Ovarian cancer risk of Hormonal Contraception

	Tweet

The incidence of ovarian cancer is reduced by pregnancy, lactation, tubal ligation and oral contraceptives ⁽²⁴⁾. The role of sex hormones seems important for ovarian carcinogenesis. 

Epidemiological observations and experimental data from the animal model indicate that estrogens may have an adverse effect, while progesterone/progestins reduce the effect directly on the ovarian epithelium. There is evidence that oral contraceptive use provides substantial protection against ovarian cancer and that the longer HC use offers the greater reduction in ovarian cancer risk (p< 0.001) ^(17,25).

However, the eventual public-health effects of this reduction will depend on how long the protection lasts after use ceases. Women who have used oral contraceptives for 5 years or longer, have about half the risk of ovarian cancer compared with never users ^(26,27,28). 

Recently, the Collaborative Group on Epidemiological Studies of Ovarian Cancer (Oxford) reported from a reanalysis of data from 45 epidemiological studies including 23,257 women with ovarian cancer and 87,303 controls that this reduction in risk persisted for more than 30 years after oral contraceptive use had ceased.However,it became somewhat attenuated over time; the proportional risk reductions per 5 years of use were 29% for use that had ceased less than 10 years previously, 19% for use that had ceased 10-19 years previously, and 15% for use that had ceased 20-29 years previously.  This effect is not dose-dependent considering the similar proportional risk reduction from the 1960s onwards ⁽²⁹⁾.

The incidence of mucinous tumours (12% of the total) seemed little affected by oral contraceptives, but otherwise the proportional risk reduction did not vary much between different histological types. 

Adverse Effects of Hormonal contraception Cardiovascular Effects - Myocardial Infarction - Stroke - Arterial Accidents - Venous Thromboembolism - Blood Hypertension Other Effects - Angioedema - Peliosis Hepatis - Severe Adverse Ocular Reactions - Vasculitis Moderate adverse effects Cancer Risks - Breast cancer risk - Ovarian cancer risk - Endometrial cancer risk - Cervical cancer risk - Colorectal cancer risk - Skin cancer risk - Liver cancer risk - Pancreatic cancer risk - Neurofibromas growth - Unclear cancer risks Hazardous prescription Hormonal contraception in female transplant recipients - Hormonal contraception in female kidney recipients - Hormonal contraception in female liver transplant recipients - Hormonal contraception in female heart transplant recipients - Contraception in women HIV infected Mild Adverse effects New Perspectives immunocontraception Contraceptive counseling Conclusion

These findings suggest that oral contraceptives have already prevented some 200,000 ovarian cancers and 100,000 deaths from the disease, and that over the next few decades the number of cancers prevented will rise to at least 30,000 per year ^{(18, 29 )}. The reduction of risk does not seem related to androgenicity of the hormonal contraceptives ^(27,30). Low-estrogen dose oral contraceptives confer a benefit, regarding ovarian cancer risk, similar to that conferred by earlier high-estrogen-dose formulations ^(31,32,33).

While, current available data suggest that long-term use of estrogens may slightly increase the risk, especially of endometrioid type of ovarian cancer ^(3,30). The protective effect of combined oral contraceptive pill, was confirmed in multiple studies; however, it is unclear whether this protection also covers women with a genetic predisposition to ovarian cancer or perimenopausal women. About 5% of all ovarian-cancer cases are caused by a genetic predisposition, in particular as a component of the autosomal dominant hereditary breast-ovarian-cancer syndrome.

Women with this germline mutations in the cancer susceptibility genes, BRCA1 or BRCA2, have up to an 85% lifetime risk of breast cancer and up to a 46% lifetime risk ovarian cancer ^(20,31,32). Ovarian and endometrial cancer also occur in families with Lynch/hereditary non-polyposis colorectal cancer syndrome (HNPCC). The syndrome is caused by germline mutations in DNA mismatch-repair genes.  Women at high risk of gynaecological cancer based upon familial clustering of disease or a demonstrated pathogenic germ-line mutation are candidates for surveillance:  annual gynaecological examinations, including vaginal echoscopy and serum carcinoma antigen CA125 testing.  Prophylactic surgery in the form of adnexectomy leads to a marked, but not complete, reduction of ovarian-cancer risk in high-risk cases ^(17,18,34).

There is insufficient evidence to advise against, the use of oral contraceptives or hormonal substitution after adnexectomy for healthy women with a genetic predisposition to breast cancer.  Recommendations for surveillance and prevention should be given only after genetic-risk counselling, based on a detailed family study and DNA-based diagnosis ^(17,18,32). 

There is emerging evidence that familial breast cancer,including BRCA1 and BRCA2 mutations,could be estrogen sensitive ⁽³⁵⁾.

Therefore, endogenous and exogenous estrogens, such as hormonal contraceptives,may increase the risk of breast cancer in BRCA1 mutation carriers. So, HCs, especially,in older women should be used with caution in BRCA1 or BRCA2 mutation carriers ⁽³⁶⁾.

