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

Calle, Eugenia E.; Heath, Clark W.; Miracle-McMahill, Heidi L.; Coates, Ralph J.; Liff, Jonathan M.; Franceschi, Silvia; Talamini, Renato; Chantarakul, N; Koetsawang, Suporn; RachawatRachawat, D.; Morabia, Alfredo; Schuman, Leonard M.; Stewart, Walter F.; Szklo, Moysés; Bain, Christopher; Schofield, F. D.; Siskind, Victor; Band, Pierre R.; Coldman, A.; Gallagher, R; Hislop, T. Gregory; Yang, Po‐Sheng; Duffy, Stephen W.; Kolonel, L. M.; Nomura, Abraham M. Y.; Oberle, Mark W.; Ory, Howard W.; Hb, Peterson; Wilson, Hoyt G.; Wingo, Phyllis A.; Ebeling, K; Kunde, D; Nishan, P.; Colditz, Graham A.; Martin, Nimit; Pardthaisong, Tieng; Silpisornkosol, Suporn; Theetranont, Choti; Boosiri, Banpot; Chutivongse, Supawat; Jimakorn, P; Virutamasen, Pramuan; Wongsrichanalai, Chansuda; McMichael, Anthony J.; Rohan, Thomas E.; Ewertz, Marianne; Paul, Charlotte; Skegg, D. C. G.; Boyle, P.; Evstifeeva, M.; Daling, Janet R.; Malone, Kathleen E.; Noonan, Elizabeth A.; Stanford, Janet L.; Thomas, David B.; Weiss, Noel S.; White, Emily; Andrieu, Nadine; Brémond, A.; Clavel, F; Gairard, B.; Lansac, J.; Piana, L; Rénaud, R; Fine, S. R.P.; Cuevas, Héctor Rodriguez; Ontiveros, Patricia; Palet, A.; Salazar, S. B.; Aristizabel, N.; Cuadros, Alvaro; Bachelot, Anne; Lê, Monique G.; Deacon, Judith; Peto, Julian; Taylor, C; Alfandary, Esther; Modan, Baruch; Ron, Elaine; Friedman, Gary D.; Hiatt, Robert A.; Bishop, D. Timothy; Kosmelj, J.; Primic-Žakelj, Maja; Ravnihar, B; Stare, Janez; Beeson, W. Lawrence; Fraser, Gary E.; Allen, D. S.; Bulbrook, R. D.; Cuzick, Jack; Fentiman, IS; Hayward, J. L.; Wang, D. Y.; Hanson, R. L.; Leske, M. C.; Mahoney, M. C.; Nasca, Philip C.; Varma, Andre O.; Weinstein, A. L.; Möller, Torgil; Olsson, Håkan; Ranstam, Jonas; Goldbohm, R. Alexandra; Brandt, Piet A. van den; Apelo, R; Baens, J.; Cruz, J. R. de la; Benı́tez, Javier; Lacaya, Lyndon B.; Ngelangel, Corazon A.; Vecchia, C. La; Negri, Eva; Marubini, Ettore; Ferraroni, Monica; Gerber, Mariette; Richardson, Sylvia; Ségala, Claire; Gatei, D.; Kenya, Patrick; Kung'u, A; Mati, J. G.; Brinton, Louise A.; Hoover, Robert N.; Schairer, Catherine; Spirtas, Robert; Lee, H. P.; Rookus, M.A.; Leeuwen, Flora van; Schoenberg, J. A.; Gammon, Marilie D.; Clarke, E. Aileen; Jones, Lesley; McPherson, Klim; Neil, Andrew; Vessey, Martin; Yeates, David; Beral, Valerie; Bull, Diana; Crossley, Barbara; Hermon, C; Jones, Stephanie; Key, Timothy J.; Lewis, Claire E.; Reeves, Gillian; Smith, Pamela G.; Collins, Rory; Doll, Richard; Pető, Richárd; Pc, Hannaford; Kay, CliffordR.; Rosero-Bixby, Luis; Gao, Yu‐Tang; Yuan, Jun; Wei, Hu; Yun, Tae-Jin; Chen, Zhiheng; Berry, Geoffrey; Booth, J. Cooper; Jelihovsky, Tatiana; MacLennan, Robert; Shearman, Rodney P.; Wang, Q. S.; Baines, Cornelia J.; Miller, Anthony B.; Wall, Claus; Lund, Eiliv; Stalsberg, Helge; Dabancens, Alfredo; Martinez, L.; Molina, Ramiro; Salas, O; Alexander, FE; Hulka, Barbara S.; Chilvers, Clair; Bernstein, Leslie; Haile, Robert W.; Paganini‐Hill, Annlia; Pike, Malcolm C.; Ross, Ronald K.; Ursin, Giske; Yu, Mimi C.; Adami, Hans‐Olov; Bergström, Reinhold; Longnecker, Matthew P.; Newcomb, Polly A.; Farley, T. M.N.; Holck, S; Meirik, Olav

doi:10.1016/s0140-6736(96)90806-5

Cited by 1,153 publications

(167 citation statements)

