Ovarian cancer and oral contraceptives: Collaborative reanalysis of data from 45 epidemiological studies including 23,257 women with ovarian cancer and 87,303 controls

Collaborative Group on Epidemiological Studies of Ovarian Cancer, Calle, E. E, Rodriguez, C, Dal Maso, L, Talamini, R, Bain, Christopher J., Green, Adele C. and Purdie, David M. (2008) Ovarian cancer and oral contraceptives: Collaborative reanalysis of data from 45 epidemiological studies including 23,257 women with ovarian cancer and 87,303 controls. The Lancet, 371 9609: 303-314. doi:10.1016/S0140-6736(08)60167-1

Author Collaborative Group on Epidemiological Studies of Ovarian Cancer
Calle, E. E
Rodriguez, C
Dal Maso, L
Talamini, R
Bain, Christopher J.
Green, Adele C.
Purdie, David M.
Title Ovarian cancer and oral contraceptives: Collaborative reanalysis of data from 45 epidemiological studies including 23,257 women with ovarian cancer and 87,303 controls
Journal name The Lancet   Check publisher's open access policy
ISSN 0140-6736
Publication date 2008-01-26
Year available 2008
Sub-type Article (original research)
DOI 10.1016/S0140-6736(08)60167-1
Open Access Status Not yet assessed
Volume 371
Issue 9609
Start page 303
End page 314
Total pages 12
Editor Richard Horton
Place of publication United Kingdom
Publisher The Lancet Publishing Group
Language eng
Subject C1
920102 Cancer and Related Disorders
111706 Epidemiology
11 Medical and Health Sciences
Abstract Background: Oral contraceptives were introduced almost 50 years ago, and over 100 million women currently use them. Oral contraceptives can reduce the risk of ovarian cancer, but the eventual public-health effects of this reduction will depend on how long the protection lasts after use ceases. We aimed to assess these effects. Methods: Individual data for 23 257 women with ovarian cancer (cases) and 87 303 without ovarian cancer (controls) from 45 epidemiological studies in 21 countries were checked and analysed centrally. The relative risk of ovarian cancer in relation to oral contraceptive use was estimated, stratifying by study, age, parity, and hysterectomy. Findings: Overall 7308 (31%) cases and 32 717 (37%) controls had ever used oral contraceptives, for average durations among users of 4·4 and 5·0 years, respectively. The median year of cancer diagnosis was 1993, when cases were aged an average of 56 years. The longer that women had used oral contraceptives, the greater the reduction in ovarian cancer risk (p<0·0001). This reduction in risk persisted for more than 30 years after oral contraceptive use had ceased but became somewhat attenuated over time-the proportional risk reductions per 5 years of use were 29% (95% CI 23-34%) for use that had ceased less than 10 years previously, 19% (14-24%) for use that had ceased 10-19 years previously, and 15% (9-21%) for use that had ceased 20-29 years previously. Use during the 1960s, 1970s, and 1980s was associated with similar proportional risk reductions, although typical oestrogen doses in the 1960s were more than double those in the 1980s. The incidence of mucinous tumours (12% of the total) seemed little affected by oral contraceptives, but otherwise the proportional risk reduction did not vary much between different histological types. In high-income countries, 10 years use of oral contraceptives was estimated to reduce ovarian cancer incidence before age 75 from 1·2 to 0·8 per 100 users and mortality from 0·7 to 0·5 per 100; for every 5000 woman-years of use, about two ovarian cancers and one death from the disease before age 75 are prevented. Interpretation: Use of oral contraceptives confers long-term protection against ovarian cancer. These findings suggest that oral contraceptives have already prevented some 200 000 ovarian cancers and 100 000 deaths from the disease, and that over the next few decades the number of cancers prevented will rise to at least 30 000 per year.
