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

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Abstract

Purpose

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.

Methods

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.

Results

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 (≤1 year) 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).

Conclusion

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.

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Acknowledgments

We would like to thank the participants and staff of the Nurses’ Health Study and Nurses’ Health Study II 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, and WY. The authors assume full responsibility for analyses and interpretation of these data. This project was supported by the National Institutes of Health (P01 CA87969, UM1 CA176726). Amy Shafrir was supported by Training Grant T32 HD060454 in Reproductive, Perinatal, and Pediatric Epidemiology from the National Institute of Child Health and Human Development, National Institutes of Health. Amy Shafrir was also supported by the Cancer Epidemiology Training Program from the National Institutes of Health (NIH T32CA09001).

Funding

This project was supported by the National Institutes of Health (P01 CA87969, UM1 CA176726). Amy Shafrir was supported by Training Grant T32 HD060454 in Reproductive, Perinatal, and Pediatric Epidemiology from the National Institute of Child Health and Human Development, National Institutes of Health. Amy Shafrir was also supported by the Cancer Epidemiology Training Program from the National Institutes of Health (NIH T32CA09001).

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Authors and Affiliations

  1. Division of Adolescent/Young Adult Medicine, Boston Center for Endometriosis, Boston Children’s Hospital, 1 Autumn Street, 5th Floor, Boston, MA, 02115, USA

    Amy L. Shafrir

  2. Department of Pediatrics, Harvard Medical School, Boston, MA, USA

    Amy L. Shafrir

  3. Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany

    Helena Schock

  4. Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA

    Elizabeth M. Poole, Rulla M. Tamimi, Susan E. Hankinson, Bernard A. Rosner & Shelley S. Tworoger

  5. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA

    Kathryn L. Terry, Rulla M. Tamimi, Susan E. Hankinson & Shelley S. Tworoger

  6. Obstetrics and Gynecology Epidemiology Center, Department of Obstetrics and Gynecology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA

    Kathryn L. Terry

  7. Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA, USA

    Susan E. Hankinson

  8. Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA

    Bernard A. Rosner

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  1. Amy L. Shafrir
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  2. Helena Schock
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Correspondence to Amy L. Shafrir.

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Shafrir, A.L., Schock, H., Poole, E.M. et al. A prospective cohort study of oral contraceptive use and ovarian cancer among women in the United States born from 1947 to 1964. Cancer Causes Control 28, 371–383 (2017). https://doi.org/10.1007/s10552-017-0876-0

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  • DOI: https://doi.org/10.1007/s10552-017-0876-0

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