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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
HIV / AIDS RESEARCH
Increase
in condom use and decline in HIV and sexually transmitted
diseases among female sex workers in Abidjan, Côte
d'Ivoire, 1991-1998
Related News Article: Program Cuts
HIV Among Ivory Coast Sex Workers
Modeling
HIV/AIDS Epidemics in Botswana & India: Impact
of Interventions to Prevent Transmission 
HIV Prevalence in a Gold Mining Camp in the Amazon Region, Guyana
Anti-HIV Drugs Linked to Baby Gene Mutations
HIV / AIDS NEWS
Taiwan-AIDS: Taiwan's HIV Cases Rise 21 Percent in 2001
HIV/AIDS: South Africa to Boost Drug Research, Not Offer Universal Access
HIV/AIDS Cases on the Rise in Uzbekistan
Campaign
to Save Women from HIV
AIDS
Village Causes "More Harm Than Good"
HIV/AIDS:
Megacities Network Announced at U.N. Meeting to Fight
Disease
Nigeria:
Olikoye Regrets Slow Reaction to HIV/AIDS Scourge
MATERNAL AND CHILD HEALTH RESEARCH
Low
Consumption of Seafood in Early Pregnancy as a Risk
Factor for Preterm Delivery: Prospective Cohort Study
Related News Article: Fish
Diet Cuts Premature Birth Risk
A
Systematic Review of Nonpharmacological and Nonsurgical
Therapies for Gastroesophageal Reflux in Infants
Related News Article: 'Low-Tech'
Solutions for Baby Vomiting May Not Work
Cosleeping
and Sudden Unexpected Death in Infancy
Pulmonary
Embolism and Stroke in Relation to Pregnancy: How
Can High-risk Women be Identified?
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
MEN'S HEALTH NEWS
Opinion:
Shouldn't Men Have a Choice, Too?
POPULATION RESEARCH
POPULATION NEWS
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
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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