General Gynecology Breast Health

A case-control study of oral contraceptive use and incident breast cancer

Rosenberg L, Zhang Y, Coogan PF, Strom BL, Palmer JR

Published February 15, 2009 American Journal of Epidemiology, 169(4), 473-479
DOI 10.1093/aje/kwn360 PMID 19074777 PMC PMC2726644

RRM Academy Synopsis

Oral contraceptive use tied to higher breast cancer odds in a US study

Women who had used oral contraceptives for a year or more had higher breast cancer odds (odds ratio 1.5, 95% confidence interval 1.2 to 1.8, against under 1 year of use). This US hospital-based case-control study compared 907 women with invasive breast cancer and 1,711 controls interviewed from 1993 to 2007.

Key Findings

  • Compared with under 1 year of use, 1 year or more of oral contraceptive use gave a multivariable odds ratio of 1.5 (95% CI: 1.2, 1.8) for invasive breast cancer.
  • Across four duration categories, odds ratios ranged from 1.3 (95% CI: 1.0, 1.6) for 1 to 4 years of use to 1.9 (95% CI: 1.4, 2.7) for 10 to 14 years.
  • Under age 50 years, the odds ratio for 1 year or more of use versus under 1 year was 1.6 (95% CI: 1.2, 2.0); at age 50 years or more, 1.4.
  • At 1 year or more of use, the odds ratio was 1.8 (95% CI: 1.2, 2.6) in black women and 1.4 (95% CI: 1.1, 1.7) in white women (interaction P = 0.23).
  • In 571 cases, 1 year or more of use gave odds ratios of 1.7 (95% CI: 1.3, 2.2) for estrogen receptor-positive and 1.7 (95% CI: 1.2, 2.3) for estrogen receptor-negative tumors.

Interpretation

This case-control study compared past oral contraceptive use in women with invasive breast cancer against women admitted to hospital for conditions judged unrelated to the medication. The women were black or white, aged 25 to 69 years, from hospitals in three US cities. The authors note that mammography data were unavailable for some participants. The findings support larger studies of oral contraceptive use and breast cancer risk.

RRM Context

Oral contraceptives are suppressive medications, while RRM looks for the cause of a menstrual problem. Contraception was the stated reason for 96% of use, and others gave menstrual problems, cycle regulation or endometriosis.

Abstract

Oral contraceptive (OC) use has been linked to increased risk of breast cancer, largely on the basis of studies conducted before 1990. In the Case-Control Surveillance Study, a US hospital-based case-control study of medication use and cancer, the authors assessed the relation of OC use to breast cancer risk among 907 case women with incident invasive breast cancer (731 white, 176 black) and 1,711 controls (1,152 white, 559 black) interviewed from 1993 to 2007. They evaluated whether the association differed by ethnicity or tumor hormone receptor status. After control for breast cancer risk factors, the multivariable odds ratio for 1 year or more of OC use, relative to less than 1 year of use, was 1.5 (95% confidence interval: 1.2, 1.8). The estimates were similar within age strata (<50 years and >or= 50 years). The odds ratios were larger for use within the previous 10 years, long-duration use, and black ethnicity, but these differences were not statistically significant. The association of OC use with breast cancer risk did not differ according to the estrogen or progestogen receptor status of the tumor. These results suggest that OC use is associated with an increased risk of breast cancer diagnosed in recent years.

Topics

By this author

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General Gynecology › Breast Health › Breast Cancer Risk · Contraception › Oral Contraceptives › Cancer Risk
Lynn Rosenberg, Yuqing Zhang, Patricia F Coogan, Brian L Strom, Julie R Palmer
L Rosenberg, Y Zhang, Pat Coogan, Trish Coogan, P Coogan, B Strom, J Palmer
PMID 19074777 19074777 DOI 10.1093/aje/kwn360 10.1093/aje/kwn360 Rosenberg et al. 2009, Rosenberg 2009