Critical Appraisal of Research on Oral Contraceptives & Breast Cancer

This report presents a critical appraisal of a research paper investigating the correlation between oral contraceptive (OC) use and the risk of premenopausal breast cancer, specifically within the Norwegian Women and Cancer Study. The critique assesses the study's research problem, literature review, theoretical framework (or lack thereof), variables, hypotheses, methodology, data analysis, and ethical considerations. The original study aimed to evaluate the increased risk of breast cancer associated with OC use in Norwegian women, noting the established link in existing literature, particularly concerning young women and those using OCs before their first pregnancy. The critique points out the absence of a specific theoretical framework in the original research, suggesting Levine's Conservation Model as a potentially relevant theory. The study employed a qualitative, population-based cohort design, collecting data from 74,862 premenopausal women to understand the effect of OC on breast cancer. Multivariable analysis and separate regression models were used for data analysis, with ethical considerations addressed to avoid obligations from participants. The critique highlights the study's strengths, such as its prospective design and detailed hormone use assessment, while also noting limitations like the failure to explore other OC types and the homogeneity of the study population. The report concludes by emphasizing the significance of the research for nursing, particularly in identifying risk factors for breast cancer in patients using oral contraceptives and in designing better management and prevention strategies.

Running head: CRITICAL APPRAISAL OF A PAPER
Name of the student:
Name of the university:
Author note:

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CRITICAL APPRAISAL OF A PAPER
Busund, M., Bugge, N. S., Braaten, T., Waaseth, M., Rylander, C., & Lund, E. (2018).
Progestin‐only and combined oral contraceptives and receptor‐defined premenopausal
breast cancer risk: The Norwegian Women and Cancer Study. International journal of
cancer, 142(11), 2293-2302.
Research Problem/Purpose:
The purpose of the paper is to evaluate how Oral contraceptives increase in the risk of
breast cancer in the population of the Norway. This issue is worth studying since accumulated
literature highlighted an association between consumption of oral consumption and break cancer
in younger women. The authors considered two subgroups, young women who used OCs for
extended duration and women who used OCs prior to a first-term pregnancy. The investigation
placed the study problem not only within the context of existing knowledge but also explored
through experimental observation. This research solves a problem relevant to nursing since this
study assists nurses to identify the risk factor of premenopausal breast cancer. This research will
help in designing interventions for the reduction of the prevalence of breast cancer in women of
Norway.
Review of the Literature:
In the paper, the mountain of literature was explored and each of the literature
highlighted that the use of oral contraceptive increases the risk of breast cancer is a long-standing

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concern. The authors highlighted that estrogen-progestin contraceptives combined are classified
as carcinogenic to humans since it induced premenopausal breast cancer. The key concept that
was highlighted in the literature review was the role of hormone in etiology of breast cancer
where exogenous hormones influence breast cancer risk. It was also highlighted that estrogen
rate is elevated during the consumption of oral contraceptive pill which further contributed to the
breast cancer since breast cells have hormone receptor attached to them. A higher level of
estrogen helps cancer cells to grow (Shivappa et al., 2016).
The references are not current since the issue is not a current issue; rather it is a long-
standing concern.
Theoretical Framework
No theoretical framework was mentioned in this paper, normal concept of breast cancer
and oral contraceptive pills were mentioned .Since it is an experimental cohort study, the
researchers did not use any nursing theory, rather they conducted population based cohort study
based on the explored literature (Guo, Wei & Zhan, 2015). Levine's theory of Conservation
Model can be used which help an individual to adapt health challenges with least amount of
effort (Shivappa et al., 2016).
Variables/Hypotheses/Questions/Assumptions:
The hypothesis of the paper is oral contraceptive pills consumption may contribute to the
increased risk of breast cancer. In the current study, the increased risk of breast cancer is
dependent variable whereas consumption of oral contraceptive pills is an independent variable.
The operational definition of the variable was given. It was measurable since the dependent and
independent variables and the link between them by asking questions about the conception of

