Combined effect of oral contraceptive use and hormone replacement therapy on breast cancer risk in postmenopausal women.
OBJECTIVE
We examined breast cancer risk related to lifetime exposure to oral contraceptives (OCs) and hormone replacement therapy (HRT) in postmenopausal women.


METHODS
The Women's Contraceptive and Reproductive Experiences (CARE) Study was a population-based case-control study that included 1847 postmenopausal women with incident invasive breast cancer, and 1932 control subjects, identified using random digit dialing.


RESULTS
45% of cases and 49% of controls used both OCs and HRT. OC users were not at increased risk regardless of subsequent HRT exposure. HRT users who had used OCs previously did not have a higher risk of breast cancer than women with no exposure to OCs. We observed a negative interaction (p-value: 0.032) of combined hormone replacement therapy (CHRT) and past OC use. The increase in risk with CHRT was stronger in women who had never used OCs in the past (odds ratio: 1.05; 95% confidence interval: 1.01-1.10 per year of exclusive CHRT use) than in women who had used OCs (odds ratio: 1.00; 95% confidence interval: 0.97-1.03).


CONCLUSIONS
We found no indication that adverse effects of exposure to OCs or HRT appeared only in the presence of the other hormone or were exacerbated by exposure to the other hormone.
Norman
Sandra A
SA
Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA 19104-6021, USA. snorman@cceb.med.upenn.edu
Berlin
Jesse A
JA
Weber
Anita L
AL
Strom
Brian L
BL
Daling
Janet R
JR
Weiss
Linda K
LK
Marchbanks
Polly A
PA
Bernstein
Leslie
L
Voigt
Lynda F
LF
McDonald
Jill A
JA
Ursin
Giske
G
Liff
Jonathan M
JM
Burkman
Ronald T
RT
Malone
Kathleen E
KE
Simon
Michael S
MS
Folger
Suzanne G
SG
Deapen
Dennis
D
Wingo
Phyllis A
PA
Spirtas
Robert
R
D000328:Adult; D001943:Breast Neoplasms / Q000139:chemically induced* / Q000453:epidemiology; D002140:California / Q000453:epidemiology; D016022:Case-Control Studies; D003276:Contraceptives, Oral / Q000009:adverse effects*; D004359:Drug Therapy, Combination; D015914:Estrogen Replacement Therapy / Q000009:adverse effects*; D005260:Female; D005845:Georgia / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008824:Michigan / Q000453:epidemiology; D008875:Middle Aged; D010414:Pennsylvania / Q000453:epidemiology; D017698:Postmenopause; D012307:Risk Factors; D014861:Washington / Q000453:epidemiology; D016387:Women's Health
D003276:Contraceptives, Oral