Table 2.
Oral Contraceptive Use and the Time to Diagnosis of Incident Invasive Cancers, Overall Results and Those Stratified by Age at Baseline, National Institutes of Health-AARP Diet and Health Study, United States, 1995–2011
| Cancer Outcome/OC Use | Overall (n = 196,536) | ≤60 Years Old (n = 74,608) | >60 Years Old (n = 121,928) | |||||
|---|---|---|---|---|---|---|---|---|
| No. of Noncases | No. of Cases | Adjusted HRa | 95% CI | Adjusted HRa | 95% CI | Adjusted HRa | 95% CI | |
| Any cancer | ||||||||
| Any OC use (vs. none/<1 year) | 162,918 | 33,618 | 0.97 | 0.95, 0.99 | 0.94 | 0.91, 0.98 | 0.99 | 0.96, 1.02 |
| Duration of use, years | ||||||||
| None/<1 | 96,913 | 21,231 | 1.00 | Referent | 1.00 | Referent | 1.00 | Referent |
| 1–4 | 29,309 | 5,557 | 0.99 | 0.95, 1.02 | 0.95 | 0.90, 1.00b | 1.01 | 0.97, 1.05 |
| 5–9 | 20,723 | 3,841 | 0.96 | 0.93, 1.00b | 0.95 | 0.90, 1.01 | 0.96 | 0.91, 1.01 |
| ≥10 | 15,973 | 2,989 | 0.96 | 0.92, 1.00b,c | 0.92 | 0.86, 0.98c | 0.98 | 0.93, 1.04 |
| Acute myeloid leukemia | ||||||||
| Any use | 196,332 | 204 | 0.87 | 0.63, 1.20 | 0.60 | 0.35, 1.05 | 1.05 | 0.72, 1.52 |
| Duration of use, years | ||||||||
| None/<1 | 118,008 | 136 | 1.00 | Referent | 1.00 | Referent | 1.00 | Referent |
| 1–4 | 34,839 | 27 | 0.80 | 0.52, 1.24 | 0.46 | 0.21, 1.00 | 1.07 | 0.65, 1.78 |
| 5–9 | 24,538 | 26 | 1.03 | 0.65, 1.62 | 0.92 | 0.46, 1.85 | 1.03 | 0.56, 1.88 |
| ≥10 | 18,947 | 15 | 0.80 | 0.46, 1.40 | 0.47 | 0.16, 1.34 | 1.02 | 0.53, 1.96 |
| Bladder | ||||||||
| Any use | 195,989 | 547 | 1.04 | 0.86, 1.26 | 0.75 | 0.58, 0.99 | 0.92 | 0.76, 1.12 |
| Duration of use, years | ||||||||
| None/<1 | 117,790 | 354 | 1.00 | Referent | 1.00 | Referent | 1.00 | Referent |
| 1–4 | 34,779 | 87 | 1.06 | 0.83, 1.36 | 0.97 | 0.71, 1.32 | 0.89 | 0.68, 1.17 |
| 5–9 | 24,508 | 56 | 0.97 | 0.72, 1.31 | 0.54 | 0.35, 0.84 | 1.00 | 0.74, 1.36 |
| ≥10 | 18,912 | 50 | 1.09 | 0.80, 1.48 | 0.63 | 0.39, 1.01c | 0.87 | 0.61, 1.23 |
| Brain | ||||||||
| Any use | 196,179 | 357 | 0.82 | 0.64, 1.04 | 0.83 | 0.58, 1.20 | 0.81 | 0.59, 1.12 |
| Duration of use, years | ||||||||
| None/<1 | 117,909 | 235 | 1.00 | Referent | 1.000 | Referent | 1.00 | Referent |
| 1–4 | 34,812 | 54 | 0.83 | 0.60, 1.14 | 0.67 | 0.41, 1.10 | 1.03 | 0.69, 1.54 |
| 5–9 | 24,528 | 36 | 0.73 | 0.50, 1.08 | 1.00 | 0.61, 1.62 | 0.42 | 0.20, 0.85 |
| ≥10 | 18,930 | 32 | 0.91 | 0.62, 1.33 | 0.91 | 0.52, 1.60 | 0.91 | 0.53, 1.54 |
| Breast | ||||||||
| Any use | 185,937 | 10,599 | 1.04 | 1.00, 1.09 | 1.03 | 0.96, 1.10 | 1.05 | 0.99, 1.11 |
