Years Of Oral Contraceptive Use Research Articles

Effect of Oral Contraceptive Use in Relation to Fertile Years on the Risk of Endometriosis in Women with Primary Infertility: A Ten-Year Single-Centre Retrospective Analysis.

Background and Objectives: Oral contraceptives (OCs) are usually used to treat endometriosis; however, the evidence is inconsistent about whether OC use in the past, when given to asymptomatic women, is protective against the development of future disease. We aimed to assess the relationship between the use of OCs and the likelihood of discovering endometriosis, considering the length of time under OCs during their fertile age. Materials and Methods: This was a monocentric retrospective cohort study in a tertiary-care University Hospital (Department of Human Reproduction, Division of Gynaecology and Obstetrics, University Medical Centre Ljubljana, Slovenia) carried out from January 2012 to December 2022. Reproductive-aged women scheduled for laparoscopic surgery for primary infertility and subsequent histopathological diagnosis of endometriosis were compared to women without an endometriosis diagnosis. They were classified based on the ratio of years of OC use to fertile years in four subgroups: never, <25%, between 25 and 50%, and >50. Results: In total, 1923 women (390 with and 1533 without endometriosis) were included. Previous OC use was higher in those with endometriosis than controls (72.31% vs. 58.64%; p = 0.001). Overall, previous OC usage was not related to histopathological diagnosis of endometriosis (aOR 1.06 [95% CI 0.87-1.29]). Women who used OCs for less than 25% of their fertile age had reduced risk of rASRM stage III endometriosis (aOR 0.50 [95% CI 0.26-0.95]; p = 0.036) or superficial implants (aOR 0.88 [95% CI 0.58-0.95]; p = 0.040). No significant results were retrieved for other rASRM stages. Using OCs for <25%, between 25 and 50%, or >50% of fertile age did not increase the risk of developing superficial endometriosis, endometriomas, or DIE. Conclusions: When OCs are used at least once, histological diagnoses of endometriosis are not increased. A protective effect of OCs when used for less than 25% of fertile age on superficial implants may be present. Prospective research is needed to corroborate the findings due to constraints related to the study's limitations.

The risk of venous thromboembolism in oral contraceptive users: the role of genetic factors—a prospective cohort study of 240,000 women in the UK Biobank

More than 150 million women worldwide use oral contraceptives. Women with inherited thrombophilia and carriers of certain thrombophilia gene variants, such as factor V Leiden and the prothrombin, are at an increased risk for venous thromboembolism, especially when combined with oral contraceptive use. Venous thromboembolism is a complex disorder involving many genetic risk factors, and recently, polygenic risk scores have been proposed to capture a significant proportion of the genetic risk of venous thromboembolism. The aim of this study was to estimate the risk for developing venous thromboembolism when initiating oral contraceptive use (first 2 years) and during continued use among women with a high genetic liability. We used a prospective study design in which 244,420 participants from the UK Biobank were followed from birth. The effect of oral contraceptive use during the first 2 years and in the remaining years of oral contraceptive use on the risk of developing venous thromboembolism was estimated using a Cox regression with a time-dependent exposure variable. Women were stratified according to their polygenic risk scores and whether they were carriers of factor V Leiden and/or prothrombin variants. When genetic risk was not considered, an increased risk for venous thromboembolism was observed during the first 2 years of oral contraceptive use (hazard ratio, 3.09; 95% confidence interval, 3.00-3.20) but not during continued use (hazard ratio, 0.92; 95% confidence interval, 0.80-1.05). However, when genetic risk was considered, women in the highest polygenic risk score category had a more pronounced risk of developing a venous thromboembolism during the first 2 years of oral contraceptive use (hazard ratio, 6.35; 95% confidence interval, 4.98-8.09), and a high risk was also observed among factor V Leiden (hazard ratio, 5.73; 95% confidence interval, 5.31-6.17) and prothrombin variant carriers (hazard ratio, 5.23; 95% confidence interval, 4.67 - 5.87). A high polygenic risk score in combination with being a factor V Leiden and prothrombin variant carrier conferred the highest risk for developing a venous thromboembolism during the first 2 years of oral contraceptive use (hazard ratio, 14.8; 95% confidence interval, 9.28-23.6). Women with a high genetic liability also had an increased risk during continued use but it was less pronounced, and the highest risk was conferred to carriers of both factor V Leiden and the prothrombin variant (hazard ratio, 4.93; 95% confidence interval, 3.16-7.7). Evaluating polygenic risk can identify additional venous thromboembolism risk that is not captured in the commonly investigated genes for inherited thrombophilia. Our results indicate that oral contraceptive use is associated with an increased risk for developing a venous thromboembolism, particularly among women with a high genetic predisposition, and that oral contraceptive use dramatically increases the risk thereof short after initiation of use, which decreases with continued use. This suggests that the polygenic risk score could be used to identify women who are at high risk for developing a venous thromboembolism and advise them on alternative methods of contraception.

