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  • Title: Oral contraceptives and breast cancer.
    Author: Schlesselman JJ.
    Journal: Am J Obstet Gynecol; 1990 Oct; 163(4 Pt 2):1379-87. PubMed ID: 2220962.
    Abstract:
    Among women in general the risk of breast cancer through 59 years of age does not appear to be affected appreciably by the use of oral contraceptives. Nonetheless, concern continues to be expressed about the effects of early age at first use, long-term duration of use, formulation, and a variety of other factors thought to influence breast cancer risk in the presence of oral contraception. A number of recent studies restricted to young women suggest that long-term use may increase the risk of disease occurring very early, but the present lack of consistent findings in well-conducted epidemiologic studies prevents any certain conclusion with regard to cause-and-effect. However, if an increased risk were indeed present, the most plausible interpretation is that long-term oral contraception promotes earlier clinical manifestation of breast cancer in some women while having no net impact on their lifetime risk of the disease. Among women in general the risk of breast cancer through 59 years of age does not appear to be affected appreciably by the use of oral contraceptives. Nonetheless, concern continues to be expressed about the effects of early age at 1st use, long-term duration of use, formulation, and a variety of other factors thought to influence breast cancer risk in the presence of oral contraception. A number of recent studies restricted to young women are examined. Analysis of several studies indicated that relative risks of breast cancer in women 45 years tend to be elevated with use 4 years and are uniformly in excess of 1.0 after 8 years' duration. Other studies investigating the relative risk with progressively longer periods of oral contraception before 1st-term pregnancy; the relative risks were about 1.5 at 4-6 years' duration and 2.3 at 8-10 years of use. Additionally, examination of another study indicated the possibility that prolonged oral contraceptive use in excess of 8 years may accelerate the onset of clinically apparent breast cancer in nulliparous women, particularly those with an early age at menarche. Women of parity 1 who use oral contraceptives have also been identified as at increased risk. There are also findings indicating that 3 years of oral contraceptive use before age 25 years carries a slightly elevated risk of breast cancer; however, other studies have indicated that duration of use, not age at 1st use, is the important factor. No definitive conclusions have been made regarding the effect of oral contraceptive formulation on increased risk or the increased risk with oral contraceptive use in women with a family history of breast cancer. Furthermore, the long-term latency hypothesis has not been supported. These studies suggest that long-term use may increase the risk of disease occurring very early, but the present lack of consistent findings in well-conducted epidemiologic studies prevents any certain conclusion with regard to cause-and-effect. However, if an increased risk were indeed present, the most plausible interpretation is that long-term oral contraception promotes earlier clinical manifestation of breast cancer in some women while having no net impact on their lifetime risk of the disease.
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