Oral contraceptive use and risk of gestational trophoblastic tumors

Julie R. Palmer, Shirley G. Driscoll, Lynn Rosenberg, Ross S. Berkowitz, John R. Lurain, John Soper, Leo B. Twiggs, David M. Gershenson, Ernest I. Kohorn, Michael Berman, Samuel Shapiro, R. Sowmya Rao

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Abstract

Background: Gestational trophoblastic disease refers to a spectrum of rare benign and malignant gynecologic disorders whose pathogenesis is not well understood. Recent studies from China and the United States have raised the hypothesis that long-term use of oral contraceptives before conception may increase the risk of gestational trophoblastic tumors. A multicenter case-control study of gestational trophoblastic tumors was undertaken to test this hypothesis. Methods - Telephone interviews were conducted with 235 case patients, including 50 with geStational choriocarcinoma, and 413 control subjects matched on recentness of pregnancy, age at pregnancy, and area of residence. Relative risks (odds ratios) were computed by conditional logistic regression. Reported P values are two-sided. Results: The relative risk estimate for ever having used oral contraceptives before the index pregnancy was 1.9 (95% confidence interval [CI] = 1.2-3.0), and the risk increased with duration of use (P for trend = .05). The estimate was highest for women who used oral contraceptives during the cycle in which they became pregnant (relative risk = 4.0; 95% CI = 1.6-10), but there was no consistent pattern according to the time interval since last use. Separate analyses of choriocarcinoma and persistent mole yielded similar results, i.e., the relative risk estimates for oral contraceptive use were 2.2 (95% CI = 0.8- 6.4) and 1.8 (95% CI = 1.0-3.0), respectively. Control for the number of sexual partners, which was independently associated with risk (P for trend = .05), did not materially change the results. Conclusions: This study, the largest to date, indicates that long duration of oral contraceptive use before conception increases the risk of gestational trophoblastic tumors. These findings may provide clues to the pathogenesis of this rare disease. Changes in use of oral contraceptives are not warranted, however, because the incidence attributable to oral contraceptive use is very low.

Original languageEnglish
Pages (from-to)635-640
Number of pages6
JournalJournal of the National Cancer Institute
Volume91
Issue number7
StatePublished - Apr 7 1999
Externally publishedYes

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Trophoblastic Neoplasms
Oral Contraceptives
Confidence Intervals
Choriocarcinoma
Odds Ratio
Pregnancy
Gestational Trophoblastic Disease
Sexual Partners
Rare Diseases
Case-Control Studies
China
Logistic Models
Interviews

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Palmer, J. R., Driscoll, S. G., Rosenberg, L., Berkowitz, R. S., Lurain, J. R., Soper, J., ... Rao, R. S. (1999). Oral contraceptive use and risk of gestational trophoblastic tumors. Journal of the National Cancer Institute, 91(7), 635-640.

Oral contraceptive use and risk of gestational trophoblastic tumors. / Palmer, Julie R.; Driscoll, Shirley G.; Rosenberg, Lynn; Berkowitz, Ross S.; Lurain, John R.; Soper, John; Twiggs, Leo B.; Gershenson, David M.; Kohorn, Ernest I.; Berman, Michael; Shapiro, Samuel; Rao, R. Sowmya.

In: Journal of the National Cancer Institute, Vol. 91, No. 7, 07.04.1999, p. 635-640.

Research output: Contribution to journalArticle

Palmer, JR, Driscoll, SG, Rosenberg, L, Berkowitz, RS, Lurain, JR, Soper, J, Twiggs, LB, Gershenson, DM, Kohorn, EI, Berman, M, Shapiro, S & Rao, RS 1999, 'Oral contraceptive use and risk of gestational trophoblastic tumors', Journal of the National Cancer Institute, vol. 91, no. 7, pp. 635-640.
Palmer JR, Driscoll SG, Rosenberg L, Berkowitz RS, Lurain JR, Soper J et al. Oral contraceptive use and risk of gestational trophoblastic tumors. Journal of the National Cancer Institute. 1999 Apr 7;91(7):635-640.
Palmer, Julie R. ; Driscoll, Shirley G. ; Rosenberg, Lynn ; Berkowitz, Ross S. ; Lurain, John R. ; Soper, John ; Twiggs, Leo B. ; Gershenson, David M. ; Kohorn, Ernest I. ; Berman, Michael ; Shapiro, Samuel ; Rao, R. Sowmya. / Oral contraceptive use and risk of gestational trophoblastic tumors. In: Journal of the National Cancer Institute. 1999 ; Vol. 91, No. 7. pp. 635-640.
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abstract = "Background: Gestational trophoblastic disease refers to a spectrum of rare benign and malignant gynecologic disorders whose pathogenesis is not well understood. Recent studies from China and the United States have raised the hypothesis that long-term use of oral contraceptives before conception may increase the risk of gestational trophoblastic tumors. A multicenter case-control study of gestational trophoblastic tumors was undertaken to test this hypothesis. Methods - Telephone interviews were conducted with 235 case patients, including 50 with geStational choriocarcinoma, and 413 control subjects matched on recentness of pregnancy, age at pregnancy, and area of residence. Relative risks (odds ratios) were computed by conditional logistic regression. Reported P values are two-sided. Results: The relative risk estimate for ever having used oral contraceptives before the index pregnancy was 1.9 (95{\%} confidence interval [CI] = 1.2-3.0), and the risk increased with duration of use (P for trend = .05). The estimate was highest for women who used oral contraceptives during the cycle in which they became pregnant (relative risk = 4.0; 95{\%} CI = 1.6-10), but there was no consistent pattern according to the time interval since last use. Separate analyses of choriocarcinoma and persistent mole yielded similar results, i.e., the relative risk estimates for oral contraceptive use were 2.2 (95{\%} CI = 0.8- 6.4) and 1.8 (95{\%} CI = 1.0-3.0), respectively. Control for the number of sexual partners, which was independently associated with risk (P for trend = .05), did not materially change the results. Conclusions: This study, the largest to date, indicates that long duration of oral contraceptive use before conception increases the risk of gestational trophoblastic tumors. These findings may provide clues to the pathogenesis of this rare disease. Changes in use of oral contraceptives are not warranted, however, because the incidence attributable to oral contraceptive use is very low.",
author = "Palmer, {Julie R.} and Driscoll, {Shirley G.} and Lynn Rosenberg and Berkowitz, {Ross S.} and Lurain, {John R.} and John Soper and Twiggs, {Leo B.} and Gershenson, {David M.} and Kohorn, {Ernest I.} and Michael Berman and Samuel Shapiro and Rao, {R. Sowmya}",
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AU - Driscoll, Shirley G.