Risk of Depression May Increase During First Two Years of Oral Contraceptive Use

Risk of Depression May Increase During First Two Years of Oral Contraceptive Use

Population-based cohort study of oral contraceptive use and risk of depression.

Research on the effect of oral contraceptive (OC) use on the risk of depression shows inconsistent findings, especially in adult OC users. One possible reason for this inconsistency is the omission of women who discontinue OCs due to adverse mood effects, leading to healthy user bias. To address this issue, we aim to estimate the risk of depression that is associated with the initiation of OCs as well as the effect of OC use on lifetime risk of depression. This is a population-based cohort study based on data from 264,557 women from the UK Biobank. Incidence of depression was addressed via interviews, inpatient hospital or primary care data. The hazard ratio (HR) between OC use and incident depression was estimated by multivariable Cox regression with OC use as a time-varying exposure. To validate causality, we examined familial confounding in 7,354 sibling pairs. We observed that the first 2 years of OC use were associated with a higher rate of depression compared to never users (HR=1.71, 95% confidence interval [CI]: 1.55-1.88). Although the risk was not as pronounced beyond the first 2 years, ever OC use was still associated with an increased lifetime risk of depression (HR=1.05, 95% CI: 1.01-1.09). Previous OC use were associated with a higher rate of depression compared to never users, with adolescent OC users driving the increased hazard (HR=1.18, 95% CI: 1.12-1.25). No significant association were observed among adult OC users who had previously used OCs (HR=1.00, 95% CI: 0.95-1.04). Notably, the sibling analysis provided further evidence for a causal effect of OC use on the risk of depression. Our findings suggest that the use of OCs, particularly during the first 2 years, increases the risk of depression. Additionally, OC use during adolescence might increase the risk of depression later in life. Our results are consistent with a causal relationship between OC use and depression, as supported by the sibling analysis. This study highlights the importance of considering the healthy user bias as well as family-level confounding in studies of OC use and mental health outcomes. Physicians and patients should be aware of this potential risk when considering OCs, and individualized risk-benefit assessments should be conducted.

Oral Contraceptives, Hormone Replacement Therapy, and Stroke Risk.

Millions of women worldwide use exogenous hormones as oral contraceptives or hormone replacement therapy. Still, time-dependent and long-term consequences of exogenous hormones on stroke risk remains unclear. We examined the association between self-reported oral contraceptive and hormone replacement therapy use and stroke risk in 257 194 women from the UK Biobank, born between 1939 and 1970. Outcomes included any type of stroke, ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage. Exposures were analyzed as time-varying variables in Cox regression models. During first year of oral contraceptive use, an increased event rate of any stroke was observed (hazard ratio [HR], 2.49 [95% CI, 1.44-4.30]), while the hazards were found to be comparable during remaining years of use (HR, 1.00 [95% CI, 0.86-1.14]), compared with nonusers. Similarly, first year of hormone replacement therapy use was associated with higher hazard rates of any stroke (HR, 2.12 [95% CI, 1.66-2.70]), as well as cause-specific stroke, including ischemic stroke (HR, 1.93 [95% CI, 1.05-3.57]) and subarachnoid hemorrhage (HR, 2.17 [95% CI, 1.25-3.78]), which remained increased for any stroke during remaining years of use (HR, 1.18 [95% CI, 1.05-1.31]), and after discontinuation (HR, 1.16 [95% CI, 1.02-1.32]). Oral contraceptive use and hormone replacement therapy were associated with an increased risk of stroke, especially during the first year of use, possibly due to immediate changes in hemostatic balance. This study provides new insights on the effects of hormone exposure on stroke risk and provide evidence of not only an overall risk but also a pronounced effects seen in the beginning of treatment.