References 54 publications

(3 reference statements)

Supporting

Mentioning

150

Contrasting

Unclassified

Order By: Relevance

“…Early menarche and late menopause increase breast cancer risk, as they prolong exposure to oestrogen and progesterone. [13][14][15][16][17][18][19][20][21][22] Long-term combined hormone replacement therapy (HRT) treatment (> 5 years) after the menopause is associated with a significant increase in risk. However, shorter-term treatments may still be associated with risk to those with a family history of breast cancer.…”

Section: Hormonal and Reproductive Risk Factorsmentioning

confidence: 99%

“…[16][17][18][19] A meta-analysis also suggested that both during current use of the combined oral contraceptive and 10 years post use, there may be a 24% increase in risk of breast cancer. 13 A woman's age at first pregnancy influences the relative risk (RR) of breast cancer, as pregnancy transforms breast parenchymal cells into a more stable state, potentially resulting in less proliferation in the second half of the menstrual cycle. As a result, early first pregnancy offers some protection, while women having their first child over the age of 30 years have double the risk of women delivering their first child under the age of 20 years, and these are likely to be similar in those at highest risk from a BRCA1/BRCA2 mutation.…”

Section: Hormonal and Reproductive Risk Factorsmentioning

confidence: 99%

“…utsouthwestern.edu/breasthealth/cagene/default.asp), Ford (BRCAPRO) (BayesMendel Lab, Harvard University, Boston, MA, USA; http://bcb.dfci.harvard.edu/bayesmendel/index.php) and Tyrer-Cuzick (TC) (version 6; Professor Jack Cuzick, Centre for Cancer Prevention, London, UK) risk prediction models, using observed data from 3170 women with a family history of breast cancer in the UK, we showed that the TC model performed best. 13 We identified a need to reassess these models in larger numbers of women and also to compare the BOADICEA (Breast and Ovarian Analysis of Disease Incidence and Carrier Estimation Algorithm; Cambridge University, http://ccge.medschl.cam.ac.uk/boadicea/) model alongside these models in the family history population. There has not been a large-scale study comparing risk models in the general population, and, therefore, we aimed to assess the TC and Gail models in the general population.…”

Section: Risk Modelsmentioning

confidence: 99%

“…15 A meta-analysis suggested that both during current use of the combined oral contraceptive and 10 years post use, there may be a 24% increase in risk of breast cancer. 13 The age at first full-term pregnancy influences the RR of breast cancer, with early first full-term pregnancy offering some protection by transforming breast parenchymal cells into a more stable state, potentially resulting in less proliferation in the second half of the menstrual cycle. Women having their first full-term pregnancy over the age of 30 years have double the risk of women who had their first full-term pregnancy under the age of 20 years, and this is the case for both women in the general population and those at highest risk from a BRCA1/BRCA2 mutation.…”

Section: -21mentioning

confidence: 99%

See 3 more Smart Citations

Improvement in risk prediction, early detection and prevention of breast cancer in the NHS Breast Screening Programme and family history clinics: a dual cohort study