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menopausal status, collecting data of their menstrual cycles, postmenopausal hormone use, POC
and COC consumption of each participant and multivariable Cox regression models were used to
calculate hazard ratios (HR) for breast cancer.
Methodology
The qualitative research design was used in this study where authors conducted
population based cohort study to gain an understanding of the research (Reed, Fitzgerald & Rae,
2016). In the study, inductive reasoning was present. Inductive reasoning is a method of reason
in which premises are view as a supplying of some evidence. One of the crucial characters of
inductive reasoning was observed that is inductive reasoning allows for the possibility that the
conclusion is false (Reed, Fitzgerald & Rae, 2016).
OC use was collected from 74,862 premenopausal women at baseline for understanding
the effect of OC on best cancer. The study conducted in Norway. Initially, randomly selected
participants were recruited to evaluate the study. After using questioners, 51,850 women were
recruited for taking follow up where Assessment of OC exposure was done by asking questions
to them. Hormonal receptor status of each patient was measured. Moreover, the imputation
model as a regression model was used for gaining data.
The questionnaire is an effective Measurement tool to aging the understanding of the
feelings of the participants whereas imputation models as a measurement tool were used for
obtaining numerical values related to variables and help to obtain misusing values (Noble &
Smith, 2015)

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Data analysis:
Multivariable analysis was done in the study Separate regression models were used as a
data analysis tool. The prime reason behind it is that in Separate regression models independent
variable is partitioned into intervals and a separate line segment is fit to each interval which
further help to confirm whether OC is increased the risk of premenopausal breast cancer (Noble
& Smith, 2015). Ethics was taken into consideration in this study for avoiding illegal obligations
from participants. The main finding of the study is that the use of oral contraceptive pills was
associated with hormone receptor-positive premenopausal breast cancer if younger women used
for 5 years or more.
Conclusions, Implications, and Recommendations:
The strength of the study is that its prospective design, avoiding concerns of selection
and recall bias which is a major limitation for the case-control study. Moreover, it also provided
a reliable and detailed assessment of hormone use. However, the limitation of the study is that
the study failed to explore the potentials of other OC due to the limitation of availability of OC
contraceptive in the market (Aquino et al., 2016) Moreover, the study only included pre-
menopausal women. The homogeneity of the study also observed because it is typically based on
the women who lived in Norway. Therefore, it hinders the exploration of the study in another
region.
It is generalized or it has a potent impact on other population but further exploration
required for evaluating the effect of the study in pregnant women for reducing breast cancer.
The study is significant to nursing since the result help to identify the risk factors of
breast cancer in patients who are consuming oral contraceptive for five years or more than five

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years. Moreover, it is also relevant to nursing since the research help to design better the
management of breast cancer and prevention of breast cancer. Besides, it also provides the
opportunity to the nurses for exploring the effect of oral contraceptive pills for women who want
to get pregnant soon.

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References:
Aquino, E., Lee, Y. M., Spawn, N., & Bishop-Royse, J. (2018). The impact of burnout on
doctorate nursing faculty's intent to leave their academic position: A descriptive survey
research design. Nurse education today, 69, 35-40.
Busund, M., Bugge, N. S., Braaten, T., Waaseth, M., Rylander, C., & Lund, E. (2018). Progestin‐
only and combined oral contraceptives and receptor‐defined premenopausal breast cancer
risk: The Norwegian Women and Cancer Study. International journal of cancer, 142(11),
2293-2302.
Colditz, G. A. (2016). Nurses' Health Study: Demonstrating the impact of research, and adapting
new measures and approaches to increase relevance and effect of cohort studies.
Guo, J., Wei, W., & Zhan, L. (2015). Red and processed meat intake and risk of breast cancer: a
meta-analysis of prospective studies. Breast cancer research and treatment, 151(1), 191-
198.
Noble, H., & Smith, J. (2015). Issues of validity and reliability in qualitative research. Evidence-
Based Nursing, ebnurs-2015.
Reed, F. M., Fitzgerald, L., & Rae, M. (2016). Mixing methodology, nursing theory and research
design for a practice model of district nursing advocacy. Nurse Researcher
(2014+), 23(3), 37.
Shivappa, N., Blair, C. K., Prizment, A. E., Jacobs, D. R., & Hébert, J. R. (2017). Prospective
study of the dietary inflammatory index and risk of breast cancer in postmenopausal
women. Molecular nutrition & food research, 61(5), 1600592.

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