Symptomatic Gallstones in Young Patients Under the Age of 30 Years.

IntroductionGallstones are deposits of digestive fluid that is hardened into small pellets. Gallstones can be symptomatic or asymptomatic. The present study assessed the sociodemographic and clinical characteristics of patients under the age of 30 years old with symptomatic gallstones.MethodologyA prospective, observational study was conducted at Surgical Unit-3, at Jinnah Postgraduate Medical Centre (JPMC), Pakistan, from July 2020 to July 2021. All patients suspected of having gallstone disease underwent ultrasonic examination. A diagnosis of gallstone disease was made if the gallbladder showed a hyperechoic mass casting a posterior acoustic shadow, with a change of position. All of the patients with gallstone disease were hospitalized. The patients were asked about their age, past history (with special emphasis on last pregnancy and years of oral contraceptive use, if any), socioeconomic status, and other demographic data. The patients were treated with a cholecystectomy, either laparoscopic or open. Postcholecystectomy complications, if any, were recorded.ResultsA total of 210 patients under the age of 30 years were included. The mean age of patients was 25 ± 3 years. The majority of the population were females, i.e., 170 (81%). Upon assessing the risk factors, it was found that 31.84% of the female patients had used oral contraceptives, 32.96% were pregnant at the time of presentation, 20.48% had diabetes mellitus, and 27.14% had a history of gallstones. Furthermore, it was found that about 114 (54.29%) patients were overweight with a body mass index (BMI) of 25-30 kg/m2. High triglyceride levels and high cholesterol levels were found in 108 (51.43%) and 115 (54.76%) of the patients, respectively, indicating a link between symptomatic gallstones and younger age.ConclusionOur study indicated that young people are prone to symptomatic gallstones. The rate of disease was considerably high among females and in patients with high cholesterol and triglyceride levels and abnormal body mass index. Further exploratory studies are needed to determine the cause of gallstones.

Risk factors for Luminal A ductal carcinoma in situ (DCIS) and invasive breast cancer in the Carolina Breast Cancer Study.

PurposeInvasive breast cancers are thought to arise from in situ lesions, but some ductal carcinoma in situ (DCIS) are indolent with low likelihood of progressing to invasive carcinoma. Comparison of risk factor associations between DCIS and invasive disease may elucidate which factors influence early versus late stages of carcinogenesis. Therefore, we determined whether there were differences in risk factor profiles for screen-detected DCIS and invasive breast cancer among Luminal A lesions.MethodsWe conducted a case-control analysis using data from the Carolina Breast Cancer Study (1993–2001). Analyses were restricted to Luminal A tumors and screen-detected tumors among mammography-eligible women, to limit confounding by mode of detection (N = 108 DCIS; N = 203 invasive). Logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CI) for associations between risk factors and lesion type.ResultsIn stratified analyses, we observed qualitative differences in the direction of association for ever smoking, obese BMI, high waist-to-hip-ratio (WHR), and ≥10 years of oral contraceptive use between DCIS and invasive disease. Breastfeeding was inversely associated with invasive disease and was not associated with DCIS. Interaction tests for risk factor associations between Luminal A DCIS and invasive breast cancer were not statistically significant (p>0.05).ConclusionsAmong Luminal A tumors, established breast cancer risk factors may exert stronger effects on progression of early lesions to invasive disease, with lesser effects on risk of DCIS.

Oral Contraceptive Use and Risks of Cancer in the NIH-AARP Diet and Health Study.

