Prescribing Oral Contraceptives in Women With Breast Diseases: A Matter of Concern for the Gynecologist

Main Article Content

Sadaf Alipour
Amirhossein Eskandari

Keywords

Breast cancer, Contraception, Disease, Hormones, Steroid

Abstract

Background: The association of exogenous steroid hormones with breast malignancy has long been, and still is, a subject of investigation. This manuscript, as part of a series of articles about effects of exogenous sex hormones on breast conditions, reviews the adverse and beneficial effects of oral contraceptives in various entities separately: benign and malignant breast diseases, women with risk factors of breast cancer, and the general population.
Methods: We first reviewed international clinical guidelines about the subject. Then, a comprehensive search of the literature was carried out using appropriate keywords. Clinical trials, population-based or cohort studies, nested case-control studies, and narrative/systematic reviews were reviewed and relevant data were extracted.
Results: Oral contraceptives are contraindicated in women with current or previous breast cancer. Among women at high risk for breast cancer, those with preceding chest wall irradiation should not use pills, while these are allowed in cases with BRCA mutations or with a positive family history of breast cancer. Oral contraceptives may be beneficial for benign breast diseases. For low-risk woman, pills either pose no risk or may induce a very mild risk for breast cancer.
Conclusion: Oral contraceptives are generally safe regarding breast diseases except in breast cancer patients or high-risk women, especially those with a history of chest wall irradiation.

References

1. Yager JD, Davidson NE. Estrogen carcinogenesis in breast cancer. The New England journal of medicine. 2006;354(3):270-82.
2. Hankinson SE, Willett WC, Manson JE, Colditz GA, Hunter DJ, Spiegelman D, et al. Plasma sex steroid hormone levels and risk of breast cancer in postmenopausal women. J Natl Cancer Inst. 1998;90(17):1292-9.
3. Wang K, Li F, Chen L, Lai YM, Zhang X, Li HY. Change in risk of breast cancer after receiving hormone replacement therapy by considering effect-modifiers: a systematic review and dose-response meta-analysis of prospective studies. Oncotarget. 2017;8(46):81109-24.
4. Pizot C, Boniol M, Mullie P, Koechlin A, Boniol M, Boyle P, et al. Physical activity, hormone replacement therapy and breast cancer risk: A meta-analysis of prospective studies. European Journal of Cancer. 2016;52:138-54.
5. Toniolo PG. Endogenous estrogens and breast cancer risk: the case for prospective cohort studies. Environmental health perspectives. 1997;105 Suppl 3:587-92.
6. Clemons M, Goss P. Estrogen and the risk of breast cancer. New England Journal of Medicine. 2001;344(4):276-85.
7. Gierisch JM, Coeytaux RR, Urrutia RP, Havrilesky LJ, Moorman PG, Lowery WJ, et al. Oral contraceptive use and risk of breast, cervical, colorectal, and endometrial cancers: a systematic review. Cancer Epidemiology and Prevention Biomarkers. 2013;22(11):1931-43.
8. Humans IWGotEoCRt, Cancer IAfRo, Organization WH. Hormonal contraception and post-menopausal hormonal therapy: World Health Organization; 1999.
9. Cooper DB, Adigun R. Oral Contraceptive Pills. StatPearls [Internet]: StatPearls Publishing; 2017.
10. Bucciero M, Parda-Chlebowicz M. Contraception: Overview. Ambulatory Gynecology: Springer; 2018. p. 33-57.
11. Hall KS, Trussell J. Types of combined oral contraceptives used by US women. Contraception. 2012;86(6):659-65.
12. Goldstuck N. Progestin potency–Assessment and relevance to choice of oral contraceptives. Middle East Fertility Society Journal. 2011;16(4):248-53.
13. Apgar BS, Greenberg G. Using progestins in clinical practice. American family physician. 2000;62(8):1839-46, 49-50.
14. Davtyan C. Four generations of progestins in oral contraceptives. Proceedings of UCLA healthcare. 2012;16:1-3.
15. Michels KA, Pfeiffer RM, Brinton LA, Trabert B. Modification of the associations between duration of oral contraceptive use and ovarian, endometrial, breast, and colorectal cancers. JAMA oncology. 2018;4(4):516-21.
16. Lovett JL, Chima MA, Wexler JK, Arslanian KJ, Friedman AB, Yousif CB, et al. Oral contraceptives cause evolutionarily novel increases in hormone exposureA risk factor for breast cancer. Evolution, medicine, and public health. 2017;2017(1):97-108.
