Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Cancer Causes & Control
Published in: Cancer Causes & Control 1/2015

01-01-2015 | Original paper

Nonlinear reduction in risk for colorectal cancer by oral contraceptive use: a meta-analysis of epidemiological studies

Authors: Nan-Nan Luan, Lang Wu, Ting-Ting Gong, Yong-Lai Wang, Bei Lin, Qi-Jun Wu

Published in: Cancer Causes & Control | Issue 1/2015

Login to get access

Abstract

Purpose

Although the relationship between oral contraceptive (OC) use and colorectal cancer (CRC) risk has been studied extensively, the results of epidemiological studies are controversial. Therefore, we carried out a meta-analysis of epidemiological studies to summarize the available evidence and to quantify the potential dose–response relation.

Methods

We searched PubMed database for studies of OC use and CRC risk that were published until the end of March 2014. Random- and fixed-effects models were applied to estimate summary relative risks (RRs) and 95 % confidence intervals (CIs).

Results

Twelve cohorts and seventeen case–control studies with a total of 15,790 CRC cases were included in the final analysis. The summary RR for the ever versus never category of OC use was 0.82 (95 % CI 0.76–0.88). Similar result was observed when we compared the longest duration of OC use with the shortest duration (RR = 0.86, 95 % CI 0.76–0.96). Furthermore, the results of stratified analysis were comparable to those of overall meta-analysis. In dose–response analysis, significant inverse associations emerged in nonlinear models for the duration of OC use and CRC (P nonlinearity = 0.001). The greatest risk reduction was observed when the duration of OC use was approximately 42 months. There was moderate heterogeneity in the analysis, and no evidence of small-study bias was observed.