----
Rosa Sabatini and Giuseppe Loverro
Dept. Obstetrics and Gynecology,
General Hospital Policlinico-University of Bari, Italy
----

REFERENCES

1. La Vecchiam, C., Negri, E., Franceschi, S., Parazzini, F. (1993). Long-term impact of reproductive factors on cancer risk. Int J Cancer, Jan 21, 53(2), 215-9.
   
2. Medard, M.L., Ostrowska, L.  (2007).Combined oral contraception and the risk of reproductive organs cancer in women .Ginekol Pol, Aug,78(8), 637-41. 
   
3. Casey, P.M., Cerhan, J.R., Pruthi, S. (2008). Oral contraceptive use and risk of breast cancer. Mayo Clin Proc,Jan,83),86-90
   
4. Deligeoroglou, E., Michailidis, E., Creatsas, G. (2003).Oral contraceptives and reproductive system cancer. Ann N Y Acad Sci,Nov,997,199-208.
   
5. White, E., Malone, K.E., Weiss, N.S., Daling, J.R.  (1994). Breast cancer among young US women in relation to oral contraceptive use.  J.  Nati Cancer Inst, 86(7), 505-14
   
6. Brohet, R.M., Goldgar, D.E., Easton, D.F., Antoniou, A.C., Andrieu, N., Chang-Claude, J., Peock, S., Eeles, R.A., Cook, M., Chu, C., Noguès, C., Lasset, C., Berthet, P., Meijers-Heijboer, H., Gerdes, A.M., Olsson, H., Caldes, T., van Leeuwen, F.E., Rookus, M.A.  (2007). Oral contraceptives and breast cancer risk in the international BRCA1/2 carrier cohort study: a report from EMBRACE, GENEPSO, GEO-HEBON, and the IBCCS Collaborating Group.J Clin Oncol, Sep 1,25(25), 3831-6.
   
7. Haile, R.W., Thoma, D.C., McGuire, V., Felberg, A., John, E.M., Milne, R.L., Hopper, J.L. et.al. (2006). BRCA1 and BRCA2 mutation carriers, oral contraceptives use,and breast cancer before age 50. Cancer Epidemiol.Biomarker Prev, 15(10), 1863-70.
   
8. Daling, J.R., Brinton, L.A., Voigt, L.F., Weiss, N.S., Coates, R.J., Malone, K.E., Schoenberg, J.B., Gammon, M. (1996). Risk of breast cancer among white women following induced abortion. Am J Epidemiol, Aug 15,144(4), 373-80. 
   
9. Daling, J.R., Malone, K.E., Voigt, L.F., White, E., Weiss, N.S. (1997). Risk of breast cancer among young women:  relationship Med to induced abortion. N Engl J, 336(2), 81-5
   
10. Rookus, M.A., van Leeuwen, F.E.  (1996).Induced abortion and risk for breast cancer:  reporting (recall) bias in a Dutch case-control study.  J Natl Cancer Inst, 88 (23),1759-64
    
11. Van Leeuwen, F.E.  (1991). Epidemiologic aspects of exogenous progestagens in relation to their role in pathogenesis of human breast cancer. Acta Endocrinol, 125(1), 13.

Full References

Provided by ArmMed Media

RELATED STORIES:
Contraceptive counseling   Progesterone Receptor Modulators (PMRS) and Progesterone Antagonists (PAS)   Conclusion - adverse effects of Hormonal contraception   New Perspectives immunocontraception   Low Libido as adverse effect of Hormonal contraception   Vaginal Infections as adverse effect of Hormonal contraception   Depression as adverse effect of Hormonal contraception   Ovarian cysts as adverse effect of Hormonal contraception   Irregular Bleeding Pattern as adverse effect of Hormonal contraception   Mild Adverse effects of Hormonal contraception   Dermatological Adverse effects   Headache as Adverse Effect of Hormonal contraception   Adverse effects on carbohydrate and lipid metabolism   Moderate adverse effects hepatobiliary complications   Hormonal contraception in female heart transplant recipients

Comments

[ + Post Your Own ]

Now you're in the public comment zone. What follows is not Armenian Medical Network's stuff; it comes from other people and we don't vouch for it. A reminder: By using this Web site you agree to accept our Terms of Service. Click here to read the Rules of Engagement.

There are no comments for this entry yet. [ + Comment here + ]

We are pleased to let readers post comments about an article. Please increase the credibility of your post by including your full name and email.

All comments are reviewed by our editors before they are posted on the site. Just keep it clean, kids.

Name:

Email:

Location:

URL:

Remember my personal information

Notify me of follow-up comments?

Please enter the word you see in the image below:

   [advanced search]   

Interactive Quiz:

1. The most common form of contraception used by couples in the United States is Pills Condom Diaphragm Intrauterine device (IUD) Permanent sterilization