Cumulative use of estrogen-containing or combined hormonal contraception (combined oral c...

Детермінований перегляд YAML-сутності з джерельної бази. Клінічний авторитет лишається за вказаними source ID та статусом клінічного sign-off.

ID	`RF-IATROGENIC-LONG-TERM-HRMNL-CONTRACEPTION-PREVENTION`
Тип	Тривожна ознака
Статус	переглянуто 2026-05-18 \| очікує клінічного підпису
Хвороби	`DIS-BREAST` `DIS-CERVICAL`
Джерела	`SRC-NCCN-BREAST-2025` `SRC-NCCN-CERVICAL-2025` `SRC-USPSTF-BREAST-2024` `SRC-USPSTF-CERVICAL-2018`

Походження тривожної ознаки

Визначення	Cumulative use of estrogen-containing or combined hormonal contraception (combined oral contraceptive, combined patch, combined vaginal ring) ≥10 years — IARC Group 1 carcinogen (estrogen-progestogen combined oral contraceptives). Modest, small-magnitude relative-risk elevation: breast cancer +1.2-1.3x during current/recent use (effect attenuates within 10 years of stopping; population-level absolute increment ~13 extra cases per 100,000 woman-years for ages 35-39); cervical cancer +1.5-2.0x at ≥5y use among high-risk HPV-positive cohort (mechanism: probable co-factor for HPV persistence + cervical squamous-cell carcinoma progression). NOTE: this iatrogenic-persona RF is intentionally distinct from RF-REPRODUCTIVE-OCP-LONG-TERM, which carries the BALANCED risk-benefit counseling framing (substantial ovarian + endometrial protection lifelong). The iatrogenic-persona view focuses on the e...
Клінічний напрям	investigate
Категорія	other

Логіка спрацьовування

{
  "any_of": [
    {
      "finding": "cumulative_hormonal_contraception_ge_10y",
      "value": true
    },
    {
      "finding": "prior_hormonal_contraception_ge_10y_off_now",
      "value": true
    },
    {
      "finding": "current_hormonal_contraception_ge_10y_with_hpv_positive",
      "value": true
    }
  ],
  "type": "lab_value"
}

Нотатки

Prevention-persona RedFlag for cumulative hormonal-contraception exposure ≥10y, iatrogenic-axis only (exposure-as-risk). Engine routes to PreventionPlan recommending HPV co-test on schedule per ASCCP / USPSTF, age-appropriate mammographic screening per USPSTF, attentive symptom history (breast lump, abnormal bleeding). Severity minor — absolute risk increment small, effect on breast cancer attenuates after stop. Distinct from RF-REPRODUCTIVE-OCP-LONG-TERM (balanced risk-benefit counseling, see §20 reproductive bucket). STUB pending two-Clinical-Co-Lead signoff per CHARTER §6.1 dev-mode.

Де використовується

Indications

IND-IATROGENIC-LONG-TERM-HRMNL-CONTRACEPTION-PREVENTION-OBSERVATION - IND-IATROGENIC-LONG-TERM-HRMNL-CONTRACEPTION-PREVENTION-OBSERVATION
IND-IATROGENIC-LONG-TERM-HRMNL-CONTRACEPTION-PREVENTION-SURVEILLANCE - IND-IATROGENIC-LONG-TERM-HRMNL-CONTRACEPTION-PREVENTION-SURVEILLANCE