The word cancer comes from a Latin word meaning “crab”, refers to an abnormal proliferation of cells. Almost all tissues in our body can be affected by this disorder whose causes, trends and consequences are very different.

1. Cancer

Each of us consists of approximately 100,000 billion cells. They multiply, differentiate and die. This “death” is called cellular apoptosis. Thus, the daily deaths of some 200 billion between them is immediately offset by the birth of their replacements. Cancer cells, however, proliferate in an uncontrolled manner.

The starting point of any cancer, whatever and wherever it appears in the body is the focus of a single cell on his own interest. Now it no longer fulfills the function for which it was manufactured, to infinity and proliferates uncontrollably. She refused orders to “kill” (normally triggered when the DNA of a cell is too damaged to be repaired), and ignores the messages from neighboring cells commanding him to stop multiplying.

In addition, the tumor formed by the cluster of cells “abnormal”, appears capable of inducing the creation of new blood vessels to connect to the vascular network in place.Thus, it draws nutrients it needs to thrive. Some tumor cells may also break off and invade other organs via the bloodstream and lymphatic system.

Where does this cell behavior chaotic? Successive traumas caused the accumulation of genetic defects in the cancer cell. These alterations are particularly serious if they affect key fragments of DNA of the cell, such as genes normally responsible for controlling the division, differentiation or cell death. This type of damage is not provided only a first step in carcinogenesis. For the disease develops other anomalies must accumulate at different key points of the genome of the cell.

2. A process invariably

The history of each cancer is written in his own pace. But it usually covers several years and always follows the same stages of development.

The birth of the cancer cell.

First, the proliferation of the cell origin of cancer gives rise to a cluster of daughter cells that our body does not need to compress and destroy adjacent normal cells. Over time, new mutations, their descendants show something more unique. As long as they remain confined in the tissue where they were born, said the cancer is in situ. Since new mutations give them the ability to invade surrounding tissue, it is called invasive cancer. If cancer cells slip into the bloodstream or lymphatic vessels, they can spread to other parts of the body, sometimes very far from the original tumor. Hence the appearance of metastases (from the Greek word “metastasis” which means change of place).

Each new tumor may disrupt or block the functioning of the body where it develops.

3. Benign or malignant?

A tumor is classified as benign if the cells that compose retain the properties of normal tissue and prove unable to invade other tissues.

In contrast, a malignant tumor cells present not only in size, shape and structure have much more to do with those of the original tissue but above all they are detached from their birthplace and migrate to other organs.

The border between Benin and clever is not always simple. Indeed, a benign tumor can be life threatening if it compresses the patient’s body as the key brain or nerve. It can also be precancerous, such as a colon polyp with a high risk to progress to cancer.

Conversely, some malignant tumors proliferate little slow to seize other tissues and their first location does not interfere with the functioning of the body.

4. The types of cancers

Any body part can be affected. Depending on location, the cancer will display characteristics and a particular development. Quite naturally, the cancer classification has therefore established the type of cell, tissue or organ affected initially.

We can distinguish four major families of cancer.

• Carcinomas are the most common (more than 85%). They grow from the tissues lining internal or external to the body: lung, breast, skin, colon, prostate …
• Sarcomas appear in the supporting tissues of the body structure (bones, muscles …).
• Lymphomas, in turn, develop from cells of the immune system, most often in lymph nodes.
• Leukemias denote cancers arising in the bone marrow, which are made all the blood cells.

5. Cancer by the Numbers

Since 2004, cancer has replaced cardiovascular disease the leading causes of premature mortality. It affects one in two men and three women.

According to the National Institute of Health Surveillance (INVS), an estimated 320 000 new cases of cancer in France in 2005, 183,000 males and 137,000 in women. In 25 years this figure has almost doubled: + 93% males and +84% in women. At the same time, the risk of dying from cancer fell by 25%.

Why the most aggressive cancers (esophagus, stomach, ENT) fell while those with a better prognosis (breast, prostate) increased? Explanations: the aging population, development of screening and prevention.

6. The World Cancer

Globally, 25 million people are now suffering from cancer. According to the latest report of the International Agency for Research on Cancer (IARC), the number of patients doubled between 1970 and 2000.

In 2008, 12 million new cancer cases were diagnosed, 7 million people died from cancer and 25 million people living with this disease. By 2030 it is estimated that there will be more than 26 million incident cases of cancer each year.

