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Journal articles

Oral Contraceptive Use and Breast Cancer Risk: Retrospective and Prospective Analyses From a BRCA1 and BRCA2 Mutation Carrier Cohort Study

Lieske H Schrijver 1 Håkan Olsson 2 Kelly-Anne Phillips 3, 4 Mary Beth Terry 5 David E Goldgar 6 Karin Kast 7 Christoph Engel 8, 9 Thea M Mooij 1 Julian Adlard 10 Daniel Barrowdale 11 Rosemarie Davidson 12 Ros Eeles 13 Steve Ellis 11 D Gareth Evans 14 Debra Frost 11 Louise Izatt 15 Mary E Porteous 16 Lucy E Side 17 Lisa Walker 18 Pascaline Berthet 19 Valérie Bonadona 20 Dominique Leroux 21, 22 Emmanuelle Mouret-Fourme 23 Laurence Venat-Bouvet 24 Saundra S Buys 25 Melissa C Southey 26 Esther M John 27, 28 Wendy K Chung 29 Mary B Daly 30 Anita Bane 31, 32 Christi J van Asperen 33 Encarna B Gómez Garcia 34 Marian J E Mourits 35 Theo a M van Os 36 Marie-José Roos-Blom 1 Michael L Friedlander 37, 38 Sue-Anne Mclachlan 4, 39 Christian F Singer 40 yen y Tan 40 Lenka Foretova 41 Marie Navratilova 41, 42 Anne-Marie Gerdes 43 Trinidad Caldes 44 Jacques Simard 45 Edith Olah 46 Anna Jakubowska 47 Brita Arver 32 Ana Osorio 48 Catherine Noguès 49 Nadine Andrieu 50 Douglas F Easton 11 Flora E van Leeuwen 1 John L Hopper 4 Roger L Milne 4, 51 Antonis C Antoniou 11 Matti A Rookus 1 
Abstract : Background: For BRCA1 and BRCA2 mutation carriers, the association between oral contraceptive preparation (OCP) use and breast cancer (BC) risk is still unclear. Methods: Breast camcer risk associations were estimated from OCP data on 6030 BRCA1 and 3809 BRCA2 mutation carriers using age-dependent Cox regression, stratified by study and birth cohort. Prospective, left-truncated retrospective and full-cohort retrospective analyses were performed. Results: For BRCA1 mutation carriers, OCP use was not associated with BC risk in prospective analyses (hazard ratio [HR] = 1.08, 95% confidence interval [CI] = 0.75 to 1.56), but in the left-truncated and full-cohort retrospective analyses, risks were increased by 26% (95% CI = 6% to 51%) and 39% (95% CI = 23% to 58%), respectively. For BRCA2 mutation carriers, OCP use was associated with BC risk in prospective analyses (HR = 1.75, 95% CI = 1.03 to 2.97), but retrospective analyses were inconsistent (left-truncated: HR = 1.06, 95% CI = 0.85 to 1.33; full cohort: HR = 1.52, 95% CI = 1.28 to 1.81). There was evidence of increasing risk with duration of use, especially before the first full-term pregnancy (BRCA1: both retrospective analyses, P < .001 and P = .001, respectively; BRCA2: full retrospective analysis, P = .002). Conclusions: Prospective analyses did not show that past use of OCP is associated with an increased BC risk for BRCA1 mutation carriers in young middle-aged women (40-50 years). For BRCA2 mutation carriers, a causal association is also not likely at those ages. Findings between retrospective and prospective analyses were inconsistent and could be due to survival bias or a true association for younger women who were underrepresented in the prospective cohort. Given the uncertain safety of long-term OCP use for BRCA1/2 mutation carriers, indications other than contraception should be avoided and nonhormonal contraceptive methods should be discussed.
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Submitted on : Monday, September 13, 2021 - 2:43:57 PM
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Lieske H Schrijver, Håkan Olsson, Kelly-Anne Phillips, Mary Beth Terry, David E Goldgar, et al.. Oral Contraceptive Use and Breast Cancer Risk: Retrospective and Prospective Analyses From a BRCA1 and BRCA2 Mutation Carrier Cohort Study. JNCI Cancer Spectrum, Oxford University Press, 2021, 2 (2), pky023. ⟨10.1093/jncics/pky023⟩. ⟨inserm-03342591⟩



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