Next Gen in 10: How Birth Control Choices Are Changing and Why It Matters for Cancer

Join us on this episode of Next Gen in 10 as Sabrina sits down with Alice Mei, an undergraduate neuroscience student at UBC 🧠. Alice shares her research on contraceptive use patterns in British Columbia and explores how these trends may relate to ovarian cancer risk 🎗️. From surprising shifts in birth control choices to the challenges of working with large population-based data 📊, this episode dives into the science, insights, and real-world implications of her findings. Whether you’re curious about reproductive health, cancer research, or the next generation of scientists, this conversation is full of valuable takeaways! 

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Transcript

00:00:02 Intro 

Thanks for listening to the GOSH podcast—The Gynecologic Oncology Sharing Hub. We share real, evidence-based discussions on gynecologic cancers, featuring stories from patients, survivors, researchers, and clinicians. Our podcast is produced and recorded on traditional unceded territories of the Musqueam, Squamish, and Tsleil-Waututh Nations. It is produced by the Gynecologic Cancer Initiative, a BC-wide effort to advance research and care for gynecologic cancers.   

00:00:35 Sabrina 

Hi everyone! My name is Sabrina, and I would like to welcome you back to our new segment on the GOSH Podcast called Next Gen in 10 where we feature GCI trainee research. Today we are joined by Alice who is an undergraduate student in Neuroscience at UBC. Under the supervision of Dr. Gillian Hanley, her research examines contraceptive trends and their relationship to ovarian cancer. She focuses on understanding contraceptive use patterns in British Columbia and their potential impacts on cancer outcomes. Her projects have been supported by the VCHRI SPARKS Award and the UBC Faculty of Medicine SSRP Award. Welcome Alice! 

00:01:20 Alice 

Thank you so much for the introduction. It's really exciting to be here with you today. 

00:01:26 Sabrina 

So could you give us a bit of background on your research topic and maybe the gap that your research aims to fill? 

00:01:33 Alice 

Yeah, so currently in Canada, there's a huge variety on contraceptive methods that women can choose from, and these methods can vary in their levels of invasiveness and the ability for it to be reversed in a lifetime. So two of the most common forms of reversible contraception are the combined oral contraceptive, which is commonly known as the pill. And the second one is called an intrauterine device, which is also known as an IUD. So intrauterine devices come in two forms, where the first one is copper and the 2nd is levonorgestrel. So levonorgestrel is a synthetic progesterone hormonal IUD and I'll be referring to it today as the LNG IUD. And then in terms of irreversible contraception, we would be talking about tubal ligation, which is the tying of the fallopian tubes, and bilateral salpingectomy, which would be like the surgical removal of both fallopian tubes. And when we're looking at contraceptive use, two really important outcomes are pregnancy planning, of course, but also cancer risk and protective factors for cancers like breast, ovarian, endometrial, and colorectal. 

00:02:48 Sabrina 

Super interesting. Yeah, that's a great background to bring everyone up to speed on what you're doing. Could you tell us the overarching research question that you guys are asking or what your objectives are? 

00:03:02 Alice 

Yeah. So in this project, we wanted to look at the changes of various contraceptives over the time period of 2001 to 2021 in British Columbia. And then we also wanted to look at these effects and talk about what kind of effects we would see on cancer outcomes because of these changes. 

00:03:22 Sabrina 

Very interesting. And how did you go about doing this? Or what were your methods? 

00:03:26 Alice 

Yeah, so we used really large population-based data from British Columbia, and we created these annual cohorts of women who were aged 15 to 55 in BC. And so the things that we were looking to measure were if they had used any form of contraception. And this could look like filling a prescription for the pill or any surgical records for those irreversible ones that I was talking about, and even like the insertions of contraceptive devices like the IUD or something like the patch. And then in particular, something interesting about this project was that we were looking to measure IUD use in two different ways because the first way was that we would measure just the incidence, which is the number of new insertions that were happening every year. But we realized that this might not be fully covering all the individuals who are using it in a year. So then we decided to estimate the number of users in a year by calculating and summing up the new insertions over the past five years. And we did this because we're assuming that everyone who had had it inserted was keeping their IUD for five years, making them users for the continuing years. 

00:04:37 Sabrina 

Interesting. Yeah, that makes lots of sense. And what have you found? What have your findings suggested so far? And have you found anything significant? 