Conclusions

Based on the findings of this meta-analysis, ever use of OC is associated with lower risk of CRC. Additionally, there is a statistically significant nonlinear inverse association between the duration of OC use and CRC risk.
Appendix
Available only for authorised users
Literature
1.
Ferlay J, Soerjomataram I, Ervik M et al (2013) GLOBOCAN 2012 v1.0, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11 [Internet]. Lyon, France: International Agency for Research on Cancer; 2013. Available from: http://​globocan.​iarc.​fr, Accessed on 1/April/2014
2.
3.
McMichael AJ, Potter JD (1980) Reproduction, endogenous and exogenous sex hormones, and colon cancer: a review and hypothesis. J Natl Cancer Inst 65:1201–1207PubMed
4.
Ma J, Pollak MN, Giovannucci E, Chan JM, Tao Y et al (1999) Prospective study of colorectal cancer risk in men and plasma levels of insulin-like growth factor (IGF)-I and IGF-binding protein-3. J Natl Cancer Inst 91:620–625PubMedCrossRef
5.
Weissberger AJ, Ho KK, Lazarus L (1991) Contrasting effects of oral and transdermal routes of estrogen replacement therapy on 24-hour growth hormone (GH) secretion, insulin-like growth factor I, and GH-binding protein in postmenopausal women. J Clin Endocrinol Metab 72:374–381PubMedCrossRef
6.
Campagnoli C, Abba C, Ambroggio S, Peris C (2003) Differential effects of progestins on the circulating IGF-I system. Maturitas 46(Suppl 1):S39–S44PubMedCrossRef
7.
Gunter MJ, Hoover DR, Yu H, Wassertheil-Smoller S, Rohan TE et al (2008) Insulin, insulin-like growth factor-I, endogenous estradiol, and risk of colorectal cancer in postmenopausal women. Cancer Res 68:329–337PubMedCentralPubMedCrossRef
8.
Narisawa T, Magadia NE, Weisburger JH, Wynder EL (1974) Promoting effect of bile acids on colon carcinogenesis after intrarectal instillation of N-methyl-N′-nitro-N-nitrosoguanidine in rats. J Natl Cancer Inst 53:1093–1097PubMed
9.
Chlebowski RT, Wactawski-Wende J, Ritenbaugh C, Hubbell FA, Ascensao J et al (2004) Estrogen plus progestin and colorectal cancer in postmenopausal women. N Engl J Med 350:991–1004PubMedCrossRef
10.
Ritenbaugh C, Stanford JL, Wu L, Shikany JM, Schoen RE et al (2008) Conjugated equine estrogens and colorectal cancer incidence and survival: the Women’s Health Initiative randomized clinical trial. Cancer Epidemiol Biomarkers Prev 17:2609–2618PubMedCentralPubMedCrossRef
11.
Bosetti C, Bravi F, Negri E, La Vecchia C (2009) Oral contraceptives and colorectal cancer risk: a systematic review and meta-analysis. Hum Reprod Update 15:489–498PubMedCrossRef
12.
Cibula D, Gompel A, Mueck AO, La Vecchia C, Hannaford PC et al (2010) Hormonal contraception and risk of cancer. Hum Reprod Update 16:631–650PubMedCrossRef
13.
Fernandez E, La Vecchia C, Balducci A, Chatenoud L, Franceschi S et al (2001) Oral contraceptives and colorectal cancer risk: a meta-analysis. Br J Cancer 84:722–727PubMedCentralPubMedCrossRef
14.
Gierisch JM, Coeytaux RR, Urrutia RP, Havrilesky LJ, Moorman PG et al (2013) Oral contraceptive use and risk of breast, cervical, colorectal, and endometrial cancers: a systematic review. Cancer Epidemiol Biomarkers Prev 22:1931–1943PubMedCrossRef
15.
Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 339:b2535PubMedCentralPubMedCrossRef
16.
Zervoudakis A, Strickler HD, Park Y, Xue X, Hollenbeck A et al (2011) Reproductive history and risk of colorectal cancer in postmenopausal women. J Natl Cancer Inst 103:826–834PubMedCentralPubMedCrossRef
17.
Tsilidis KK, Allen NE, Key TJ, Bakken K, Lund E et al (2010) Oral contraceptives, reproductive history and risk of colorectal cancer in the European Prospective Investigation into Cancer and Nutrition. Br J Cancer 103:1755–1759PubMedCentralPubMedCrossRef
18.
Kabat GC, Miller AB, Rohan TE (2008) Oral contraceptive use, hormone replacement therapy, reproductive history and risk of colorectal cancer in women. Int J Cancer 122:643–646PubMedCrossRef
19.
Hannaford PC, Selvaraj S, Elliott AM, Angus V, Iversen L et al (2007) Cancer risk among users of oral contraceptives: cohort data from the Royal College of General Practitioner’s oral contraception study. BMJ 335:651PubMedCentralPubMedCrossRef
20.
Lin J, Zhang SM, Cook NR, Manson JE, Buring JE et al (2007) Oral contraceptives, reproductive factors, and risk of colorectal cancer among women in a prospective cohort study. Am J Epidemiol 165:794–801PubMedCrossRef
21.
Rosenblatt KA, Gao DL, Ray RM, Nelson ZC, Thomas DB (2004) Contraceptive methods and induced abortions and their association with the risk of colon cancer in Shanghai, China. Eur J Cancer 40:590–593PubMedCrossRef
22.
Vessey M, Painter R, Yeates D (2003) Mortality in relation to oral contraceptive use and cigarette smoking. Lancet 362:185–191PubMedCrossRef
23.
