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Nonlinear reduction in risk for colorectal cancer by oral contraceptive use: a meta-analysis of epidemiological studies

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Abstract

Purpose

Although the relationship between oral contraceptive (OC) use and colorectal cancer (CRC) risk has been studied extensively, the results of epidemiological studies are controversial. Therefore, we carried out a meta-analysis of epidemiological studies to summarize the available evidence and to quantify the potential dose–response relation.

Methods

We searched PubMed database for studies of OC use and CRC risk that were published until the end of March 2014. Random- and fixed-effects models were applied to estimate summary relative risks (RRs) and 95 % confidence intervals (CIs).

Results

Twelve cohorts and seventeen case–control studies with a total of 15,790 CRC cases were included in the final analysis. The summary RR for the ever versus never category of OC use was 0.82 (95 % CI 0.76–0.88). Similar result was observed when we compared the longest duration of OC use with the shortest duration (RR = 0.86, 95 % CI 0.76–0.96). Furthermore, the results of stratified analysis were comparable to those of overall meta-analysis. In dose–response analysis, significant inverse associations emerged in nonlinear models for the duration of OC use and CRC (P nonlinearity = 0.001). The greatest risk reduction was observed when the duration of OC use was approximately 42 months. There was moderate heterogeneity in the analysis, and no evidence of small-study bias was observed.

Conclusions

Based on the findings of this meta-analysis, ever use of OC is associated with lower risk of CRC. Additionally, there is a statistically significant nonlinear inverse association between the duration of OC use and CRC risk.

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Acknowledgments

This study was supported by The National Natural Science Foundation of China (Grants 81072118, 81172491, and 81101527 for Bei Lin); the PhD Programs Foundation of Ministry of Education of China (Grants 20112104110016 and 20112104120019 for Bei Lin); the Shengjing Free Researcher Project (Grant 200807 for Bei Lin); the Younger research fund of Shengjing Hospital (Grant 2014sj09 for Qi-Jun Wu).

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Shengjing Hospital, China Medical University, Shenyang, People’s Republic of China

    Nan-Nan Luan, Ting-Ting Gong, Yong-Lai Wang & Bei Lin

  2. Center for Clinical and Translational Science, Mayo Clinic, Rochester, MN, USA

    Lang Wu

  3. Division of Clinical Epidemiology, Shengjing Hospital of China Medical University, No. 36, San Hao Street, Shenyang, 110004, Liaoning, People’s Republic of China

    Qi-Jun Wu

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  1. Nan-Nan Luan
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  5. Bei Lin
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Correspondence to Qi-Jun Wu.

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10552_2014_483_MOESM1_ESM.tif

Forest plot (fixed-effects model) of ever use of oral contraceptive and colon cancer risk. Squares indicate study-specific relative risks (size of the square reflects the study-specific statistical weight); horizontal lines indicate 95% CIs; diamond indicates the summary relative risk estimate with its 95% CI. CI: confidence interval; RR: relative risk (TIFF 2486 kb)

10552_2014_483_MOESM2_ESM.tif

Forest plot (fixed-effects model) of ever use of oral contraceptive and rectal cancer risk. Squares indicate study-specific relative risks (size of the square reflects the study-specific statistical weight); horizontal lines indicate 95% CIs; diamond indicates the summary relative risk estimate with its 95% CI. CI: confidence interval; RR: relative risk (TIFF 1926 kb)

10552_2014_483_MOESM3_ESM.tif

Forest plot (random-effects model) of the duration of oral contraceptive use and colon cancer risk. Squares indicate study-specific relative risks (size of the square reflects the study-specific statistical weight); horizontal lines indicate 95% CIs; diamond indicates the summary relative risk estimate with its 95% CI. CI: confidence interval; RR: relative risk (TIFF 2142 kb)

10552_2014_483_MOESM4_ESM.tif

Forest plot (fixed-effects model) of the duration of oral contraceptive and rectal cancer risk. Squares indicate study-specific relative risks (size of the square reflects the study-specific statistical weight); horizontal lines indicate 95% CIs; diamond indicates the summary relative risk estimate with its 95% CI. CI: confidence interval; RR: relative risk (TIFF 2015 kb)

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Luan, NN., Wu, L., Gong, TT. et al. Nonlinear reduction in risk for colorectal cancer by oral contraceptive use: a meta-analysis of epidemiological studies. Cancer Causes Control 26, 65–78 (2015). https://doi.org/10.1007/s10552-014-0483-2

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  • DOI: https://doi.org/10.1007/s10552-014-0483-2

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