Is there a link between breast cancer and birth control devices?

Is there a link between breast cancer and common birth control devices? We asked the experts...

Studies have found a link between breast cancer and certain birth control devices says specialist surgeon, Dr Justus Apffelstaedt, who has a special interest in breast, thyroid and parathyroid health. However, there’s no need to panic and go off all birth control immediately. Dr Apffelstaedt says there’s a lot you can do to reduce your risk of breast cancer, even while being on a birth control device…

ALSO SEE: 5 birth control myths busted

Here are his answers to a few important questions we asked about birth control devices:

Q: What are the benefits of birth control devices?

A: Women living in the 21st Century are blessed with many modern medical options our female ancestors would be envious of, with birth control being one of the first that comes to mind.

Many women opt for hormonal birth control methods such as the pill, patch or progestogen-releasing Intrauterine Devices (IUDs) due to the numerous lifestyle and medicinal advantages associated with them. These include effective pregnancy prevention and reduced menstruation as well as links to a risk reduction of ovarian, endometrial and colon cancers.

Q: But could your birth control device or medication be increasing your risk of breast cancer?

A: An observational population-wide cohort study conducted in Finland and published in Obstetrics & Gynecology in August 2014, made startling links between the use of progestogen containing IUDs, such as the popular Mirena, and an increased risk of developing breast cancer.

The study collected data from over 90 000 Finnish women between the ages of 30 to 49 years old, who, from 1994 – 2007 had received a progestogen-releasing IUD (that’s over 10 years). The resultant database was then linked to the Finnish Cancer Registry data in order to compare the incidence of cancers from progestogen-releasing IUD users with cancer incidences in the general population.

Q: Did this study find links between hormone-releasing IUDs and breast cancer?

A: Yes, the Cancer Risk in Women Using the Levonorgestrel-Releasing Intrauterine System in Finland study published in Obstetrics & Gynecology (August 2014) did find links between hormone releasing IUDs and breast cancer. The risk of ductal carcinomas (the most common form of breast cancer which accounts for approximately 80% of all breast cancers) as well as lobular carcinomas (which constitutes approximately 10% of all breast cancers) increased.

The study states, “The finding of an increased standardised incidence ration for breast cancer after five or more years of follow-up may reflect causality between extended progestin exposure and cancer risk, but the results should be interpreted with caution in light of the limitations of the study.”

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Q: What should we do with this information?

A: The most important points to consider are:

  • That breast cancer risk is time dependent and only increases after five years of using a hormone-releasing IUD.
  • If you’re above the age of 40, even if you have no significant risk factors such as cancer in your family, you should go for mammographic screening.
  • If you have breast cancer in your family, speak to your gynaecologist about exploring non-hormonal contraceptive options.
  • There is currently no concrete data on whether removing the device will return the risk profile to normal. While the risk may subside, it will still remain elevated in comparison with pre-insertion levels.

Q: If a woman has a progestogen-releasing Intrauterine Device (IUD) – why shouldn’t she panic?

A: There’s no need to schedule an emergency appointment to have your IUD removed says Dr Apffelstaedt.

The truth is, any form of medical intervention carries risks and benefits which you need to consider holistically. Do you trade-off of a small increase in breast cancer risk versus the lifestyle benefits these devices offer? This is an informed decision you should make in consultation with your doctor, preferably a gynaecologist.

There is no such thing as a 100% risk free contraceptive. Realistically, if you are changing your internal hormonal environment for an extended period (between 10 – 30 years), there are bound to be consequences and Dr Apffelstaedt therefore does not recommend the use of a hormone-releasing IUD for more than five years.

How to reduce your risk of breast cancer

If you wish to use a birth control device for longer than five years, it’s wise to discuss the risks with your gynaecologist. There are, however, numerous lifestyle changes you can make to decrease the risk of developing breast cancer without changing your birth control device:

  • The easiest way to lower one’s risk of developing breast cancer is to live a healthier lifestyle. To reduce your risk:
  • Watch your diet and exercise regularly. Obesity increases a woman’s breast cancer risk by up to 70% in pre-menopausal years, according to the American Association For Cancer Research. This is far higher than the risk associated with having an IUD for over 10 years. It’s of utmost importance to lead a healthy, active lifestyle and do your best to stay within a healthy weight range.
  • Reduce your alcohol intake. Habitual drinking can also increase your risk. Alcoholics in particular have a far higher risk of developing breast cancer than non-drinkers, according to the National Cancer Institute.
  • Screen your breasts on a regular basis. Check for lumps by hand if you’re under age 40 and see your mammographer if you are over 40.

Only once you have considered all of the above, should you start worrying about the risks your IUD may carry.

ALSO SEE: Your guide to birth control while breastfeeding

Q: Why should we take note of this study if others haven’t found a link between breast cancer and birth control devices?

A: As a surgeon and researcher, Dr Apffelstaedt looks very critically at how studies are conducted.

In his opinion, this study is excellent in comparison to the prior, smaller studies which did not have the level of statistical power necessary to detect the links between hormone releasing IUDs and an increased breast cancer risk.

This was a large-scale study which covered the entire population of the country. It was able to track how many women in the population are on hormone-releasing IUDs based on data extracted from the national Reimbursement Register of the Social Insurance Institution which contains data on purchases of the IUDs since 1994. This could then be isolated to determine the influence in relation to the breast cancer development rate – something they can do with ease as Finland has complete records of breast cancer cases since the 1970s to date.

Also, if you look at how post-menopausal hormone replacement therapy, which contains pure oestrogen, decreases the risk of breast cancer in comparison with how combined hormone replacement therapy increases the risk of breast cancer, it would be surprising if a progestogen-releasing IUD did not increase the breast cancer risk. Whilst there are some shortcomings in the study, Dr Apffelstaedt believes this is a practice-changing study that more will be drawn from in future.

Concludes Apffelstaedt, “The study may sound scary but speaking to your doctor to explore all your options is the best way forward. Every woman is different and birth control is a highly personal decision. The only reason to consider studies such as this is in order to ensure you’re making an informed decision.”

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