Applied Evidence
Abnormal bleeding in your female patient? Consider a progestin IUD
Abnormal bleeding is common in women of childbearing age. For some, insertion of a levonorgestrel-releasing IUD—easily done in a family practice...
Modern combined OCPs don’t raise risk in women with BRCA1/2 mutations
A meta-analysis of 5 studies (one retrospective cohort, 4 case-control, with a total of 2855 breast cancer cases and 2944 controls) evaluated whether combined OCPs increased the risk of breast cancer in women, all of whom were carrying BRCA1/2 mutations.6
Using modern combined OCPs didn’t raise the risk of breast cancer in BRCA1/2 carriers overall (RR=1.13; 95% CI, 0.88-1.45) or separately in BRCA1 carriers (5 studies, RR=1.09; 95% CI, 0.77-1.54) or BRCA2 carriers (3 studies, RR=1.15; 95% CI, 0.88-1.45).
However, pre-1975 (higher dose) combined OCPs produced significantly increased risk (RR=1.47; 95% CI, 1.06-2.04). Similarly, women who had used combined OCPs >10 years before the study (older women, likely to have been using pre-1975 OCPs) also had significantly increased risk (RR=1.46; 95% CI, 1.07-2.07).
A bit of good news: Combined OCPs reduce ovarian cancer risk
The analysis also determined that combined OCPs significantly reduced the risk of ovarian cancer in women carrying BRCA1/2 mutations (RR=0.50; 95% CI, 0.33-0.75), with an additional linear decrease in risk for each 10 years of OCP use (RR=0.64; 95% CI, 0.53-0.78).
RECOMMENDATIONS
The World Health Organization guidelines outlining criteria for contraceptive use state that OCPs don’t alter the risk of breast cancer among women with either a family history of breast cancer or breast cancer susceptibility genes.7
The American College of Obstetricians and Gynecologists (ACOG) says that a positive family history of breast cancer shouldn’t be regarded as a contraindication to OCP use.8 ACOG also says that women with the BRCA1 mutation have an increased risk of breast cancer if they used OCPs for longer than 5 years before age 30, but this risk may be more than balanced by the benefit of a greatly reduced risk of ovarian cancer.
