Abstract
Results of previous epidemiologic studies have provided reassurance that there is little, if any, increase in risk of breast cancer with oral contraceptive (OC) use in general. However, in several studies, an increased risk of breast cancer has been observed in two subgroups, young women who used OCs for extended durations and in women who used OCs prior to a first-term pregnancy. We evaluated these relationships using data from the ongoing Nurses' Health Study cohort (United States). We documented 3,383 cases of breast cancer from 1976 to 1992 among 1.6 million person-years of follow-up. We observed no overall relationship between duration of OC use and breast cancer risk, even among women who reported using OCs for 10 or more years (multivariate relative risk [RR]=1.11, 95 percent confidence interval [CI]=0.94-1.32). Among women less than 45 years of age, the multivariate RR for using OCs for 10 or more years was 1.07 (CI=0.70-1.65) compared with never-users. The risk associated with five or more years of OC use prior to a first full-term pregnancy compared with never-use was 0.96 (CI=0.65-1.43). Among women less than 45 years of age, we observed no evidence of an increased risk with OC use before a first full-term pregnancy (use for five or more years: RR=0.57, CI=0.24-1.31). Because of the age distribution of our cohort, we were unable to evaluate these relationships among women less than 40 years of age. Our study provides considerable evidence that long-term past OC use, either overall or prior to a first full-term pregnancy, does not result in any appreciable increase in breast cancer risk in women over 40 years of age.
Similar content being viewed by others
References
American Cancer Society. Cancer Facts and Figures-1995. Atlanta, GA (USA): American Cancer Society, 1995.
Thomas DB. Oral contraceptives and breast cancer: Review of the epidemiologic literature. Contraception 1991; 43: 597–642.
Romieu I, Berlin JA, Colditz GA. Oral contraceptives and breast cancer: Review and meta-analysis. Cancer 1990; 66: 2253–63.
Malone KE, Daling JR, Weiss NS, et al. Oral contraceptives in relation to breast cancer. Epidemiol Rev 1993; 15: 80–97.
Brinton LA, Daling JR, Gammon MD, Hanson L, Hoover RN. Oral contraceptives and breast cancer risk among younger women. JNCI 1995; 87: 827–35.
White E, Malone KE, Weiss NS, Daling JR. Breast cancer among young U.S. women in relation to oral contraceptive use. JNCI 1994; 86: 505–14.
Rosenberg L, Palmer JR, Rao RS, et al. Case-control study of oral contraceptive use and risk of breast cancer. Am J Epidemiol 1996; 143: 25–37.
Collaborative Group on Hormonal Factors in Breast Cancer. Breast cancer and hormonal contraceptives: collaborative reanalysis of individual data on 53,297 women with breast cancer and 100,239 women without breast cancer from 54 epidemiological studies. Lancet 1996; 347: 1713–27.
Romieu I, Willett WC, Colditz GA, et al. Prospective study of oral contraceptive use and risk of breast cancer in women. JNCI 1989; 81: 1313–21.
Colditz GA, Stampfer MJ, Willett WC, et al. Reproduci-bility and validity of self-reported menopausal status in a prospective cohort of women. Am J Epidemiol 1987; 126: 319–25.
Willett WC, Sampson L, Stampfer MJ, et al. Reproducibil-ity and validity of a semiquantitative food frequency questionnaire. Am J Epidemiol 1985; 122: 51–65.
Willett W, Sampson L, Browne ML, et al. The use of a self-administered questionnaire to assess diet four years in the past. Am J Epidemiol 1988; 127: 188–99.
Giovannucci E, Colditz GA, Stampfer MJ, et al. The assessment of alcohol consumption by a simple self-admin-istered questionnaire. Am J Epidemiol 1991; 133: 810–7.
Stampfer MJ, Willett WC, Speizer FE, et al. Test of the National Death Index. Am J Epidemiol 1984; 119: 837–9.
Rich-Edwards JW, Corsano KA, Stampfer MJ. Test of the National Death Index and Equifax Nationwide Death Search. Am J Epidemiol 1994; 140: 1016–9.
Miettinen O. Estimability and estimation in case-referent studies. Am J Epidemiol 1976; 103: 226–35.
