Postscript: starting oral contraceptives (25 May, page 41)

In our article on oral contraceptives (OCs) we state that ‘oral contraceptives increase the risk of breast cancer with long-term use but reduce the risk of endometrial and ovarian cancer’. Some commentators have questioned the breast cancer risk. The UK National Case-Control (UKNCC) study, which looked at oral contraceptive use in women with breast cancer diagnosed before age 36, found a trend for increased risk associated with duration of use.1 ‘The simplest and most plausible explanation’, say the authors of the study, ‘must be that there is a substantial causal relation between prolonged use and breast cancer in young women.’ The increased risk seems to be associated particularly with OC use before the first full-term pregnancy.2 Several studies found no excess risk in OC users aged 45 or over, few of whom had taken the pill before their first pregnancy.3–5 In the UKNCC study the relative risk of breast cancer was 1.43 after 4–8 years’ use and 1.74 after more than 8 years’ use. In broad terms this means that three women in 1000 who use oral contraceptives for 4 or more years might be expected to be under treatment for breast cancer by age 36, compared with two per 1000 non-users.

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The risk of breast, cervical, endometrial and ovarian cancer in oral contraceptive users

Medicinski pregled ◽

10.2298/mpns1010657v ◽

2010 ◽

Vol 63 (9-10) ◽

pp. 657-661 ◽

Cited By ~ 5

Author(s):

Milena Veljkovic ◽

Slavimir Veljkovic

Keyword(s):

Breast Cancer ◽

Ovarian Cancer ◽

Cervical Cancer ◽

Oral Contraceptive ◽

Oral Contraceptives ◽

Young Women ◽

Contraceptive Use ◽

Epidemiologic Studies ◽

Oral Contraceptive Use ◽

Increased Risk

Introduction. Oral contraceptives, mainly combined monophasic pills, are widely used by young women who expect their physicians to prescribe them safe drugs which will not harm their health and which will simplify their life. Numerous epidemiologic studies have been performed to determine the relation between oral contraceptive use and the development of neoplasms. Breast cancer. An increased incidence of breast cancer has occurred simultaneously with the growing use of oral contraceptives. The possibility of a link between the oral contraceptive use and breast cancer has led to intensive research, but studies have provided inconsistent results causing confusion among clinicians. It was noticed that the risk of breast cancer was slightly elevated in current and recent young oral contraceptives users. That finding could be influenced by a detection bias or could be due to the biologic effect of the pills. The absolute number of additional breast cancer cases will be very small because of low baseline incidence of the disease in young women. Oral contraceptives probably promote growth of the already existing cancer, they are probably promoters not initiators of breast cancer. The available data do not provide a conclusive answer that is need. Cervical cancer. Numerous factors may influence the development of cervical cancer. The evidence suggests that current and recent oral contraceptive users have an increased risk of cervical cancer which decline after discontinuation of the application of medication. Oral contraceptives might increase the biological vulnerability of the cervix. Cervical cancer develops slowly over a long time period and can be effectively prevented by periodic cervical screening. Fortunately, oral contraceptives do not mask abnormal cervical citology. Conclusions regarding invasive cervical cancer and oral contraceptive use are not definitive but if there is any increased risk, it is low. Endometrial cancer. In oral contraceptive users the endometrium is almost under the influence of progestin component which suppresses endometrial mitotic activity and its proliferation. Most epidemiologic studies show that oral contraceptives reduce the risk of endometrial cancer and that this protective effect exists many years after the discontinuation of medication. Ovarian cancer. It has been long known that the oral contraceptive use causes protective an ovulation and reduces the risk of ovarian cancer. This powerful reduction is the best demonstrated major benefit of oral contraception. This protection is especially observed in nulliparous and seems to persist for many years after the discontinuation of medication.

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Use of Oral Contraceptives as a Potential Risk Factor for Breast Cancer: A Systematic Review and Meta-Analysis of Case-Control Studies Up to 2010

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18094638 ◽

2021 ◽

Vol 18 (9) ◽

pp. 4638

Author(s):

Wiesław Kanadys ◽

Agnieszka Barańska ◽

Maria Malm ◽

Agata Błaszczuk ◽

Małgorzata Polz-Dacewicz ◽

...

Keyword(s):

Breast Cancer ◽

Systematic Review ◽

Oral Contraceptives ◽

Meta Analysis ◽

Case Control ◽

Full Term ◽

Term Pregnancy ◽

Case Control Studies ◽

Nulliparous Women ◽

Increased Risk

Despite numerous studies evaluating the risk of breast cancer among oral contraception users, the effect of oral contraceptive on developing breast cancer remains inconclusive. Therefore, we conducted a systematic review of literature with meta-analysis in order to quantitative estimate this association. The bibliographic database MEDLINE and EMBASE, and reference lists of identified articles were searched, with no language restrictions, from the start of publication to August 2010. We performed a reanalysis and overall estimate of 79 case-control studies conducted between 1960–2010, including a total of 72,030 incidents, histologically confirmed cases of breast cancer and 123,650 population/hospital controls. A decrease was observed in cancer risk in OC users before age 25 years (0.91, 0.83–1.00). However, the use of OCs before the first full-term pregnancy had a significant increased risk of breast cancer (OR, 1.14, 1.01–1.28, p = 0.04), as did OC use longer than 5 years (1.09, 1.01–1.18, p = 0.02). Pooled crude odds ratios of breast cancer in ever-users of oral contraceptives was 1.01 [95% confidence interval (CI), 0.95–1.07], compared with never-users. There was no significant increase in risk among premenopausal women (1.06, 0.92–1.22), postmenopausal women (0.99, 0.89–1.10), or nulliparous women (1.02, 0.82–1.26). Oral contraceptives do not appear to increase the risk of breast cancer among users. However, OC use before a first full-term pregnancy or using them longer than 5 years can modify the development of the breast cancer.

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Oral contraceptive use and abortion before first term pregnancy in relation to breast cancer risk

British Journal of Cancer ◽

10.1038/bjc.1982.58 ◽

1982 ◽

Vol 45 (3) ◽

pp. 327-331 ◽

Cited By ~ 75

Author(s):

M P Vessey ◽

K McPherson ◽

D Yeates ◽

R Doll

Keyword(s):

Breast Cancer ◽

Oral Contraceptive ◽

Breast Cancer Risk ◽

Cancer Risk ◽

Contraceptive Use ◽

Term Pregnancy ◽

Oral Contraceptive Use

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The use of oral contraceptives in women over age 35 years

Reproductive Medicine Review ◽

10.1017/s0962279900001113 ◽

1995 ◽

Vol 4 (2) ◽

pp. 115-120

Author(s):

Robert F Casper ◽

Selim Senoz ◽

Avraham Ben-Chetrit

Keyword(s):

Cardiovascular Disease ◽

Oral Contraceptive ◽

Oral Contraceptives ◽

Contraceptive Use ◽

Older Woman ◽

Oral Contraceptive Use ◽

Increased Risk ◽

Potential Risks ◽

Europe Today ◽

The Impact

Oral contraceptives remain the most widely used form of contraception in North America and Europe today. In spite of the concerns of many women relating to the potential risks of these preparations, recent data have demonstrated that currently available oral contraceptives are safe, with no increased risk of cardiovascular disease or cancer in nonsmoking women. The present review will focus on the impact of oral contraceptive use in the older woman, including a discussion of the noncontraceptive health benefits of oral contraceptives.

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