Although use of oral contraceptives (OCs) is common, their influence on carcinogenesis is not fully understood. We used Cox proportional hazards models to examine OC use (never/<1 year (referent), 1-4, 5-9, ≥10 years) and development of incident cancers across body sites within the same base population: women in the prospective National Institutes of Health-AARP Diet and Health Study (enrolled 1995-1996 and followed until 2011). Adjustment for confounding varied by outcome; all models accounted for age, race, body mass index, and smoking status, and included at least 100,000 women. Any OC use conferred a 3% reduction in the risk for any cancer (hazard ratio = 0.97, 95% confidence interval: 0.95, 0.99). Expected risk reductions that strengthened with duration of use were identified for ovarian and endometrial cancers and were suggested for kidney cancer (all P for trend < 0.05). Non-Hodgkin lymphoma risk (hazard ratio = 0.79, 95% confidence interval: 0.64, 0.97) was reduced with 10 or more years of OC use. There was a 37% reduced risk for bladder cancer and 46% increased risk for pancreatic cancer among long-term OC users who were 60 years of age or younger at baseline. OC use did not influence risks for most other cancers evaluated. Given the high prevalence of use and changing formulations, additional studies are warranted to fully understand the chemopreventive effects of these medications.

Abstract 3011: Dietary fat, fatty acids, and ovarian cancer risk: Preliminary findings from the Shanghai Women’s Health Study

Abstract Introduction: Dietary fat is an essential nutrient for human growth and development, but epidemiological studies have linked excess fat to the development of multiple malignancies. The few existing studies on ovarian cancer risk are inconsistent, possibly due to differences in sources and subtypes of fat. For example, omega-3 (n-3) polyunsaturated fatty acids (PUFAs) are thought to be antineoplastic, while omega-6 (n-6) PUFAs may promote carcinogenesis. Approach: We evaluated dietary fat in relation to ovarian cancer risk in the prospective Shanghai Women’s Health Study (SWHS). Intake levels were determined from food frequency questionnaires (FFQ) administered at baseline and during follow-up; specific nutrient components were based on the sum of specific foods multiplied by nutrient content from the Chinese Food Composition Table. Cox proportional hazards regression was used to estimate relative risks (RR) and 95% confidence intervals (CI) for dietary fat and fatty acid components categorized into quintiles. Minimal models included age and residual adjustment for total energy intake; fully adjusted models also included education, years of menstruation, years of oral contraceptive use, parity, years of breastfeeding, family history of ovarian cancer, smoking, drinking, NSAID use, BMI, and physical activity. Results: Among 73,144 SWHS participants, we identified a total of 219 ovarian cancer cases in 1,114,828 person-years of follow-up. We found significant dose-response relationships between increasing total PUFA (P-trend=0.032) and n-6 PUFA (P-trend=0.022) intakes and decreased ovarian cancer risk. In both minimally and fully adjusted models, women with the highest quintile of total dietary PUFAs were approximately 35% less likely to develop ovarian cancer (RR=0.65, 95% CI: 0.43-1.00), and women with the highest n-6 PUFA intake had a nearly 40% lower risk (RR=0.61, 95% CI: 0.40-0.93). Total fat, monounsaturated fat, and n-3 PUFA intake were not significantly related to ovarian cancer risk. Conclusions: Findings from our preliminary analysis of a large prospective cohort of Chinese women suggest that total PUFA intake may be protective of ovarian cancer, and that this association may be driven by n-6 rather than n-3 PUFAs. Further evaluation, including stratification, sensitivity analysis, and evaluation of source of dietary fatty acids, is currently underway. Citation Format: Eftitan Y. Akam, Harvey J. Murff, Yong-Bing Xiang, Nikhil K. Khankari, Hui Cai, Xiao O. Shu, Wei Zheng, Alicia Beeghly-Fadiel. Dietary fat, fatty acids, and ovarian cancer risk: Preliminary findings from the Shanghai Women’s Health Study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 3011. doi:10.1158/1538-7445.AM2017-3011

Abstract A27: Timing of pregnancies and oral contraceptive use and risk of ovarian cancer

