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

Departments of ¹ Epidemiology and ² Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; ³ Cancer Prevention Program, ⁴ Division of Human Biology, Fred Hutchinson Cancer Research Center, Seattle, Washington; ⁵ Department of Epidemiology, Rollins School of Public Health, Emory University, ⁶ Surveillance and Epidemiology Branch, Divisions of Global Migration and Quarantine and ⁷ Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, and ⁸ Winship Cancer Center, Emory University School of Medicine, Atlanta, Georgia; ⁹ Department of Community and Family Medicine, Cancer Prevention and Control Research Program, Duke University Medical Center, Durham, North Carolina; and ¹⁰ Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Department of Health and Human Services, Bethesda, Maryland

Requests for reprints: Katrina F. Trivers, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway, NE, MS K-52, Atlanta, GA 30341. Phone: 770-488-1086; Fax: 770-488-4760. E-mail: ktrivers{at}cdc.gov

Recent oral contraceptive (OC) use is associated with modestly higher breast cancer incidence among younger women, but its impact on survival is unclear. This study examined the relationship between OC use before breast cancer diagnosis and survival. A population-based sample of 1,264 women aged 20 to 54 years with a first primary invasive breast cancer during 1990 to 1992 were followed up for 8 to 10 years. OC and covariate data were obtained by interviews conducted shortly after diagnosis and from medial records. All-cause mortality was ascertained through the National Death Index (n = 292 deaths). Age- and income-adjusted hazard ratios (HR) and 95% confidence intervals (95% CI) were estimated by Cox regression methods. All-cause mortality was not associated with ever use of OCs or duration of use. Compared with nonusers, mortality estimates were elevated among women who were using OCs at diagnosis or stopped use in the previous year (HR, 1.57; 95% CI, 0.95-2.61). The HR for use of high-dose estrogen pills within 5 years before diagnosis was double that of nonusers (HR, 2.39; 95% CI, 1.29-4.41) or, if the most recent pill included the progestin levonorgestrel, compared with nonusers (HR, 2.01; 95% CI, 1.03-3.91). Because subgroup estimates were based on small numbers of OC users, these results should be cautiously interpreted. Overall, most aspects of OC use did not seem to influence survival, although there is limited evidence that OC use just before diagnosis, particularly use of some pill types, may negatively impact survival in breast cancer patients aged 20 to 54 years. (Cancer Epidemiol Biomarkers Prev 2007;16(9):1822–7)