Fw: OCP use in younger women/ breast cancer

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NOTE: To view the article with Web enhancements, go to:http://www.medscape.com/viewarticle/547238--------------------------------------------------------------------------------This activity is supported by funding from WebMD.Oral Contraceptive Use Increases Risk for Premenopausal Breast Cancer CME/CE News Author: Laurie Barclay, MDCME Author: Vega, MD, FAAFPComplete author affiliations and disclosures, and other CME information, are available at the end of this activity.Release Date: November 6, 2006; Valid for credit through November 6, 2007 Credits AvailablePhysicians - maximum of 0.25 AMA PRA Category 1 Credit(s)? for physicians;Family Physicians - up to 0.25 AAFP Prescribed credit(s) for physicians;Nurses - 0.3 nursing contact hours (0.3 contact hours are in the area of pharmacology) All other healthcare professionals completing continuing education credit for this activity will be issued a certificate of participation.Physicians should only claim credit commensurate with the extent of their participation in the activity.--------------------------------------------------------------------------------November 6, 2006 ? Oral contraceptive (OC) use is associated with increased risk for premenopausal breast cancer, according to the results of a meta-analysis reported in the October issue of the Mayo Clinic Proceedings."Although the medical research community has long recognized breast cancer risk factors such as a positive family history of breast cancer, early menarche, late menopause, nulliparity, and lack of breastfeeding, concordance is lacking regarding the carcinogenic potential of female hormones," write Kahlenborn, MD, from Altoona Hospital in Pennsylvania, and colleagues. "The Women's Health Initiative Clinical Trial reported that prolonged exposure to exogenous estrogens and progestins in hormone therapy increases a woman's risk of developing breast cancer. In addition, the World Health Organization recently classified both postmenopausal hormone replacement and oral contraceptives (OCs) as group 1 carcinogens."The investigators searched the MEDLINE and PubMed databases and bibliography reviews for case-control studies of OCs and premenopausal breast cancer published during or after 1980, and they identified 34 studies meeting inclusion criteria. Two reviewers extracted data from the original research articles or from additional data provided by study authors.Use of OCs was associated with increased risk of premenopausal breast cancer in general (odds ratio [OR], 1.19; 95% confidence interval [CI], 1.09 - 1.29) and across various patterns of OC use. In studies providing separate data for nulliparous and parous women, OC use was associated with breast cancer risk both in parous women (OR, 1.29; 95% CI, 1.20 - 1.40) and in nulliparous women (OR, 1.24; 95% CI, 0.92 - 1.67).In nulliparous women, longer duration of use did not substantially affect risk (OR, 1.29; 95% CI, 0.85 - 1.96). In parous women, increased risk was more pronounced when OCs were used before the first full-term pregnancy (OR, 1.44; 95% CI, 1.28 - 1.62) than after first full-term pregnancy (OR, 1.15; 95% CI, 1.06 - 1.26). The association between OC use and breast cancer risk was highest in parous women who used OCs 4 or more years before first full-term pregnancy (OR, 1.52; 95% CI, 1.26 - 1.82)."Use of OCs is associated with an increased risk of premenopausal breast cancer, especially with use before [first full-term pregnancy] in parous women," the authors write.Study limitations include use of populations differing substantially in race and culture, reliance on assumptions underlying the random-effects model, relatively rapid change in the age of first use of OCs during the past few decades, possible survivor bias, possible recall bias, use of crude ORs instead of adjusted ORs, and lack of specific data regarding timing since last use for premenopausal parous women who used OCs before first full-term pregnancy.The National Institutes of Health supported this work in part.In an accompanying editorial, R. Cerhan, MD, PhD, from the Mayo Clinic College of Medicine in Rochester, Minnesota, discusses changes in OC formulations, breast cancer epidemiology, and patterns of use of OCs over time. He suggests that risk-benefit analysis should be applied to individual patient decisions regarding OC use."From the perspective of epidemiology and public health, we must continue to closely follow the epidemiology of OC use and health outcomes, given the widespread use of these agents and their high potential to impact women's health in both a beneficial and a deleterious manner," Dr. Cerhan writes."The current study highlights the need for a close evaluation of OC use before first full-term pregnancy since this is an important biologic issue with clear clinical and public health implications," according to Dr. Cerhan. "Any association would also add additional support for identifying other exposures during the time before first full-term pregnancy associated with breast cancer risk in later life because identification of modifiable factors in this period would support expanding the window for breast cancer prevention to earlier in life."Mayo Clinic Proc. 2006;81:1287, 1290-1302.Learning Objectives for This Educational ActivityUpon completion of this activity, participants will be able to: Describe the epidemiology of breast cancer among premenopausal women in the United States. Identify the effects of OCs on the risk for breast cancer among premenopausal women. Clinical ContextApproximately 1 in 5 cases of breast cancer is diagnosed in women younger than 50 years in the United States, according to the authors of the current study. Breast cancer is the most common cause of cancer death among US women between the ages of 20 and 59 years. While the overall prevalence of breast cancer has increased in the last 4 decades, the increased frequency of breast cancer diagnosis has been particularly marked among women younger than 50 years.It remains largely unclear whether the use of OCs has contributed to the higher prevalence of breast cancer. The current meta-analysis examines case-control data to determine whether OCs promote breast cancer in women younger than 50 years.Study HighlightsResearchers examined MEDLINE and PubMed databases for case-control studies examining the risk for breast cancer among women who were either younger than 50 years or defined to be premenopausal. The authors included studies in which breast cancer was diagnosed during or after 1980. They could not adjust for possible confounders of breast cancer risk, and therefore the main study outcome was the crude odds ratio between the use of OCs and the risk for breast cancer. 