Abstract Background: Parity and use of oral contraceptive (OC) are associated with reduced risk of ovarian cancer. However, it is not clear whether these exposures have similar risk effects during different periods of life. In a large consortial analysis, we seek to evaluate the risk reductions associated with pregnancy and with OC use in different periods during the lifetime of a woman. Methods: We combined data from 17 population-based case-control studies of ovarian cancer that are part of the Ovarian Cancer Association Consortium (OCAC). Odds ratios (ORs) and 95% confidence intervals (CI) for associations between age of pregnancies and duration of OC use were estimated in individual studies using logistic regression and combined using random effects meta-analysis. Analyses were adjusted for age, duration of OC use, number of pregnancies, and race (Caucasian, Black, Asian and other). Studies that matched on ethnicity were additionally adjusted for Hispanic ethnicity (yes/no). All tests were two-sided and P-values less than 0.05 were considered statistically significant. Results: The analysis included 15,033 ovarian cancer cases and 25,312 controls. The median age for cases was 57 (interquantile range: 50-65) and 56 for controls (interquantile range: 48-64). Approximately 83.4% of cases and 88.5% of controls reported at least one pregnancy and 55.4% of cases and 61.7% of controls reported OCs use for at least one month. On average, each pregnancy was associated with a 17% reduced risk of ovarian cancer (OR=0.83, 95% CI: 0.8-0.85) while each year of OC use was associated with a 6% reduced risk (OR=0.94, CI 0.92-0.95). Among women who reported having at least one pregnancy, older age at last pregnancy was associated with lower risk of ovarian cancer (P&amp;lt;0.0001). Specifically, compared to women whose last pregnancy was before the age of 25, women who had their last pregnancy between the ages of 25-30 had a 15% reduced risk of ovarian cancer (OR=0.85, 95% CI: 0.78-0.93), women who had their last pregnancy between the ages of 30-35 had a 18% reduced risk of ovarian cancer (OR=0.82, 95% CI: 0.74-0.90) and women who had their last pregnancy after the age of 35 had a 21% reduced risk of ovarian cancer (OR=0.79, 95% CI: 0.70-0.90). Similar findings were observed when analyses were stratified by increasing number of pregnancies. With respect to OC use, compared to women who reported the age at last used before the age of 25, those who reported the age at last use to be between the ages of 25-30 had a 15% lower risk of ovarian cancer (OR=0.85, 95% CI: 0.73-0.98) and those who reported the age of last use was after the age of 30 had a 18% reduced risk of ovarian cancer (OR=0.82, 95% CI: 0.66-1.03 for age at last used between 30-35; OR=0.82, 95% CI: 0.63-1.07 for age at last older than 35), but the trend was not significant. Conclusions: In summary, older age at last pregnancy was significantly associated with reduced risk of ovarian cancer. There was a suggestion that older age at last used of OCs was associated with lower risk of ovarian cancer. These findings suggest that use of OCs to later ages in life can reduce ovarian cancer risk. A joint evaluation of life periods with pregnancies and OC use and ovarian cancer risk is under way. Citation Format: Clara Bodelon, Harvey Risch, Francesmary Modugno, Penelope Webb, Celeste Leigh Pearce, Malcolm Pike, Nicolas Wentzensen. Timing of pregnancies and oral contraceptive use and risk of ovarian cancer. [abstract]. In: Proceedings of the AACR Special Conference: Improving Cancer Risk Prediction for Prevention and Early Detection; Nov 16-19, 2016; Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(5 Suppl):Abstract nr A27.

A prospective cohort study of oral contraceptive use and ovarian cancer among women in the United States born from 1947 to 1964.

Oral contraceptives (OCs) have been consistently associated with a reduced ovarian cancer risk; however, most previous studies included women in older birth cohorts using high-dose OC formulations. We assessed OC use, including type and dose, and ovarian cancer risk among women born between 1947 and 1964 using more recent formulations. We included 110,929 Nurses' Health Study II participants. Women reported duration of OC use and brands used from age 13 to baseline (1989) and every 2 years thereafter through 2009. We categorized brands by estrogen and progestin type, dose, and potency, and used Cox proportional hazards models, adjusted for age, calendar time, reproductive factors, and body mass index, to assess associations with ovarian cancer. Over 2,178,679 person-years of follow-up, we confirmed 281 cases. At baseline, 83% of participants reported ever using OCs. Compared to never use, we observed an increased risk of ovarian cancer with ≤6 months of OC use (HR 1.82; 95% CI 1.13-2.93) but a non-significant 57% (95% CI 0.18-1.03) decreased risk with ≥15 years of OC use. The increased risk among short-term users (≤1year) was restricted to OCs containing mestranol (HR 1.83; 95% CI 1.16-2.88) and first-generation progestin (HR 1.72; 95% CI 1.11-2.65). The associations between OCs and ovarian cancer observed for this younger birth cohort differ substantially from the results of previous cohort studies, possibly reflecting changes in OC formulations and use patterns over time, although these results could be due to chance. Additional studies should evaluate newer OC formulations and ovarian cancer risk.