Kleinbaum DG, Kupper LL, Morgenstern H. Epidemiologic Research: Principles and Quantitative Methods. Belmont, CA (USA): Lifetime Learning, 1982.
Cox DR. Regression models and life-tables. J R Stat Soc 1972; 32: 187–220.
D'Agostino RB, Lee ML, Belanger AJ, Cupples LA, Anderson K, Kannel WB. Relation of pooled logistic regression to time dependent Cox regression analysis: The Framingham Heart Study. Stat Med 1990; 9: 1501–15.
Hankinson SE, Colditz GA, Hunter DJ, et al. A prospective study of reproductive factors and risk of epithelial ovarian cancer. Cancer 1995; 76: 284–90.
Stampfer MJ, Goldhaber SZ, Manson JE, et al. A prospec-tive study of exogenous hormones and risk of pulmonary embolism in women [Abstract]. Circulation 1992; 86(Suppl 1): 2689.
Harris JR, Lippman ME, Veronsei U, Willett WC. Breast cancer. N Engl J Med (3 parts) 1992; 327: 319–28, 390–8, 473–80.
Anderson TJ, Battersby S, King RJB, McPherson K, Going JJ. Oral contraceptive use influences resting breast prolif-eration. Hum Pathol 1989; 20: 1139–44.
Williams G, Anderson E, Howell A, et al. Oral contracep-tive (OCP) use increases proliferation and decreases oestrogen receptor content of epithelial cells in the normal human breast. Int J Cancer 1991; 48: 206–10.
Anderson TJ, Battersby S, King RJB, McPherson K. Breast epithelial responses and steroid receptors during oral con-traceptive use. In: Mann RD, ed. Oral Contraceptives and Breast Cancer. ParkRidge, New Jersey (USA): Parthenon Publishing Group,1990.
Institute of Medicine. Oral Contraceptives and Breast Cancer. Washington DC: National Academy Press, 1991.
Selby C. Sex hormone binding globulin: origin, function and clinical significance. Ann Clin Biochem 1990; 27: 532–41.
Annegers JF. Patterns of oral contraceptive use in the United States. Br J Rheumatology 1989; 28: 48–50.
Piper JM, Kennedy DL. Oral contraceptives in the United States: Trends in content and potency. Int J Epidemiol 1987; 16: 215–21.
Rookus MA, van Leeuwen FE, for the Netherlands Oral Contraceptives and Breast Cancer Study Group. Oral contraceptives and risk of breast cancer in women aged 20–54 years. Lancet 1994; 344: 844–51.
Ewertz M. Oral contraceptives and breast cancer risk in Denmark. Eur J Cancer 1992; 28A: 1176–81.
Vessey MP. Results from the Oxford-Family Planning Association Study. In: Mann, RD, ed. Oral Contraceptives and Breast Cancer. Park Ridge, NJ (USA): Parthenon Pub-lishing Group, 1990; 271–84.
Vessey MP, McPherson K, Villard-Mackintosh L, Yeates D. Oral contraceptives and breast cancer: latest finding in a large cohort study. Br J Cancer 1989; 59: 613–7.
Kay CR, Hannaford PC. Breast cancer and the pill-A further report from the Royal College of General Practi-tioners' oral contraceptive study. Br J Cancer 1988; 58: 675–80.
UK National Case-Control Study Group. Oral contracep-tive use and breast cancer risk in young women. Lancet 1989; i: 973–82.
McPherson K, Vessey MP, Neil A, Doll R, Jones L, Roberts M. Early oral contraceptive use and breast cancer: results of another case-control study. Br J Cancer 1987; 56: 653–60.
Skegg DCG. Potential bias in case-control studies of oral contraceptives and breast cancer. Am J Epidemiol 1988; 127: 205–12.
Paul C, Skegg DCG, Spears GFS. Oral contraceptives and risk of breast cancer. Int J Cancer 1990; 46: 366–73.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Hankinson, S.E., Colditz, G.A., Manson, J.E. et al. A prospective study of oral contraceptive use and risk of breast cancer (Nurses' Health Study, United States). Cancer Causes Control 8, 65–72 (1997). https://doi.org/10.1023/A:1018435205695
Issue Date:
DOI: https://doi.org/10.1023/A:1018435205695