Use of oral contraceptives in BRCA mutation carriers and risk for ovarian and breast cancer: a systematic review

Abstract

Purpose BRCA mutation carriers have an increased risk of developing breast or ovarian cancer. Oral contraception (OC) is known to increase breast cancer and reduce ovarian cancer risk in the general population. This review analyses the published data on OC and risk of cancer in BRCA mutation carriers. Methods We included all relevant articles published in English from 1995 to 2018. Literature was identified through a search on PubMed and Cochrane Library. Results We included four meta-analyses, one review, one case–control study and one retrospective cohort study on the association between ovarian cancer and OC in BRCA mutation carriers. All report a risk reduction for the OC users and several also describe an inverse correlation with duration of use. Regarding breast cancer, we included four meta-analyses, one review, one case–control study, two case-only studies, one prospective and one retrospective cohort study. Some studies report a risk elevation, while others did not find an association between OC use and breast cancer in BRCA mutation carriers. In other studies, the association was limited to early-onset breast cancer and/or associated with young age at first start of OC. Conclusion Oral contraception leads to a risk reduction of ovarian cancer also in BRCA mutation carriers. An increase in breast cancer risk due to OC cannot be excluded. Women with BRCA mutation who consider OC use have to be informed about possible increase in breast cancer risk and alternative contraceptive methods. OC should not be used for the prevention of ovarian cancer in this population.

Contraceptive Challenges in Women With Common Medical Conditions

“…A systematic review recommended that BRCA carriers be informed that COC may reduce risk of ovarian cancer but potentially increase risk for breast cancer. 48…”

Hormonelle Kontrazeption und Krebs

“…Brustkrebs Bei Frauen mit BRCA1/2-Mutationen hat die OC-Einnahme ähnliche Assoziationen mit dem Brustkrebsrisiko wie in der Allgemeinbevölkerung. Es wurden keine oder leichte, nicht signifikante Risikoerhöhungen beschrieben (OR 1,21; 95 %-KI 0,93-1,58) [37,38]. Die "Hereditary Breast Cancer Clinical Study Group" fand jedoch ein signifikant erhöhtes Brustkrebsrisiko für BRCA1-Mutationsträgerinnen, welche die Pilleneinnahme vor dem 20.…”

“…Das Ovarialkarzinomrisiko wird bei Trägerinnen von BRCA1/2-Mutationen in vergleichbarem Ausmaß durch OC reduziert wie bei Frauen aus der Allgemeinbevölkerung [31,37,38].…”

“…Insgesamt erscheint die Evidenz nicht ausreichend, um bei BRCA1/2-Mutationsträgerinnen die OC-Einnahme alleine zum Zwecke der Chemoprävention von Ovarialkarzinomen zu empfehlen [31,37,38]. Wenn allerdings Trägerinnen von BRCA1/2-Mutationen den Wunsch zur hormonellen Kontrazeption äußern, besteht kein Grund, von OC abzuraten.…”

“…Wenn allerdings Trägerinnen von BRCA1/2-Mutationen den Wunsch zur hormonellen Kontrazeption äußern, besteht kein Grund, von OC abzuraten. Auf das möglicherweise erhöhte Mammakarzinomrisiko sollte jedoch hingewiesen werden [31,37,38,40].…”