17. Kurian A, Kaushik K, Subeesh V, Maheswari E, Kunnavil R. Safety Profile of Levonorgestrel: A Disproportionality Analysis of Food and Drug Administration Adverse Event Reporting System (Faers) Database. Journal of reproduction & infertility. 2018;19(3):152.
18. Obstetricians ACo, Gynecologists. Emergency Contraception. ACOG Practice Bulletin Number 69: Clinical Management Guidelines for Obstetrician-Gynecologists. Obstetrics & Gynecology. 2015;106(6).
19. Ben-Aharon I, Gafter-Gvili A, Leibovici L, Stemmer SM. Pharmacological interventions for fertility preservation during chemotherapy: a systematic review and meta-analysis. Breast cancer research and treatment. 2010;122(3):803-11.
20. Koren G, Carey N, Gagnon R, Maxwell C, Nulman I, Senikas V. Cancer chemotherapy and pregnancy. Journal of Obstetrics and Gynaecology Canada. 2013;35(3):263-78.
21. Howell S, Shalet S. Gonadal damage from chemotherapy and radiotherapy. Endocrinology and metabolism clinics of North America. 1998;27(4):927-43.
22. Mody SK, Panelli DM, Hulugalle A, Su HI, Gorman JR. Contraception concerns, utilization and counseling needs of women with a history of breast cancer: a qualitative study. International journal of women's health. 2017;9:507.
23. Castro-Sanchez A, Martinez-Cannon BA, Platas A, Mohar A, Fonseca A, Vega Y, et al. Suboptimal Use of Effective Contraceptive Methods in Young Mexican Women With Breast Cancer. Journal of global oncology. 2018(4):1-7.
24. Altshuler AL, Gaffield ME, Kiarie JN. The WHO’s medical eligibility criteria for contraceptive use: 20 years of global guidance. Current opinion in obstetrics & gynecology. 2015;27(6):451.
25. Casey PM, Faubion SS, MacLaughlin KL, Long ME, Pruthi S. Caring for the breast cancer survivor's health and well-being. World journal of clinical oncology. 2014;5(4):693-704.
26. Curtis KM, Tepper NK, Jatlaoui TC, Berry-Bibee E, Horton LG, Zapata LB, et al. US medical eligibility criteria for contraceptive use, 2016. 2016.
27. Curtis KM, Jatlaoui TC, Tepper NK, Zapata LB, Horton LG, Jamieson DJ, et al. US selected practice recommendations for contraceptive use, 2016. 2016.
28. Evans G, Sutton EL. Oral contraception. The Medical clinics of North America. 2015;99(3):479-503.
29. Black A, Guilbert E, Costescu D, Dunn S, Fisher W, Kives S, et al. Canadian Contraception Consensus (Part 3 of 4): Chapter 8–Progestin-Only Contraception. Journal of Obstetrics and Gynaecology Canada. 2016;38(3):279-300.
30. Black A, Guilbert E, Costescu D, Dunn S, Fisher W, Kives S, et al. No. 329-Canadian contraception consensus part 4 of 4 chapter 9: Combined hormonal contraception. Journal of Obstetrics and Gynaecology Canada. 2017;39(4):229-68. e5.
31. Patel A, Schwarz EB. Cancer and contraception. Contraception. 2012;86(3):191-8.
32. Calhoun K, Hansen N. The effect of pregnancy on survival in women with a history of breast cancer. Breast disease. 2005;23:81-6.
33. Blakely LJ, Buzdar AU, Lozada JA, Shullaih SA, Hoy E, Smith TL, et al. Effects of pregnancy after treatment for breast carcinoma on survival and risk of recurrence. Cancer. 2004;100(3):465-9.
34. Kranick JA, Schaefer C, Rowell S, Desai M, Petrek JA, Hiatt RA, et al. Is pregnancy after breast cancer safe? The breast journal. 2010;16(4):404-11.
35. Lambertini M, Kroman N, Ameye L, Cordoba O, Pinto A, Benedetti G, et al. Long-term Safety of Pregnancy Following Breast Cancer According to Estrogen Receptor Status. J Natl Cancer Inst. 2018;110(4):426-9.
36. de Bree E, Makrigiannakis A, Askoxylakis J, Melissas J, Tsiftsis DD. Pregnancy after breast cancer. A comprehensive review. Journal of surgical oncology. 2010;101(6):534-42.