| Duration of use, years | ||||||||
| None/<1 | 111,797 | 6,347 | 1.00 | Referent | 1.00 | Referent | 1.00 | Referent |
| 1–4 | 32,970 | 1,896 | 1.04 | 0.98, 1.10 | 1.03 | 0.95, 1.12 | 1.05 | 0.97, 1.13 |
| 5–9 | 23,235 | 1,329 | 1.03 | 0.97, 1.10 | 1.04 | 0.95, 1.15 | 1.02 | 0.93, 1.11 |
| ≥10 | 17,935 | 1,027 | 1.05 | 0.97, 1.12 | 1.01 | 0.91, 1.12 | 1.08 | 0.98, 1.18 |
| Chronic lymphocytic leukemia | ||||||||
| Any use | 196,209 | 327 | 1.01 | 0.79, 1.29 | 0.91 | 0.59, 1.40 | 1.07 | 0.79, 1.44 |
| Duration of use, years | ||||||||
| None/<1 | 117,934 | 210 | 1.00 | Referent | 1.00 | Referent | 1.00 | Referent |
| 1–4 | 34,820 | 46 | 0.91 | 0.65, 1.28 | 0.66 | 0.36, 1.20 | 1.10 | 0.74, 1.65 |
| 5–9 | 24,527 | 37 | 1.00 | 0.69, 1.45 | 1.19 | 0.68, 2.07 | 0.81 | 0.47, 1.37 |
| ≥10 | 18,928 | 34 | 1.20 | 0.83, 1.75 | 1.01 | 0.53, 1.94 | 1.31 | 0.83, 2.08 |
| Colorectal | ||||||||
| Any use | 193,290 | 3,246 | 0.96 | 0.88, 1.04 | 0.98 | 0.84, 1.15 | 0.95 | 0.86, 1.05 |
| Duration of use, years | ||||||||
| None/<1 | 115,988 | 2,156 | 1.00 | Referent | 1.00 | Referent | 1.00 | Referent |
| 1–4 | 34,400 | 466 | 0.93 | 0.83, 1.04 | 0.94 | 0.77, 1.14 | 0.93 | 0.81, 1.07 |
| 5–9 | 24,226 | 338 | 0.96 | 0.84, 1.08 | 1.03 | 0.84, 1.27 | 0.91 | 0.78, 1.07 |
| ≥10 | 18,676 | 286 | 1.02 | 0.89, 1.16 | 1.00 | 0.79, 1.27 | 1.03 | 0.88, 1.21 |
| Endometrial | ||||||||
| Any use | 112,412 | 2,189 | 0.78 | 0.70, 0.86 | 0.71 | 0.62, 0.82 | 0.83 | 0.73, 0.94 |
| Duration of use, years | ||||||||
| None/<1 | 66,595 | 1,455 | 1.00 | Referent | 1.00 | Referent | 1.00 | Referent |
| 1–4 | 19,884 | 333 | 0.78 | 0.69, 0.89 | 0.75 | 0.63, 0.90 | 0.78 | 0.65, 0.95 |
| 5–9 | 14,219 | 245 | 0.86 | 0.75, 0.99 | 0.76 | 0.63, 0.93 | 0.96 | 0.78, 1.17 |
| ≥10 | 11,714 | 156 | 0.66 | 0.56, 0.79c | 0.57 | 0.45, 0.74c | 0.75 | 0.59, 0.95c |
| Head and neck | ||||||||
| Any use | 195,937 | 599 | 0.96 | 0.80, 1.16 | 1.01 | 0.75, 1.37 | 0.94 | 0.75, 1.18 |
| Duration of use, years | ||||||||
| None/<1 | 117,775 | 369 | 1.00 | Referent | 1.00 | Referent | 1.00 | Referent |
| 1–4 | 34,764 | 102 | 0.97 | 0.77, 1.23 | 0.93 | 0.63, 1.36 | 1.03 | 0.76, 1.40 |
| 5–9 | 24,492 | 72 | 0.94 | 0.71, 1.24 | 1.05 | 0.70, 1.57 | 0.86 | 0.58, 1.26 |
| ≥10 | 18,906 | 56 | 0.98 | 0.73, 1.32 | 1.12 | 0.72, 1.75 | 0.87 | 0.58, 1.32 |
| Kidney and renal pelvis | ||||||||
| Any use | 195,721 | 815 | 0.87 | 0.74, 1.02 | 0.77 | 0.58, 1.00 | 0.93 | 0.77, 1.13 |
| Duration of use, years | ||||||||
| None/<1 | 117,606 | 538 | 1.00 | Referent | 1.00 | Referent | 1.00 | Referent |
