phenomena) in American and other
women worldwide. Such an event was not envisioned or foreseen in the early
1970s, when my breast cancer study was first proposed and carried out at
the Universities of North Carolina, at Chapel Hill, and of Pennsylvania,
in Philadelphia. The dramatic rise of breast cancer was attributed to the
increased prevalence of the indiscriminate and persistent condom use (with
technical effects of absolute male sterility, on an unprecedented scale)
in the community. In addition, ecological studies of the perplexing rise
of breast cancer, were readily conducted because of the once-in-a-lifetime
opportunity to test the semen-factor hypothesis on a global scale. As expected,
the ecological studies, unpublished and published (Gjorgov, 1995A, 1995B),
strongly corroborated the conclusions of the field case-control study about
the disease etiology and of the potential for prevention of breast cancer
as an epidemic disease. Ecological studies cannot prove a causal link between
the two factors, the increased prevalence of condom use and the increased
incidence of breast cancer worldwide, but any causal hypothesis has to
be able to interpret the evidence and other facts of life which the ecologic
and other descriptive studies carry. With respect, the three CDC officers,
authors of the reply, are apparently loaded with comprehensive responsibilities
in the country, including women’s health and human fertility, besides AIDS.
But still, they seem to accentuate a traditional way of thinking in the
etiology of breast cancer, conveying a negative conclusion of no prevention
of the epidemic breast cancer at the present time, already contested outlook
notwithstanding. I wonder whether such inconclusive messages as conferred
by the CDC reply could serve as a surrogate answer to the petition on breast
cancer (Love & Evans, 1994), signed by 2.6 million American women and
submitted to the U.S. President, in 1994, requesting a new national policy
and preventive and innovative approaches in the search of the cause and
prevention of breast cancer, the on-going epidemic, burden and threat in
the country. The proposed alternative approach and challenge for a primary
(non-chemical) prevention of breast cancer in the U.S. and other advanced
countries, including the U.K., with elimination of the use of condoms as
contraceptive methods, is postulated to bring about immediate returns (remedial
impact) in the community.
References:
Cancer and Steroid Hormone
Study (CSHS) of the Centers for Disease Control and the National Institute
of Child Health and Human Development (1986). Oral contraceptive use and
the risk of breast cancer. New Engl J Med 315: 405-411.
Gjorgov AN (1978). Barrier
contraceptive practice and male infertility as related factors to breast
cancer in married women. Preliminary results. Oncology 35:
97-100.
Gjorgov AN (1980). Barrier
Contraception and Breast Cancer. S.Karger, Basel-New York.
Gjorgov AN (1993). Emerging
worldwide trends of breast cancer incidence in the 1970s and 1980s: data
from 23 cancer registration centres. Eur J Cancer Prev 2:
423-440.
Gjorgov AN (1995A). Stop the
natural experimental trial in breast cancer because of the increasing incidence:
summarizing the evidence. Eur J Cancer Prev 4: 97-103.
Gjorgov AN (1995B). Worldwide
breast cancer incidence: ecological rising trends and the potential for
prevention. The possible carcinogenic effects of condom use.
Spec Sci Techn 18:
16-27.
Lê GL, Bachelot A, Hill
A (1989). Characteristics of reproductive life and risk of breast cancer
in a case-control study of young nulliparous women. J Clinical Epidemiol
42:1227-33.
Love S, Evans N (1994). Breast
cancer in the United States today. Presentation at the International
Breast Cancer Challenge Lancet Conference, Brugge, Belgium, April 21-22,1994.
Pikhut PM, Levshin VF, Moskaleva
LI (1991). (Methods of contraception and the risk of development of breast
cancer.) Sovyetskaya Med, iss. 12: pp. 70-72.
A N Gjorgov
G. Hadzi-Panzov St., No. 2,
Skopje
Republic of Macedonia.
Fax: (+389) 91 127 361.
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