37. Pagani O, Partridge A, Korde L, Badve S, Bartlett J, Albain K, et al. Pregnancy after breast cancer: if you wish, ma'am. Breast cancer research and treatment. 2011;129(2):309-17.
38. Hartnett KP, Mertens AC, Kramer MR, Lash TL, Spencer JB, Ward KC, et al. Pregnancy after cancer: Does timing of conception affect infant health? Cancer. 2018;124(22):4401-7.
39. Kroman N, Jensen MB, Wohlfahrt J, Ejlertsen B. Pregnancy after treatment of breast cancer--a population-based study on behalf of Danish Breast Cancer Cooperative Group. Acta oncologica (Stockholm, Sweden). 2008;47(4):545-9.
40. Dominick SA, McLean MR, Whitcomb BW, Gorman JR, Mersereau JE, Bouknight JM, et al. Contraceptive practices among female cancer survivors of reproductive age. Obstetrics and gynecology. 2015;126(3):498.
41. Vaz-Luis I, Partridge AH. Exogenous reproductive hormone use in breast cancer survivors and previvors. Nature reviews Clinical oncology. 2018;15(4):249-61.
42. Patel A, Schwarz E. Society of Family Planning. Cancer and contraception. Release date May 2012. SFP Guideline# 20121. Contraception. 2012;86(3):191-8.
43. Rosenberg L, Palmer JR, Rao RS, Zauber AG, Strom BL, Warshauer ME, et al. Case-control study of oral contraceptive use and risk of breast cancer. American Journal of Epidemiology. 1996;143(1).
44. Ursin G, Ross RK, Sullivan-Halley J, Hanisch R, Henderson B, Bernstein L. Use of oral contraceptives and risk of breast cancer in young women. Breast cancer research and treatment. 1998;50(2):175-84.
45. Grabrick DM, Hartmann LC, Cerhan JR, Vierkant RA, Therneau TM, Vachon CM, et al. Risk of breast cancer with oral contraceptive use in women with a family history of breast cancer. Jama. 2000;284(14):1791-8.
46. Brinton LA, Hoover R, Szklo M, FRAUMENI Jr JF. Oral contraceptives and breast cancer. International journal of epidemiology. 1982;11(4):316-22.
47. Hennekens CH, Speizer FE, Lipnick RJ, Rosner B, Bain C, Belanger C, et al. A case-control study of oral contraceptive use and breast cancer. JNCI: Journal of the National Cancer Institute. 1984;72(1):39-42.
48. Harris RE, Zang EA, Wynder EL. Oral contraceptives and breast cancer risk: a case-control study. International journal of epidemiology. 1990;19(2):240-6.
49. Marchbanks PA, McDonald JA, Wilson HG, Folger SG, Mandel MG, Daling JR, et al. Oral contraceptives and the risk of breast cancer. New England journal of medicine. 2002;346(26):2025-32.
50. Toss A, Grandi G, Cagnacci A, Marcheselli L, Pavesi S, De Matteis E, et al. The impact of reproductive life on breast cancer risk in women with family history or BRCA mutation. Oncotarget. 2017;8(6):9144.
51. Grandi G, Toss A, Cagnacci A, Marcheselli L, Pavesi S, Facchinetti F, et al. Combined hormonal contraceptive use and risk of breast cancer in a population of women with a family history. Clinical breast cancer. 2018;18(1):e15-e24.
52. Silvera SA, Miller AB, Rohan TE. Oral contraceptive use and risk of breast cancer among women with a family history of breast cancer: a prospective cohort study. Cancer causes & control. 2005;16(9):1059-63.
53. Cancer CGoHFiB. Familial breast cancer: collaborative reanalysis of individual data from 52 epidemiological studies including 58 209 women with breast cancer and 101 986 women without the disease. The Lancet. 2001;358(9291):1389-99.
54. Gaffield ME, Culwell KR, Ravi A. Oral contraceptives and family history of breast cancer. Contraception. 2009;80(4):372-80.
55. Moorman PG, Havrilesky LJ, Gierisch JM, Coeytaux RR, Lowery WJ, Peragallo Urrutia R, et al. Oral contraceptives and risk of ovarian cancer and breast cancer among high-risk women: a systematic review and meta-analysis. Journal of Clinical Oncology. 2013;31(33):4188-98.
56. Freund R, Kelsberg G, Safranek S. Do oral contraceptives put women with a family history of breast cancer at increased risk? 2014.