39 studies were available for analysis. There was significant heterogeneity among the individual research studies. Overall, the use of OCs was associated with a significant OR of 1.19 for the development of breast cancer. Of studies that provided data on any use of OCs vs no previous OC use, 29 demonstrated an increased risk for breast cancer with OCs, while 8 trials demonstrated a protective effect of OCs against breast cancer. The duration of OC use did not significantly affect the risk of developing breast cancer (OR among nulliparous women who ever-used OCs and nulliparous women with at least 4 years of OC use: 1.24 and 1.29, respectively). OC use raised the risk for breast cancer to a similar degree among parous and nulliparous women. OC use prior to a first full-term pregnancy increased the risk for breast cancer to a larger degree than OC use after a term pregnancy (OR, 1.44 and 1.15, respectively). Pearls for PracticeBreast cancer is growing more prevalent, particularly among younger women, and it is the most common cause of cancer death for women between the ages of 20 and 59 years. The current meta-analysis suggests that the use of OCs increases the risk for breast cancer diagnosed prior to the age of 50 years. While parity and the duration of OC use did not significantly affect this risk, women who used OCs prior to a first full-term pregnancy appeared to be at higher risk for breast cancer. Instructions for Participation and CreditThere are no fees for participating in or receiving credit for this online educational activity. For information on applicability and acceptance of continuing education credit for this activity, please consult your professional licensing board.This activity is designed to be completed within the time designated on the title page; physicians should claim only those credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the activity online during the valid credit period that is noted on the title page.FOLLOW THESE STEPS TO EARN CME/CE CREDIT*: Read the target audience, learning objectives, and author disclosures. Study the educational content online or printed out. Online, choose the best answer to each test question. To receive a certificate, you must receive a passing score as designated at the top of the test. Medscape encourages you to complete the Activity Evaluation to provide feedback for future programming. You may now view or print the certificate from your CME/CE Tracker. You may print the certificate but you cannot alter it. Credits will be tallied in your CME/CE Tracker and archived for 5 years; at any point within this time period you can print out the tally as well as the certificates by accessing "Edit Your Profile" at the top of your Medscape homepage.*The credit that you receive is based on your user profile. Target AudienceThis article is intended for primary care clinicians, obstetrician-gynecologists, oncologists, and other specialists who care for women considering family planning options.GoalThe goal of this activity is to provide medical news to primary care clinicians and other healthcare professionals in order to enhance patient care.Accreditation StatementsFor PhysiciansMedscape, LLC is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.Medscape, LLC designates this educational activity for a maximum of 0.25 AMA PRA Category 1 Credit(s)?. Physicians should only claim credit commensurate with the extent of their participation in the activity. Medscape Medical News has been reviewed and is acceptable for up to 200 Prescribed credits by the American Academy of Family Physicians. AAFP accreditation begins 09/01/06. Term of approval is for 1 year from this date. This activity is approved for 0.25 Prescribed credits. Credit may be claimed for 1 year from the date of this activity. AAFP credit is subject to change based on topic selection throughout the accreditation year.AAFP Accreditation QuestionsFor questions regarding the content of this activity, contact the accredited provider for this CME/CE activity: CME@.... For technical assistance, contact CME@....For NursesThis Activity is sponsored by Medscape Continuing Education Provider Unit: Medscape is an approved provider of continuing nursing education by the New York State Nurses Association, an accredited approver by the American Nurses Credentialing Center's Commission on Accreditation.Approved for 0.3 contact hour(s) of continuing education for RNs and NPs; 0.3 contact hours are in the area of pharmacology.Provider Number: 6FDKKC-PRV-05--------------------------------------------------------------------------------Authors and DisclosuresAs an organization accredited by the ACCME, Medscape, LLC requires everyone who is in a position to control the content of an education activity to disclose all relevant financial relationships with any commercial interest. The ACCME defines "relevant financial relationships" as financial relationships in any amount, occurring within the past 12 months, including financial relationships of a spouse or life partner, that could create a conflict of interest.Medscape, LLC encourages Authors to identify investigational products or off-label uses of products regulated by the US Food and Drug Administration, at first mention and where appropriate in the content.News AuthorLaurie Barclay, MDis a freelance reviewer and writer for Medscape.Disclosure: Laurie Barclay, MD, has disclosed no relevant financial relationships.CME Author P Vega, MDAssociate Professor, Residency Director, Department of Family Medicine, University of California, IrvineDisclosure: Vega, MD, FAAFP, has disclosed that he has received grants for educational activities from Pfizer.About News CMENews CME is designed to keep physicians and other healthcare professionals abreast of current research and related clinical developments that are likely to affect practice, as reported by the Medscape Medical News group. Send comments or questions about this program to cmenews@.... Medscape Medical News 2006. ©2006 Medscape Legal DisclaimerThe material presented here does not necessarily reflect the views of Medscape or companies that support educational programming on www.medscape.com. These materials may discuss therapeutic products that have not been approved by the US Food and Drug Administration and off-label uses of approved products. A qualified healthcare professional should be consulted before using any therapeutic product discussed. Readers should verify all information and data before treating patients or employing any therapies described in this educational activity. Registration for CME credit and the post test must be completed online.To access the activity Post Test, please go to:http://www.medscape.com/viewarticle/547238 Harry Truman once quipped, "I never give them hell. I just tell the truth and they think its hell."ahuntley@...