Abstract
Several studies have suggested an inverse association between use of combined oral contraceptives (OC) and the risk of colorectal cancer and here we present a meta-analysis of published studies. Articles considered were epidemiological studies published as full papers in English up to June 2000 that included quantitative information on OC use. The pooled relative risks (RR) of colorectal cancer for ever OC use from the 8 case-control studies was 0.81 (95% confidence interval (CI): 0.69–0.94), and the pooled estimate from the 4 cohort studies was 0.84 (95% CI: 0.72–0.97). The pooled estimate from all studies combined was 0.82 (95% CI: 0.74–0.92), without apparent heterogeneity. Duration of use was not associated with a decrease in risk, but there was some indication that the apparent protection was stronger for women who had used OCs more recently (RR = 0.46; 95% CI: 0.30–0.71). A better understanding of this potential relation may help informed choice of contraception. © 2001 Cancer Research Campaign
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References
Beral V, Hermon C, Clifford K, Hannaford P, Darby S and Reeves G (1999) Mortality in relation to oral contraceptive use: 25-year follow-up of women in the Royal College of General Practitioners’ Oral Contraception Study. Br Med J 318: 96–100
Bostick RM, Potter JD and Kushi LH (1994) Sugar, meat, and fat intake, and non-dietary risk factors for colon cancer incidence in lowa women (United States). Cancer Causes Control 5: 38–52
Campagnoli C, Biglia N, Cantamessa C, Lesca L, Lotano MR and Sismondi P (1998) Insulin-like growth factor I (IGF-1) serum level modifications during transdermal estradiol treatment in postmenopausal women: a possible bimodal effect depending on basal IGF-I values. Gynecol Endocrinol 12: 259–266
Chute CG, Willett WC, Colditz GA, Stampfer MJ, Rosner B and Speizer FE (1991) A prospective study of reproductive history and exogenous estrogens on the risk of colorectal cancer in women. Epidemiology 2: 201–207
Collaborative Group on Hormonal Factors in Breast Cancer (1996) Breast cancer and hormonal contraceptives: Collaborative reanalysis of individual data on 53 297 women with breast cancer and 100 239 women without breast cancer from 54 epidemiological studies. Lancet 347: 1713–1727
Dickersin K and Min YI (1993) Publication bias: the problem that won’t go away. Ann N Y Acad Sci 703: 135–146
Dos Santos Silva I and Swerdlow AJ (1996) Sex differences in time trends of colorectal cancer in England and Wales: the possible effect of female hormonal factors. Br J Cancer 73: 692–697
Egger M, Davey Smith G, Schneider M and Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. Br Med J 315: 629–634
El Atiq F, Garrouste F, Remacle-Bonnet M, Sastre B and Pommier G (1994) Alterations in serum levels of insulin-like growth factors and insulin-like growth-factor-binding proteins in patients with colorectal cancer. Int J Cancer 57: 491–497
Fernandez E, La Vecchia C, D’Avanzo B, Franceschi S, Negri E and Parazzini F (1996) Oral contraceptives, hormone replacement therapy and the risk of colorectal cancer. Br J Cancer 73: 1431–1435
Fernandez E, La Vecchia C, Franceschi S, Braga C, Talamini R, Negri E and Parazzini F (1998) Oral contraceptive use and risk of colorectal cancer. Epidemiology 9: 295–300
Fernandez E, Bosetti C, La Vecchia C, Levi F, Fioretti F and Negri E (2000a) Sex differences in colorectal cancer mortality in Europe, 1955–1996. Eur J Cancer Prev 9: 99–104
Fernandez E, Franceschi S and La Vecchia C (2000b) Colorectal cancer and hormone replacement therapy: a review of epidemiological studies. J Br Menop Soc 6: 8–14
Franceschi S and La Vecchia C (1998) Oral contraceptives and colorectal tumors. A review of epidemiologic studies. Contraception 58: 335–343
Franceschi S, Bidoli E, Talamini R, Barra S and La Vecchia C (1991) Colorectal cancer in northeastern Italy: reproductive, menstrual and female hormone-related factors. Eur J Cancer 27: 604–608
Fraumeni JF, Lloyd JW, Smith EM and Wagoner JK (1969) Cancer mortality among nuns; role of marital status in etiology of neoplastic disease in women. J Natl Cancer Inst 42: 455–468
Furner SE, Davis FG, Nelson RL and Haenszel W (1989) A case-control study of large bowel cancer and hormone exposure in women. Cancer Res 49: 4936–4940
Galbraith RF (1988) A note on graphical presentation of estimated odds ratios from several clinical trials. Statist Med 7: 889–894
Gerhardsson de Verdier M and London S (1992) Reproductive factors, exogenous female hormones, and colorectal cancer by subsite. Cancer Causes Control 3: 355–360
