OBJECTIVE
To perform a meta-analysis of case-control studies that addressed whether prior oral
contraceptive (OC) use is associated with premenopausal breast cancer.
METHODS
We searched the MEDLINE and PubMed databases and bibliography reviews to identify
case-control studies of OCs and premenopausal breast cancer published in or after
1980. Search terms used included breast neoplasms, oral contraceptives, contraceptive agents, and case-control studies. Studies reported in all languages were included. Thirty-four studies were identified
that met inclusion criteria. Two reviewers extracted data from original research articles
or additional data provided by study authors. We used the DerSimonian-Laird method
to compute pooled odds ratios (ORs) and confidence intervals (CIs) and the Mantel-Haenszel
test to assess association between OC use and cancer.
RESULTS
Use of OCs was associated with an increased risk of premenopausal breast cancer in
general (OR, 1.19; 95% CI, 1.09-1.29) and across various patterns of OC use. Among
studies that provided data on nulliparous and parous women separately, OC use was
associated with breast cancer risk in both parous (OR, 1.29; 95% CI, 1.20-1.40) and
nulliparous (OR, 1.24; 95% CI, 0.92-1.67) women. Longer duration of use did not substantially
alter risk in nulliparous women (OR, 1.29; 95% CI, 0.85-1.96). Among parous women,
the association was stronger when OCs were used before first full-term pregnancy (FFTP)
(OR, 1.44; 95% CI, 1.28-1.62) than after FFTP (OR, 1.15; 95% CI, 1.06-1.26). The association
between OC use and breast cancer risk was greatest for parous women who used OCs 4
or more years before FFTP (OR, 1.52; 95% CI, 1.26-1.82).
CONCLUSION
Use of OCs is associated with an increased risk of premenopausal breast cancer, especially
with use before FFTP in parous women.
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Article Info
Footnotes
This work was supported in part by grant K07-CA80668 from the National Institutes of Health (F.M.).
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© 2006 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
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- Oral Contraceptive Use and Breast Cancer Risk: Current StatusMayo Clinic ProceedingsVol. 81Issue 10
- PreviewOne might have thought that the issue of whether oral contraceptives (OCs) are associated with breast cancer risk would have been settled by now, given that these agents were introduced in the early 1960s and more than 60 case-control and 10 cohort studies, several meta-analyses,1–4 a very large pooled analysis,5 and a major monograph6 have addressed this issue. On the basis of the accumulated data, the International Agency for Research on Cancer (IARC) classified oral estrogen-progestogen contraceptives as carcinogenic to humans (group 1 carcinogen) in 2005, which is a higher classification than the 1999 IARC evaluation.
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