Oral contraception and increased bc risk from NEJM's April issue

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Estrogens and Breast Cancer

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Related Articleby Yager, J. D.Find Similar ArticlesPubMed CitationTo the Editor: Yager and Davidson (Jan. 19 issue)1 state unequivocally that the use of oral contraceptives is associated with an increased risk of breast cancer. This view is not supported by an article that appeared in the Journal in 20022 and in the accompanying editorial.3 In light of this recent information, I hope that the authors will modify their conclusions.


Charles L. Blander, M.D.
North Shore Medical Center
Salem, MA 01970
cblander@blandermd.com

References

1. Yager JD, Davidson NE. Estrogen carcinogenesis in breast cancer. N Engl J Med 2006;354:270-282. [Full Text]
2. Marchbanks PA, McDonald JA, Wilson HG, et al. Oral contraceptives and the risk of breast cancer. N Engl J Med 2002;346:2025-2032. [Abstract/Full Text]
3. Davidson NE, Helzlsouer KJ. Good news about oral contraceptives. N Engl J Med 2002;346:2078-2079. [Full Text]

The authors reply: Dr. Blander is concerned that recent data do not support our statement that the use of oral contraceptives is associated with a small but significant risk of breast cancer. Our conclusion rests on the 1996 meta-analysis of oral-contraceptive use and breast cancer.1 We agree that results reported by Marchbanks et al., which received a favorable comment from one of us,2 did not support this association. However, the conclusion from the study by Marchbanks et al. must be tempered by the subsequent report by Kumle et al.,3 which described a prospective study of more than 100,000 women between the ages of 30 and 49 years at the time of enrollment. It demonstrated that current or recent use of oral contraceptives is associated with an increased risk of breast cancer. For this reason, we continue to believe that the totality of the evidence suggests a small but real increase in the risk of breast cancer for current users. Of course, this small absolute risk must be considered in the context of the numerous health benefits that oral-contraceptive use affords to so many young women.


James D. Yager, Ph.D.
Johns Hopkins Bloomberg School of Public Health
Baltimore, MD 21205
jyager@jhsph.edu