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Human Reproduction Update Advance Access originally published online on May 4, 2009
Human Reproduction Update 2009 15(5):489-498; doi:10.1093/humupd/dmp017
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© The Author 2009. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Oral contraceptives and colorectal cancer risk: a systematic review and meta-analysis

Cristina Bosetti1,3, Francesca Bravi1,2, Eva Negri1 and Carlo La Vecchia1,2

1 Department of Epidemiology, Istituto di Ricerche Farmacologiche "Mario Negri", Via Giuseppe La Masa 19 20156, Milan, Italy 2 Istituto di Statistica Medica e Biometria "G.A. Maccacaro", Università degli Studi di Milano, Via Venezian 1 20133, Milan, Italy

3 Correspondence address. Tel: +39-0239014526; Fax: +39-0233200231; E-mail: bosetti{at}marionegri.it

BACKGROUND: Various studies have reported an inverse relation between oral contraceptive (OC) use and the risk of colorectal cancer, but the issue is still open.

METHODS: In order to quantify the association between OC use and colorectal cancer risk, we performed a systematic review and meta-analysis of studies on this issue. We identified all relevant studies published, in English, as original articles up to December 2008 through a search of the literature using PubMed and EMBASE, and by reviewing the references from the retrieved articles.

RESULTS: The summary relative risk of colorectal cancer for ever versus never OC use was 0.82 (95% confidence interval, CI, 0.69–0.97) from 11 case–control studies, 0.81 (95% CI, 0.75–0.89) from seven cohort studies, and 0.81 (95% CI, 0.72–0.92) from all studies combined. The results were similar for colon and rectal cancer. No difference was evident according to duration of OC use both for colon and rectal cancer, although there is an indication that the protection is stronger for more recent use (OR = 0.70, 95% CI, 0.53–0.90, on the basis of four studies).

CONCLUSION: Epidemiological data consistently indicate that OC users have a reduced risk of colorectal cancer, and that the protection is greater for recent use in the absence, however, of a duration–risk relation.

Key words: colorectal cancer / epidemiology / meta-analysis / oral contraceptives / risk

Received on February 18, 2009; revised March 31, 2009; accepted on April 6, 2009


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