A prospective study of oral contraceptive use and colorectal adenomas
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The influence of reproductive factors on colorectal cancer, including oral contraceptive (OC) use, has been examined, but less research is available on OC use and adenomas.
Participants of the Nurses’ Health Study who had a lower bowel endoscopy between 1986 (when endoscopies were first assessed) and 2008 were included in this study. Multivariable logistic regression models for clustered data were used to estimate odds ratios and 95 % confidence intervals [OR (95 % CIs)].
Among 73,058 participants, 51 % (n = 37,382) reported ever using OCs. Ever OC use was associated with a slight increase in non-advanced adenomas [OR 1.11, 95 % CI (1.02, 1.21)] but not with any other endpoints. Duration of OC use was not associated with adenomas, but longer times since last OC use were associated with increased odds of adenomas [e.g., compared to never use, 15+ years since last use: OR 1.17 (1.07, 1.27)]. Shorter times since last OC use were inversely associated [e.g., ≤4 years since last use: OR 0.74 (0.65, 0.84)].
We observed a modest borderline increase in risk of colorectal adenomas with any prior OC use. Additionally, more recent OC use may decrease risk, while exposure in the distant past may modestly increase risk of adenomas.
KeywordsAdenoma Colorectal neoplasms Contraceptives Oral Intestinal polyps Reproductive history
The NHS was supported by research Grants UM1CA186107 and P01CA87969 of the National Institutes of Health. BMC was supported by the Training Programs in Cancer Epidemiology (T32CA09001) from the National Cancer Institute and in Reproductive, Perinatal, and Pediatric Epidemiology (T32HD060454) as well as Grant F32HD084000 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health. WW was supported by Entertainment Foundation National Colon Cancer Research Alliance. An abstract of this work was presented at the Association for Cancer Research Annual Meeting on 7 April 2014 and the Society for Epidemiologic Research Annual Conference on 26 June 2014. We would like to thank the participants and staff of the Nurses’ Health Study for their valuable contributions as well as the following state cancer registries for their help: AL, AZ, AR, CA, CO, CT, DE, FL, GA, ID, IL, IN, IA, KY, LA, ME, MD, MA, MI, NE, NH, NJ, NY, NC, ND, OH, OK, OR, PA, RI, SC, TN, TX, VA, WA, WY. The authors assume full responsibility for analyses and interpretation of these data. Also, special thanks to Scott Smith for his programming assistance.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
Return of the questionnaires was considered informed consent.
Research involving human participants
The study was approved by the Institutional Review Board of Brigham and Women’s Hospital in Boston.
- 9.Hannaford PC, Selvaraj S, Elliott AM, Angus V, Iversen L, Lee AJ (2007) Cancer risk among users of oral contraceptives: cohort data from the Royal College of General Practitioner’s oral contraception study. BMJ 335(7621):651. doi: 10.1136/bmj.39289.649410.55 CrossRefPubMedPubMedCentralGoogle Scholar
- 29.Potter JD, Bostick RM, Grandits GA, Fosdick L, Elmer P, Wood J, Grambsch P, Louis TA (1996) Hormone replacement therapy is associated with lower risk of adenomatous polyps of the large bowel: the Minnesota Cancer Prevention Research Unit Case-Control Study. Cancer Epidemiol Biomarkers Prev 5(10):779–784PubMedGoogle Scholar
- 30.Rossouw JE, Anderson GL, Prentice RL, LaCroix AZ, Kooperberg C, Stefanick ML, Jackson RD, Beresford SA, Howard BV, Johnson KC, Kotchen JM, Ockene J (2002) Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women’s Health Initiative randomized controlled trial. JAMA 288(3):321–333CrossRefPubMedGoogle Scholar
- 32.Woodson K, Lanza E, Tangrea JA, Albert PS, Slattery M, Pinsky J, Caan B, Paskett E, Iber F, Kikendall JW, Lance P, Shike M, Weissfeld J, Schatzkin A (2001) Hormone replacement therapy and colorectal adenoma recurrence among women in the Polyp Prevention Trial. J Natl Cancer Inst 93(23):1799–1805CrossRefPubMedGoogle Scholar
- 35.Campagnoli C, Biglia N, Altare F, Lanza MG, Lesca L, Cantamessa C, Peris C, Fiorucci GC, Sismondi P (1993) Differential effects of oral conjugated estrogens and transdermal estradiol on insulin-like growth factor 1, growth hormone and sex hormone binding globulin serum levels. Gynecol Endocrinol 7(4):251–258CrossRefPubMedGoogle Scholar
- 36.Hunter DJ, Colditz GA, Hankinson SE, Malspeis S, Spiegelman D, Chen W, Stampfer MJ, Willett WC (2010) Oral contraceptive use and breast cancer: a prospective study of young women. Cancer Epidemiol Biomarkers Prev 19(10):2496–2502. doi: 10.1158/1055-9965.EPI-10-0747 CrossRefPubMedPubMedCentralGoogle Scholar
- 41.Colin EM, Van Den Bemd GJ, Van Aken M, Christakos S, De Jonge HR, Deluca HF, Prahl JM, Birkenhager JC, Buurman CJ, Pols HA, Van Leeuwen JP (1999) Evidence for involvement of 17beta-estradiol in intestinal calcium absorption independent of 1,25-dihydroxyvitamin D3 level in the Rat. J Bone Miner Res 14(1):57–64. doi: 10.1359/jbmr.1922.214.171.124 CrossRefPubMedGoogle Scholar
- 48.Smirnoff P, Liel Y, Gnainsky J, Shany S, Schwartz B (1999) The protective effect of estrogen against chemically induced murine colon carcinogenesis is associated with decreased CpG island methylation and increased mRNA and protein expression of the colonic vitamin D receptor. Oncol Res 11(6):255–264PubMedGoogle Scholar