Oral contraceptive use and breast cancer risk: a meta-analysis of variations with age at diagnosis, parity and total duration of oral contraceptive use

Br J Obstet Gynaecol. 1992 Mar;99(3):239-46. doi: 10.1111/j.1471-0528.1992.tb14506.x.

Abstract

Objective: To review published reports of risk of breast cancer with oral contraceptive use.

Design: Meta-analysis of study results, using regression techniques to explore the inter-study heterogeneity.

Setting: Twenty-seven epidemiological studies of breast cancer risk and oral contraceptive use published 1980-1989.

Main outcome measures: Relative risk of breast cancer with oral contraceptive use; variations by age at diagnosis, parity, and total duration of use, and with study design characteristics.

Results: The overall relative risk estimate was 1.16 (95% CI 1.07-1.25) for the less than 45 years group, 1.21 (95% CI 0.99-1.47) for the nulliparous subgroup, and 1.27 (95% CI 1.12-1.44) for durations of use of more than 8 years. Source of subjects, their marital status, the type of study, data collection methods, matching for geographical area, the number of adjustment factors used in the study analysis, the country of study and the calendar period in which the study ended were all important explanatory factors for inter-study variation, but a substantial proportion of inter-study variation remained unexplained.

Conclusions: These meta-analyses suggest that risk of breast cancer may be raised by around 20% in younger, nulliparous and long use duration subgroups of oral contraceptive users. Risk estimates appear to be influenced by several study design factors, which should be considered carefully in designing and reviewing future studies.

PIP: 27 epidemiological studies of breast cancer risk and oral contraceptive (OC) use published between 1980-89 were reviewed. A meta-analysis of study results, using regression techniques to explore the interstudy heterogeneity, was utilized. The main outcome measures examined were relative risk of breast cancer with OC use, variations by age at diagnosis, parity, and total duration of use, and those with study design characteristics. The overall risk estimate was 1.16 (95% CI 1.07-1.25) for the 45-year group, 1.21 (95% CI 0.99-1.47) for the nulliparous subgroup, and 1.27 (95% CI 1.12-1.44) for durations of use of more than 8 years. Source of subjects, their marital status, type of study, data collection methods, matching for geographical area, the number of adjustment factors used in the study analysis, the country of study, and the calendar period in which the study ended were all important explanatory factors for interstudy variation. However, a substantial proportion of interstudy variation remained unexplained. These meta-analyses suggest that the risk of breast cancer may be raised by around 20% in younger, nulliparous, and long-use duration subgroups of OC users. Risk estimates appear to be influenced by several study design factors which must be considered carefully in designing and reviewing future studies.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Age Factors
  • Breast Neoplasms / chemically induced*
  • Breast Neoplasms / diagnosis
  • Breast Neoplasms / epidemiology
  • Contraceptives, Oral / adverse effects*
  • Female
  • Humans
  • Meta-Analysis as Topic
  • Parity
  • Risk Factors
  • Time Factors

Substances

  • Contraceptives, Oral