Evans

Astley

Stavrinos³

et al. 2016

Programme Grants Appl Res

108

114

View full text Add to dashboard Cite

BackgroundIn the UK, women are invited for 3-yearly mammography screening, through the NHS Breast Screening Programme (NHSBSP), from the ages of 47–50 years to the ages of 69–73 years. Women with family histories of breast cancer can, from the age of 40 years, obtain enhanced surveillance and, in exceptionally high-risk cases, magnetic resonance imaging. However, no NHSBSP risk assessment is undertaken. Risk prediction models are able to categorise women by risk using known risk factors, although accurate individual risk prediction remains elusive. The identification of mammographic breast density (MD) and common genetic risk variants [single nucleotide polymorphisms (SNPs)] has presaged the improved precision of risk models.ObjectivesTo (1) identify the best performing model to assess breast cancer risk in family history clinic (FHC) and population settings; (2) use information from MD/SNPs to improve risk prediction; (3) assess the acceptability and feasibility of offering risk assessment in the NHSBSP; and (4) identify the incremental costs and benefits of risk stratified screening in a preliminary cost-effectiveness analysis.DesignTwo cohort studies assessing breast cancer incidence.SettingHigh-risk FHC and the NHSBSP Greater Manchester, UK.ParticipantsA total of 10,000 women aged 20–79 years [Family History Risk Study (FH-Risk); UK Clinical Research Network identification number (UKCRN-ID) 8611] and 53,000 women from the NHSBSP [aged 46–73 years; Predicting the Risk of Cancer At Screening (PROCAS) study; UKCRN-ID 8080].InterventionsQuestionnaires collected standard risk information, and mammograms were assessed for breast density by a number of techniques. All FH-Risk and 10,000 PROCAS participants participated in deoxyribonucleic acid (DNA) studies. The risk prediction models Manual method, Tyrer–Cuzick (TC), BOADICEA (Breast and Ovarian Analysis of Disease Incidence and Carrier Estimation Algorithm) and Gail were used to assess risk, with modelling based on MD and SNPs. A preliminary model-based cost-effectiveness analysis of risk stratified screening was conducted.Main outcome measuresBreast cancer incidence.Data sourcesThe NHSBSP; cancer registration.ResultsA total of 446 women developed incident breast cancers in FH-Risk in 97,958 years of follow-up. All risk models accurately stratified women into risk categories. TC had better risk precision than Gail, and BOADICEA accurately predicted risk in the 6268 single probands. The Manual model was also accurate in the whole cohort. In PROCAS, TC had better risk precision than Gail [area under the curve (AUC) 0.58 vs. 0.54], identifying 547 prospective breast cancers. The addition of SNPs in the FH-Risk case–control study improved risk precision but was not useful inBRCA1(breast cancer 1 gene) families. Risk modelling of SNPs in PROCAS showed an incremental improvement from using SNP18 used in PROCAS to SNP67. MD measured by visual assessment score provided better risk stratification than automatic measures, despite wide intra- and inter-reader variability. Using a MD-adjusted TC model in PROCAS improved risk stratification (AUC = 0.6) and identified significantly higher rates (4.7 per 10,000 vs. 1.3 per 10,000;p < 0.001) of high-stage cancers in women with above-average breast cancer risks. It is not possible to provide estimates of the incremental costs and benefits of risk stratified screening because of lack of data inputs for key parameters in the model-based cost-effectiveness analysis.ConclusionsRisk precision can be improved by using DNA and MD, and can potentially be used to stratify NHSBSP screening. It may also identify those at greater risk of high-stage cancers for enhanced screening. The cost-effectiveness of risk stratified screening is currently associated with extensive uncertainty. Additional research is needed to identify data needed for key inputs into model-based cost-effectiveness analyses to identify the impact on health-care resource use and patient benefits.Future workA pilot of real-time NHSBSP risk prediction to identify women for chemoprevention and enhanced screening is required.FundingThe National Institute for Health Research Programme Grants for Applied Research programme. The DNA saliva collection for SNP analysis for PROCAS was funded by the Genesis Breast Cancer Prevention Appeal.

show abstract

Section: Hormonal and Reproductive Risk Factorsmentioning

confidence: 99%

Section: Hormonal and Reproductive Risk Factorsmentioning

confidence: 99%

Section: Risk Modelsmentioning

confidence: 99%

Section: -21mentioning

confidence: 99%

See 2 more Smart Citations

Improvement in risk prediction, early detection and prevention of breast cancer in the NHS Breast Screening Programme and family history clinics: a dual cohort study

Evans

Astley

Stavrinos³

et al. 2016

Programme Grants Appl Res

108

114

View full text Add to dashboard Cite

show abstract

“…The risk of breast cancer in current users of the COCP is 24% above the baseline risk [35]. This risk reduces after stopping the COCP and returns to baseline risk after 10 years.…”

Section: The Cocpmentioning

confidence: 99%

Menstrual Disorders in Adolescents: Review of Current Practice

Williams

Creighton²

2012

Horm Res Paediatr

View full text Add to dashboard Cite

Menstrual disorders are common in adolescent girls. Periods can be irregular, heavy and/or painful, especially in the first few years following menarche. Serious pathology is rare; however, menstrual dysfunction can have a significant effect on daily activities and result in school absence. There are many treatment options which are safe to use in adolescents, although the evidence for their use is extrapolated from adult data. We present a clinical review of the current practice, including management of girls with other medical problems and learning difficulties.

show abstract

Recommendations for Follow-up Care of Individuals With an Inherited Predisposition to Cancer

Burke¹

1997

JAMA

557

View full text Add to dashboard Cite

Efficacy of cancer surveillance or other measures to reduce risk in individuals who carry cancer-predisposing mutations is unknown. Based on expert opinion concerning presumptive benefit, early breast cancer and ovarian cancer screening are recommended for individuals with BRCA1 mutations and early breast cancer screening for those with BRCA2 mutations. No recommendation is made for or against prophylactic surgery (eg, mastectomy, oophorectomy); these surgeries are an option for mutation carriers, but evidence of benefit is lacking, and case reports have documented the occurrence of cancer following prophylactic surgery. It is recommended that individuals considering genetic testing be counseled regarding the unknown efficacy of measures to reduce risk and that care for individuals with cancer-predisposing mutations be provided whenever possible within the context of research protocols designed to evaluate clinical outcomes.

show abstract

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

Cited by 1,153 publications

References 54 publications

Improvement in risk prediction, early detection and prevention of breast cancer in the NHS Breast Screening Programme and family history clinics: a dual cohort study

Improvement in risk prediction, early detection and prevention of breast cancer in the NHS Breast Screening Programme and family history clinics: a dual cohort study

Menstrual Disorders in Adolescents: Review of Current Practice

Recommendations for Follow-up Care of Individuals With an Inherited Predisposition to Cancer

Contact Info

Product

Resources

About