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a contraceptive pill imageDecember 13 2017

Women using hormonal contraceptives are exposed to a 20% increased risk of developing breast cancer, a 17-year-long study has shown. The relative risk is considered small, however, equating to an overall absolute increase in breast cancer of 13 per 100,000 person-years, or approximately one extra case for every 7,690 women using hormonal contraception for a year.

Findings come from analysis of data relating to 1.8 million Danish women aged below 50 years. On average, each woman’s records were followed for 10.9 years, amounting to 19.6 million person-years’ worth of data. During the study period from 1995 to 2012, there were 11,517 cases of breast cancer.

Compared to women who had never used hormonal contraceptives, the relative risk of breast cancer among current and recent users was found to be 1.20, ranging from 1.09 in women who had used hormonal contraception for less than a year to 1.38 in women who had been using it for more than 10 years. The study also found that there was an elevated risk of breast cancer five years after hormonal contraception ended.

The study was conducted by researchers at Rigshospitalet, University of Copenhagen, in collaboration with the University of Aberdeen, and is the largest prospective cohort study conducted on hormonal contraception and breast cancer.

“There was little evidence of consistent differences in risk between users of combined oral contraceptives with different progestogens. Researchers did not detect an increased risk in former users who had used hormonal contraception for less than five years, while the increased risk in long-term users gradually decreased by time and disappeared five to ten years after stopping,” said the University of Aberdeen.

The RCGP’s Oral Contraception Study, the world’s longest-running study of the effects of taking the contraceptive pill, is also being run from the Institute of Applied Health Sciences, University of Aberdeen. It has been following an original cohort of 46,000 women for up to 44 years to examine the very long-term cancer effects associated with the pill.

Professor Phil Hannaford, who led the research team based in Aberdeen, said: “The [RCGP] study found an increased risk of breast and cervical cancer in current and recent pill users, risks which disappeared within approximately 5 years of stopping oral contraception. Importantly, the study also found that women who had ever used the pill were less likely to have colorectal, endometrial or ovarian cancer than women who had never used the pill – benefits that persisted for many years after stopping the pill, perhaps 30 or more years. And new cancer risks did not appear as the women got to the age when cancer becomes common.

“The similar breast cancer results in both cohort studies suggest that today’s pills have similar cancer risks and benefits as older preparations. If this suggestion is confirmed, then evidence from the RCGP’s study indicates that, like previous generations of users, today’s pill users do not increase their overall lifetime risk of cancer by choosing hormonal contraception.”

Commenting on the new study findings, Bekki Burbidge, Deputy Chief Executive of the sexual health charity FPA, said: “Previous research has suggested that users of hormonal contraception appear to have a small increased risk of being diagnosed with breast cancer compared to non-users of hormonal contraception – importantly, this risk reduces with time after stopping the method. This new study appears to support this.

“Millions of women rely on hormonal contraception to prevent pregnancy and for a range of other benefits such as help with heavy, painful periods. If women are worried, they shouldn’t suddenly stop using their contraception, which could lead to unplanned pregnancy, but should discuss the benefits and risks with a doctor or nurse.”

Ms Burbidge noted that hormonal contraception can also offer protection against certain cancers. “The benefits and risks of any method of contraception should always be discussed with a doctor or nurse before starting that method. With 15 methods to choose from, no one should stay on a contraceptive method that they’re unhappy with.”

Links:
University of Aberdeen announcement  
LS Mørch et al. ‘Contemporary Hormonal Contraception and the Risk of Breast Cancer’. N Engl J Med. December 7 2017. 377:2228-2239                  
FPA comment    

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