Parity and Oral Contraceptive Use in Relation to Ovarian Cancer Risk in Older Women.

Several studies have suggested that the ovarian cancer risk reductions associated with parity and oral contraceptive use are weaker in postmenopausal than premenopausal women, yet little is known about the persistence of these reductions as women age. This question gains importance with the increasing numbers of older women in the population. We addressed the question using data from three large U.S. cohort studies involving 310,290 white women aged 50+ years at recruitment, of whom 1,815 developed subsequent incident invasive epithelial ovarian cancer. We used Cox regression, stratified by cohort, to examine age-related trends in the HRs per full-term pregnancy and per year of oral contraceptive use. The parity-associated risk reductions waned with age (Ptrend < 0.001 in HR with increasing age), particularly among women aged 75 years or more, for whom we observed no association with parity. However, we observed no such attenuation in the oral contraceptive-associated risk reductions (P = 0.79 for trend in HR with increasing age). These findings suggest that prior oral contraceptive use is important for ovarian cancer risk assessment among women of all ages, while the benefits of parity wane as women age. This information, if duplicated in other studies, will be useful to preventive counseling and risk prediction, particularly for women at increased ovarian cancer risk due to a personal history of breast cancer or a family history of ovarian cancer. Cancer Epidemiol Biomarkers Prev; 25(7); 1059-63. ©2016 AACR.

Low dose oestrogen combined oral contraception and risk of pulmonary embolism, stroke, and myocardial infarction in five million French women: cohort study

Objective To assess the risk of pulmonary embolism, ischaemic stroke, and myocardial infarction associated with combined oral contraceptives according to dose of oestrogen (ethinylestradiol) and progestogen.Design Observational cohort study.Setting Data...

Oral Contraceptive Use and Prevalence of Self-Reported Glaucoma or Ocular Hypertension in the United States

To investigate the association between oral contraceptive (OC) use and glaucoma prevalence in the United States. Cross-sectional study. A total of 3406 female participants, aged 40 years or older, from the 2005 to 2008 National Health and Nutrition Examination Survey, who reported a presence or absence of glaucoma or ocular hypertension completed both the vision and the reproductive health questionnaires and underwent eye examinations. Multivariate regression analysis was used to assess the correlation between OC use and self-reported glaucoma or ocular hypertension (n = 231 cases), controlling for potential confounders, including age, ethnicity, systemic comorbidities such as hypertension and stroke, ocular diseases such as cataract and diabetic retinopathy, and reproductive health factors, including age at menopause, age at menarche, history of hormone replacement therapy, and gynecological surgical history. The outcome variable was self-reported glaucoma or ocular hypertension. After adjusting for confounders, those with ≥3 years of OC use had greater odds (odds ratio, 1.94; 95% confidence interval, 1.22-3.07) of self-reported glaucoma or ocular hypertension. Other factors associated with higher glaucoma or ocular hypertension prevalence included older age, African American race, and later age at menarche. Oral contraceptive use may be associated with increased risk of self-reported glaucoma or ocular hypertension.

Pregnancy During or Soon After Use of the Pill

Remembering to take a pill every day can be difficult; thus, 9% of oral contraceptive (OC) users conceive within their first year of OC use. To assess