57. Claus EB, Stowe M, Carter D. Oral contraceptives and the risk of ductal breast carcinoma in situ. Breast cancer research and treatment. 2003;81(2):129-36.
58. Milne RL, Knight JA, John EM, Dite GS, Balbuena R, Ziogas A, et al. Oral contraceptive use and risk of early-onset breast cancer in carriers and noncarriers of BRCA1 and BRCA2 mutations. Cancer Epidemiology and Prevention Biomarkers. 2005;14(2):350-6.
59. Lee E, Ma H, McKean-Cowdin R, Van Den Berg D, Bernstein L, Henderson BE, et al. Effect of reproductive factors and oral contraceptives on breast cancer risk in BRCA1/2 mutation carriers and noncarriers: results from a population-based study. Cancer Epidemiology and Prevention Biomarkers. 2008;17(11):3170-8.
60. Ursin G, Henderson BE, Haile RW, Pike MC, Zhou N, Diep A, et al. Does oral contraceptive use increase the risk of breast cancer in women with BRCA1/BRCA2 mutations more than in other women? Cancer Research. 1997;57(17):3678-81.
61. Narod SA, Dubé M-P, Klijn J, Lubinski J, Lynch HT, Ghadirian P, et al. Oral contraceptives and the risk of breast cancer in BRCA1 and BRCA2 mutation carriers. Journal of the National Cancer Institute. 2002;94(23):1773-9.
62. Haile RW, Thomas DC, McGuire V, Felberg A, John EM, Milne RL, et al. BRCA1 and BRCA2 mutation carriers, oral contraceptive use, and breast cancer before age 50. Cancer Epidemiology and Prevention Biomarkers. 2006;15(10):1863-70.
63. Brohet RM, Goldgar DE, Easton DF, Antoniou AC, Andrieu N, Chang-Claude J, et al. Oral contraceptives and breast cancer risk in the international BRCA1/2 carrier cohort study: a report from EMBRACE, GENEPSO, GEO-HEBON, and the IBCCS Collaborating Group. Journal of clinical oncology. 2007;25(25):3831-6.
64. Bernholtz S, Laitman Y, Kaufman B, Shimon SP, Friedman E. Cancer risk in Jewish BRCA1 and BRCA2 mutation carriers: effects of oral contraceptive use and parental origin of mutation. Breast cancer research and treatment. 2011;129(2):557.
65. Kotsopoulos J, Lubinski J, Moller P, Lynch HT, Singer CF, Eng C, et al. Timing of oral contraceptive use and the risk of breast cancer in BRCA1 mutation carriers. Breast cancer research and treatment. 2014;143(3):579-86.
66. Rieder V, Salama M, Glöckner L, Muhr D, Berger A, Tea MK, et al. Effect of lifestyle and reproductive factors on the onset of breast cancer in female BRCA 1 and 2 mutation carriers. Molecular genetics & genomic medicine. 2016;4(2):172-7.
67. Cibula D, Zikan M, Dusek L, Majek O. Oral contraceptives and risk of ovarian and breast cancers in BRCA mutation carriers: a meta-analysis. Expert review of anticancer therapy. 2011;11(8):1197-207.
68. Iodice S, Barile M, Rotmensz N, Feroce I, Bonanni B, Radice P, et al. Oral contraceptive use and breast or ovarian cancer risk in BRCA1/2 carriers: a meta-analysis. European journal of cancer. 2010;46(12):2275-84.
69. Friebel TM, Domchek SM, Rebbeck TR. Modifiers of cancer risk in BRCA1 and BRCA2 mutation carriers: a systematic review and meta-analysis. Journal of the National Cancer Institute. 2014;106(6):dju091.
70. Schrijver LH, Olsson H, Phillips K-A, Terry MB, Goldgar DE, Kast K, et al. Oral Contraceptive Use and Breast Cancer Risk: Retrospective and Prospective Analyses From a BRCA1 and BRCA2 Mutation Carrier Cohort Study. JNCI Cancer Spectrum. 2018;2(2):pky023.
71. Cancer IAfRo. Hormonal contraceptives, progestogens only. IARC monographs on the evaluation of carcinogenic risks to humans. 1999;72:339-97.
72. Practitioners RCoG. Oral Contraception Study: Effect on hypertension and benign breast disease of progestogen component in combined oral contraceptives. Lancet. 1977;1(8012):624.