van Wayenburg CA, van der Schouw YT, van Noord PA, Peeters PH (2000) Age at menopause, body mass index, and the risk of colorectal cancer mortality in the Dutch Diagnostisch Onderzoek Mammacarcinoom (DOM) cohort. Epidemiology 11:304–308PubMedCrossRef
24.
Troisi R, Schairer C, Chow WH, Schatzkin A, Brinton LA et al (1997) Reproductive factors, oral contraceptive use, and risk of colorectal cancer. Epidemiology 8:75–79PubMedCrossRef
25.
Martinez ME, Grodstein F, Giovannucci E, Colditz GA, Speizer FE et al (1997) A prospective study of reproductive factors, oral contraceptive use, and risk of colorectal cancer. Cancer Epidemiol Biomarkers Prev 6:1–5PubMed
26.
Bostick RM, Potter JD, Kushi LH, Sellers TA, Steinmetz KA et al (1994) Sugar, meat, and fat intake, and non-dietary risk factors for colon cancer incidence in Iowa women (United States). Cancer Causes Control 5:38–52PubMedCrossRef
27.
Rudolph A, Toth C, Hoffmeister M, Roth W, Herpel E et al (2013) Colorectal cancer risk associated with hormone use varies by expression of estrogen receptor-beta. Cancer Res 73:3306–3315PubMedCrossRef
28.
Lo AC, Soliman AS, Khaled HM, Aboelyazid A, Greenson JK (2010) Lifestyle, occupational, and reproductive factors and risk of colorectal cancer. Dis Colon Rectum 53:830–837PubMedCentralPubMedCrossRef
29.
Long MD, Martin CF, Galanko JA, Sandler RS (2010) Hormone replacement therapy, oral contraceptive use, and distal large bowel cancer: a population-based case–control study. Am J Gastroenterol 105:1843–1850PubMedCentralPubMedCrossRef
30.
Campbell PT, Newcomb P, Gallinger S, Cotterchio M, McLaughlin JR (2007) Exogenous hormones and colorectal cancer risk in Canada: associations stratified by clinically defined familial risk of cancer. Cancer Causes Control 18:723–733PubMedCrossRef
31.
Nichols HB, Trentham-Dietz A, Hampton JM, Newcomb PA (2005) Oral contraceptive use, reproductive factors, and colorectal cancer risk: findings from Wisconsin. Cancer Epidemiol Biomarkers Prev 14:1212–1218PubMedCrossRef
32.
Levi F, Pasche C, Lucchini F, La Vecchia C (2003) Oral contraceptives and colorectal cancer. Dig Liver Dis 35:85–87PubMedCrossRef
33.
Fernandez E, La Vecchia C, Franceschi S, Braga C, Talamini R et al (1998) Oral contraceptive use and risk of colorectal cancer. Epidemiology 9:295–300PubMedCrossRef
34.
Kampman E, Potter JD, Slattery ML, Caan BJ, Edwards S (1997) Hormone replacement therapy, reproductive history, and colon cancer: a multicenter, case–control study in the United States. Cancer Causes Control 8:146–158PubMedCrossRef
35.
Jacobs EJ, White E, Weiss NS (1994) Exogenous hormones, reproductive history, and colon cancer (Seattle, Washington, USA). Cancer Causes Control 5:359–366PubMedCrossRef
36.
Kampman E, Bijl AJ, Kok C, Van’T VP (1994) Reproductive and hormonal factors in male and female colon cancer. Eur J Cancer Prev 3:329–336PubMedCrossRef
37.
38.
Kune GA, Kune S, Watson LF (1990) Oral contraceptive use does not protect against large bowel cancer. Contraception 41:19–25PubMedCrossRef
39.
Furner SE, Davis FG, Nelson RL, Haenszel W (1989) A case–control study of large bowel cancer and hormone exposure in women. Cancer Res 49:4936–4940PubMed
40.
Potter JD, McMichael AJ (1983) Large bowel cancer in women in relation to reproductive and hormonal factors: a case–control study. J Natl Cancer Inst 71:703–709PubMed
41.
Weiss NS, Daling JR, Chow WH (1981) Incidence of cancer of the large bowel in women in relation to reproductive and hormonal factors. J Natl Cancer Inst 67:57–60PubMed
42.
Wu-Williams AH, Lee M, Whittemore AS, Gallagher RP, Jiao DA et al (1991) Reproductive factors and colorectal cancer risk among Chinese females. Cancer Res 51:2307–2311PubMed
43.
Dorjgochoo T, Shu XO, Li HL, Qian HZ, Yang G et al (2009) Use of oral contraceptives, intrauterine devices and tubal sterilization and cancer risk in a large prospective study, from 1996 to 2006. Int J Cancer 124:2442–2449PubMedCentralPubMedCrossRef
44.
Luan NN, Wu QJ, Gong TT, Vogtmann E, Wang YL et al (2013) Breastfeeding and ovarian cancer risk: a meta-analysis of epidemiologic studies. Am J Clin Nutr 98:1020–1031PubMedCentralPubMedCrossRef
45.
Guan HB, Wu QJ, Gong TT (2013) Parity and kidney cancer risk: evidence from epidemiologic studies. Cancer Epidemiol Biomarkers Prev 22:2345–2353PubMedCrossRef
46.
Higgins JP, Thompson SG (2002) Quantifying heterogeneity in a meta-analysis. Stat Med 21:1539–1558PubMedCrossRef
47.
48.
Hamling J, Lee P, Weitkunat R, Ambuhl M (2008) Facilitating meta-analyses by deriving relative effect and precision estimates for alternative comparisons from a set of estimates presented by exposure level or disease category. Stat Med 27:954–970PubMedCrossRef
49.