History of oral contraceptive use and risk of spontaneous abortion

PurposeTo examine the association between pregravid oral contraceptive (OC) use and spontaneous abortion (SAB). MethodsIn an Internet-based preconception cohort study of 4862 Danish pregnancy planners, we used Cox proportional hazards models to estimate adjusted hazard ratios and 95% confidence intervals (CIs) for the association between OC use and SAB. We controlled for maternal age, physical activity, parity, education, alcohol and caffeine consumption, body mass index, and smoking. ResultsCompared with women who discontinued OCs >1 year before conception, HRs were 0.95 (95% confidence interval (CI) = 0.77–1.17), 0.99 (95% CI = 0.82–1.19), and 0.80 (95% CI = 0.60–1.06) for women who discontinued OCs 7–12, 2–6, and 0–1 months before conception, respectively. Compared with less than 4 years of OC use, HRs for 4–7, 8–11, and 12 years or more of OC use were 1.05 (95% CI = 0.80–1.37), 0.92 (95% CI = 0.71–1.19), and 0.88 (95% CI = 0.65–1.19), respectively. Dose of estrogen and generation of progestin were not materially associated with SAB risk. ConclusionsWe found no evidence that pregravid OC use is associated with an increase in SAB. Use within 1 month of conception was associated with a slightly lower risk of SAB, but this may be due to increased reproductive fitness in women who conceive quickly after discontinuation of OCs.

Abstract 860: Effects of breastfeeding and oral contraception use on the risk of breast cancer recurrence: A multinational study

Abstract Introduction: Breastfeeding (BF) decreases and oral contraceptive (OCP) increases the incidence of breast cancer (BC). However, their role in the recurrence of breast cancer (rBC) has not been established. The aim of our study was to examine the association of maternal factors in the rBC. Methods: Data were obtained from the Global Epidemiological Study (GES), an IRB approved multinational biorepository and database to assess disease risk factors. Pts provided their personal history, age, BMI, age of first pregnancy, BF, number of children breastfed, radiation exposure (RE), years of OCP use, benign breast disease (BD), hysterectomy, hormone replacement therapy (HRT) and rBC. The t-test and chi-square test were used for continuous and categorical variables, respectively. The association [adjusted odds ratio (aOR)] between rBC and each risk factor was obtained using logistic regression after adjusting for all the variables including stage of cancer. Results: A total of 2546 patients were surveyed, of which 218 patients had rBC later in life. The average age of pts with recurrence was 54 yrs and those without rBC was 56 yrs. Of the total, 73.5% had BF, 25% had used OCP, 17.3% used HRT, 5.6% had RE, 16.6% had a hysterectomy, and 16% had BD. In multivariate analysis, age, BF, OCP and RE each had significant impacts on the rBC. Pts who did not BF had a 3-fold increased risk of recurrence compared to those who breastfed at least 3 children [aOR of 2.9 (1.7-4.9)]. Pts who did not use OCPs were 53% less likely to have rBC compared to those who used OCPs [aOR of 0.47 (0.32-0.69)]. A statistically significant dose-effect for number of children breastfed and rBC, and years of OCPs usage and rBC was found. BMI, HRT, hysterectomy, BD, and age at first pregnancy did not have an effect on rBC. Conclusion: Our study suggests that breastfeeding decreases the risk of recurrence of breast cancer, while OCP usage increases the risk of recurrence of breast cancer. Further studies are needed to validate our results. Predictors of recurrence of breast cancer (rBC)Variablesβ EstimateAdjusted OR (CI)p-valueAge0.0221.02 (1.008-1.03)0.002Breastfed (BF, none vs. &amp;gt;3 children)1.062.9 (1.7-4.9)&amp;lt;0.0001Breastfed (BF, &amp;lt; 3 vs. &amp;gt; 3 children)0.742.09 (1.2-3.5)0.006Oral Contraceptive use (OCP, no vs. yes)-0.7430.47 (0.32-0.69)0.0001Radiation exposure (RE, no vs. yes)-1.310.26 (0.16- 0.13)&amp;lt;0.0001HRT (no vs. yes)0.41.49 (0.96-2.3)0.07 Citation Format: Teresa A. Lehman, Mohammed Shaik, Ramakrishna V. Modali, Borys Hrinczenko. Effects of breastfeeding and oral contraception use on the risk of breast cancer recurrence: A multinational study. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 860. doi:10.1158/1538-7445.AM2015-860

Linear reduction in thyroid cancer risk by oral contraceptive use: a dose–response meta-analysis of prospective cohort studies