73. Calle E, Heath C, Miracle-McMahill H, Coates R, Liff J, Franceschi S, et al. Breast cancer and hormonal contraceptives: further results: Collaborative group on hormonal factors in breast cancer. Contraception. 1996;54(3):1-106.
74. Kumle M, Weiderpass E, Braaten T, Persson I, Adami H-O, Lund E. Use of oral contraceptives and breast cancer risk: The Norwegian-Swedish Women’s Lifestyle and Health Cohort Study. Cancer Epidemiology and Prevention Biomarkers. 2002;11(11):1375-81.
75. Brinton LA, Brogan DR, Coates RJ, Swanson CA, Potischman N, Stanford JL. Breast cancer risk among women under 55 years of age by joint effects of usage of oral contraceptives and hormone replacement therapy. Menopause (New York, NY). 2018;25(11):1195-200.
76. Morch LS, Skovlund CW, Hannaford PC, Iversen L, Fielding S, Lidegaard O. Contemporary Hormonal Contraception and the Risk of Breast Cancer. The New England journal of medicine. 2017;377(23):2228-39.
77. Machado RB. Hormonal Contraceptives and Risk of Breast Cancer: How to Explain it without Controversy. Revista Brasileira de Ginecologia e Obstetrícia. 2018;40(2):57-8.
78. Vessey M, Doll R, Peto R, Johnson B, Wiggins P. A long-term follow-up study of women using different methods of contraception—an interim report. Journal of biosocial science. 1976;8(4):373-427.
79. Hankinson SE, Colditz GA, Manson JE, Willett WC, Hunter DJ, Stampfer MJ, et al. A prospective study of oral contraceptive use and risk of breast cancer (Nurses' Health Study, United States). Cancer Causes & Control. 1997;8(1):65-72.
80. Hannaford PC, Selvaraj S, Elliott AM, Angus V, Iversen L, Lee AJ. Cancer risk among users of oral contraceptives: cohort data from the Royal College of General Practitioner's oral contraception study. BMJ (Clinical research ed). 2007;335(7621):651.
81. Vessey M, Yeates D. Oral contraceptive use and cancer: final report from the Oxford–Family Planning Association contraceptive study. Contraception. 2013;88(6):678-83.
82. Joukar F, Ahmadnia Z, Atrkar-Roushan Z, Hasavari F, Rahimi A. The Investigation of Risk Factors Impacting Breast Cancer in Guilan Province. Asian Pacific journal of cancer prevention: APJCP. 2016;17(10):4623.
83. Soroush A, Farshchian N, Komasi S, Izadi N, Amirifard N, Shahmohammadi A. The role of oral contraceptive pills on increased risk of breast cancer in Iranian populations: a meta-analysis. Journal of cancer prevention. 2016;21(4):294.
84. Chaveepojnkamjorn W, Pichainarong N, Thotong R, Sativipawee P, Pitikultang S. Relationship between breast cancer and oral contraceptive use among Thai premenopausal women: a case-control study. Asian Pacific journal of cancer prevention: APJCP. 2017;18(5):1429.
85. Cho MK. Use of Combined Oral Contraceptives in Perimenopausal Women. Chonnam medical journal. 2018;54(3):153-8.
86. Fabre A, Fournier A, Mesrine S, Desreux J, Gompel A, Boutron-Ruault M-C, et al. Oral progestagens before menopause and breast cancer risk. British journal of cancer. 2007;96(5):841.
87. Samson M, Porter N, Orekoya O, Hebert JR, Adams SA, Bennett CL, et al. Progestin and breast cancer risk: a systematic review. Breast cancer research and treatment. 2016;155(1):3-12.
88. Samson ME, Adams SA, Mulatya CM, Zhang J, Bennett CL, Hebert J, et al. Types of oral contraceptives and breast cancer survival among women enrolled in Medicaid: a competing-risk model. Maturitas. 2017;95:42-9.
89. Busund M, Bugge NS, Braaten T, Waaseth M, Rylander C, Lund E. Progestin‐only and combined oral contraceptives and receptor‐defined premenopausal breast cancer risk: The Norwegian Women and Cancer Study. International journal of cancer. 2018;142(11):2293-302.
90. Dolle JM, Daling JR, White E, Brinton LA, Doody DR, Porter PL, et al. Risk factors for triple-negative breast cancer in women under the age of 45 years. Cancer Epidemiology and Prevention Biomarkers. 2009;18(4):1157-66.
91. Rosenberg L, Boggs DA, Wise LA, Adams-Campbell LL, Palmer JR. Oral contraceptive use and estrogen/progesterone receptor–negative breast cancer among African American women. Cancer Epidemiology and Prevention Biomarkers. 2010;19(8):2073-9.
