Oral contraceptives and endometrial cancer: Do other risk factors modify the association?

The joint effect of use of combination‐type oral contraceptives and other exposure factors on risk of endometrial cancer was examined in data from a multicenter case‐control study conducted in 5 areas of the United States. Cases were 405 women with histologically confirmed invasive epithelial endometrial cancer first treated at one of 7 participating hospitals. A total of 297 population‐based controls of similar age, race, and geographic area were selected as a comparison group. Information on exposure factors was derived from in‐person interviews. Combination‐type oral contraceptive (COC) use was associated with a significant reduction in risk of endometrial cancer, with an adjusted odds ratio (OR) of 0.4 (95% confidence interval 0.3 to 0.7) for ever compared to never use. Long‐term (≥ 10 years) users experienced a markedly lower risk (OR = 0.2). Women who discontinued COC use ≥20 years earlier remained at reduced risk (OR = 0.7) compared with non‐users. The negative association with COC use was apparent regardless of the presence or level of several other risk factors for endometrial cancer, including age, menopausal status, parity, obesity, ever‐use of menopausal estrogens, smoking history, or history of infertility. The magnitude of the negative association observed in COC users, however, was considerably diminished in women with no full‐term births and in women who subsequently used replacement estrogens for 3 or more years. These results provide new evidence that the protective effect of COC use lasts for 20 or more years after use is discontinued, and highlight several sub‐groups of users in whom the level of protection is attenuated by the presence of other risk factors for this disease.