Giovannucci E, Pollak MN, Platz EA, Willett WC, Stampfer MJ, Majeed N, Colditz GA, Speizer FE and Hankinson SE (2000) A prospective study of plasma insulin-like growth factor-1 and binding protein-3 and risk of colorectal neoplasia in women. Cancer Epidemiol Biomarkers Prev 9: 345–349
Greenland S (1987) Quantitative methods in the review of epidemiologic literature. Epidemiol Rev 9: 1–30
Herbert-Croteau N (1998) A meta-analysis of hormone replacement therapy and colon cancer in women. Cancer Epidemiol Biomarkers Prev 7: 653–659
IARC Monographs on the Evaluation of Carcinogenic Risks to Humans. Vol 72, Hormonal Contraception and Postmenopausal Hormonal Therapy, Lyon: IARC (1999). 180–186, 294–338
Issa JP, Ottaviano YL, Celano P, Hamilton SR, Davidson EN and Baylin SB (1994) Methylation of the oestrogen receptor CpG islands links ageing and neoplasia in human colon. Nat Genet 7: 536–540
Jacobs EJ, White E and Weiss NS (1994) Exogenous hormones, reproductive history, and colon cancer (Seattle, Washington, USA). Cancer Causes Control 5: 359–366
Kampman E, Bijl AJ, Kok C and van’t Veer P (1994) Reproductive and hormonal factors in male and female colon cancer. Eur J Cancer Prev 3: 329–336
Kampman E, Potter JD, Slattery ML, Caan BJ and Edward S (1997) Hormone replacement therapy, reproductive history, and colon cancer: a multicenter, case-control study in the United States. Cancer Causes Control 8: 146–158
Kune GA, Kune S and Watson LF (1990) Oral contraceptive use does not protect against large bowel cancer. Contraception 41: 19–25
La Vecchia C, Tavani A, Franceschi S and Parazzini F (1996) Oral contraceptives and cancer. A review of the evidence. Drug Safety 14: 260–272
La Vecchia C, Negri E, Levi F, Decarli A and Boyle P (1998) Cancer mortality in Europe: effects of age, cohort of birth and period of death. Eur J Cancer 34: 118–141
Lointier P, Wildrick DM and Boman BM (1992) The effects of steroid hormones on a human colon cancer cell line in vitro. Anticancer Res 12: 1327–1330
Martinez ME, Grodstein F and Giovannucci E (1997) A prospective study of reproductive factors, oral contraceptive use, and risk of colorectal cancer. Cancer Epidemiol Biomarkers Prev 6: 1–5
McMichael AJ and Potter J (1985) Host factors in carcinogenesis: certain bile-acid metabolic profiles that selectively increase the risk of proximal colon cancer. J Natl Cancer Inst 75: 185–191
Negri E, La Vecchia C and Parazzini F (1989) Reproductive and menstrual factors and risk of colorectal cancer. Cancer Res 49: 7158–7161
Peters RK, Pike MC, Chang WWL and Mack TM (1990) Reproductive factors and colon cancers. Br J Cancer 61: 741–748
Potter JD (1999) Colorectal cancer: molecules and populations. J Natl Cancer Inst 91: 916–932
Potter JD and McMichael AJ (1983) Large bowel cancer in women in relation to reproductive and hormonal factors: a case-control study. J Natl Cancer Inst 71: 703–709
Potter JD, Slattery ML, Bostick RM and Gapstur SM (1993) Colon cancer: a review of the epidemiology. Epidemiol Rev 15: 499–545
Risch HA and Howe GR (1995) Menopausal hormone use and colorectal cancer in Saskatchewan: A record linkage cohort study. Cancer Epidemiol Biomarkers Prev 4: 21–28
Talamini R, Franceschi S, Dal Maso L, Negri E, Conti E, Filiberti R, Montella M, Nanni O and La Vecchia C (1998) The influence of reproductive and hormonal factors on the risk of colon and rectal cancer in women. Eur J Cancer 34: 1070–1076
Thomas ML, Xu X, Norfleet AM and Watson CS (1993) The presence of functional estrogen receptors in intestinal epithelial cells. Endocrinology 132: 426–430
Thornton A and Lee P (2000) Publication bias in meta-analysis: its causes and consequences. J Clin Epidemiol 53: 207–216
Troisi R, Schairer C, Chow W-H, Schatzkin A, Brinton LA and Fraumeni JF Jr (1997) Reproductive factors, oral contraceptive use, and risk of colorectal cancer. Epidemiology 8: 75–79
van Wayenburg CAM, van der Schouw YT, van Noord PAH and Peeters PHM (2000) Age at menopause, body mass index, and the risk of colorectal cancer mortality in the Dutch Diagnostisch Onderzoeck Mammacarcinoom (DOM) cohort. Epidemiology 11: 304–308
Weiss NS, Daling, JR and Chow WH (1981) Incidence of cancer of the large bowel in women in relation to reproductive and hormonal factors. J Natl Cancer Inst 67: 57–60
Wu-Williams AH, Lee M and Whittemore AS (1991) Reproductive factors and colorectal cancer risk among Chinese females. Cancer Res 51: 2307–2311
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Fernandez, E., Vecchia, C., Balducci, A. et al. Oral contraceptives and colorectal cancer risk: a meta-analysis. Br J Cancer 84, 722–727 (2001). https://doi.org/10.1054/bjoc.2000.1622
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DOI: https://doi.org/10.1054/bjoc.2000.1622
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