Oral Contraceptive Use and Breast Cancer Risk : Retrospective and Prospective Analyses From a BRCA1 and BRCA2 Mutation Carrier Cohort Study
(2018) In JNCI Cancer Spectrum 2(2).- Abstract
Background: For BRCA1 and BRCA2 mutation carriers, the association between oral contraceptive preparation (OCP) use and breast cancer (BC) risk is still unclear.
Methods: Breast camcer risk associations were estimated from OCP data on 6030 BRCA1 and 3809 BRCA2 mutation carriers using age-dependent Cox regression, stratified by study and birth cohort. Prospective, left-truncated retrospective and full-cohort retrospective analyses were performed.
Results: For BRCA1 mutation carriers, OCP use was not associated with BC risk in prospective analyses (hazard ratio [HR] = 1.08, 95% confidence interval [CI] = 0.75 to 1.56), but in the left-truncated and full-cohort retrospective analyses, risks were increased by 26% (95% CI = 6% to... (More)
Background: For BRCA1 and BRCA2 mutation carriers, the association between oral contraceptive preparation (OCP) use and breast cancer (BC) risk is still unclear.
Methods: Breast camcer risk associations were estimated from OCP data on 6030 BRCA1 and 3809 BRCA2 mutation carriers using age-dependent Cox regression, stratified by study and birth cohort. Prospective, left-truncated retrospective and full-cohort retrospective analyses were performed.
Results: For BRCA1 mutation carriers, OCP use was not associated with BC risk in prospective analyses (hazard ratio [HR] = 1.08, 95% confidence interval [CI] = 0.75 to 1.56), but in the left-truncated and full-cohort retrospective analyses, risks were increased by 26% (95% CI = 6% to 51%) and 39% (95% CI = 23% to 58%), respectively. For BRCA2 mutation carriers, OCP use was associated with BC risk in prospective analyses (HR = 1.75, 95% CI = 1.03 to 2.97), but retrospective analyses were inconsistent (left-truncated: HR = 1.06, 95% CI = 0.85 to 1.33; full cohort: HR = 1.52, 95% CI = 1.28 to 1.81). There was evidence of increasing risk with duration of use, especially before the first full-term pregnancy (BRCA1: both retrospective analyses, P < .001 and P = .001, respectively; BRCA2: full retrospective analysis, P = .002).
Conclusions: Prospective analyses did not show that past use of OCP is associated with an increased BC risk for BRCA1 mutation carriers in young middle-aged women (40-50 years). For BRCA2 mutation carriers, a causal association is also not likely at those ages. Findings between retrospective and prospective analyses were inconsistent and could be due to survival bias or a true association for younger women who were underrepresented in the prospective cohort. Given the uncertain safety of long-term OCP use for BRCA1/2 mutation carriers, indications other than contraception should be avoided and nonhormonal contraceptive methods should be discussed.
(Less)
- author
- author collaboration
- organization
- publishing date
- 2018-04
- type
- Contribution to journal
- publication status
- published
- subject
- in
- JNCI Cancer Spectrum
- volume
- 2
- issue
- 2
- article number
- pky023
- publisher
- Oxford University Press
- external identifiers
-
- scopus:85071374291
- pmid:31360853
- ISSN
- 2515-5091
- DOI
- 10.1093/jncics/pky023
- language
- English
- LU publication?
- no
- id
- 774b8a1a-6956-4d8e-9462-d0ba634198bb
- date added to LUP
- 2020-01-28 08:42:20
- date last changed
- 2024-09-19 17:22:19
@article{774b8a1a-6956-4d8e-9462-d0ba634198bb, abstract = {{<p>Background: For BRCA1 and BRCA2 mutation carriers, the association between oral contraceptive preparation (OCP) use and breast cancer (BC) risk is still unclear.</p><p>Methods: Breast camcer risk associations were estimated from OCP data on 6030 BRCA1 and 3809 BRCA2 mutation carriers using age-dependent Cox regression, stratified by study and birth cohort. Prospective, left-truncated retrospective and full-cohort retrospective analyses were performed.</p><p>Results: For BRCA1 mutation carriers, OCP use was not associated with BC risk in prospective analyses (hazard ratio [HR] = 1.08, 95% confidence interval [CI] = 0.75 to 1.56), but in the left-truncated and full-cohort retrospective analyses, risks were increased by 26% (95% CI = 6% to 51%) and 39% (95% CI = 23% to 58%), respectively. For BRCA2 mutation carriers, OCP use was associated with BC risk in prospective analyses (HR = 1.75, 95% CI = 1.03 to 2.97), but retrospective analyses were inconsistent (left-truncated: HR = 1.06, 95% CI = 0.85 to 1.33; full cohort: HR = 1.52, 95% CI = 1.28 to 1.81). There was evidence of increasing risk with duration of use, especially before the first full-term pregnancy (BRCA1: both retrospective analyses, P < .001 and P = .001, respectively; BRCA2: full retrospective analysis, P = .002).</p><p>Conclusions: Prospective analyses did not show that past use of OCP is associated with an increased BC risk for BRCA1 mutation carriers in young middle-aged women (40-50 years). For BRCA2 mutation carriers, a causal association is also not likely at those ages. Findings between retrospective and prospective analyses were inconsistent and could be due to survival bias or a true association for younger women who were underrepresented in the prospective cohort. Given the uncertain safety of long-term OCP use for BRCA1/2 mutation carriers, indications other than contraception should be avoided and nonhormonal contraceptive methods should be discussed.</p>}}, author = {{Schrijver, Lieske H and Olsson, Håkan and Phillips, Kelly-Anne and Terry, Mary Beth and Goldgar, David E and Kast, Karin and Engel, Christoph and Mooij, Thea M and Adlard, Julian and Barrowdale, Daniel and Davidson, Rosemarie and Eeles, Ros and Ellis, Steve and Evans, D Gareth and Frost, Debra and Izatt, Louise and Porteous, Mary E and Side, Lucy E and Walker, Lisa and Berthet, Pascaline and Bonadona, Valérie and Leroux, Dominique and Mouret-Fourme, Emmanuelle and Venat-Bouvet, Laurence and Buys, Saundra S and Southey, Melissa C and John, Esther M and Chung, Wendy K and Daly, Mary B and Bane, Anita and van Asperen, Christi J and Gómez Garcia, Encarna B and Mourits, Marian J E and van Os, Theo A M and Roos-Blom, Marie-José and Friedlander, Michael L and McLachlan, Sue-Anne and Singer, Christian F and Tan, Yen Y and Foretova, Lenka and Navratilova, Marie and Gerdes, Anne-Marie and Caldes, Trinidad and Simard, Jacques and Olah, Edith and Jakubowska, Anna and Arver, Brita and Osorio, Ana and Noguès, Catherine and Andrieu, Nadine}}, issn = {{2515-5091}}, language = {{eng}}, number = {{2}}, publisher = {{Oxford University Press}}, series = {{JNCI Cancer Spectrum}}, title = {{Oral Contraceptive Use and Breast Cancer Risk : Retrospective and Prospective Analyses From a BRCA1 and BRCA2 Mutation Carrier Cohort Study}}, url = {{http://dx.doi.org/10.1093/jncics/pky023}}, doi = {{10.1093/jncics/pky023}}, volume = {{2}}, year = {{2018}}, }