Oral Contraceptives and Survival in Breast Cancer Patients Aged 20 to 54 Years

Trivers, Katrina F.; Gammon, Marilie D.; Abrahamson, Page E.; Lund, Mary Jo; Flagg, Elaine W.; Moorman, Patricia G.; Kaufman, Jay S.; Cai, Jianwen; Porter, Peggy L.; Brinton, Louise A.; Eley, J. William; Coates, Ralph J.

doi:10.1158/1055-9965.epi-07-0053

Cited by 20 publications

(20 citation statements)

References 35 publications

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“…However, none of these studies observed a clear dose-response effect for duration of use, age at first use or years between last use and breast cancer diagnosis. Studies that have reported poorer survival for OC users had limited sample sizes suggesting that these study results should be interpreted with caution (21–24). …”

Section: Discussionmentioning

confidence: 85%

Oral Contraceptive Use and Survival in Women with Invasive Breast Cancer

Lu¹,

Ma²,

Malone

et al. 2011

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Background Oral contraceptives (OCs) are widely used in the U.S. Although the relation between OC use and breast cancer incidence has been widely studied, the few studies examining associations between OC use prior to breast cancer diagnosis and survival are inconsistent. Methods Women with invasive breast cancer participating in the Women's Contraceptive and Reproductive Experiences (CARE) Study, a population-based case-control study (4565 women ages 35–64 years), and the California Teachers Study (CTS) cohort (3929 women ages 28–91 years) were followed for vital status. 1064 women died in the CARE Study (median follow-up, 8.6 years) and 523 died in the CTS (median follow-up, 6.1 years). Cox proportional hazards regression provided hazard rate ratio estimates (RRs) with 95% confidence intervals (CIs) for risk of death from any cause and from breast cancer. Results No association was observed for any OC use prior to diagnosis and all-cause mortality (CARE Study: RR=1.01 (95% CI=0.86–1.19); CTS: RR=0.84 (95% CI=0.67–1.05)). A decreased risk of all-cause mortality was observed in the CTS among women with more than 10 years of OC use (RR=0.67, 95% CI=0.47–0.96); however, no trend of decreasing risk with increasing OC duration was observed (P-trend=0.22), and no association was observed in the CARE study. No associations were observed for breast cancer-specific mortality. Conclusions OC use is not associated with all-cause or breast cancer-specific mortality among women with invasive breast cancer. Impact These two independent studies demonstrated no overall association between OC use and survival among women with breast cancer.

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Section: Discussionmentioning

confidence: 85%

Oral Contraceptive Use and Survival in Women with Invasive Breast Cancer

Lu¹,

Ma²,

Malone

et al. 2011

Cancer Epidemiology, Biomarkers &Amp; Prevention

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“…Failure to account for exposure windows may partially explain the lack of association observed for breast cancer incidence. In contrast, for survival following breast cancer, the relevant windows of exposure to environmental contaminants, including continued endogenous exposure from the release of stored toxins, may extend from as early as 5 years before diagnosis 56 through death. 55 Thus, a possible explanation for our observation of stronger associations with 5-year mortality, rather than 15-year mortality, may be that biomarker concentrations assessed at baseline are more likely to reflect the relevant exposure period influencing mortality closer to diagnosis, rather than the exposures that are likely to have changed over the 15-year period of follow-up; although we were not able to assess how organochlorine levels changed over time as a result of ongoing low-level dietary exposure.…”

Section: Discussionmentioning

confidence: 99%

Organochlorine insecticides DDT and chlordane in relation to survival following breast cancer

Parada

Wolff

Engel

et al. 2015

Intl Journal of Cancer

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Organochlorine insecticides have been studied extensively in relation to breast cancer incidence and results from two meta-analyses have been null for late-life residues, possibly due to measurement error. Whether these compounds influence survival remains to be fully explored. We examined associations between organochlorine insecticides (p,p’-DDT, its primary metabolite, p,p’-DDE, and chlordane) assessed shortly after diagnosis and survival among women with breast cancer. A population-based sample of women diagnosed with a first primary invasive or in situ breast cancer in 1996–1997 and with available organochlorine blood measures (n=633) were followed for vital status through 2011. After follow-up of 5 and 15 years, we identified 55 and 189 deaths, of which 36 and 74, respectively, were breast cancer-related. Using Cox regression models, we estimated the multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for lipid-adjusted organochlorine concentrations with all-cause and breast cancer-specific mortality. At 5 years after diagnosis, the highest tertile of DDT concentration was associated with all-cause (HR=2.19; 95%CI: 1.02, 4.67) and breast cancer-specific (HR=2.72; 95%CI: 1.04, 7.13) mortality. At 15 years, middle tertile concentrations of DDT (HR=1.42; CI 0.99, 2.06) and chlordane (HR=1.42; 95%CI: 0.94, 2.12) were modestly associated with all-cause and breast cancer-specific mortality. Third tertile DDE concentrations were inversely associated with 15-year all-cause mortality (HR=0.66; 95%CI: 0.44, 0.99). This is the first population-based study in the United States to show that DDT may adversely impact survival following breast cancer diagnosis. Further studies are warranted given the high breast cancer burden and the ubiquity of these chemicals.

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“…This suggests that the dosage schedule associated with triphasic levonorgestrel use may confer risk, but that use of triphasic preparations with other progestins may not convey this risk. Interestingly, in a study of breast cancer survival among younger women, risk of death was increased if the most recent oral contraceptive used prior to diagnosis included levonorgestrel, but no association was seen for other progestin types (16). …”

Section: Discussionmentioning

confidence: 99%

Oral Contraceptive Use and Breast Cancer: A Prospective Study of Young Women

Hunter

Colditz²,

Hankinson³

et al. 2010

Cancer Epidemiology, Biomarkers &Amp; Prevention

170

119

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Background: 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. Cancer Epidemiol

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Oral Contraceptives and Survival in Breast Cancer Patients Aged 20 to 54 Years

Cited by 20 publications

References 35 publications

Oral Contraceptive Use and Survival in Women with Invasive Breast Cancer

Oral Contraceptive Use and Survival in Women with Invasive Breast Cancer

Organochlorine insecticides DDT and chlordane in relation to survival following breast cancer

Oral Contraceptive Use and Breast Cancer: A Prospective Study of Young Women

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