Scientists and doctors are working daily to improve the management of colorectal cancer, including making his earlier diagnosis, better awareness of the disease for better targeted therapeutics with more precise.

1. Diagnosis

Radiological techniques are becoming more accurate detection of precancerous polyps is becoming easier, which is essential to prevent the onset of cancer.

2. Knowledge of disease

Scientists seek to identify prognostic factors, resistance or sensitivity to treatment.Genome analysis of colon and rectal tumors may help to better predict their evolution.Similarly, researchers are developing techniques known as pharmacogenomics to predict the level of response to chemotherapy as the appearance of side effects.

3. Advances in treatments

The development of oral forms of chemotherapy is likely, for some patients, facilitate the maintenance of an active lifestyle.

Advances in chemotherapy are regular, new treatments such as monoclonal antibodies are a step in the treatment of metastatic colon cancer.

New hopes are also allowed in patients resistant to treatment through the development of new molecules being tested on cell cultures, animal models or in patients currently in treatment failure.

4. The CRA and research on colorectal cancer

Over the past 5 years on all research projects supported by the CRA, 1 of 6 focused on colorectal cancer for $ 19M.

The CRA subsidizes teams seeking to understand how a cell becomes cancerous, and to discover better treatments or find new diagnostic methods and means of cancer prevention.

5. Research on cancer cells …

Most projects related to colon cancer study the metabolism of cancer cells and the mechanisms involved in cancer development. Researchers analyze the particular genetic and biological mechanisms involved, and factors that may influence the cancer process, such as inflammation of the colon.

The mechanisms of tumor invasion, surveillance by the immune system, creation of new blood vessels (angiogenesis) and metastasis are also considered.

6. Research on colorectal cancer

Some projects are more specific treatments for colon cancer: analysis of resistance to chemotherapy, chemotherapy innovative research, new methods to protect healthy tissue during radiation therapy or the development of immunotherapies.

The combination of several approaches, including anti-angiogenesis in addition to radiotherapy or chemotherapy, is also tested.

Other work focuses on finding molecular markers that could be used for diagnosis, monitoring or prognosis of the disease as targets for new therapies.

Finally, the role of food, anti-inflammatory, viruses and bacteria on the development of colon cancer are also discussed.

Treatment of colorectal cancer, like other cancers, may cause troublesome side effects, sometimes severe. However, most of the time these effects can be prevented or relieved.

1. Common side effects

Gastrointestinal disorders: surgical removal of all colon cancer can cause diarrhea, sometimes disabling, persistent two to three months.

Similarly, chemotherapy or radiation therapy often cause an acceleration of transit due to irritation of the bowel. Patients treated with irinotecan have a significant risk of diarrhea and should benefit from a systematic prescription of antidiarrheal.

These transit problems are usually corrected by dietary measures as a system rather restrictive: avoid eating raw vegetables, fruits and vegetables rich in fiber or meat sauce can enhance the comfort of life.

Similarly dressings or intestinal transit speed reducers may help. Once those problems solved, the patient eats and lives quite normally.

Impotence surgery, such as radiation can also cause erectile dysfunction, especially if the intervention focused on the rectum. Although they are most often physical, consulting a sex therapist can sometimes help overcome these effects.

2. Effects due to radiotherapy

Side effects of radiotherapy are variable among individuals.

The redness of the skin can be alleviated by local treatment.

A compelling urge urination associated with burning sensations called cystitis can arise.

It is relieved by drinking plenty, especially water rich in bicarbonates.

3. Effects due to chemotherapy

Side effects of chemotherapy depend on the products used.

In general, chemotherapy for colorectal cancer has mild side effects, with little risk of alopecia (hair loss) that does occur in 40% of cases during the use of irinotecan, little nausea, sometimes diarrhea.

If chemotherapy is increasingly tolerated, because the treatment is accompanied today by the administration of products preventing or limiting side effects such as vomiting.For example, powerful anti-nausea are systematically associated with chemotherapy in particular when using oxaliplatin or irinotecan.

Where possible, treatments are performed on an outpatient basis, that is to say, coming into the structure of care for half a day and then returning home.

In some cases it is possible to receive all the treatment at home. For intravenous treatments. Catheter or implantable port has become almost routine in order to preserve the integrity of the veins of patients.

