Do Contraceptives Decrease Risk for All Ovarian Cancers?
BACKGROUND AND PURPOSE:
Older studies using older hormonal contraceptive formulations protect against ovarian cancer
Limited data on newer formulations
Iverson et al. (BMJ, 2018) assessed whether contemporary combined hormonal contraceptives are associated with overall and specific types of ovarian cancer
Prospective, nationwide cohort study (1995-2014)
Women age 15-45 years
Follow-up until whichever came first: First diagnosis of ovarian cancer death, emigration, age 50 years, or end of follow-up (December 31, 2014)
Women’s exposure to contraceptives were categorized as
Never users (reference): No record of being dispensed hormonal contraception
Recent users: ≤1 year after stopping use
Former users: >1 year after stopping use
Contraceptives were categorized by
Progestogen type in combined preparations
All progestogen-only products (including non-oral preparations)
Separate analyses examined women followed up to their first contraception type switch and those with full contraceptive histories
Relative risk (RR) of ovarian cancer
1,879,227 women were included
During 21.4 million person years, 1,249 incident ovarian cancers occurred
Among ever users of hormonal contraception, 478 ovarian cancers were recorded over 13,344,531 person years
Never users had 771 ovarian cancers during 8,150,250 person years
Compared with never users, ovarian cancer risk was reduced among those who had used hormonal contraceptives
Current or recent use: RR 0.58 (95% CI, 0.49 to 0.68)
Former use: RR 0.77 (95% CI, 0.66 to 0.91)
Relative risks among current or recent users decreased with increasing duration (P<0.001)
≤1 year use: RR 0.82 (95% CI, 0.59 to 1.12)
>10 years’ use: RR 0.26 (95% CI, 0.16 to 0.43)
Little evidence of major differences based on
Progestogen content of combined OCPs
Progestogen-only products did not alter ovarian cancer risk
Contemporary combined hormonal contraceptives, like previous formulations, are associated with a reduction in ovarian cancer risk
No effect seen in progesterone-only contraceptives
Duration of use increased the protective effect
The authors state
It has been suggested that recent downward trends in ovarian cancer mortality rates in North America and Europe can be partly attributed to the use of combined oral contraceptives. We found a population prevented fraction of 21% with use of hormonal contraception, which supports the notion that these ovarian cancer mortality benefits are likely to continue.
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