Hormonal contraceptive use and risk of pancreatic cancer—A cohort study among premenopausal women

Abstract

ImportanceThe association between the use of hormonal contraceptive and pancreatic cancer among premenopausal women has until now been unclear. This is the first study to investigate the risk of pancreatic cancer in pre-menopausal women.ObjectiveTo determine whether hormonal contraception increases the risk of developing pancreatic cancer in pre-menopausal women.DesignA nationwide prospective cohort study followed all women in Denmark in the age range of 15–49 years without previous cancer or venous thrombosis from 1995 to 2014. The Danish National Prescription Registry provided individually updated exposure information on use of hormonal contraception. The Danish Cancer Registry provided cancer diagnoses, and the Danish National Patient Register containing clinical diagnoses and surgical codes at discharge from public and private hospitals.SettingPopulation-based cohort study.ParticipantsAll women living in Denmark aged 15–49 years at January 1st, 1995, and those subsequently reaching age 15 years up to December 31st, 2014 were eligible for the study.ResultsAmong 1.9 million women who were followed on average for 11.4 years, 235 pancreatic cancers occurred. Compared to never users, ever users of any type of hormonal contraception had a relative risk (RR) of pancreatic cancer of 0.90 (95% confidence interval (CI) 0.68–1.19). No overall association between duration of hormonal contraceptive use and pancreatic cancer risk was found. Neither was long-term use of hormonal contraception associated with pancreas cancer, RR 0.83 (95% CI 0.47–1.50). The risk did not vary between users of combined and progestogen-only products. All models were adjusted for age, completed or ongoing education, polycystic ovary syndrome, endometriosis and among parous women; parity, age at first birth, smoking and body mass index.Conclusions and relevanceCompared to never users the risk of pancreatic cancer is not significantly higher among current and recent users of contemporary hormonal contraception and does not vary between users of combined and progestogen-only products. In conclusion, our study suggests no risk of pancreatic cancer with use of any type of hormonal contraception.

Reproductive Factors, Use of Exogenous Hormones, and Pancreatic Cancer Incidence: The Norwegian Women and Cancer Study

“…A previous meta-analysis by Tang et al and the study by Butt et al based on all premenopausal women in Denmark found no effect of OC use on pancreatic cancer incidence, which was supported by a recent prospective cohort study. 12 , 26 , 27 As our study sample consisted of women with a mean age of approximately 50 years at baseline, our study is not suitable for assessing the effects of current OC use in relation to pancreatic cancer incidence, as the prevalence of current use was very low.…”

“… 26 More recent prospective studies have mainly supported the finding of no association with use of OCs. 12 , 27 For MHT use, controversies exist, and inverse relationships between MHT use and pancreatic cancer risk have recently been reported. 8 , 19 , 22 Furthermore, one study has identified increased risk with increasing age at menarche.…”

Estradiol 17-β Induces Pancreatic Beta-Cell Proliferation through Distinct Estrogen Receptors in a Glucose Dependent Manner

“…Still, tamoxifen, which is currently recognized as a GPER agonist [16], is broadly used as first-line treatment for human breast cancer. While concerns could be raised that the proliferative estrogenic effects in the pancreas might affect the exocrine pancreas as well, the limited clinical and epidemiological information accrued thus far does not support this possibility [17][18][19].…”

Hormonelle Kontrazeption und Krebs

“…In einer aktuellen Metaanalyse und in der großen dänischen Kohortenstudie wurden keine Zusammenhänge zwischen hormoneller Kontrazeption und dem Risiko für ein Pankreaskarzinom gefunden [11,33]. In der finnischen Levonorgestrel-IUP-Kohortenstudie war das Pankreaskarzinomrisiko bei Anwenderinnen deutlich reduziert (SIR 0,5; 95 %-KI 0,28-0,81) [6].…”

“…In der finnischen Levonorgestrel-IUP-Kohortenstudie war das Pankreaskarzinomrisiko bei Anwenderinnen deutlich reduziert (SIR 0,5; 95 %-KI 0,28-0,81) [6]. Dies mag z. T. darauf zurückzuführen sein, dass die Anwenderinnen von Levonorgestrel-IUP sich in den nicht erfassten Confoundern (Rauchen, Alkohol, Adipositas) von der Vergleichsgruppe (Normalbevölkerung) unterschieden und für diese Parameter in der finnischen im Gegensatz zur dänischen Studie nicht korrigiert wurde [6,11].…”