92. Ma H, Wang Y, Sullivan-Halley J, Weiss L, Marchbanks PA, Spirtas R, et al. Use of four biomarkers to evaluate the risk of breast cancer subtypes in the women's contraceptive and reproductive experiences study. Cancer research. 2010;70(2):575-87.
93. Phipps AI, Chlebowski RT, Prentice R, McTiernan A, Wactawski-Wende J, Kuller LH, et al. Reproductive history and oral contraceptive use in relation to risk of triple-negative breast cancer. Journal of the National Cancer Institute. 2011;103(6):470-7.
94. Beaber EF, Malone KE, Tang M-TC, Barlow WE, Porter PL, Daling JR, et al. Oral contraceptives and breast cancer risk overall and by molecular subtype among young women. Cancer Epidemiology and Prevention Biomarkers. 2014;23(5):755-64.
95. Beaber EF, Buist DS, Barlow WE, Malone KE, Reed SD, Li CI. Recent oral contraceptive use by formulation and breast cancer risk among women 20 to 49 years of age. Cancer research. 2014;74(15):4078-89.
96. Barnard ME, Boeke CE, Tamimi RM. Established breast cancer risk factors and risk of intrinsic tumor subtypes. Biochimica et Biophysica Acta (BBA)-Reviews on Cancer. 2015;1856(1):73-85.
97. Li L, Zhong Y, Zhang H, Yu H, Huang Y, Li Z, et al. Association between oral contraceptive use as a risk factor and triple-negative breast cancer: A systematic review and meta-analysis. Molecular and clinical oncology. 2017;7(1):76-80.
98. Branchini G, Schneider L, Cericatto R, Capp E, Brum IS. Progesterone receptors A and B and estrogen receptor alpha expression in normal breast tissue and fibroadenomas. Endocrine. 2009;35(3):459-66.
99. Janerich DT, Glebatis DM, Dugan JM. Benign breast disease and oral contraceptive use. Jama. 1977;237(20):2199-201.
100. Vessey MP, Doll R, Sutton PM. Oral contraceptives and breast neoplasia: a retrospective study. Br Med J. 1972;3(5829):719-24.
101. Nomura A, Comstock GW. Benign breast tumor and estrogenic hormones: a population-based retrospective study. Am J Epidemiol. 1976;103(5):439-44.
102. Ory H, Cole P, MacMahon B, Hoover R. Oral contraceptives and reduced risk of benign breast diseases. The New England journal of medicine. 1976;294(8):419-22.
103. Brinton LA, Vessey MP, Flavel R, Yeates D. Risk factors for benign breast disease. American journal of epidemiology. 1981;113(3):203-14.
104. Berkowitz GS, Kelsey JL, LiVolsi VA, Holford TR, Merino MJ, Ort S, et al. Oral contraceptive use and fibrocystic breast disease among pre-and postmenopausal women. American journal of epidemiology. 1984;120(1):87-96.
105. Vessey M. Oral contraception and health. The British Journal of General Practice. 1998;48(435):1639.
106. Rohan TE, Miller AB. A cohort study of oral contraceptive use and risk of benign breast disease. Int J Cancer. 1999;82(2):191-6.
107. Coriaty Nelson Z, Ray RM, Gao DL, Thomas DB. Risk factors for fibroadenoma in a cohort of female textile workers in Shanghai, China. Am J Epidemiol. 2002;156(7):599-605.
108. Vessey M, Yeates D. Oral contraceptives and benign breast disease: an update of findings in a large cohort study. Contraception. 2007;76(6):418-24.
109. Estevao RA, Nazario AC, Baracat EC. Effect of oral contraceptive with and without associated estriol on ultrasound measurements of breast fibroadenoma: randomized clinical trial. Sao Paulo medical journal = Revista paulista de medicina. 2007;125(5):275-80.
110. Bidgoli SA, Eftekhari T. Role of exogenous and endogenous sources of estrogen on the incidence of breast fibroadenoma: case-control study in Iran. Asian Pacific journal of cancer prevention : APJCP. 2011;12(5):1289-93.
111. Zera RT, Danielson D, Van Camp JM, Schmidt-Steinbrunn B, Hong J, McCoy M, et al. Atypical hyperplasia, proliferative fibrocystic change, and exogenous hormone use. Surgery. 2001;130(4):732-7.