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes Full list of Contributors: Writing committee: V Beral, R Doll*, C Hermon, R Peto, G Reeves. Steering committee: L Brinton, A C Green, P Marchbanks, E Negri, R Ness, P Peeters, M Vessey. Collaborators (in alphabetical order of institution, study name, or location): American Cancer Society, Atlanta, USA: E E Calle, C Rodriguez; Aviano Cancer Center, Pordenone, Italy: L Dal Maso, R Talamini; Brigham and Women’s Hospital and Harvard Medical School, USA: D Cramer and Channing Laboratory: S E Hankinson, S S Tworoger for the Nurses’ Health Study; Cancer and Radiation Epidemiology Unit, the Gertner Institute, Israel: A Chetrit, G Hirsh-Yechezkel, F Lubin, S Sadetzki; Cancer Epidemiology Unit, Oxford, UK (Secretariat): P Appleby, E Banks, V Beral, A Berrington de Gonzalez, D Bull, B Crossley, A Goodill, I Green, J Green, C Hermon, T Key, G Reeves; Cancer Research UK/MRC/BHF Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Oxford, UK: R Collins, R Doll*, R Peto; Catalan Institute of Oncology, Barcelona, Spain: C A Gonzalez; Centers for Disease Control & Prevention, GA, USA: N Lee, P Marchbanks, H W Ory, H B Peterson, P A Wingo; Chiang Mai University, Chiang Mai, Thailand: N Martin, T Pardthaisong, S Silpisornkosol, C Theetranont; Chulalongkorn University, Bangkok, Thailand: B Boosiri, S Chutivongse, P Jimakorn, P Virutamasen, C Wongsrichanalai; Dartmouth Medical School, New Hampshire, USA: L Titus-Ernstoff ; Department of Gynaecology and Obstetrics, Herlev University Hospital, Denmark: B J Mosgaard; Department of Public Health, Oxford, UK: M Vessey, D Yeates; Deutsches Krebsforschungszentrum, Heidelberg, Germany: J Chang-Claude; Fred Hutchinson Cancer Research Center, University of Washington, Seattle, USA: M A Rossing, D Thomas, N Weiss; International Agency for Research in Cancer, Lyon, France: S Franceschi; Istituto “Mario Negri”, University of Milan, Italy: C La Vecchia, E Negri; Karolinska Institutet, Stockholm, Sweden: H O Adami, C Magnusson, T Riman, E Weiderpass; A Wolk; National Cancer Institute, MD, USA: L A Brinton, D M Freedman, P Hartge, J M Lacey, R Hoover; Maastricht University, Netherlands: L J Schouten, P A van den Brandt; Mahidol University, Bangkok, Thailand: N Chantarakul, S Koetsawang, D Rachawat; Norwegian Institute of Public Health, Oslo, Norway: S Graff -Iversen, R Selmer; Queensland Institute of Medical Research and University of Queensland: C J Bain, A C Green, D M Purdie, V Siskind, P M Webb; Roswell Park Cancer Institute, New York, USA: S E McCann; Royal College of General Practitioners Oral Contraception Study, UK: P Hannaford, C Kay; School of Public Health, Curtin University of Technology, Perth, Australia: C W Binns, A H Lee, M Zhang; School of Public Health and Health Sciences, University of Massachusetts, USA: P Nasca; Slone Epidemiology Center, Boston University, USA: P F Coogan, L Rosenberg; Stanford University, Stanford, USA: J Kelsey, R Paff enbarger*; A Whittemore; University of Athens Medical School, Athens, Greece: K Katsouyanni, A Trichopoulou, D Trichopoulos, A Tzonou; University of Chile, Santiago, Chile: A Dabancens, L Martinez, R Molina, O Salas; University of Hawaii, USA: M T Goodman, G Laurie, M E Carney, L R Wilkens; University Hospital, Lund, Sweden: A Bladstrom, H Olsson; University of Pittsburgh, Pittsburgh, USA: R B Ness; University of Pennsylvania, Philadelphia, USA: J A Grisso, M Morgan, J E Wheeler; University Medical Centre Utrecht, Netherlands: P Peeters; University of Southern California, LA, USA: J Casagrande, M C Pike, RK Ross*, AH Wu; University of Tromso, Tromso, Norway: M Kumle,

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Created: Mon, 30 Mar 2009, 23:37:02 EST by Geraldine Fitzgerald on behalf of School of Public Health