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\nWhat are oral contraceptives?
\nOral contraceptives (birth control pills) are hormone-containing medications that are taken by mouth to prevent pregnancy. They prevent pregnancy by inhibiting ovulation and also by preventing sperm from penetrating through the cervix.
\nBy far the most commonly prescribed type of oral contraceptive in the United States contains synthetic versions of the natural female hormones estrogen and progesterone. This type of birth control pill is often called a combined oral contraceptive. Another type of oral contraceptive, sometimes called the mini pill, contains only progestin, which is a man-made version of progesterone.
\nWhat is known about the relationship between oral contraceptive use and cancer?
\nNearly all the research on the link between oral contraceptives and cancer risk comes from observational studies, both large prospective cohort studies and population-based case\u2013control studies. Data from observational studies cannot definitively establish that an exposure\u2014in this case, oral contraceptives\u2014causes (or prevents) cancer. That is because women who take oral contraceptives may differ from those who don\u2019t take them in ways other than their oral contraceptive use, and it is possible that these other differences\u2014rather than oral contraceptive use\u2014are what explains their different cancer risk.
\nOverall, however, these studies have provided consistent evidence that the risks of breast and cervical cancers are increased in women who use oral contraceptives, whereas the risks of endometrial, ovarian, and colorectal cancers are reduced (1\u20133).
\nHow could oral contraceptives influence cancer risk?
\nNaturally occurring estrogen and progesterone stimulate the development and growth of some cancers (e.g., cancers that express receptors for these hormones, such as breast cancer). Because birth control pills contain synthetic versions of these female hormones, they could potentially also increase cancer risk.
\nIn addition, oral contraceptives might increase the risk of cervical cancer by changing the susceptibility of cervical cells to persistent infection with high-risk HPV types (the cause of virtually all cervical cancers).
\nResearchers have proposed multiple ways that oral contraceptives may lower the risks of some cancers, including
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[PubMed Abstract]Bassuk SS, Manson JE. Oral contraceptives and menopausal hormone therapy: Relative and attributable risks of cardiovascular disease, cancer, and other health outcomes. Annals of Epidemiology 2015; 25(3):193\u2013200.
[PubMed Abstract]Wentzensen N, Berrington de Gonzalez A. The Pill's gestation: From birth control to cancer prevention. Lancet Oncology 2015; 16(9):1004\u20131006. doi: 10.1016/S1470-2045(15)00211-9
Collaborative Group on Hormonal Factors in Breast Cancer. 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 1996; 347(9017):1713\u20131727.
[PubMed Abstract]Hunter DJ, Colditz GA, Hankinson SE, et al. Oral contraceptive use and breast cancer: A prospective study of young women. Cancer Epidemiology Biomarkers and Prevention 2010; 19(10):2496\u20132502.
[PubMed Abstract]Bhupathiraju SN, Grodstein F, Stampfer MJ, et al. Exogenous hormone use: Oral contraceptives, postmenopausal hormone therapy, and health outcomes in the Nurses' Health Study. American Journal of Public Health 2016; 106(9):1631\u20131637.
[PubMed Abstract]Beaber EF, Buist DS, Barlow WE, et al. Recent oral contraceptive use by formulation and breast cancer risk among women 20 to 49 years of age. Cancer Research 2014; 74(15):4078\u20134089.
[PubMed Abstract]M\u00f8rch LS, Skovlund CW, Hannaford PC, et al. Contemporary hormonal contraception and the risk of breast cancer. New England Journal of Medicine 2017; 377(23):2228\u20132239.
[PubMed Abstract]Smith JS, Green J, Berrington de Gonzalez A, et al. Cervical cancer and use of hormonal contraceptives: A systematic review. Lancet 2003; 361(9364):1159\u20131167.
[PubMed Abstract]International Collaboration of Epidemiological Studies of Cervical Cancer, Appleby P, Beral V, et al. Cervical cancer and hormonal contraceptives: Collaborative reanalysis of individual data for 16,573 women with cervical cancer and 35,509 women without cervical cancer from 24 epidemiological studies. Lancet 2007; 370(9599):1609\u20131621.
[PubMed Abstract]Roura E, Travier N, Waterboer T, et al. The influence of hormonal factors on the risk of developing cervical cancer and pre-cancer: Results from the EPIC Cohort. PLoS One 2016; 11(1):e0147029.
[PubMed Abstract]Iversen L, Sivasubramaniam S, Lee AJ, Fielding S, Hannaford PC. Lifetime cancer risk and combined oral contraceptives: The Royal College of General Practitioners' Oral Contraception Study. American Journal of Obstetrics and Gynecology 2017; 216(6):580.e1\u2013580.e9.
[PubMed Abstract]Michels KA, Pfeiffer RM, Brinton LA, Trabert B. Modification of the associations between duration of oral contraceptive use and ovarian, endometrial, breast, and colorectal cancers. JAMA Oncology 2018; 4(4):516\u2013521.
[PubMed Abstract]Gierisch JM, Coeytaux RR, Urrutia RP, et al. Oral contraceptive use and risk of breast, cervical, colorectal, and endometrial cancers: A systematic review. Cancer Epidemiology, Biomarkers and Prevention 2013; 22(11):1931\u20131943.
[PubMed Abstract]Collaborative Group on Epidemiological Studies on Endometrial Cancer. Endometrial cancer and oral contraceptives: An individual participant meta-analysis of 27 276 women with endometrial cancer from 36 epidemiological studies. Lancet Oncology 2015; 16(9):1061\u20131070.
[PubMed Abstract]IARC Working Group on the Evaluation of Carcinogenic Risks to Humans. Pharmaceuticals. Combined estrogen-progestogen contraceptives. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans 2012; 100A:283\u2013311.
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[PubMed Abstract]Wentzensen N, Poole EM, Trabert B, et al. Ovarian cancer risk factors by histologic subtype: An analysis from the Ovarian Cancer Cohort Consortium. Journal of Clinical Oncology 2016; 34(24):2888\u20132898.
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[PubMed Abstract]Moorman PG, Havrilesky LJ, Gierisch JM, et al. Oral contraceptives and risk of ovarian cancer and breast cancer among high-risk women: A systematic review and meta-analysis. Journal of Clinical Oncology 2013; 31(33):4188\u20134198.
[PubMed Abstract]Friebel TM, Domchek SM, Rebbeck TR. Modifiers of cancer risk in BRCA1 and BRCA2 mutation carriers: Systematic review and meta-analysis. Journal of the National Cancer Institute 2014; 106(6):dju091.
[PubMed Abstract]Luan NN, Wu L, Gong TT, et al. Nonlinear reduction in risk for colorectal cancer by oral contraceptive use: A meta-analysis of epidemiological studies. Cancer Causes and Control 2015; 26(1):65\u201378.
[PubMed Abstract]Murphy N, Xu L, Zervoudakis A, et al. Reproductive and menstrual factors and colorectal cancer incidence in the Women's Health Initiative Observational Study. British Journal of Cancer 2017; 116(1):117\u2013125.
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