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March 23, 2023
2 minute read
Key take away food :
- The relative risk of breast cancer increases by about 20-30% with recent use of any oral contraceptive.
- Current or recent use of progestogen-only contraceptives increases the risk of breast cancer, regardless of the mode of delivery.
Current or recent use of progestogen-only contraceptives has been associated with a ‘mild’ increased risk of breast cancer, according to results from a nested case-control study and meta-analysis published in PLOS Medicine.
“In England, for example, prescriptions for progestogen-only oral contraceptives have nearly doubled over the past decade; and in 2020, there were almost as many prescriptions for progestin-only oral contraceptives as for combined oral contraceptives,” Danielle Fitzpatrick, MY, from the Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, UK and Adelaide School of Medicine, University of Adelaide, Australia -Southern, and his colleagues wrote. “Given the tendency to increased use of progestogen-only contraceptivesit is important to reliably quantify their effects on breast cancer risk.
Researchers compared hormonal contraceptive prescriptions recorded in a UK primary care database for 9,498 women under 50 with incident invasive breast cancer diagnosed between 1996 and 2017 and 18,171 matched controls . Each case and their matched controls had an average of 7.3 years of clinical records before the date of diagnosis.
The researchers observed prescriptions for hormonal contraceptives an average of 3.1 years before diagnosis in 44% of women with breast cancer and 39% of matched controls. Almost half of the prescriptions were for progestin-only contraceptives.
Compared with women who did not use hormonal contraception during the study period, those who used hormonal contraception had an increased risk of breast cancer if their last prescription was an oral combination (OR = 1.23; CI to 95%, 1.14-1.32; P <0.001), progestogen-only oral (OR=1.26; 95% CI, 1.16-1.37; P <0.001), injected progestin (OR=1.25; 95% CI, 1.07-1.45; P = 0.004) or progestin-releasing IUD (OR = 1.32; 95% CI, 1.17-1.49; P < .001).
Current or recent use of progestogen-only contraceptives resulted in a significantly increased risk of breast cancer for oral contraceptives (RR=1.29; 95% CI, 1.21-1.37), injected (RR= 1.18; 95% CI <1.07-1.3), implanted (RR=1.28; 95% CI, 1.08-1.51) and IUD (RR=1.21; 95%, 1.14-1.28).
When researchers combined results from the UK Primary Care Database with previously published results, they observed around eight cases per 100,000 users aged 16 to 20 and 265 cases per 100,000 users aged 35 to 39 years, resulting in an absolute excess of breast cancer over 15 years. risk associated with 5-year use of progestin-only combined oral contraceptives in high-income countries, they wrote.
“This study provides important new evidence that current or recent use of progestin-only contraceptives is associated with a small increased risk of breast cancer, which does not appear to vary by mode of delivery and is of similar magnitude. to that associated with combined hormone therapy contraceptives,” the researchers wrote.
“Further research is … needed to elucidate the mechanisms behind the similar associations of recent use of combined contraceptives and progestins only with breast cancer risk seen here,” the researchers wrote.
Perspective
The study published in PLoS by Reeves and colleagues examines whether progestin-only contraceptives carry similar increased risks of breast cancer as combined oral contraceptives containing estrogen and progestin. Some, but not all, previous studies have shown that combined oral contraceptives cause a small increase in breast cancer risk close to the time of their use. This article demonstrates a small but statistically significant risk with progestin-only methods. It should be noted that they are at increased risk with all progestin-only methods, including progestin-containing IUDs.
Several factors are notable from reading this article. Progestin-only oral contraceptives are much more widely used in the UK than in the US, where only 4% of contraceptive users use progestin-only pills; in the UK, progestin-only pills are used as frequently as combined oral contraceptives.
Progestogen-inducing IUDs promote a high concentration of progestin in the uterus, but not systemically. There is no obvious explanation why a minimal increase in serum progestin levels would affect the breast.
From the data collected on participants, we do not know the stratification of breast cancer risk factors among patients; full family history is not known. One possible explanation is that perhaps providers, when hearing about a strong family history, with a perception of estrogen as problematic for breast cancer risk, might suggest that this patient use a progestogen-only contraceptive. .
When deciding on contraception, especially in the post-Dobbs In the United States, women must use very reliable contraception, provided by many methods here under consideration. Women should also be reminded that combined oral contraceptives significantly decrease the incidence of ovarian and endometrial cancers (even in women with high-risk mutations). Since the increased risk of breast cancer demonstrated in this study is very small, this should only be a small part of the choice in deciding the best contraceptive method for them.
Mary Jane Minkin, MD
Clinical Professor
Obstetrics and Gynecology
Yale School of Medicine
Disclosures: Minkin does not report any relevant financial information.
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Sources 2/ https://www.healio.com/news/womens-health-ob-gyn/20230323/slight-increase-in-breast-cancer-risk-with-recent-progestogenonly-contraceptive-use The mention sources can contact us to remove/changing this article |
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