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  • Title: Depot medroxyprogesterone acetate and breast cancer. A review of current knowledge.
    Author: Chilvers CE.
    Journal: Drug Saf; 1996 Sep; 15(3):212-8. PubMed ID: 8879975.
    Abstract:
    Depot medroxyprogesterone acetate (DMPA) has been used worldwide since 1964 as a contraceptive and by 1993 was in use in more than 90 countries. It was licensed for contraceptive use in the US in 1992. One of the reasons for this delay in licensing in the US was the possibility of an increased risk of breast cancer associated with its use. A pooled analysis has recently been published, which brings together the data from 2 large studies of breast cancer risk associated with DMPA use. The overall results are reassuring, but there is some evidence of an increased risk of breast cancer associated with recent use of DMPA. There are substantial difficulties in interpreting this increase in risk. It is certainly possible that it may be the result of surveillance bias, although it could be a short term increase in risk that is not in fact sustained. The conclusion that DMPA should not be restricted as a contraceptive, provided that appropriate advice is given before use, is well-founded. However, further epidemiological work is needed on the long term effects of DMPA. Although further epidemiological studies of the long-term effects of depot medroxyprogesterone acetate (DMPA) on breast cancer risk are needed, preliminary research results are reassuring. Pooled analysis of the results of two large case-control studies--the World Health Organization Study (involving women newly diagnosed with breast cancer in 1979-88 in Thailand, Kenya, and Mexico) and the New Zealand Study (comprised of women with breast cancer diagnosed in 1983-87)--has facilitated assessment of this association. Overall, 219 of the 1768 breast cancer cases and 1725 of the 13,905 controls had ever used DMPA (odds ratio, 1.1; 95% confidence interval, 0.97-1.4), with no increase in risk with increasing duration of use. Women under 35 years of age at diagnosis and those initiating DMPA use before 25 years of age had marginally statistically significant increases in breast cancer risk. The highest risks were recorded among women who had initiated DMPA use within 5 years of diagnosis. Risks declined with time since first use in all age categories. After 5 years since last use, DMPA use for more than 2 years was associated with a decreased risk of breast cancer. The raised relative risks in certain subgroups are difficult to interpret and may reflect surveillance bias. Enhanced understanding of the biology of breast cancer will aid interpretation of these results.
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