AU - Rosenberg, Lynn

AU - Berkowitz, Ross S.

AU - Lurain, John R.

AU - Soper, John

AU - Twiggs, Leo B.

AU - Gershenson, David M.

AU - Kohorn, Ernest I.

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AU - Shapiro, Samuel

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N2 - Background: Gestational trophoblastic disease refers to a spectrum of rare benign and malignant gynecologic disorders whose pathogenesis is not well understood. Recent studies from China and the United States have raised the hypothesis that long-term use of oral contraceptives before conception may increase the risk of gestational trophoblastic tumors. A multicenter case-control study of gestational trophoblastic tumors was undertaken to test this hypothesis. Methods - Telephone interviews were conducted with 235 case patients, including 50 with geStational choriocarcinoma, and 413 control subjects matched on recentness of pregnancy, age at pregnancy, and area of residence. Relative risks (odds ratios) were computed by conditional logistic regression. Reported P values are two-sided. Results: The relative risk estimate for ever having used oral contraceptives before the index pregnancy was 1.9 (95% confidence interval [CI] = 1.2-3.0), and the risk increased with duration of use (P for trend = .05). The estimate was highest for women who used oral contraceptives during the cycle in which they became pregnant (relative risk = 4.0; 95% CI = 1.6-10), but there was no consistent pattern according to the time interval since last use. Separate analyses of choriocarcinoma and persistent mole yielded similar results, i.e., the relative risk estimates for oral contraceptive use were 2.2 (95% CI = 0.8- 6.4) and 1.8 (95% CI = 1.0-3.0), respectively. Control for the number of sexual partners, which was independently associated with risk (P for trend = .05), did not materially change the results. Conclusions: This study, the largest to date, indicates that long duration of oral contraceptive use before conception increases the risk of gestational trophoblastic tumors. These findings may provide clues to the pathogenesis of this rare disease. Changes in use of oral contraceptives are not warranted, however, because the incidence attributable to oral contraceptive use is very low.

AB - Background: Gestational trophoblastic disease refers to a spectrum of rare benign and malignant gynecologic disorders whose pathogenesis is not well understood. Recent studies from China and the United States have raised the hypothesis that long-term use of oral contraceptives before conception may increase the risk of gestational trophoblastic tumors. A multicenter case-control study of gestational trophoblastic tumors was undertaken to test this hypothesis. Methods - Telephone interviews were conducted with 235 case patients, including 50 with geStational choriocarcinoma, and 413 control subjects matched on recentness of pregnancy, age at pregnancy, and area of residence. Relative risks (odds ratios) were computed by conditional logistic regression. Reported P values are two-sided. Results: The relative risk estimate for ever having used oral contraceptives before the index pregnancy was 1.9 (95% confidence interval [CI] = 1.2-3.0), and the risk increased with duration of use (P for trend = .05). The estimate was highest for women who used oral contraceptives during the cycle in which they became pregnant (relative risk = 4.0; 95% CI = 1.6-10), but there was no consistent pattern according to the time interval since last use. Separate analyses of choriocarcinoma and persistent mole yielded similar results, i.e., the relative risk estimates for oral contraceptive use were 2.2 (95% CI = 0.8- 6.4) and 1.8 (95% CI = 1.0-3.0), respectively. Control for the number of sexual partners, which was independently associated with risk (P for trend = .05), did not materially change the results. Conclusions: This study, the largest to date, indicates that long duration of oral contraceptive use before conception increases the risk of gestational trophoblastic tumors. These findings may provide clues to the pathogenesis of this rare disease. Changes in use of oral contraceptives are not warranted, however, because the incidence attributable to oral contraceptive use is very low.

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