Breast Cancer: Birth Control May Increase Risk By Up To 38 Percent

David Hunter — Nuffield Department of Population Health

The study shows that "the search for an oral contraceptive that does not elevate the risk of breast cancer needs to continue", said Dr. David Hunter of the University of Oxford in a Journal editorial. "Thus, it is not exclusively estrogen that increases the risk of breast cancer". Most cases of breast cancer were seen in women using oral contraceptives in their 40s. The women were followed for almost 11 years.

While contraceptive drugs that contain oestrogen have always been suspected of increasing the likelihood of breast cancer, researchers had expected smaller doses of the hormone, often combined with the drug progestin, would be safer, said Lina Morch, an epidemiologist at Copenhagen University Hospital who led a study analysing the records of 1.8 million women in Denmark. Risk increased with longer use, from a 9 percent increase in risk with less than a year of contraceptive use to a 38 percent increase after more than 10 years of use.

The new findings, reported in The New England Journal of Medicine, show that they do not, and the longer the products were used, the greater the danger.

The data for the study was collected from 1.8 million Danish women for more than a decade.

"Progestin-only products also increased the risk of breast cancer", Morch noted.

What really surprised the researchers was that the increased risk was not confined to women using oral contraceptive pills, but also was seen in women using implanted intrauterine devices, or IUDs, that contain the hormone progestin. But according to a new study, even the contraceptives with lower dosages of estrogen still come with a slightly increased chance of breast cancer. "Beyond the fact that they provide an effective means of contraception and may benefit women with dysmenorrhea or menorrhagia, the use of oral contraceptives is associated with substantial reductions in the risks of ovarian, endometrial, and colorectal cancers later in life", he wrote, highlighting this further emphasizes the need for a new form of hormonal contraceptive that does not carry an associated breast cancer risk. Risk seemed to increase the longer the contraceptive was used. Yet the new study found increased risks that were similar in magnitude to the heightened risks reported in earlier studies based on birth control pills used in the 1980s and earlier, Hunter said.

They include smoking, obesity, starting menstruation early, having children late in life or not at all and not breastfeeding.

For now, Morch said, even with the newer pharmaceuticals, women whose families have a strong history of breast cancer or heart disease may want to consider using other methods of birth control, such as employing condoms or spermicidal devices.

"Estrogen has been the primary focus of breast cancer research in general, and so we know much more about it than we do progesterone", Gaudet said.

"The relative risk increase in this study is only 1.2 on average". For a 20-year-old woman, for example, the probability of developing breast cancer in the next 10 years is 0.06 per cent, or 1 in 1,732, according to breastcancer.org. "In particular the knowledge of risk with newer progestins was sparse". Don't forget there is relative risk of death in pregnancy, too.

The new study looked at all women in Denmark ages 15 to 49 who had not had cancer, clots in their veins, or treatment for infertility. That roughly translates to a 12 percent lifetime risk for a woman, although many factors affect breast cancer risk.

IUDs infused with hormones also appear to pose a risk, Morch said, so "so there's a lot of things to take into account when deciding what type of contraception to use". But he suggested doctors take time to discuss the pros and cons of different types of contraception with their patients, and that they be frank about the potential risks, suggesting women reassess hormone use as they age.

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