Is there an association between oral contraceptive (OC) use and thyroid cancer risk in females? OC use is inversely associated with the risk of thyroid cancer in females. OC use may be relevant to the risk of thyroid cancer as suggested by some epidemiological studies. However, the findings are inconsistent regarding the effect direction and size. This systematic review and meta-analysis included a total of 1906 patients from about 1.3 million individuals who had participated in 9 prospective cohort studies. The follow-up length ranged 7.5-15.9 years. PubMed (MEDLINE) was searched through to January 2015 for eligible studies. References of relevant review articles were also manually screened. Prospective cohort studies that evaluated the association between OC use and thyroid cancer risk were included. Study characteristics including patients' characteristics, length of the follow-up and risk estimates were extracted. The quality of the studies was also assessed. The included studies were of high methodological quality according to the Newcastle-Ottawa Quality Assessment Scale. After pooling risk estimates from all the studies, there was a significant inverse association between the longest versus shortest duration of OC use and the risk of thyroid cancer [relative risk (RR) = 0.84, 95% confidence interval (CI) 0.73-0.97], with no considerable heterogeneity (I(2) = 26.1%). There was no significant publication bias. The significant association persisted in the subgroup of high-quality studies (RR = 0.84, 95% CI 0.72-0.97). By dose-response analysis, there was a linear relationship (P = 0.0001) between the duration of OC use and thyroid cancer risk. The summary RR for an increment of 1 year of OC use was 0.96 (95% CI 0.94-0.98), with no significant heterogeneity. Individual patient data were unavailable for a more accurate estimation. These results indicate that OC use may decrease the risk of thyroid cancer in females. This may have implications for women's decisions regarding the use of OC. No funding was involved for this study. No conflicts of interest are declared.

Pre-gravid oral contraceptive use in relation to birth weight: a prospective cohort study.

Few studies have evaluated the association between pregravid oral contraceptive (OC) use and birth weight, and findings have been conflicting. We conducted a prospective cohort study of 5921 pregnancy planners in Denmark to evaluate recency, duration, and type of OC used before conception in relation to infant birth weight. Participants completed online questionnaires and reported detailed information on contraceptive history and covariates at baseline. Participants completed bimonthly follow-up questionnaires to update their pregnancy status for up to 12months or until conception occurred. Birth weight data were ascertained from the Danish Medical Birth Registry for 4046 live births delivered by study participants between 2008 and 2010. We used multivariable linear and log-binomial regression analyses to control for confounding. Mean birth weight was higher among women who had used OCs within 0-1months (mean difference=97g, CI 26, 168) or 2-6months (mean difference=40g, CI -5, 85) before conception, compared with more than 12months before conception. Mean birth weight was lower among women who had used OCs for long durations (mean difference comparing ≥12 with <4years of OC use=-85g, CI -158, -11). Our findings indicate that pregravid OC use within 6months of conception may be associated with a small increase in birth weight, but that long duration of use may have the opposite effect. Results were stronger among male infants, among 2nd and 4th generation OC users, and among users of OCs with a higher estrogen dose.

Risk factors for facial melasma in women: a case-control study.

Melasma is a localized chronic acquired hypermelanosis, common in adult women and which has an important impact on their life quality. Its pathology is unknown, despite some recognized triggering factors. To evaluate risk factors for developing facial melasma in women. This was a case-control study involving adult women with or without facial melasma, paired by age. Variables were grouped into hierarchical levels: personal characteristic data, exposure variables, links to hormonal stimuli and the State-Trait Anxiety Inventory questionnaire, Brazilian version. The data were analysed using conditional multiple logistic regression. We evaluated 207 patients and 207 controls. The mean age was 38 years. Cases differed from controls for phototype, Amerindian ancestry [odds ratio (OR) 2·59], years of beach or rural residence (OR 1·06), time exposed to sun at work (OR 1·65), time exposed to sun in leisure activities (OR 1·04), antidepressant/anxiolytic use (OR 4·96), menstrual irregularity (OR 3·83), pregnancy history (OR 3·59), years of oral contraceptive use (OR 1·23) and anxiety scores (OR 1·08). A family history of melasma was reported in 61% of cases and 13% of controls (OR 10·40). Facial melasma is independently associated with elements linked to pigmentation capacity, family ancestry, chronic sun exposure, sexual hormone stimuli, psychotropics and anxiety traits.