Do Birth Control Pills Increase Your Risk Of Breast Cancer?
It is not unusual for a medical study-especially an epidemiologic one--to raise
more questions than it answers. This study is no exception. In fact, the major
value of this study will be the questions that were raised which will stimulate
further research. These questions include:
- Is there a difference in family history relevance or study if the genetic
tests for BRCA-1 and BRCA-2 are conducted and factored in?
- Are the newer pills containing low doses of estrogen and progestin are safer
(lower risk) than the previous pill formulations, particularly the latest
low dose pills containing only 20 micrograms of estrogen?
Even in women with a strong family history of breast cancer, does the disadvantage
of increased risk of breast cancer with the Pill outweigh the advantage of the
greatly reduced risk of ovarian cancer from the Pill, especially since women
with a strong family history of breast cancer have a greatly increased risk
of ovarian cancer?
This last question is the most troubling clinical issue when it comes to making
recommendations on the basis of this study alone. We know that women with the
inherited genetic mutation for breast cancer are also at greatly increased risk
for ovarian cancer. We also know that birth control pill use is one of the
few methods to reduce the risk of ovarian cancer. In the accompanying editorial
to the JAMA study, Dr. Wylie Burke of the University of Washington wrote that
this study "argues for avoidance of oral contraceptives, but at the price of
forgoing an attractive option for reducing ovarian cancer risk''. This is a
particular concern because ovarian cancer is harder to detect, harder to treat,
and as a result usually more deadly than breast cancer.
This highlights the challenges we face whenever making any clinical recommendations
based upon the results of one study, especially one that is not a long-term,
prospective clinical trial.
How this study applies to you:
If you have no family history of breast cancer (or no family history of the
genetic type of breast cancer), this study DOES NOT apply to you, whether or
not you took the Pill. If you do have a family history of breast cancer, this
study DOES NOT apply to you if you took the Pill only after 1975.
This study only applies to women who took the pill before 1975, who
have 3 or more close relatives (mother, sister, aunt, grandmother) who had breast
cancer. If you are in that group, don't panic: talk with your doctor about
how this study might apply to you and whether you need to make any changes
in your current Pill usage or in further diagnostic testing.
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Created: 10/13/2000  - Donnica Moore, M.D.