| 1–4 | 34,731 | 135 | 0.95 | 0.78, 1.17 | 0.97 | 0.71, 1.33 | 0.90 | 0.69, 1.18 |
| 5–9 | 24,482 | 82 | 0.80 | 0.62, 1.03 | 0.55 | 0.35, 0.85 | 1.01 | 0.75, 1.37 |
| ≥10 | 18,902 | 60 | 0.79 | 0.59, 1.04c | 0.65 | 0.40, 1.03c | 0.88 | 0.62, 1.24 |
| Lung and bronchial | ||||||||
| Any use | 191,113 | 5,423 | 0.96 | 0.90, 1.02 | 0.95 | 0.85, 1.06 | 0.96 | 0.90, 1.04 |
| Duration of use, years | ||||||||
| None/<1 | 114,681 | 3,463 | 1.00 | Referent | 1.00 | Referent | 1.00 | Referent |
| 1–4 | 33,980 | 886 | 0.97 | 0.90, 1.05 | 0.92 | 0.80, 1.05 | 1.01 | 0.92, 1.12 |
| 5–9 | 23,986 | 578 | 0.92 | 0.84, 1.01 | 0.94 | 0.80, 1.09 | 0.90 | 0.80, 1.02 |
| ≥10 | 18,466 | 496 | 0.97 | 0.88, 1.08 | 1.01 | 0.86, 1.20 | 0.95 | 0.84, 1.08 |
| Multiple myeloma | ||||||||
| Any use | 196,099 | 437 | 1.21 | 0.98, 1.50 | 1.05 | 0.72, 1.55 | 1.29 | 1.001, 1.67 |
| Duration of use, years | ||||||||
| None/<1 | 117,878 | 266 | 1.00 | Referent | 1.00 | Referent | 1.00 | Referent |
| 1–4 | 34,793 | 73 | 1.17 | 0.89, 1.55 | 1.06 | 0.66, 1.69 | 1.21 | 0.85, 1.72 |
| 5–9 | 24,510 | 54 | 1.25 | 0.91, 1.71 | 1.04 | 0.61, 1.76 | 1.38 | 0.93, 2.03 |
| ≥10 | 18,918 | 44 | 1.24 | 0.88, 1.75 | 1.07 | 0.60, 1.93 | 1.33 | 0.88, 2.03 |
| Non-Hodgkin lymphoma | ||||||||
| Any use | 195,042 | 1,494 | 0.93 | 0.83, 1.05 | 0.97 | 0.79, 1.17 | 0.91 | 0.79, 1.06 |
| Duration of use, years | ||||||||
| None/<1 | 117,176 | 968 | 1.00 | Referent | 1.00 | Referent | 1.00 | Referent |
| 1–4 | 34,622 | 244 | 1.00 | 0.86, 1.16 | 1.07 | 0.85, 1.35 | 0.94 | 0.76, 1.14 |
| 5–9 | 24,392 | 172 | 0.95 | 0.80, 1.13 | 0.96 | 0.73, 1.26 | 0.96 | 0.76, 1.21 |
| ≥10 | 18,852 | 110 | 0.79 | 0.64, 0.97 | 0.76 | 0.54, 1.05 | 0.83 | 0.63, 1.08 |
| Ovarian | ||||||||
| Any use | 149,638 | 1,223 | 0.74 | 0.65, 0.84 | 0.77 | 0.63, 0.94 | 0.72 | 0.60, 0.85 |
| Duration of use of use, years | ||||||||
| None/<1 | 88,612 | 827 | 1.00 | Referent | 1.00 | Referent | 1.00 | Referent |
| 1–4 | 26,980 | 200 | 0.84 | 0.71, 0.996 | 0.84 | 0.66, 1.08 | 0.85 | 0.67, 1.07 |
| 5–9 | 19,192 | 116 | 0.70 | 0.57, 0.86 | 0.69 | 0.51, 0.93 | 0.72 | 0.54, 0.96 |
| ≥10 | 14,854 | 80 | 0.61 | 0.48, 0.76c | 0.73 | 0.52, 1.01c | 0.50 | 0.34, 0.72c |
| Pancreatic | ||||||||
| Any use | 195,536 | 1,000 | 1.11 | 0.97, 1.28 | 1.37 | 1.05, 1.78 | 1.02 | 0.86, 1.20 |
| Duration of use, years | ||||||||
| None/<1 | 117,518 | 626 | 1.00 | Referent | 1.00 | Referent | 1.00 | Referent |
| 1–4 | 34,693 | 173 | 1.16 | 0.97, 1.38 | 1.33 | 0.97, 1.83 | 1.11 | 0.89, 1.39 |
