Long-term combined oral contraceptive use (≥10 cumulative years). Mixed cancer risk profi...

Deterministic view of the source YAML entity. Clinical authority remains with the cited source IDs and reviewer sign-off state.

ID	`RF-REPRODUCTIVE-OCP-LONG-TERM`
Type	Red flag
Status	reviewed 2026-05-18 \| pending_clinical_signoff
Diseases	`DIS-BREAST` `DIS-CERVICAL` `DIS-ENDOMETRIAL` `DIS-OVARIAN`
Sources	`SRC-NCCN-BREAST-2025` `SRC-NCCN-CERVICAL-2025` `SRC-NCCN-OVARIAN-2025` `SRC-NCCN-UTERINE-2025`

Red Flag Origin

Definition	Long-term combined oral contraceptive use (≥10 cumulative years). Mixed cancer risk profile per IARC Monograph 100A + Collaborative Group on Hormonal Factors in Breast Cancer + IARC reviews: - Modest BREAST cancer risk increase during current use + ~5y post- cessation (RR ~1.08-1.20; effect declines after cessation, baseline risk restored ~10y post-cessation). - Modest CERVICAL cancer risk increase with long-term use in HPV- positive women (RR ~1.5 at ≥5y use; effect attenuates post-cessation). HPV is the necessary cofactor. - SUBSTANTIAL PROTECTION against OVARIAN cancer (~50% reduction at ≥5y use, durable for ≥30y post-cessation). - SUBSTANTIAL PROTECTION against ENDOMETRIAL cancer (~50% reduction at ≥5y use, durable post-cessation). - Modest CRC protective association (less robust). Net cancer balance is favorable for most users. Prevention-persona RedFlag triggers a COUNSELING-BALAN...
Clinical direction	investigate
Category	other

Trigger Logic

{
  "any_of": [
    {
      "finding": "combined_ocp_use_ge_10_years",
      "value": true
    },
    {
      "finding": "combined_ocp_current_long_term_use",
      "value": true
    }
  ],
  "type": "lab_value"
}

Notes

Prevention-persona RedFlag for long-term combined OCP use ≥10y. Mixed cancer profile — modest risk increase (breast, cervical-with-HPV) AND substantial protection (ovarian, endometrial). Engine routes to PreventionPlan recommending COUNSELING-BALANCE indication, not unidirectional risk warning. Critical that render layer present full risk-benefit panel. STUB pending two-Clinical-Co-Lead signoff per CHARTER §6.1 dev-mode.

Used By

Indications

IND-IATROGENIC-LONG-TERM-HRMNL-CONTRACEPTION-PREVENTION-SURVEILLANCE - IND-IATROGENIC-LONG-TERM-HRMNL-CONTRACEPTION-PREVENTION-SURVEILLANCE
IND-REPRODUCTIVE-OCP-LONG-TERM-COUNSELING - IND-REPRODUCTIVE-OCP-LONG-TERM-COUNSELING
IND-REPRODUCTIVE-OCP-LONG-TERM-OBSERVATION - IND-REPRODUCTIVE-OCP-LONG-TERM-OBSERVATION

Red flag

RF-IATROGENIC-LONG-TERM-HRMNL-CONTRACEPTION-PREVENTION - Cumulative use of estrogen-containing or combined hormonal contraception (combined oral c...