Even the so-called mini-pill and the progestogen-only IUD – and not just contraceptives that combine estrogen and progestogen together – seem to slightly increase the risk of developing breast cancer, especially if used after the age of 35. The correlation is shown by a new observational (retrospective) analysis conducted in the United Kingdom using the data of almost 30,000 women, and which confirms what has already emerged in previous research. According to new estimates by researchers at the University of Oxford, published today in PloS Medicine, there is talk of an increased risk of 20-30%, regardless of the type of hormonal contraceptive used and the method of administration. This means that if the average lifetime risk of the female general population (without family history of breast cancer) is around 12%, taking hormonal contraceptives can lead to a risk of between 14% and 16%.
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“The estimate of the slight increase in risk is in line with what was already known for combined estrogen-progestogen contraceptives, but the importance of the study concerns the data on progestogen-only contraceptives, the use of which has grown significantly in recent years – explains to Oncoline Laura Cortesioncologist at the University Hospital of Modena – Actually already a study published in 2017 on the New England Journal of Medicine and conducted on Danish women who used progestogens had brought out this correlation, but the new analysis brings scientifically robust confirmation”.
What are the risk factors for breast cancer
The data used comes from a UK primary care database, the Clinical Practice Research Datalink (CPRD), which also records contraceptive use. Almost 9,500 women aged 20 to 49 with invasive breast cancer (diagnosed between 1996-2017) were compared with over 18,000 women without breast cancer (similar in age and other characteristics that can influence the likelihood of getting the disease). Well, it emerged that 44% of those with breast cancer were using contraceptives (or had recently stopped), against 39% of the control group. The researchers used this data to calculate the increased risk associated with contraceptives, after eliminating other confounders. With 5 years of using any type of contraceptive, the increase was very small for girls aged 16-20 (an excess of just 8 extra cases per 100,000 women), while it was greatest for 35- 39 year olds (250 more cases of cancer per 100,000 women).
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“If you look at the statistics, using a medicated spiral seems to carry the highest risk. And this is surprising, because low concentrations of progesterone released locally were thought to have less impact than the pill – comments a Oncoline Lucia DelMastro, professor of Oncology at the University of Genoa and director of the Medical Oncology Clinic of the San Martino Policlinico Hospital – The message, however, must not be absolutely alarmist: the increase in the risk of breast cancer for the general population is very low , and the same goes for the already known slightly increased risk of cervical cancer. And this in the face of a strong decrease in the risk of ovarian cancer, as well as that of the endometrium and colorectal”.
As reported by the National Cancer Institute website In the United States, nearly all of the research on the link between oral contraceptives and cancer risk comes from observational studies, both large prospective cohort studies and population-based case-control studies. Data from observational studies cannot conclusively establish that an exposure, in this case to contraceptives, causes or prevents cancer, but can only show a correlation. Overall, however, these studies have provided consistent data that the risk of breast and cervical cancer is increased in women who use oral contraceptives, while that of endometrial, ovarian and colorectal cancer is reduced.
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Nonetheless – continues Del Mastro – the risks of a lack of contraception must be considered, especially for young women. We need to know the disadvantages and benefits, and evaluate them on a case-by-case basis”. And these are exactly the conclusions of the authors of the study, who write: “Given that the risk of breast cancer increases with advancing age, the excess risk associated with the use of both types of oral contraceptives will be less in women who use it at a younger age rather than at an older age. In any case, this risk must be considered in the context of the established benefits of contraceptive use in the childbearing years”.
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Evaluate case by case, especially in BRCA mutated women
A separate discussion should be made for women with genetic mutations that predispose to breast, ovarian and other cancers, such as BRCA mutations. In fact, these women have, right from the start, an enormously higher risk of getting sick than the general population. One of the frequent questions that patients ask, for example, is whether their daughters who have inherited the mutation can take the pill. “All the more reason in these cases the assessment must be ad personam – resumes Cortesi, who directs the Oncological Genetics Structure in Modena – Depending on age and other factors, the strong reduction in the risk of breast cancer must be balanced ovary with the slight increase of that for breast cancer.The important thing – he concludes – is that the person has all the information to be able to make an informed decision independently”.
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