{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T07:12:17Z","timestamp":1778656337274,"version":"3.51.4"},"reference-count":36,"publisher":"BMJ","issue":"6532","license":[{"start":{"date-parts":[[1986,5,24]],"date-time":"1986-05-24T00:00:00Z","timestamp":517276800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/www.bmj.com\/company\/legal-information\/terms-conditions\/legal-information\/tdm-licencepolicy"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Br Med J (Clin Res Ed)"],"published-print":{"date-parts":[[1986,5,24]]},"abstract":"<jats:p>A case-control study of the use of oral contraceptives was conducted among women certified as having died from cancer of the liver in the period 1979-82 and in the age range 20-44 years. An age matched group of women who died from other causes, not related to use of oral contraceptives, in the same period were used as controls. Information about use of oral contraceptives was obtained from the general practitioners' notes for both cases and controls. Information was obtained for 30 women with histologically confirmed liver cancer, 19 with hepatocellular carcinoma and 11 with cholangiocarcinoma, and for 147 controls. The results were analysed after adjusting for age at diagnosis and year of birth and showed that use of oral contraceptives was associated with a significantly (p less than 0.05) raised relative risk for hepatocellular carcinoma of 3.8 (95% confidence interval 1.0 to 14.6) and use for eight years or more was associated with a significantly (p less than 0.01) increased relative risk of 20.1 (2.3 to 175.7). There were no apparent increases in risk for cholangiocarcinoma. Despite the small number of cases in this study and the methodological problems in assessing use of oral contraceptives from general practitioners' notes, the results were consistent with other similar studies. Although in the United Kingdom primary liver cancer remains an exceptionally rare disease, especially in young women, further research on the role of oral contraceptives is needed in those countries where it is a much more common disease.<\/jats:p>","DOI":"10.1136\/bmj.292.6532.1357","type":"journal-article","created":{"date-parts":[[2009,4,2]],"date-time":"2009-04-02T15:19:55Z","timestamp":1238685595000},"page":"1357-1361","source":"Crossref","is-referenced-by-count":95,"title":["Cancer of the liver and the use of oral contraceptives."],"prefix":"10.1136","volume":"292","author":[{"given":"D","family":"Forman","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"T J","family":"Vincent","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R","family":"Doll","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[1986,5,24]]},"reference":[{"key":"ref_1","first-page":"1144","article-title":"Hepatomas in young women n ofral contraceptives: report oftwo cases and review of the literatre","volume":"2","author":"KV, I.Gala; TW, Griffin","year":"1983","unstructured":"I Gala KV, Griffin TW. Hepatomas in young women n ofral contraceptives: report oftwo cases and review of the literatre.J SwgOucol 1983;2:1144.","journal-title":"J SwgOucol"},{"key":"ref_2","first-page":"321","article-title":"Primary mnlignnt liver rumors-association with oral contraceptives","volume":"79","author":"Vana, J.; Murphy, G.P.","year":"1979","unstructured":"Vana J, Murphy GP. Primary mnlignnt liver rumors-association with oral contraceptives. NY Satej? Med 1979;79:321-5.","journal-title":"NY Satej? Med"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1055\/s-2008-1040654","article-title":"Hepatic tumours induced by sex steroids","volume":"4","author":"Mays, E.T.; Christopherson, W.","year":"1984","unstructured":"Mays ET, Christopherson W. Hepatic tumours induced by sex steroids. Seain Liver Dis 1984;4:147-57.","journal-title":"Seain Liver Dis"},{"key":"ref_4","first-page":"4404","article-title":"Hepatoceiular carcinoma in women: probable lack of etologic assocition with oral contraceptive steroids","volume":"2","author":"Goodman, Z.D.; Ishak, K.G.","year":"1982","unstructured":"Goodman ZD, Ishak KG. Hepatoceiular carcinoma in women: probable lack of etologic assocition with oral contraceptive steroids. Hepatology 1982;2:4404.","journal-title":"Hepatology"},{"key":"ref_5","first-page":"349","article-title":"Trends in mortality from arcinoma of the liver and the use of oral contraceptives","volume":"48","author":"D, S.Forman; R, Doll; R, Peto","year":"1983","unstructured":"S