New evidence will reignite controversy about breast cancer risk with hormonal contraceptives.
The lower estrogen doses and different progestins in newer hormonal contraceptives were generally thought to be safer than the older ones.
Now women are hearing about a new study suggesting that newer hormonal contraceptives can raise breast cancer risk by about 20%...similar to older options.
Tell women not to panic. The 20% is just the RELATIVE risk...and other data show no increased risk.
And even with the new data, ABSOLUTE risk is very low. About 7,700 women need to use hormonal contraception for a year for one to be diagnosed with breast cancer. The risk remains low even after 10 years...treating 5,300 women seems to lead to one more breast cancer diagnosis.
This analysis also suggests a possible breast cancer link with levonorgestrel IUDs (Mirena, etc)...but it's too soon to say if progestin or underlying risks are to blame. So far, progestin-only pills, depot medroxyprogesterone, and the implant aren't linked to breast cancer.
Continue to choose a contraceptive based on patient preference, efficacy, safety, etc...and breast cancer risk.
No personal history of breast cancer. Continue to use hormonal contraception. Point out benefits beyond preventing pregnancy...reducing ovarian and endometrial cancer risk, easing heavy periods, etc.
Reassure women with a family history of breast cancer or a BRCA gene mutation that most evidence suggests their breast cancer risk will not increase further with hormonal contraceptives.
But choose NON-hormonal options instead as women age into their 50s...since breast cancer and thrombosis risk increase with age.
Personal history of breast cancer. Avoid hormonal contraception.
Consider a copper IUD for these women...or for women who prefer to avoid hormonal contraceptives.
Hear our team clarify the impact of the new evidence with PL Voices. Use our How Safe Is My Birth Control? handout to educate patients...and see our chart, Comparison of Contraceptives, for more pros and cons.
- N Engl J Med 2017;377(23):2228-39
- Contraception 2012;85(4):342-50
- MMWR Recomm Rep 2016;65(3):1-103
- PL Voices: Hormonal Contraception and the Risk of Breast Cancer
- Chart: Comparison of Oral Contraceptives and Non-Oral Alternatives
- Patient Education: How Safe Is My Birth Control?
- Guideline: U.S. Medical Eligibility Criteria for Contraceptive Use, 2016