| 5–9 | 24,446 | 118 | 1.11 | 0.90, 1.37 | 1.35 | 0.95, 1.92 | 1.03 | 0.78, 1.35 |
| ≥10 | 18,879 | 83 | 1.03 | 0.81, 1.30 | 1.46 | 1.00, 2.14c | 0.84 | 0.61, 1.15 |
| Stomach | ||||||||
| Any use | 196,232 | 304 | 0.90 | 0.69, 1.19 | 0.84 | 0.50, 1.40 | 0.93 | 0.67, 1.28 |
| Duration of use, years | ||||||||
| None/<1 | 117,935 | 209 | 1.00 | Referent | 1.00 | Referent | 1.00 | Referent |
| 1–4 | 34,826 | 40 | 0.86 | 0.59, 1.25 | 0.83 | 0.44, 1.58 | 0.85 | 0.53, 1.36 |
| 5–9 | 24,534 | 30 | 0.83 | 0.53, 1.30 | 0.77 | 0.36, 1.63 | 0.85 | 0.49, 1.48 |
| ≥10 | 18,937 | 25 | 1.07 | 0.69, 1.65 | 0.95 | 0.43, 2.08 | 1.14 | 0.68, 1.92 |
| Thyroid | ||||||||
| Any use | 196,036 | 500 | 1.00 | 0.82, 1.22 | 0.91 | 0.68, 1.21 | 1.09 | 0.84, 1.42 |
| Duration of use, years | ||||||||
| None/<1 | 117,849 | 295 | 1.00 | Referent | 1.00 | Referent | 1.00 | Referent |
| 1–4 | 34,757 | 109 | 1.23 | 0.97, 1.56 | 1.08 | 0.77, 1.52 | 1.39 | 1.00, 1.94 |
| 5–9 | 24,512 | 52 | 0.75 | 0.54, 1.04 | 0.69 | 0.44, 1.08 | 0.79 | 0.49, 1.29 |
| ≥10 | 18,918 | 44 | 0.92 | 0.66, 1.28 | 0.87 | 0.55, 1.38 | 0.93 | 0.57, 1.52 |
Abbreviations: CI, confidence interval; HR, hazard ratio; OC, oral contraceptive.
a All models were adjusted for age, race, body mass index, and smoking status (from the baseline questionnaire). Additional adjustment was made for specific cancer outcomes, as follows: any cancer (age at menarche, alcohol use, number of cigarettes smoked per day, physical activity); acute myeloid leukemia (alcohol use, number of cigarettes smoked per day, physical activity); bladder (age at menarche, cigarettes smoked per day); brain (none); breast (age at menarche, alcohol use, physical activity, family history of breast cancer); chronic lymphocytic leukemia (alcohol use, number of cigarettes smoked per day, physical activity); colorectal (age at menarche, alcohol use, family history of colon cancer); endometrial (age at menarche); head and neck (alcohol use, number of cigarettes smoked per day); kidney and renal pelvis (age at menarche, alcohol use); lung and bronchial (age at menarche, number of cigarettes smoked per day); multiple myeloma (alcohol use, physical activity); non-Hodgkin lymphoma (alcohol use, number of cigarettes smoked per day, physical activity); ovarian (age at menarche); pancreatic (alcohol use, number of cigarettes smoked per day); stomach (alcohol use, number of cigarettes smoked per day, physical activity); thyroid (alcohol use).
b Statistically significant (P < 0.05).
c Trend across categories of duration is statistically significant (P < 0.05).