The Impact of Hormonal Contraceptives on Breast Cancer Pathology

Abstract

This retrospective case series study, using data obtained through questionnaires and histopathological diagnoses from 656 patients enrolled in the Department of Defense (DoD) Clinical Breast Care Project (CBCP), evaluated associations between hormonal contraceptive use and breast cancer pathology including benign breast pathologies. Three combination hormonal contraceptive agents (COCs) Lo Ovral (LO), Ortho Novum (ON), and Ortho Tri-Cyclen (OTC) were evaluated as they represented the most commonly used hormonal contraceptives in our cohort. The results of this study suggest that the ever use of LO + ON + OTC does not influence the overall incidence of benign breast condition or malignant disease compared to other COCs; however, patients that have used OTC had an association with a diagnosis of benign or luminal A pathologies whereas ON was associated with a diagnosis of benign and DCIS; LO showed no association with any diagnosis-benign or malignant. Patients that have used LO or ON were more likely to be diagnosed with breast cancer at age ≥ 40 years whereas patients that had ever used OTC were likely to be diagnosed before the age of 40. Caucasians were less likely to have used OTC and more likely to have used ON; however, use of either hormonal agent positively correlated with premenopausal status at diagnosis and having a benign condition. Age at diagnosis, ethnicity, BMI, family history, menstruation status, and duration of use were all independent predictors of different histopathological subtypes. We conclude that patient-specific variables should be considered when deciding on which type of hormonal contraceptive to use to minimize the risk of developing breast cancer or a breast-related pathology.

Attitudes of women towards products containing hormones (hormonal contraceptives or hormone therapy): what changes from pre to postmenopause?

“…Our results confirm that breast cancer risk perception and screening behaviour are between the most important factors that must be addressed during gynaecological consultations [25]. This is true although how its risk varies during use of hormonal treatments is not fully understood [26,27], also in women with a family history [28].…”

Keterkaitan Cara Kerja Kontrasepsi Hormonal Dengan Risiko Terjadinya Kanker Payudara

“…Dosis estrogen rendah (<20 μg) tidak meningkatkan risiko kejadian kanker payudara, sedangkan dosis estrogen sedang (30-35 μg) dan tinggi (50 μg) meningkatkan risiko kejadian kanker payudara 1,6-2,7 kali lipat lebih tinggi [43] . Meskipun ada kenaikan risiko pada pengunaan kontrasepsi hormonal, kebanyakan wanita menggunakannya pada usia 20-an dan 30-an ketika risiko terkena kanker payudara rendah [40] .…”

A Review of Breast Cancer Risk Factors in Adolescents and Young Adults

“…When considering the contraceptive and non-contraceptive benefits of CHC use, the overall benefit likely outweighs the small increased risk of breast cancer for most women. Patient factors such as a family history of disease, BMI, age, and intended duration of use should be considered when choosing a CHC method [ 189 , 190 ].…”