00:04:47 Alice 

Yeah, super interesting. So in this project, we found that from 2001 to 2021, the oral contraceptive use decreased from around 16% of the total population to 11.5% of the population. And then at the same time, we're seeing that big increase in LNG IUD use since it was introduced in 2001. So prevalence increased over the time period of up to 10% in 2001, which is also a really big change. Also something that I thought was super interesting was that when we were looking at that median age of LNG/IUD users, the median age decreased from 36 to 32 years old over the time period. And so this shift from like oral contraceptive users to LNG-IUD users has really big impacts on cancer outcomes because we know like over a long period of time that oral contraceptive decreases ovarian cancer risk by around 40%, but it's still so unknown for the LNG-IUD because it's so new. And then the second part of our project was about those irreversible contraceptive methods that I was talking about. And we saw an overall decrease in these surgical records, like how many people are having these surgeries. But when we looked at tubal ligation and bilateral salpingectomy separately, we saw that the decrease, like that overall decrease, is characterized by an increase in bilateral salpingectomy and an even larger decrease in tubal ligation. So this is important when we're talking about ovarian cancer risk because tubal ligation decreases ovarian cancer risk by 13%, but bilateral salpingectomy decreases it by almost 80%. So even though we're seeing that increase in bilateral salpingectomy, if irreversible contraception in general continues to decrease in popularity, we might be missing that kind of opportunity for ovarian cancer prevention. 

00:06:41 Sabrina 

Interesting. Yeah, I think both of those points are super important findings from your study and I think we'll have to follow up later to see how these trends continue to change. How was that the project as a whole using these large population data sets? What was it like working with all of that data as a student and did you find anything particularly challenging? 

00:07:06 Alice 

Yeah, so I started this project coming out of my first year of my undergrad. So I was super new to working with these population-based data sets. But I was really lucky to have worked with Dr. Elena Abreo-Doval in Dr. Gillian Hanley's lab, who was super experienced in working with this raw data and running statistical analyses. And I don't see it necessarily as a challenge, but something that I thought was super eye-opening was that getting engaged in research for the first time, I was realizing how important these data analysis skills were in healthcare research, because it was so different from the things I was learning in class, like neuroscience and anatomy. So kind of broadening that my understanding of what research looks like and also it really developed my interest in learning how to work with data and how to run statistical analyses to understand these like larger scale healthcare changes. 

00:08:02 Sabrina 

Yeah and definitely some transferable skills you've developed there that you can bring to multiple different facets of research. So yeah your study touched on contraceptive trends and how they relate to cancer risk. And you just went over some of the big points. Is there anything else that you think is important takeaways for patients or healthcare providers from your findings overall? 

00:08:27 Alice 

Yeah, so I would say the biggest takeaway that I feel strongly about is the need for more individualized contraception care, because on top of the cancer risk and protective factors that I was talking about earlier, there are just so many ways that contraceptive use can affect individuals differently, like their mental health or even personal preferences for like levels of invasiveness that you're willing to willing to use. So I think an important note for healthcare providers is to consider individualized contraceptive needs and avoid that kind of one size fits all attitude. 

00:09:05 Sabrina 

Yeah, I think, I mean, that can also go to patients when they go for contraceptive counseling to advocate for lots of different things to be considered and what is important to them to be considered as well. Okay, so we want to wrap up this episode, as we do with all of our Next Gen in 10 episodes, by asking you if you could only say one thing to everyone who will listen to this podcast about your field of research, what would you say? 

00:09:34 Alice 

I would recommend looking at contraceptive use as a lot more than just pregnancy prevention, because it's also about so many broader health care outcomes, like mental health, cancer risk, and protective factors. And so understanding all these different components of choices that we make for ourselves and for our health will make us better informed on what kind of contraceptive is really the best choice for us. 

00:10:00 Sabrina 

Fantastic. I think that's a great takeaway. And anyone listening to this podcast can start to think about that a little bit more in their lives. Well, thank you so much for coming on the podcast today, Alice, and sharing all of your research with all of our listeners. 

00:10:14 Alice 

Thank you so much for having me. 

00:10:18 Outro 

Thanks for joining us on the GOSH Podcast. To learn more about the Gynecologic Cancer Initiative and our podcast, make sure to check out our website at gynecancerinitiative.ca.