Epidemiology of hepatocellular adenoma. The role of oral contraceptive use

Abstract

A case-control study of hepatocellular adenoma (HCA), a serious though nonmalignant liver tumor, was conducted by the Center for Disease Control and the Armed Forces Institute of Pathology (AFIP). Interviews with 79 women with HCA and with 220 age- and neighborhood-matched controls were completed. Limited information was obtained on nine additional patients who had died. Women with HCA and hemorrhage have a greater risk of morbidity and death than those with other symptoms. Increasing duration of OC use increases the risk of HCA. Use of OCs with high hormonal potency and age over 30 years may further increase a woman's risk of HCA. Long-term users of OCs have an estimated annual incidence of HCA of 3 to 4 per 100,000.

PIP: In a retrospective case control study, undertaken by the Center for Disease Control and the Armed Forces Institute of Pathology, women who had taken oral contraceptives for a prolonged period of time were at greater risk of developing hepatocellular adenoma (HCA), a nonmalignant liver tumor. There was some evidence that the risk of HCA was further increased for women who used high potency oral contraceptives and for those who used the pill after age 31. The study population included 79 patients with diagnosed HCA and 220 controls who were matched for age and neighborhood residence. A medical history, including an obstetrics and contraceptive history, was obtained by interviewing each patient and control. Each patient was assigned an index date in reference to when they first underwent liver tumor surgery, and their matched controls were assigned the same index date. The cases and controls were compared in terms of contraceptive use prior to the index date. 52% of the women with HCA, compared to only 12% of the controls, had used oral contraceptives for more than 20 months. For those who used the pill for 85 months or more, the risk was increased 500-fold. Information on 9 women who died was also analysed; women who had both HCA and hemorrhage were at greater risk of dying than those with HCA who did not hemorrhage. Study results also indicated that hereditary factors may be involved in the development of HCA. Four of the 79 women with HCA reported that they had a close relative who had HCA. Tables show 1) disease outcome by bleeding status and 2) distribution of cases and controls by duration of pill use, according to index date.