• Mouth inflammation: mouthwashes containing sodium bicarbonate and antimycotics may be prescribed for prevention of oral inflammation generated by certain chemotherapies including those comprising 5-FU.
• Neuropathy: tingling in the fingers and toes, sometimes disabling and are observed during prolonged administration of oxaliplatin. In early treatment, these events are mostly related to contact with cold objects that must be avoided after the administration of oxaliplatin. With repeated treatments, these effects type of tingling, numbness can become permanent, which requires discontinuation of oxaliplatin.
• Hematological toxicity: a decrease of certain blood cells can occur during chemotherapy, especially following treatment with oxaliplatin and irinotecan.

These effects can be revealed by certain symptoms, including fever over 38 ° C or chills, shortness of breath, vomiting, or diarrhea.

In general, these effects last less than seven days and does not warrant specific treatment.

4. Side effects of monoclonal antibodies

Side effects of monoclonal antibodies are different from those of conventional chemotherapy.

Cetuximab (Erbitux ®) is the main side effect the appearance of a rash similar to acne which can be prevented by antihistamine premedication.

Bevacizumab (Avastin ®), in turn can cause bleeding more or less important and delays healing (it should be suspended for two months before an intervention), fever and hypertension. And unusually, perforation of the gastrointestinal tract or obstruction of a vessel by a clot (thrombus).

The patient’s attention should be drawn to the fact that the absence of adverse effects during chemotherapy can, and does not call into question the effectiveness of treatment.

Cancer, and more colorectal cancer, is often regarded by patients as a shameful disease. Now it is just important that the patient accepts his illness, spoke to his entourage. On this condition it has the moral and physical need to fight against his disease.

1. Colorectal Cancer

To support the treatment and return to the morale, the patient needs the full support of his family. It is recognized that disease acceptance and a strong adherence to treatment boosts the effectiveness of therapy.

Within cancer services, psychologists are available to accompany patients and their relatives in the acceptance of illness and treatment.

2. The announcement of the disease

The discovery of the disease remains a major psychological and emotional trauma.

The doctor expressed the diagnosis and therapeutic strategy envisaged the patient who has received quiet.

The sick person should not hesitate to talk with her doctor. It is important that it raises all issues of concern. Former patients suggest to write in advance a list of questions, which can not forget them during the consultation.

Then a maintenance provided by a nurse aims to enable the patient or his relatives to be heard, to clarify the information delivered by the doctor to ask questions concerning the various stages of treatment decided to formulate natural fears, to clarify the administrative procedures …

Other stakeholders are also likely to provide listening and support: social worker, psycho-oncologist, dietician …

3. After treatment

As it is impossible to ensure that no cancer cells that remains after treatment, even if signs of disease have disappeared, it is better to speak of forgiveness in the case of cancer for at least 5-7 years.

Beyond that, we can speak of cure. Even in cases of metastasis, progress that led to better control the disease with a longer survival time and most importantly better quality of life are that cancer is becoming increasingly a chronic illness. Paradoxically, the end of treatment can be destabilizing.

Often, patients have the feeling of being abandoned, living with fear of recurrence, sometimes feel staggered with those around them, hence the importance of support from relatives and caregivers to verbalize these changes and regain confidence andbalance.

After a long struggle against disease, the end of treatment involves psychological and social reconstruction (recovery of occupation, leisure, sport, travel …).

4. Living with a colostomy

Systems colostomy now available allow the patient to live the most “normal” possible.

Stoma consultations allow patients to learn to better manage their colostomy. They live almost as well as before, can play sports, bike, go swimming …

It is simply best to avoid drinks and foods likely to ferment, like cabbage or beans.

If surgery is the curative treatment of colorectal cancer database, other therapies are sometimes used alone or in combination depending on the case.

1. The removal of the tumor during a colonoscopy

All polyps removed during a colonoscopy is analyzed. The detection of a precancerous condition (dysplasia) or malignant superficial (no invasion of muscularis mucosa) that involves the removal of the polyp alone is curative.

The presence of cancer cells at the edge of the area removed or deep invasion entails a general indication of additional surgery.

2. Surgery

Surgery is the curative treatment of colorectal cancer database.

The intervention is to completely remove the area of the colon including the tumor is called a hemicolectomy.

Laparotomy: after opening the abdominal cavity, the surgeon performs a lumpectomy and vessels and adjacent areas containing the lymph nodes. Suture then connects the two ends of the colon.

