| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | COVER ARCHIVE | SEARCH |
|
|
|
||||||||
|
||||||||||
Electronic Letters to:
|
|
Electronic letters published:
![[Read eLetter]](/icons/misc/sectionDOWN.gif){kind=icon}
Response to Cubberley
Oral contraceptives and breast cancer prevention
|
|
|||
|
Martin C. Mahoney, Associate Professor of Oncology Departments of Health Behavior & Medicine, Roswell Park Cancer Institute, Buffalo, NY
Send letter to journal:
Martin.Mahoney{at}RoswellPark.org Martin C. Mahoney
|
Dear Dr. Cubberley: We appreciate your positive comments regarding our recent review [1] and your point regarding the impact of oral contraceptive use on breast cancer incidence. According to ACS Breast Cancer Facts & Figures 2007- 2008, "Recent use of oral contraceptives may slightly increase the risk of breast cancer; however, women who have stopped using oral contraceptives for 10 years or more have the same risk as women who have never used the pill" [2]. A frequently-cited meta-analysis [3] published in 1996 found a relative risk (RR) of 1.24 for current user [95% confidence interval (CI) 1.15-1.33]. The RR 1-4 years after stopping was 1.16 [95% CI 1.08-1.23], 1.07 [95% CI 1.02-1.13] 5-9 years after stopping, and 1.01 [95% CI 0.96- 1.05] 10 or more years after stopping. Breast cancers developing in current and former oral contraceptive users were significantly less advanced than those of never users. Since oral contraceptives are typically used intermittently, for short duration, and by women in age ranges with low breast cancer incidence [2,4] and the associated excess risk would have diminished or disappeared by the time they reach ages with higher incidence rates, one would expect the attributable mortality and morbidity from this exposure to be quite limited. Furthermore, a recent review notes that, "…Although epidemiological studies have documented a small increased risk of breast cancer associated with use of older OC formulations, recent studies that included newer formulations have not detected an increased risk. Even with the older formulations, the absolute (or excess) risk of breast cancer is minimal. Thus, current evidence suggests that OCs do not play a clinically important role in the risk of breast cancer. This evidence must also be weighed against the effect on other health outcomes and the risks associated with other contraceptive methods and with unintended pregnancy" [5]. Martin Mahoney, MD, PhD References 1. Mahoney MC, Bevers T, MD, Linos E, Willett WC. Opportunities and Strategies for Breast Cancer Prevention Through Risk Reduction. CA Cancer J Clin 2008;58:347-371. 2. American Cancer Society. Breast Cancer Facts & Figures 2007- 2008. Atlanta: American Cancer Society, Inc. Available at: http://www.cancer.org/downloads/STT/BCFF-Final.pdf. Accessed January 30, 2009. 3. Collaborative Group on Hormonal Factors in Breast Cancer. Breast cancer and hormonal contraceptives: collaborative reanalysis of individual data on 53,297 women with breast cancer and 100,239 women without breast cancer from 54 epidemiological studies. Lancet 1996;347(9017):1713-1727. 4. Gerstman BB, Gross TP, Kennedy DL, Bennett RC, Tomita DK, Stadel BV. Trends in the content and use of oral contraceptives in the United States, 1964-88. Am J Public Health 1991;81:90-96. 5. Casey PM, Cerhan JR, Pruthi S. Oral contraceptive use and the risk of breast cancer. Mayo Clin Proc 2008;83:86-91. |
|||
|
|
|||
|
Robert Cubberley, MD
Send letter to journal:
rclarabobb{at}juno.com Robert Cubberley, MD
|
The all-encompassing report on breast cancer prevention was excellent: many myths and false ideas were laid to rest. However, one aspect of the problem was not addressed: the use of oral contraception. In this vein the question of age of cessation, in the absence of risk factors, also warrants consideration. Perhaps these problems could be addressed. |
|||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | COVER ARCHIVE | SEARCH |
eLetters: