I’m a GP and here’s everything you need to know about the Pill and increased risk of breast cancer
POPPING the Pill first thing in the morning is a daily ritual for millions of women.
Since it was introduced to the UK in the early Sixties, the tiny tablet has helped millions of Brits take control of their reproductive cycle.
But a major new study from the University of Oxford sparked concern last week after scientists warned progestogen-only forms could raise risk of breast cancer by 26 per cent.
So what is the risk and should you really be worried?
Here, I answer some of the main questions.
Q) What did the Oxford study find?
A) SCIENTISTS looked at the medical records of 27,699 women for the study, published in the journal PLOS Medicine.
They found that 44 per cent of women with breast cancer had been taking a hormonal contraceptive three years on average before diagnosis.
This compares with 39 per cent of women who did not get breast cancer.
There was a 23 per cent increased risk of breast cancer for the combined Pill, a 26 per cent increased risk for the progestogen-only Pill — which accounts for half of Pill prescriptions — a 22 per cent increased risk for the progestogen implant and a 32 per cent increased risk for the IUS or hormonal coil.
Once women stop taking the progestogen-only Pill, their cancer risk starts to drop.
Between one and four years after stopping, the risk drops to 17 per cent, and after five years it is 15 per cent.
Ultimately, a woman’s increased risk was found to disappear completely.
Q) So how big is the risk in reality?
A) IT sounds like a sizable percentage and there is a risk that women may start to worry about their contraceptive choices as a result.
But let’s look at the actual statistics, because 20 per cent of a very small number is an even smaller number and therefore, in absolute terms, the risk is very small.
In younger women, aged 16 to 20, the average risk of developing breast cancer is very low — around 0.8 per cent over 15 years in women who do not use hormonal contraception.
The study found that taking the oral combined or progestogen-only contraceptive for five years would raise that risk to around 0.9 per cent — the equivalent to eight additional breast cancer cases for every 100,000 women over 15 years.
In women aged 35 to 39, hormonal contraception was found to cause an additional 265 cases per 100,000 over 15 years.
That’s still a very small increase in risk when considering the protective benefits of taking it, mainly unwanted pregnancies.
Q) Is this new?
A) WE have known for many years that the combined oral contraceptive Pill, which contains synthetic versions of both oestrogen and progesterone, is linked to a 20 per cent increased risk of breast cancer.
But this study is the first to help us understand the risk associated with progestogen-only methods.
Q) What are the benefits of taking the Pill?
A) ASIDE from helping to prevent unwanted pregnancies, it is worth remem-bering that both types of contraceptive Pill protect against other female cancers, namely ovarian and endometrial or womb cancer.
The combined Pill also protects against colorectal or bowel cancer.
It has been well documented that there is no overall increased cancer risk associated with taking the combined Pill.
There are also lots of other potential benefits to taking various forms of hormonal contraception.
I prescribe it to patients for a range of conditions, including polycystic ovaries and to help with heavy and painful periods.
Q) Why is the new study important?
A) STUDIES like the one reported last week are important because they give women information to help them make the right choice for them.
For most people this new research will not give any reason to change their contraception, because the benefits still outweigh any risk.
There may be a minority of women who have a particular cause for concern when it comes to breast cancer, and some may decide to stop using hormonal contraception because of these new findings.
That’s entirely their right to do so, and as doctors we want our patients to be informed and take an active role in their health care.
Q) What else should women know?
A) WHILE the study offers useful information, what isn’t mentioned much when it comes to the report is the fact that lifestyle factors have a more significant impact when it comes to our risk of getting cancer.
The risks associated with smoking, alcohol use, excess body fat and being physically inactive are far more important for health and cancer risk than hormonal contraception.
The Cancer Research UK website states that if everyone in the UK had been living a healthy lifestyle for the past ten years, then a typical GP would see only six new cases of cancer in a year, instead of ten.
We know tobacco can cause up to 15 different types of cancer: Lung, larynx, oesophagus, oral cavity, nasopharynx, pharynx, bladder, pancreas, kidney, liver, stomach, bowel, cervix, leukaemia and ovarian.
Q) What have other experts said?
A) WHEN asked for comment on the report, Kirstin Pirie, statistical programmer at Oxford Population Health and one of the lead authors, said: “The findings suggest that current or recent use of all types of progestogen-only contraceptives is associated with a slight increase in breast cancer risk, similar to that associated with use of combined oral contraceptives.
“These excess risks must, however, be viewed in the context of the well-established benefits of contraceptive use in women’s reproductive years.”
Claire Knight, senior health information manager at Cancer Research UK, added: “Combined and progestogen-only hormonal contraception can increase the risk of breast cancer, but the risk is small.
“For anyone looking to lower their cancer risk, not smoking, eating a healthy balanced diet, drinking less alcohol and keeping a healthy weight will have the most impact.”
Q) So should you stop taking it?
A) INFORMED patients make informed choices so any education around medicines can only be a good thing.
But for the vast majority of women, the increased risk of cancer if they’re taking any type of contraceptive pill is small and the benefits very much outweigh the risks.