Laparoscopic: Laparoscopic surgery is a fairly common alternative to laparotomy. For this, the instruments are inserted through holes about 1 cm and the tumor is removed through a small incision. It offers the same security and improves quality of life of patients (reduction of postoperative pain, duration of hospitalization, and discreet scarring reduced risk of incisional hernia).

When the tumor remained localized, with no lymph node involvement, surgery is said to be curative, that is to say that the patient is considered to be treated by surgery alone.

Upon discovery of metastatic liver and lung during surgery, their removal is considered immediate if it looks easy.

Chemotherapy is often prescribed in addition to surgery.

Temporary or permanent colostomy: After hemicolectomy, the two ends of colon are sutured.

In some cases it is necessary to provide a shunt (artificial anus). Is called a colostomy.

Often it is only temporary and continuity of transit is restored after healing.

Sometimes, complications of cancer type of obstruction and perforation, or failure to keep the anal sphincter in rectal cancer located very near the sphincter, the surgeon is forced to perform a permanent colostomy. The colon is then fused to the skin of the abdomen and connected to a bag that collects stool.

3. Chemotherapy

Chemotherapy involves giving the patient one or more molecules designed to specifically destroy cancer cells as possible.

This treatment reduces tumor size and eliminate any small metastases in training.Chemotherapy is administered as a preventive measure after surgery to avoid the appearance of metastases when the tumor has spread to the lymph nodes (called adjuvant chemotherapy).

As for patients with metastatic form of colon cancer, the specific drug combinations are prescribed to them in addition to surgery.

Sometimes, when the treatment is palliative surgery is not possible or is intended to reduce the size of the tumor before surgery.

The drugs most frequently used are:

• The 5-fluorouracil (5-FU), medicament reference intestinal cancer, disrupts the metabolism of cancer cells. Oral form (Xeloda ®), it allows outpatient management.Tegafur (UFT ®), an association of 5-FU and uracil, is another form of oral 5-FU.
• Oxaliplatin (Eloxatin ®) is also a major treatment in the management of colon cancer.Metastatic, it is often used in combination with 5-FU.
• Irinotecan (Campto ®) inhibits an enzyme involved in the formation of DNA, very active in cancer cells. Associated with 5-FU, it increases the effectiveness of treatment.

The chemotherapy of colon cancer cure is generally carried out over six months.

4. Radiotherapy

It is possible to irradiate the tumor to kill cancer cells before or after surgery.

Radiotherapy is most often used for cancers of the rectum where it reduces the volume of the tumor before surgical removal. This helps reduce the risk of local recurrence.

This treatment is achieved by meeting a few short minutes, five days a week for five weeks on average, but then includes a six weeks after surgery. Radiotherapy is more commonly associated with chemotherapy thus prescribed in addition to surgery before the surgery.

Radiotherapy is not usually used in colon cancer unless the tumor can be removed completely due to major flooding.

5. Monitoring after treatment

After treatment, all patients are monitored regularly for early diagnosis of possible recurrence. This includes in particular the annual chest radiographs, abdominal ultrasound scans or scheduled to monitor for possible liver metastases.

A year after the end of treatment, a colonoscopy is also performed.

6. The latest treatment: monoclonal antibodies

New therapeutic approaches such as monoclonal antibodies are very promising.

Some antibodies such as cetuximab (Erbitux ®) or panitumumab (Vectibix ®) block the receptors of a growth factor called EGF (Epidermal Growth Factor) on the surface of cancer cells. Others such as bevacizumab (Avastin ®), an inhibitor of vascular endothelial growth factor (VEGF), act by decreasing the tumor vasculature.

By preventing the emergence of new vessels, the blood supply to the tumor is reduced, thereby limiting its development.

These treatments are most often used in combination with chemotherapy that they increase efficiency without increasing toxicity.

Colorectal Cancer: Diagnosis, Like all cancers, early diagnosis is the guarantee of a better prognosis.

1. DRE

Digital rectal examination can help diagnose rectal cancer if it is located within 8 cm from the anus.

It allows in particular to assess the size of a rectal tumor, its fixity, its distance from the sphincter.

For this, the doctor inserts a gloved finger into the anus of the patient to palpate the rectum.

