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Schrijver LH, Mooij TM, Pijpe A, Sonke GS, Mourits MJE, Andrieu N, Antoniou AC, Easton DF, Engel C, Goldgar D, John EM, Kast K, Milne RL, Olsson H, Phillips KA, Terry MB, Hopper JL, van Leeuwen FE, Rookus MA. Oral Contraceptive Use in BRCA1 and BRCA2 Mutation Carriers: Absolute Cancer Risks and Benefits. J Natl Cancer Inst 2022; 114:540-552. [PMID: 35048954 PMCID: PMC9002279 DOI: 10.1093/jnci/djac004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 10/11/2021] [Accepted: 01/10/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND To help BRCA1 and 2 mutation carriers make informed decisions regarding use of combined-type oral contraceptive preparation (COCP), absolute risk-benefit estimates are needed for COCP-associated cancer. METHODS For a hypothetical cohort of 10 000 women, we calculated the increased or decreased cumulative incidence of COCP-associated (breast, ovarian, endometrial) cancer, examining 18 scenarios with differences in duration and timing of COCP use, uptake of prophylactic surgeries, and menopausal hormone therapy. RESULTS COCP use initially increased breast cancer risk and decreased ovarian and endometrial cancer risk long term. For 10 000 BRCA1 mutation carriers, 10 years of COCP use from age 20 to 30 years resulted in 66 additional COCP-associated cancer cases by the age of 35 years, in addition to 625 cases expected for never users. By the age of 70 years such COCP use resulted in 907 fewer cancer cases than the expected 9093 cases in never users. Triple-negative breast cancer estimates resulted in 196 additional COCP-associated cases by age 40 years, in addition to the 1454 expected. For 10 000 BRCA2 mutation carriers using COCP from age 20 to 30 years, 80 excess cancer cases were estimated by age 40 years in addition to 651 expected cases; by the age of 70 years, we calculated 382 fewer cases compared with the 6156 cases expected. The long-term benefit of COCP use diminished after risk-reducing bilateral salpingo-oophorectomy followed by menopausal hormone therapy use. CONCLUSION Although COCP use in BRCA1 and BRCA2 mutation carriers initially increases breast, ovarian, and endometrial cancer risk, it strongly decreases lifetime cancer risk. Risk-reducing bilateral salpingo-oophorectomy and menopausal hormone therapy use appear to counteract the long-term COCP-benefit.
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Affiliation(s)
- Lieske H Schrijver
- Department of Epidemiology, Netherlands Cancer Institute,
Amsterdam, the Netherlands
| | - Thea M Mooij
- Department of Epidemiology, Netherlands Cancer Institute,
Amsterdam, the Netherlands
| | - Anouk Pijpe
- Department of Epidemiology, Netherlands Cancer Institute,
Amsterdam, the Netherlands
| | - Gabe S Sonke
- Department of Medical Oncology, Netherlands Cancer Institute,
Amsterdam, the Netherlands
| | - Marian J E Mourits
- Department of Gynecologic Oncology, University Medical Center Groningen,
University of Groningen, Groningen, the
Netherlands
| | - Nadine Andrieu
- INSERM U900, Paris, France
- Institut Curie, Paris, France
- Mines Paris Tech, Fontainebleau, France
- PSL Research University, Paris, France
| | - Antonis C Antoniou
- Centre for Cancer Genetic Epidemiology, Department of Public Health and
Primary Care, University of Cambridge, Cambridge, UK
| | - Douglas F Easton
- Centre for Cancer Genetic Epidemiology, Department of Public Health and
Primary Care, University of Cambridge, Cambridge, UK
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University
of Cambridge, Cambridge, UK
| | - Christoph Engel
- Institute for Medical Informatics, Statistics and Epidemiology, University
of Leipzig, Germany
| | - David Goldgar
- Department of Dermatology, University of Utah School of
Medicine, Salt Lake City, UT, USA
| | - Esther M John
- Department of Epidemiology & Population Health and Medicine, Stanford
Cancer Institute, Stanford University School of Medicine, Stanford, CA,
USA
| | - Karin Kast
- Department of Gynecology and Obstetrics, Medical Faculty and University
Hospital Carl Gustav Carus, Technische Universität Dresden, Germany
| | - Roger L Milne
- Cancer Epidemiology Division, Cancer Council Victoria,
Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population
and Global Health, The University of Melbourne, Melbourne, Victoria,
Australia
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash
University, Clayton, Victoria, Australia
| | - Håkan Olsson
- Department of Oncology, Lund University Hospital, Lund,
Sweden
| | - Kelly-Anne Phillips
- Centre for Epidemiology and Biostatistics, Melbourne School of Population
and Global Health, The University of Melbourne, Melbourne, Victoria,
Australia
- The Sir Peter MacCallum Department of Oncology, University of
Melbourne, Parkville, Australia
- Department of Medical Oncology, Peter MacCallum Cancer
Centre, Victoria, Australia
| | - Mary Beth Terry
- Department of Epidemiology, Columbia University, New York,
NY, USA
| | - John L Hopper
- Centre for Epidemiology and Biostatistics, Melbourne School of Population
and Global Health, The University of Melbourne, Melbourne, Victoria,
Australia
| | - Flora E van Leeuwen
- Department of Epidemiology, Netherlands Cancer Institute,
Amsterdam, the Netherlands
| | - Matti A Rookus
- Department of Epidemiology, Netherlands Cancer Institute,
Amsterdam, the Netherlands
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