Liver tumours.
Level 5 - mechanism / opinion, no new human data
Narrative review of historical observational data and expert clinical commentary without systematic review methodology.
PubMed 2841989 · doi:10.1016/0950-3528(88)90014-0
What was done
This narrative review examined clinical and epidemiological data on drug-induced liver neoplasms, focusing on oral contraceptives, anabolic-androgenic steroids, and thorium dioxide.
What was found
Oral contraceptive use was associated with an estimated annual incidence of liver cell adenoma in the US of 3.4 per 100,000 users (~288 cases/year), with only a few hundred cases documented globally over 30 years. Case-control studies cited relative risks of 7.2–20.1 for liver cell carcinoma in oral contraceptive users, though overall risk remains low, and no link was found with focal nodular hyperplasia. Anabolic-androgenic steroids were linked to peliosis and benign adenomas rather than carcinomas. Thorium dioxide was confirmed to cause angiosarcoma, liver cell carcinoma, and bile duct carcinoma in tens of thousands of exposed patients. Because sex steroids induce vascular changes that heighten the risk of rupture and life-threatening intraperitoneal hemorrhage, surgical resection of resulting liver tumors was recommended.
Why it matters
It emphasizes that despite low overall oncogenic incidence from sex steroids, the vascular fragility of induced hepatic adenomas necessitates proactive surgical intervention to prevent fatal rupture.
Limits
The abstract describes a 1988 narrative review without systematic search or formal study quality appraisal. Total study count and precise cohort characteristics are not specified.
Cited by
- context High-dose or long-term anabolic steroid use can lead to the formation of large hepatic cysts or vascular lesions that can rupture and cause severe internal hemorrhage.