Cancer Epidemiology, Biomarkers & Prevention : a Publication of the American Association for Cancer Research, Cosponsored by the American Society of Preventive Oncology, 19(10), 2496-2502, 2010
Oral contraceptive use and breast cancer: a prospective study of young women
David J Hunter, Graham A Colditz, Susan E Hankinson
Donna Spiegelman, Weixuan Chen, Walter C Willett , Susan Malspeis , Meir J Stampfer
Previous studies convincingly showed an increase in risk of breast cancer associated with current or recent use of oral contraceptives from the 1960s to 1980s. The relation of contemporary oral contraceptive formulations to breast cancer risk is less clear.
Methods
We assessed lifetime oral contraceptive use and the specific formulations used among 116,608 female nurses ages 25 to 42 years at enrollment in 1989, and subsequently updated this information every 2 years. We related this information to risk of breast cancer up to June 1, 2001.
Results
During 1,246,967 person-years of follow-up, 1,344 cases of invasive breast cancer were diagnosed. Past use of any oral contraceptive was not related to breast cancer risk [multivariate relative risk (RR), 1.12; 95% confidence interval 0.95-1.33]. Current use of any oral contraceptive was related to a marginally significant higher risk (multivariate RR, 1.33; 95% CI, 1.03-1.73). One specific formulation substantially accounted for the excess risk: the RR for current use of triphasic preparations with levonorgestrel as the progestin was 3.05 (95% CI, 2.00-4.66; P < 0.0001).
Conclusions
Current use of oral contraceptives carries an excess risk of breast cancer. Levonorgestrel used in triphasic preparations may account for much of this elevation in risk. IMPACT: Different oral contraceptive formulations might convey different risks of breast cancer; ongoing monitoring of these associations is necessary as oral contraceptive formulations change.
oral contraceptive breast cancer young women, OCP breast cancer prospective study, hormonal contraception breast cancer risk, premenopausal breast cancer oral contraceptive, birth control pill cancer risk young, estrogen progestin breast cancer, OCP duration breast cancer, contraceptive formulation cancer risk, breast cancer risk hormonal exposure, prospective cohort OCP cancer
PMID 20802021 20802021 DOI 10.1158/1055-9965.EPI-10-0747 10.1158/1055-9965.EPI-10-0747
Cite this article
Hunter, D. J., Colditz, G. A., Hankinson, S. E., Malspeis, S., Spiegelman, D., Chen, W., Stampfer, M. J., & Willett, W. C. (2010). Oral contraceptive use and breast cancer: a prospective study of young women. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology, 19(10), 2496-2502. https://doi.org/10.1158/1055-9965.EPI-10-0747
Hunter DJ, Colditz GA, Hankinson SE, Malspeis S, Spiegelman D, Chen W, et al. Oral contraceptive use and breast cancer: a prospective study of young women. Cancer Epidemiol Biomarkers Prev. 2010;19(10):2496-2502. doi:10.1158/1055-9965.EPI-10-0747
Hunter, D. J., et al. "Oral contraceptive use and breast cancer: a prospective study of young women." Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology, vol. 19, no. 10, 2010, pp. 2496-2502.
Rosenberg L et al., 2010·Cancer Epidemiol Biomarkers Prev
Oral contraceptive formulations have changed over time, making it relevant to assess the effect of more recent formulations on breast cancer risk. In addition, some studies have found stronger positive associations of oral contraceptive use with estrogen receptor-negative (ER(-)) than with ER-positive (ER(+)) breast cancer. We carried out the first assessment of the effect of oral contraceptive use on the incidence of breast cancer classified by receptor status among African American women, a group disproportionately affected by ER(-) cancer. We followed 53,848 Black Women's Health Study participants from 1995 to 2007 through biennial health questionnaires, in which participants reported information about incident breast cancer, oral contraceptive use, and breast cancer risk factors. Pathology information was obtained on receptor status for 789 incident cases. Incidence rate ratios (IRR) with 95% confidence intervals (95% CI) were derived from Cox regression models with control for confounding factors. Ever use of oral contraceptives was more strongly associated with ER(-)PR(-) breast cancer (279 cases; IRR, 1.65; 95% CI, 1.19-2.30) than with ER(+)PR(+) cancer (386 cases; IRR, 1.11; 95% CI, 0.86-1.42). The risk of ER(-)PR(-) breast cancer increased with increasing duration of use among recent users. These results indicate that the oral contraceptive formulations used in recent decades increase breast cancer risk in African American women, with a greater effect for ER(-) than ER(+) cancer. Mechanisms to explain the adverse influence of oral contraceptive use on ER(-) breast cancer need to be elucidated.
Contraception/ComparisonGeneral OB/GYNReproductive Endocrinology
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Contraception/ComparisonReproductive Endocrinology
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Contraception/ComparisonReproductive Endocrinology
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