A recently published report in the New England Journal of Medicine from a large Danish study of 1.8 million women has shown that use of birth control pills by women for more than 1 year results in a 10% to 38% increased risk of breast cancer. This higher risk lasts not only during the time birth control pills are being taken, but also for at least 5 years after. The longer a woman had used birth control pills, the higher the increase in breast cancer risk. Since breast cancer is more common in women over 35, it was not surprising to find that birth control pills increased breast cancer risk over 6 fold more in women over 35 compared to the increased risk in those younger than 35. Two prior studies had also suggested increased breast cancer risk, and this current study was very large. So the association of birth control pills with more frequent occurrence of breast cancer is rather well-proven
Should women continue to use birth control pills? These medicines are convenient and usually inexpensive methods of contraception. Other studies have indicated that use of birth control pills also reduced cancer risks in non-breast cancers, including less ovarian, colon, rectal, and endometrial cancers.
So here are my tips for reducing breast cancer risks in women taking birth control pills.
· If you are under 35, use of birth control pills offers only slight additional breast cancer risk. But for women over 35, you should discuss the risk of breast cancer with your physician and consider the alternative of using non-hormonal contraception (for example, intrauterine devices or IUDs).
· If you have taken birth control pills, be certain to have mammograms annually starting at age 40 to detect breast cancers at earlier and more curable stages (which can avoid needing a mastectomy or total breast removal).
· Remember, other women are also at higher risk of breast cancer. Women at higher risk who should also get mammograms annually starting at age 35 to 40 include women who drink alcohol (1 or more drinks per day), smoke cigarettes, are obese, have a family history of breast or ovarian cancer, have a BRCA1 or BRCA2 mutation, have no children or had the first birth later than age 30, had their first menstrual period younger than age 12, are not physically active (no exercise), had prior radiation to the chest area, have dense breasts on mammograms, whose mother took DES (diethylstibesterol an estrogen) while the mother was pregnant with the patient, and/or have had prior breast biopsies that showed no cancer.
· If you have a BRCA 1 or 2 gene mutation, ask your physician about prevention with medications (tamoxifen, aromatase inhibitors, or raloxifine) or even preventive surgery (ovary removal or removal of breast tissue and replacement with plastic surgery reconstruction).
· Always have health insurance so that if a cancer were to occur, it can be cured easily with less treatment and future cancers can also be prevented. For information on how to get health insurance, see my book and website Surviving American Medicine.
Knowing that your risk of breast cancer is higher than normal should make you take steps to increase surveillance for early and curable cancer changes. Work with your physician to make sure breast cancer does not threaten your life.