Forman D, Doll R, Peto R. Trends in mortality from arcinoma of the liver and the use of oral contraceptives. BrJ Caxcer 1983;48:349-54.","journal-title":"BrJ Caxcer"},{"key":"ref_6","first-page":"273","article-title":"Oral contraceptiveassociated liver tumours: occurrence of malgnancy and difficulties in dignoss","volume":"i:","author":"Neuberger, J.; Portmann, B.; Nunnerky, H.B.; Laws, J.W.; Davis, M.; William, R.","year":"1980","unstructured":"Neuberger J, Portmann B, Nunnerky HB, Laws JW, Davis M, William R. Oral contraceptiveassociated liver tumours: occurrence of malgnancy and difficulties in dignoss. Lancet 1980;i:273-6.","journal-title":"Lancet"},{"key":"ref_7","first-page":"496","article-title":"Histolgical evidence of carcinoma in a hepatic tumour associated with oral contrcptives","volume":"iv:","author":"Davis, M.; Portmann, B.; Searle, M.; Wright, R.; Williams, R.","year":"1975","unstructured":"Davis M, Portmann B, Searle M, Wright R, Williams R. Histolgical evidence of carcinoma in a hepatic tumour associated with oral contrcptives. BrMedJ 1975;iv:496-8.","journal-title":"BrMedJ"},{"issue":"73","key":"ref_8","first-page":"386","article-title":"Hepatic tumours: possible relation to use of oral contraceptives","volume":"1977","author":"Kbatskin, G.","unstructured":"Kbatskin G. Hepatic tumours: possible relation to use of oral contraceptives. Gasrrourology 1977:73:386-94.","journal-title":"Gasrrourology"},{"key":"ref_9","article-title":"IARC nograps on the evaluation of the caci risk of chemicals -to humans","volume":"4","author":"Anonymous","year":"1982","unstructured":"Anonymous. IARC nograps on the evaluation of the caci risk of chemicals -to humans. IARCMo.ogrEvlC.Rue Che Ham [SuppJl 1982;4.","journal-title":"IARCMo.ogrEvlC. Rue Che Ham [SuppJl"},{"key":"ref_10","first-page":"437","article-title":"Hepatocehuar carcnoma associated with use of oralcoatives","volume":"48","author":"Henderson, B.E.; Preston-Martin, S.; Fdmoudso, H.A.; Peter, R.L.; Pike, M.C.","year":"1983","unstructured":"Henderson BE, Preston-Martin S, Fdmoudso HA, Peter RL, Pike MC. Hepatocehuar carcnoma associated with use of oralcoatives. BrJ C.icr 1983;48:437-40.","journal-title":"BrJ C.icr"},{"key":"ref_11","first-page":"1","article-title":"Shoud dead cases be matched to dead controls","volume":"115","author":"Gordis, L.","year":"1982","unstructured":"Gordis L. Shoud dead cases be matched to dead controls. Am_7Epideuol 1982;115:1-5."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"\"131","DOI":"10.1093\/oxfordjournals.aje.a113975","article-title":"Probms in the use of dead controls il casecontrol studies","volume":"\"iol\" # \"121:\"","author":"McLaughlin, J.K.; iWJ, Blot; Mehl, E.S.; Mandel, J.S.","year":"1985","unstructured":"McLaughlin JK, Blot iWJ, Mehl ES, Mandel JS. Probms in the use of dead controls il casecontrol studies. Am_ Epide,iol 1985;121:131-9 and 122:485-94.","journal-title":"Am_ Epide"},{"key":"ref_13","first-page":"838","article-title":"Ora contraception and myocardial infarction revisited: the effects of new prep and prescribing patters","volume":"8","author":"Adam, S.A.; Thmxbgood, M.; Man, J.I.","year":"1982","unstructured":"Adam SA, Thmxbgood M, Man JI. Ora contraception and myocardial infarction revisited: the effects of new prep and prescribing patters. BrJ Obsrt Gyuaeol 1982;8:838-43.","journal-title":"BrJ Obsrt Gyuaeol"},{"key":"ref_14","first-page":"127","article-title":"The ability of women to reall their oral cotacepive histories","volume":"3","author":"Coulte, A.; Vey, McPherson; K, Cr; B.","year":"1986","unstructured":"Coulte A, Vey, McPherson K, Cr B. The ability of women to reall their oral cotacepive histories. C..wcpeo 1986;3:127-34.","journal-title":"C..wcpeo"},{"key":"ref_15","article-title":"Smoking and hepatitis B neaie priary heptoclua acnoa","author":"Trickplos, D.; McMahon, B.; Sparros, L.; Mrrikas, G.","unstructured":"Trickplos D, McMahon B, Sparros L, Mrrikas G. Smoking and hepatitis B neaie priary heptoclua acnoa.JXowulfrlkcNario lCaucrurIina 1980;65:l 14-8."