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Oral Contraceptive Use for the Primary Prevention of Ovarian Cancer
Evidence Reports/Technology Assessments, No. 212
Investigators: Laura J Havrilesky, MD, Jennifer M Gierisch, PhD, Patricia G Moorman, PhD, Remy R Coeytaux, MD, PhD, Rachel Peragallo Urrutia, MD, William J Lowery, MD, Michaela Dinan, PhD, Amanda J McBroom, PhD, Liz Wing, MA, Michael D Musty, BA, Kathryn R Lallinger, MSLS, Vic Hasselblad, PhD, Gillian D Sanders, PhD, and Evan R Myers, MD, MPH.
Author Information and AffiliationsStructured Abstract
Objectives:
To estimate the overall balance of harms and benefits from the potential use of oral contraceptives (OCs) for the primary prevention of ovarian cancer
Data sources:
We searched PubMed®, Embase®, the Cochrane Database of Systematic Reviews, and ClinicalTrials.gov for English-language studies published from January 1990 to June 2012 that evaluated the potential benefits (reduction in ovarian, colorectal, and endometrial cancers) and harms (increase in breast and cervical cancer, and vascular complications) of OC use.
Review methods:
Two investigators screened each abstract and full-text article for inclusion; the investigators abstracted data, and they performed quality ratings, applicability ratings, and evidence grading. Random-effects models were used to compute summary estimates of effects. A simulation model was used to estimate the effects of OC use on the overall balance of benefits and harms.
Results:
We reviewed 55 studies relevant to ovarian cancer outcomes, 66 relevant to other cancers, and 50 relevant to vascular events. Ovarian cancer incidence was significantly reduced in OC users (OR [odds ratio], 0.73; 95% CI [confidence interval], 0.66 to 0.81), with greater reductions seen with longer duration of use. Breast cancer incidence was slightly but significantly increased in OC users (OR, 1.08; 95% CI, 1.00 to 1.17), with a significant reduction in risk as time since last use increased. The risk of cervical cancer was significantly increased in women with persistent human papillomavirus infection who used OCs, but heterogeneity prevented a formal meta-analysis. Incidences of both colorectal cancer (OR, 0.86; 95% CI, 0.79 to 0.95) and endometrial cancer (OR, 0.57; 95% CI, 0.43 to 0.76) were significantly reduced by OC use. The risk of vascular events was increased in current OC users compared with nonusers, although the increase in myocardial infarction was not statistically significant. The overall strength of evidence for ovarian cancer prevention was moderate to low, primarily because of the lack of randomized trials and inconsistent reporting of important characteristics of use, such as duration. The simulation model predicted that the combined increase in risk of breast and cervical cancers and vascular events was likely to be equivalent to or greater than the decreased risk in ovarian cancer, although the harm/benefit ratio was much more favorable when protection against endometrial and colorectal cancers was added, resulting in net gains in life expectancy of approximately 1 month.
Conclusions:
There is insufficient evidence to recommend for or against the use of OCs solely for the primary prevention of ovarian cancer. Although the net effects of the current patterns of OC use likely result in increased life expectancy when other noncontraceptive benefits are included, the harm/benefit ratio for ovarian cancer prevention alone is uncertain, particularly when the potential quality-of-life impact of breast cancer and vascular events are considered.
Contents
- Preface
- Acknowledgments
- Technical Expert Panel
- Peer Reviewers
- Executive Summary
- 1. Introduction and Methods
- 2. Oral Contraceptives and Ovarian Cancer
- 3. Oral Contraceptives and Other Cancers
- 4. Oral Contraceptives and Vascular Events
- 5. Overall Benefits and Harms of Oral Contraceptives for Prevention of Ovarian Cancer
- References
- Abbreviations
- Appendix A Exact Search Strings
- Appendix B Data Abstraction Elements
- Appendix C Included Studies
- Appendix D Excluded Studies
- Appendix E Analyses of Potential Publication Bias
- Appendix F Model Description and Parameters
Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services1, Contract No. 290-2007-10066-I. Prepared by: Duke Evidence-based Practice Center, Durham, NC
Suggested citation:
Havrilesky LJ, Gierisch JM, Moorman PG, Coeytaux RR, Peragallo Urrutia R, Lowery WJ, Dinan M, McBroom AJ, Wing L, Musty MD, Lallinger KR, Hasselblad V, Sanders GD, Myers ER. Oral Contraceptive Use for the Primary Prevention of Ovarian Cancer. Evidence Report/Technology Assessment No. 212. (Prepared by the Duke Evidence-based Practice Center under Contract No. 290-2007-10066-I.) AHRQ Publication No. 13-E002-EF. Rockville, MD: Agency for Healthcare Research and Quality. June 2013. www.effectivehealthcare.ahrq.gov/reports/final.cfm.
This report is based on research conducted by the Duke Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-2007-10066-I). The findings and conclusions in this document are those of the authors, who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.
The information in this report is intended to help health care decisionmakers—patients and clinicians, health system leaders, and policymakers, among others—make well-informed decisions and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information, i.e., in the context of available resources and circumstances presented by individual patients.
This report may be used, in whole or in part, as the basis for development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.
None of the investigators have any affiliations or financial involvement that conflicts with the material presented in this report.
- 1
540 Gaither Road, Rockville, MD 20850; www
.ahrq.gov
- Review Oral contraceptive use and risk of breast, cervical, colorectal, and endometrial cancers: a systematic review.[Cancer Epidemiol Biomarkers Pr...]Review Oral contraceptive use and risk of breast, cervical, colorectal, and endometrial cancers: a systematic review.Gierisch JM, Coeytaux RR, Urrutia RP, Havrilesky LJ, Moorman PG, Lowery WJ, Dinan M, McBroom AJ, Hasselblad V, Sanders GD, et al. Cancer Epidemiol Biomarkers Prev. 2013 Nov; 22(11):1931-43. Epub 2013 Sep 6.
- Worldwide variations in the lifetime probability of reproductive cancer in women: implications of best-case, worst-case, and likely-case assumptions about the effect of oral contraceptive use.[Contraception. 1992]Worldwide variations in the lifetime probability of reproductive cancer in women: implications of best-case, worst-case, and likely-case assumptions about the effect of oral contraceptive use.Petitti DB, Porterfield D. Contraception. 1992 Feb; 45(2):93-104.
- Review Oral contraceptives and gynecologic cancer: an update for the 1990s.[Am J Obstet Gynecol. 1992]Review Oral contraceptives and gynecologic cancer: an update for the 1990s.Kaunitz AM. Am J Obstet Gynecol. 1992 Oct; 167(4 Pt 2):1171-6.
- Noncontraceptive health benefits of oral steroidal contraceptives.[Am J Obstet Gynecol. 1982]Noncontraceptive health benefits of oral steroidal contraceptives.Mishell DR Jr. Am J Obstet Gynecol. 1982 Mar 15; 142(6 Pt 2):809-16.
- Review Oral contraceptive pills as primary prevention for ovarian cancer: a systematic review and meta-analysis.[Obstet Gynecol. 2013]Review Oral contraceptive pills as primary prevention for ovarian cancer: a systematic review and meta-analysis.Havrilesky LJ, Moorman PG, Lowery WJ, Gierisch JM, Coeytaux RR, Urrutia RP, Dinan M, McBroom AJ, Hasselblad V, Sanders GD, et al. Obstet Gynecol. 2013 Jul; 122(1):139-147.
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