2. Colonoscopy

Performed under brief general anesthesia, colonoscopy can view the internal walls of the colon. It consists of introducing into the colon a flexible tube with a camera and a video clip to make withdrawals.

Upon discovery of a lesion, colonoscopy allows to assess dangerousness, to search for possible associated lesions and to ablate or in total take a sample (biopsy) for analysis at microscope.

Colonoscopy is performed at a particular individual screening in individuals about 50 years with risk factors or symptoms suggestive. It is necessary in patients who test for blood in the stool is positive.

Virtual colonoscopy can observe the colon through the images obtained by scanner.This strategy of screening and diagnosis is being evaluated.

Some rules to follow before a colonoscopy:

• It should not take aspirin within ten days before surgery. Patients treated with anticoagulation is imperative that out.
• To allow optimal observation of the intestinal walls, it is important to clean the intestines of contents therein. For this, two days before the examination, the patient should adopt a system without fruit or vegetables, or fatty meats. Are allowed rice, pasta, fish and lean meats.
• The day before the colonoscopy, the patient will be asked to drink before dinner two liters of a drug that will cause loose stools. If the colonoscopy the next morning, a third liter should be drunk after dinner. If it takes place the next afternoon, the third liter is drunk the morning of colonoscopy. This exam is not painful because it is performed under general anesthesia which requires consultation at least 48 hours prior to the completion of the review.

3. The staging

Once diagnosed with cancer, its extent must be assessed. Additional tests are then performed.

MRI (Magnetic Resonance Imaging) is the gold standard for exploring the local extent of rectal cancer. It determines the best treatment that will be used and can be supplemented by ultrasonography (especially for small tumors) or a scanner. The chest radiograph or chest CT scan looking for possible lung metastases.

The abdominal ultrasound or abdominal CT scan better designed to detect possible liver metastasis.

Colorectal cancer can remain asymptomatic for a long time. Its symptoms are delayed and often reflect a disease already advanced.

Symptoms of colorectal cancer, The main signs found include:

• Severe abdominal pain resulting from contractions of the intestine by evolving crises of 2 or 3 days, sometimes accompanied by abdominal sounds.

• Bowel disorders (constipation or diarrhea sudden prolonged or alternation of both).

• The presence of blood in the stool from the most often unnoticed or complained to hemorrhoids.

• Anemia (hemoglobin in the blood below normal).

• Unexplained weight loss and / or mild persistent fever.

• For rectal cancer, rectal bleeding or rectal bleeding.

• In advanced stages, complications such as obstruction, tumor perforation or alteration of general condition may be cancer.

In France, an organized screening program was initiated by the government since 2002 and now affects all French departments. It is for people aged 50 to 74 years.

1. Screening for colorectal cancer

The screening is done in particular using the Hemoccult II ® which is to find a microscopic bleeding (not visible to the naked eye) in the stool. Indeed, very often large polyps and cancers of the bowel bleeding in a very discreet and not visible.

2. How to do a Hemoccult II ®?

It is to spread yourself very little fecal matter (the equivalent of a lens) on the cardboard placeholder for two consecutive days. Folded, the card is sent to the laboratory carrying out research of fecal blood.

• If the Hemoccult II ® is negative, it must be renewed every two years.
• If the test is positive, it should perform a thorough examination of the intestine through a colonoscopy, which allows to visualize the colonic mucosa and lesions.

3. Beyond the test

A positive test does not necessarily mean cancer (other causes of gastrointestinal bleeding exist), but still warrants an exploration of the intestine.

Conversely, the sensitivity of Hemoccult II ® is only about 50% (source Invs, 2009), two cancer is not detected by this test.

However, routine screening is interesting in terms of public health because it reduces from 16 to 20% mortality from colorectal cancers.

4. If family history

Individual screening in people at high risk reduces the incidence and mortality of colorectal cancers. In this case, the screening methods based on colonoscopy and genetic testing.

In patients with history of colorectal cancer in a first-degree relative 60 years or more, a screening colonoscopy every five years is recommended from the age of 40.

If colorectal cancer was diagnosed before age 60, colonoscopy is recommended every five years from 40 years from the age of five years less than that of familial cases.

The lifestyle changes the risk of colorectal cancer. The protective effect of physical activity is established, as well as the detrimental effect of overweight, a diet rich in animal fats and alcohol.