},{"key":"ref_16","first-page":"389","article-title":"an epeioloical invetgion","volume":"5","year":"1984","unstructured":"-an epeioloical invetgion. BrJ Caccr 1984;5@:389-97.","journal-title":"BrJ Caccr"},{"issue":"24","key":"ref_17","article-title":"BRlTISH mEDICAL","volume":"292","year":"1986","unstructured":"BRlTISH mEDICAL JOURNAL VOLUME 292 24 MAY 1986","journal-title":"JOURNAL VOLUME"},{"key":"ref_18","first-page":"188","article-title":"Crohn's d treated with pred ne i e","volume":"30","year":"1983","unstructured":"Crohn's d treated with pred ne i e. Hepogse 1983;30: 188.","journal-title":"Hepogse"},{"key":"ref_19","first-page":"470","article-title":"Liver cell adenonas assoiated with the use of oral comtcepeives","volume":"29","author":"Edmoadson, H.A.; Henderson, B.; Benton, B.","year":"1976","unstructured":"Edmoadson HA, Henderson B, Benton B. Liver cell adenonas assoiated with the use of oral comtcepeives. N EIl Med 1976;29:470-2.","journal-title":"N EIl Med"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"644","DOI":"10.1001\/jama.1979.03300070040020","article-title":"E gy of hepaocellular adenoma-the role of oral contaeptive uwe","volume":"242","author":"Rooks, H.J.B.; Ory, H.W.; IsLhak, K.G.; atal","year":"1979","unstructured":"Rooks HJB, Ory HW, IsLhak KG, atal. E gy of hepaocellular adenoma-the role of oral contaeptive uwe.JAMA 1979;242:644-8.","journal-title":"JAMA"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1273","DOI":"10.1016\/S0140-6736(72)92649-9","article-title":"a ald. Assocation of androgenic-anabolic steroid theapy with development of hepatocelular carcinoma","volume":"iv:","author":"Johnson, F.L.; Feogler, JR, Lrner; K.G.","year":"1972","unstructured":"Johnson FL, Feogler JR, Lrner KG, a ald.Assocation of androgenic-anabolic steroid theapy with development of hepatocelular carcinoma. Lanct 1972;iv: 1273-6.","journal-title":"Lanct"},{"key":"ref_22","first-page":"430","article-title":"Androgen induced hepatoma","volume":"i:","author":"Fannell, G.C.; Uren, R.F.; Joshua, D.E.; Perkins, K.W.; Baird, P.J.; Kronenberg, H.","year":"1975","unstructured":"Fannell GC, Uren RF, Joshua DE, Perkins KW, Baird PJ, Kronenberg H. Androgen induced hepatoma. Laxcet 1975;i:430-1.","journal-title":"Laxcet"},{"key":"ref_23","first-page":"261","article-title":"Liver danmage from log-term methyltestosterone","volume":"ii:","author":"Westaby, D.; Ogle, S.J.; Paradinas, F.J.; Randell, J.B.; Murray-Lyon, I.M.","year":"1977","unstructured":"Westaby D, Ogle SJ, Paradinas FJ, Randell JB, Murray-Lyon IM. Liver danmage from log-term methyltestosterone. Lancet 1977;ii:261-3.","journal-title":"Lancet"},{"key":"ref_24","article-title":"Estrogens and primary liver tumours. In: Horons and sxalfactorsihxm cancer aeioky","author":"Taper, H.; de Geriache, J.; Lana, M.; Pras, V.; Roberfroid, M.","unstructured":"Taper H, de Geriache J, Lana M, Pras V, Roberfroid M. Estrogens and primary liver tumours. In: Horons and sxalfactorsihxm cancer aeioky. Amsterdam: Esevier (in press)."},{"key":"ref_25","first-page":"313","article-title":"Role of estrgn as promoters of hepatic neophasia","volume":"46","author":"Wanless, I.R.; Medline, A.","year":"1982","unstructured":"Wanless IR, Medline A. Role of estrgn as promoters of hepatic neophasia. Lab In 1982;46:313-20.","journal-title":"Lab In"},{"key":"ref_26","first-page":"3680","article-title":"Oral contraceptive sterolds as promoters of hepato-carcnogenesis in female Sprague-Dawley rates","volume":"40","author":"Yager, J.D.; Yager, R.","year":"1980","unstructured":"Yager JD, Yager R. Oral contraceptive sterolds as promoters of hepato-carcnogenesis in female Sprague-Dawley rates. Cane Res 1980;40:3680-5.","journal-title":"Cane Res"},{"key":"ref_27","first-page":"63048","article-title":"Someaspects ofthe interaction between natural and synthetic female sex hormone and the liver","volume":"49","author":"Adkrcreutz, H.; Tenhunen, R.","year":"1970","unstructured":"Adkrcreutz H, Tenhunen R. Someaspects ofthe interaction between natural and synthetic female sex hormone and the liver. Am_7JMod 1970;49:63048.","journal-title":"Am_7JMod"},{"key":"ref_28","first-page":"25846","article-title":"Sex hormones and hepatic neoplasia","volume":"36","author":"Goklfarb, S.","year":"1976","unstructured":"Goklfarb S. Sex hormones and hepatic neoplasia. CancerRes 1976;36:25846.","journal-title":"CancerRes"},{"key":"ref_29","article-title":"Accepd6","year":"1986","unstructured":"(Accepd6 May 1986)"},{"issue":"12","key":"ref_30","first-page":"11","article-title":"Ninetyfour children showed fat hypertrophy at injection sites and 91 used only one or two sites; 15% ofsubjects made errors when performing the blood test and 21% made errors in the urine test; none ofthese faults were related to scores in the questionnaire. A total of 14% of