title: Oral contraceptives and survival in breast cancer patients aged 20 to 54 years.
abstract: Recent oral contraceptive (OC) use is associated with modestly higher breast cancer incidence among younger women, but its impact on survival is unclear. This study examined the relationship between OC use before breast cancer diagnosis and survival. A population-based sample of 1,264 women aged 20 to 54 years with a first primary invasive breast cancer during 1990 to 1992 were followed up for 8 to 10 years. OC and covariate data were obtained by interviews conducted shortly after diagnosis and from medial records. All-cause mortality was ascertained through the National Death Index (n = 292 deaths). Age- and income-adjusted hazard ratios (HR) and 95% confidence intervals (95% CI) were estimated by Cox regression methods. All-cause mortality was not associated with ever use of OCs or duration of use. Compared with nonusers, mortality estimates were elevated among women who were using OCs at diagnosis or stopped use in the previous year (HR, 1.57; 95% CI, 0.95-2.61). The HR for use of high-dose estrogen pills within 5 years before diagnosis was double that of nonusers (HR, 2.39; 95% CI, 1.29-4.41) or, if the most recent pill included the progestin levonorgestrel, compared with nonusers (HR, 2.01; 95% CI, 1.03-3.91). Because subgroup estimates were based on small numbers of OC users, these results should be cautiously interpreted. Overall, most aspects of OC use did not seem to influence survival, although there is limited evidence that OC use just before diagnosis, particularly use of some pill types, may negatively impact survival in breast cancer patients aged 20 to 54 years.
authors.affiliation: Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway, NE, MS K-52, Atlanta, GA 30341, USA. ktrivers@cdc.gov
authors.forename: Katrina F
authors.initials: KF
authors.lastname: Trivers
authors.forename: Marilie D
authors.initials: MD
authors.lastname: Gammon
authors.forename: Page E
authors.initials: PE
authors.lastname: Abrahamson
authors.forename: Mary Jo
authors.initials: MJ
authors.lastname: Lund
authors.forename: Elaine W
authors.initials: EW
authors.lastname: Flagg
authors.forename: Patricia G
authors.initials: PG
authors.lastname: Moorman
authors.forename: Jay S
authors.initials: JS
authors.lastname: Kaufman
authors.forename: Jianwen
authors.initials: J
authors.lastname: Cai
authors.forename: Peggy L
authors.initials: PL
authors.lastname: Porter
authors.forename: Louise A
authors.initials: LA
authors.lastname: Brinton
authors.forename: J William
authors.initials: JW
authors.lastname: Eley
authors.forename: Ralph J
authors.initials: RJ
authors.lastname: Coates
mesh_terms: D000328:Adult; D000367:Age Factors; D000375:Aging; D001943:Breast Neoplasms / Q000209:etiology / Q000401:mortality*; D016022:Case-Control Studies; D015331:Cohort Studies; D003276:Contraceptives, Oral / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008593:Menopause; D008875:Middle Aged; D012306:Risk; D012307:Risk Factors; D011795:Surveys and Questionnaires; D016019:Survival Analysis; D013997:Time Factors
chemical_list: D003276:Contraceptives, Oral