1. The causes of colorectal cancer

While the exact causes of colorectal cancer are still unclear, a number of factors can increase or decrease risk.

• Colorectal cancer seems to be associated with a diet rich in red meat and salami and liquor.
• Overweight and obesity also increases the risk of colorectal cancer.
• In contrast, physical activity decreases the risk.
• The toxic, persistent and soluble in fat: Some pesticides, including polychlorinated biphenyls (PCBs), provided by food (meat, oily fish ..) and evacuated via the feces are potentially carcinogenic to the intestinal mucosa.
• Tobacco: as in many other cancers, the harmful role of tobacco has been demonstrated in colorectal tumors.
• Gender: If colon cancer is also common in men than in women, cancer of the rectum is more common in men.
• Age: rare for fifty years, colorectal cancers are quite common about 65 years.
• Disease inflammatory bowel disease, including Crohn’s disease and ulcerative colitis: after twenty years of inflammation of the lining of the colon, the risk of developing cancer is about one third higher if entire colon is involved.
• The history of certain other cancers.
• Heredity: the risk of colorectal cancer is higher if a relative has had one. Having a first degree relative (parent, brother or sister) met, triples the risk of developing colorectal cancer. The risk is especially high as there are people living in the same family and that these cases were discovered young.

Families at very high risk have been identified, where members have a specific genetic mutation that predisposes to colorectal cancers.

2. Familial forms of colorectal cancer

According to the National Institute of Health Surveillance, hereditary cancers account for less than 5% of all colorectal cancers occur before age 40 and, more particularly the right colon.

In the adenomatous polyposis family (PAF English for “family adenomatous polyposis), numerous polyps appear in all carriers of a mutation in the Apc gene. The risk of colorectal cancer in adulthood is almost certain we will carry out short annual colonoscopies at the age of 10 years. If the diagnosis of polyposis is confirmed, a total removal of the colon at the end of puberty (around 17-18 years) can prevent cancer.

Lynch syndrome or cancer Hereditary non-polyposis colon (HNPCC in English for “hereditary non-polyposis colon cancer) is characterized by abnormalities in genes coding for proteins of particular DNA repair called MSH2 and MLH1. The colon is healthy colonoscopy, the cancer risk is less, but it remains very high and monitoring is required by total colonoscopy every two years from the age of 20 to 25 years.

Fairly uncommon, cancer of the ovary is formidable because of its poor prognosis. A new study confirms the protective role of oral contraception. The advantage is that even 30 years after stopping the pill, the protection lasts …

1. Against the ovarian cancer, gynecologic surveillance is needed

The poor prognosis of ovarian cancer is related to the fact that it is very long asymptomatic and therefore detected late, a late stage. In this context, prevention is a considerable asset. It recommends a very regular gynecological monitoring and consult her doctor or gynecologist if signs suggestive (but not specific to cancer of the ovary): swelling of the abdomen or tension, feeling of weight on his stomach, and pelvic pain lumbar, needs to urinate, digestive disorders, weight changes, menstrual disorders, painful intercourse, fatigue, etc..

Meanwhile, some women are at greater risk than others. Indeed, risk factors are well known: age (over 50 years), family history of cancer of the ovary, uterus, breast and colon cancer, a genetic predisposition involving the same gene that that associated with breast cancer, early menarche, late menopause, first child at a later age, not having children, and hormone replacement therapy for menopause.

2. One factor that protects against ovarian cancer: oral contraception

Long suggested, a new study confirms the role of a protective factor, this time: it is the oral contraceptive. How the pill (used extensively in younger women) may it be interesting vis-à-vis a cancer that occurs in most cases after menopause? Is that oral contraception protects against ovarian cancer 30 years after stopping.

Some 20,000 women with ovarian cancer (mean age of cancer diagnosis: 56 years) were compared with 87,000 control women from 21 different countries. It turns out that over the duration of oral contraceptive use was longer, the risk of ovarian cancer is decreased. Moreover, if this protective effect tends to decrease with time, it nevertheless persists beyond 30 years after stopping the pill.

When the pill was stopped less than 10 years ago, the risk is reduced by 29%. For a pill stopped 10-20 years ago, the risk reduction was 19% and is still 15% for women who stopped the pill 20 to 30 years earlier.

Knowing that hundreds of millions of young women use the pill in the world, one can expect that the pill would avoid 30,000 ovarian tumors annually in the years to come …