25 February 2002, PopReporter

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Volume 2, Number 8
25 February 2002

GUEST COMMENTARY

Do Birth Control Pills Cause Breast Cancer?
by Robert Hatcher, MD <rahtiger@alltel.net>

Since 1960 this has been the most commonly asked question about birth control pills. Below is an answer to this question.

After more than 50 studies, most experts believe that pills have little, if any, effect on the risk of developing breast cancer.
A recent summary of studies suggests that current users of pills are slightly more likely to be diagnosed with breast cancer (Relative Risk: 1.2) [Collaborative Group; Lancet 1996], but that past users have no increased risk.
Two factors may explain the increased risk of breast cancer being diagnosed in women currently taking pills: 1) a detection bias (i.e., that pill users are simply more likely to have existing breast cancer identified because they have more breast exams or more mammography or 2) promotion of an existing lesion that is nearly cancer into one that is cancer, usually an early cancer. Most authorities think the first explanation is most likely because the duration of pill use has no effect on risk and the excess risk seen in current users is restricted to breast cancers that are localized (less likely to be metastatic).
Ten years after discontinuing pills, women who have taken pills are at no increased risk for having breast cancer diagnosed [Collaborative Group; Lancet 1996]. Thus, a woman who started taking the pill at age 16 and used it for 20 years is, at age 50, at no greater risk for breast cancer than women who never took the pill.
Breast cancers diagnosed in women currently on pills or women who have taken pills in the past are more likely to be localized (less likely to be metastatic). [Collaborative Group; Lancet 1996]
By the age of 55, the risk of having had breast cancer diagnosed is the same for women who have used pills and those who have not.
The conclusion of the largest collaborative study of the risk for breast cancer in women on pills is that women with a strong family history of breast cancer do not further increase their risk for breast cancer risk by taking pills. [Collaborative Group; Lancet, 1996] This was also the conclusion of the Nurses Health Study [Lipnick, 1986] [Colditz, 1996] and the Cancer and Steroid Hormone (CASH) study.[Murray, 1989] [The Centers for Disease Control Cancer and Steroid Hormone Study, 1983]
While there are still unanswered questions about pills and breast cancer, today, four decades after their arrival on the contraceptive scene, the overall conclusion is that pills have little or no effect on breast cancer. "Many years after stopping oral contraceptive use, the main effect may be protection against metastatic disease." [Speroff and Darney, 2001] [Collaborative Group; Lancet 1996]

The above answer was reviewed by Herbert B. Peterson, MD, Mitchell Creinin, MD, David Grimes, MD, Miriam Zieman, MD, and Sharon Schnare, FNP, CNM, MSN.

This text may be used as is or adapted for use in any manner without seeking permission of Robert Hatcher, MD <rahtiger@alltel.net>. For accurate, up-to-date, practical information about contraceptive options, visit http://www.managingcontraception.com/.

REFERENCES

The Centers for Disease Control Cancer and Steroid Hormone Study. Long-term oral contraceptive use and the risk of breast cancer. JAMA. 1983;249:1591-1595.

Colditz GA, Rosner BA, et al. Risk factors for breast cancer according to family history of breast cancer. J Natl Cancer Inst. 1996;88:365-371.

Collaborative Group on Hormonal Factors in Breast Cancer. Breast cancer and hormonal contraceptives: collaborative reanalysis of individual data on 53,297 women with breast cancer and 100,239 women without breast cancer from 54 epidemiological studies. Lancet 1996; 347:1713-1727.

Lipnick RJ, Buring JE, Hennekens CH, et al. Oral contraceptives and breast cancer: a prospective cohort study. JAMA. 1986;255:58-61.

Murray PP, Stadel BV, Schlesselman JJ. Oral contraceptive use in women with a family history of breast cancer. Obstet Gynecol. 1989;73:977-983.

Speroff, L, Darney, PD. A Clinical Guide for Contraception, 3rd edition 2001. Lippincott Williams and Wilkins, Philadelphia, PA.

FAMILY PLANNING / REPRODUCTIVE HEALTH LAW AND POLICY

Dissent Grows Over AIDS Policies

Sierra Leone: Government Recognizes Commercial Sex Workers

Reproductive Rights and the State in Serbia and Croatia

FAMILY PLANNING / REPRODUCTIVE HEALTH RESEARCH

Neisserial Binding to CEACAM1 Arrests the Activation and Proliferation of CD4+ T Lymphocytes
Related news article: Protein Helps Gonorrhea Switch Off Immune Cells

Noncontraceptive Health Benefits of Intrauterine Devices: A Systematic Review

Oral Contraceptives and the Risk of Focal Nodular Hyperplasia of the Liver: A Case-Control Study

FAMILY PLANNING / REPRODUCTIVE HEALTH NEWS

Contraceptive Patch to be Marketed in Europe

Why Condom Adverts Must Continue: Opinion

MATERNAL AND CHILD HEALTH NEWS

Afghan Refugees at Risk From Pregnancy, Child Birth

MEN'S HEALTH RESEARCH

The Effects of Workplace Hazards on Male Reproductive Health

HIV Risk Characteristics and Prevention Needs in a Community Sample of Bisexual Men in St. Petersburg, Russia.

MEN'S HEALTH NEWS

Opinion: Shouldn't Men Have a Choice, Too?

POPULATION RESEARCH

Demographic Transition in Bangladesh: What Happened in the Twentieth Century and What Will Happen Next?

POPULATION NEWS

Georgia: The Shrinking Nation

Sierra Leone: Government Plans First Census Since 1985 with UNFPA Help

Demographic Shift Makes Mexico Developed Nation

WOMEN'S HEALTH RESEARCH

Intimate Partner Violence: Implications for Nursing

Are Progesterone or Progestogens Effective in Managing Premenstrual Syndrome (PMS) Symptoms?

WOMEN'S HEALTH NEWS

Kenya: Genital Mutilation Alternative Project Yields Success

YOUTH RESEARCH

Migrant Street Children on the Rise in Central America

Treatment With Highly Active Antiretroviral Therapy in Human Immunodeficiency Virus Type 1-Infected Children is Associated With a Sustained Effect on Growth

YOUTH NEWS

Kenya: Role of FLE (Family Life Education) in Curbing Teenage Pregnancies

Young Women in Sub-Saharan Africa Face a High Risk of HIV Infection

The Effects of HIV Infection and AIDS on Children in Africa

Zambia: 'Rescued' Street Kids Found With STDs

PROFILES / SPECIAL REPORTS

On-line tutorial: Care of Women Living with HIV in Limited-Resource Settings
These tutorials are designed to provide physicians, faculty and healthcare trainers with the technical knowledge they need to provide high quality healthcare services to women with HIV/AIDS and to train other healthcare providers. Topics include prevention, voluntary counseling and testing, breastfeeding, and nutrition. (Real Player software is needed to play the tutorials; access to text transcripts are available on the site.)

Integration of HIV/STI Prevention Into SRH Services
Examples of efforts taking place in Latin America and the Caribbean in providing HIV and sexually transmitted infection prevention into existing family planning and primary health care centers.

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Volume 2, Number 8 25 February 2002