subjects, however, made an error in drawing up the insulin, and mothers in these families had lower scores in the questionnaire (mean","volume":"40","author":"(53","year":"(SD)","unstructured":"Ninetyfour children showed fat hypertrophy at injection sites and 91 used only one or two sites; 15% ofsubjects made errors when performing the blood test and 21% made errors in the urine test; none ofthese faults were related to scores in the questionnaire. A total of 14% of subjects, however, made an error in drawing up the insulin, and mothers in these families had lower scores in the questionnaire (mean (SD) 40 (12) compared with 49 (13); p<005). Similarly, 37% of children left 10 minutes or less between the time of injection and meal, and their mothers scored lower than those who left more than 10 minutes (44 (15) and 50 (12) respectively; p<0 05). The mean scoresin-families who were active members of the British Diabetic Association were higher than those of non-members (53 (11-4) and 39 (12-7); p<0O05); the mean score of inactive members of the association was intermediate.","journal-title":"the British Diabetic Association were higher than those of non-members; compared with 49 (13); p<005). Similarly, 37% of children left 10 minutes or less between the time of injection and meal, and their mothers scored lower than those who left more than 10 minutes (44 (15) and 50 (12) respectively; p<0 05). The mean scoresin-families who were active members of"},{"key":"ref_31","article-title":"The relation between-membership and scores-; mayreflect motivation but suggests","author":"Associaton","unstructured":"Associaton. The relation between-membership and scores-;mayreflect motivation but suggests that the association is an effective source -of information."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1136\/adc.61.1.67","article-title":"A dietary survey of diabetics","volume":"61","author":"Hackett, A.F.; Court, S.; McCowen, C.; Parkin, J.M.","year":"1986","unstructured":"Hackett AF, Court S, McCowen C, Parkin JM. A dietary survey of diabetics. Arch Dis Chil 1986;61:67-71.","journal-title":"Arch Dis Chil"},{"key":"ref_33","article-title":"SPSSX inroducitwy assias guid","author":"Norusis, M.J.","year":"1983","unstructured":"Norusis MJ. SPSSX inroducitwy assias guid. New York: McGraw-Hill BookCompany, 1983."},{"key":"ref_34","first-page":"5","article-title":"A developmentallystged curriculum for teaching self-care to the child with insulin-dependent diabetes mellitus","author":"Kohler, E.; Horwitz, L.S.; Milan, D.","year":"1983","unstructured":"Kohler E, Horwitz LS, Milan D. A developmentallystged curriculum for teaching self-care to the child with insulin-dependent diabetes mellitus. Diabetes Care 1983 5:300-4.","journal-title":"Diabetes Care"},{"issue":"25","key":"ref_35","first-page":"470","article-title":"Bicentric evaluation of a teaching and treatment programme for (insulin dependent) diabetic patients: improvements of metabolic control and other measures of diabetes care for up to 22 months","volume":"1983","author":"Mulhauser, V.; Jorgens, M.; Berger, M.","unstructured":"Mulhauser V, Jorgens M, Berger M, et al. Bicentric evaluation of a teaching and treatment programme for (insulin dependent) diabetic patients: improvements of metabolic control and other measures of diabetes care for up to 22 months. Diabetlogia 1983,25:470-6.","journal-title":"Diabetlogia"},{"key":"ref_36","article-title":"Accepted","year":"1986","unstructured":"(Accepted 21 February 1986)"}],"container-title":["BMJ"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/data.bmj.org\/tdm\/10.1136\/bmj.292.6532.1357","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmj.292.6532.1357","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,12]],"date-time":"2025-12-12T13:19:31Z","timestamp":1765545571000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.bmj.com\/lookup\/doi\/10.1136\/bmj.292.6532.1357"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1986,5,24]]},"references-count":36,"journal-issue":{"issue":"6532","published-online":{"date-parts":[[1986,5,24]]},"published-print":{"date-parts":[[1986,5,24]]}},"alternative-id":["10.1136\/bmj.292.6532.1357"],"URL":"https:\/\/doi.org\/10.1136\/bmj.292.6532.1357","relation":{},"ISSN":["0267-0623","1468-5833"],"issn-type":[{"value":"0267-0623","type":"print"},{"value":"1468-5833","type":"electronic"}],"subject":[],"published":{"date-parts":[[1986,5,24]]}}}