Greenland S, Longnecker MP (1992) Methods for trend estimation from summarized dose-response data, with applications to meta-analysis. Am J Epidemiol 135:1301–1309PubMed
50.
Orsini N, Li R, Wolk A, Khudyakov P, Spiegelman D (2012) Meta-analysis for linear and nonlinear dose-response relations: examples, an evaluation of approximations, and software. Am J Epidemiol 175:66–73PubMedCentralPubMedCrossRef
51.
Royston P (2000) A strategy for modelling the effect of a continuous covariate in medicine and epidemiology. Stat Med 19:1831–1847PubMedCrossRef
52.
Bagnardi V, Zambon A, Quatto P, Corrao G (2004) Flexible meta-regression functions for modeling aggregate dose-response data, with an application to alcohol and mortality. Am J Epidemiol 159:1077–1086PubMedCrossRef
53.
54.
Begg CB, Mazumdar M (1994) Operating characteristics of a rank correlation test for publication bias. Biometrics 50:1088–1101PubMedCrossRef
55.
Hannaford PC, Iversen L, Macfarlane TV, Elliott AM, Angus V et al (2010) Mortality among contraceptive pill users: cohort evidence from Royal College of General Practitioners’ Oral Contraception Study. BMJ 340:927CrossRef
56.
Aune D, Lau R, Chan DS, Vieira R, Greenwood DC et al (2011) Nonlinear reduction in risk for colorectal cancer by fruit and vegetable intake based on meta-analysis of prospective studies. Gastroenterology 141:106–118PubMedCrossRef
57.
Everson GT, McKinley C, Kern FJ (1991) Mechanisms of gallstone formation in women. Effects of exogenous estrogen (Premarin) and dietary cholesterol on hepatic lipid metabolism. J Clin Invest 87:237–246PubMedCentralPubMedCrossRef
58.
McMichael AJ, Potter JD (1985) Host factors in carcinogenesis: certain bile-acid metabolic profiles that selectively increase the risk of proximal colon cancer. J Natl Cancer Inst 75:185–191PubMed
59.
Issa JP, Ottaviano YL, Celano P, Hamilton SR, Davidson NE et al (1994) Methylation of the oestrogen receptor CpG island links ageing and neoplasia in human colon. Nat Genet 7:536–540PubMedCrossRef
60.
Qiu Y, Waters CE, Lewis AE, Langman MJ, Eggo MC (2002) Oestrogen-induced apoptosis in colonocytes expressing oestrogen receptor beta. J Endocrinol 174:369–377PubMedCrossRef
61.
Campbell-Thompson M, Lynch IJ, Bhardwaj B (2001) Expression of estrogen receptor (ER) subtypes and ERbeta isoforms in colon cancer. Cancer Res 61:632–640PubMed
62.
Vongpatanasin W, Tuncel M, Wang Z, Arbique D, Mehrad B et al (2003) Differential effects of oral versus transdermal estrogen replacement therapy on C-reactive protein in postmenopausal women. J Am Coll Cardiol 41:1358–1363PubMedCrossRef
63.
Giovannucci E, Pollak MN, Platz EA, Willett WC, Stampfer MJ et al (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 9:345–349PubMed
64.
Sutton-Tyrrell K, Wildman RP, Matthews KA, Chae C, Lasley BL et al (2005) Sex-hormone-binding globulin and the free androgen index are related to cardiovascular risk factors in multiethnic premenopausal and perimenopausal women enrolled in the Study of Women Across the Nation (SWAN). Circulation 111:1242–1249PubMedCrossRef
65.
Chang CK, Ulrich CM (2003) Hyperinsulinaemia and hyperglycaemia: possible risk factors of colorectal cancer among diabetic patients. Diabetologia 46:595–607PubMedCrossRef
66.
Moorman PG, Havrilesky LJ, Gierisch JM, Coeytaux RR, Lowery WJ et al (2013) Oral contraceptives and risk of ovarian cancer and breast cancer among high-risk women: a systematic review and meta-analysis. J Clin Oncol 31:4188–4198PubMedCrossRef
Metadata
Title
Nonlinear reduction in risk for colorectal cancer by oral contraceptive use: a meta-analysis of epidemiological studies
Authors
Nan-Nan Luan
Lang Wu
Ting-Ting Gong
Yong-Lai Wang
Bei Lin
Qi-Jun Wu
Publication date
01-01-2015
Publisher
Springer International Publishing
Published in
Cancer Causes & Control / Issue 1/2015
Print ISSN: 0957-5243
Electronic ISSN: 1573-7225
DOI
https://doi.org/10.1007/s10552-014-0483-2

Other articles of this Issue 1/2015

Cancer Causes & Control 1/2015 Go to the issue

Original paper

Risk factors shared by COPD and lung cancer and mediation effect of COPD: two center case–control studies

Original paper

Hardcore smoking among continuing smokers in Canada 2004–2012

Letter to the Editor

Incidence trend of esophageal squamous cell carcinoma: an analysis of Surveillance Epidemiology, and End Results (SEER) database

Original paper

Circadian clock genes and risk of fatal prostate cancer

Original paper

Prospective study of human herpesvirus type 8 serostatus and prostate cancer risk in the placebo arm of the Prostate Cancer Prevention Trial

Original paper

Objective allergy markers and risk of cancer mortality and hospitalization in a large population-based cohort
Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras
Prof. Fabrice Barlesi
Developed by: Springer Medicine
Image Credits