Managing Contraception Questions and Answers :: At age 44 with a family history of ovarian cancer, was my doctor wise to start me on birth control pills? #102/10

1. Ovarian cancer risk reduction. Ovarian cancer is the most lethal gynecologic cancer because most of the 26,000 cases diagnosed each year in the United States are not detected until the women have advanced disease.[i][i] When compared with women who have never used COCs, COC users are 40% less likely to develop epithelial ovarian cancer. Ten years or more of use of monophasic formulations reduces a woman’s risk of developing such cancers by 80%.[ii][ii] This protection lasts for up to two decades beyond the time the woman takes her last COC.^{,^[iii][iii]} Some studies that focus on the newer lower-dose formulations (<35 mcg EE) have found that the lower-dose formulations protect as well as higher-dose formulations, but other studies report less protection with a lower dose of progestins.[iv][iv]

A compelling argument can be made that COCs can be used to prevent cancer in high-risk women even if they do not need contraception. Women with a family history of ovarian cancer enjoy a greater benefit of ovarian cancer risk reduction than do women with no family history. Women with first-degree relatives with ovarian cancer who used COCs for 4 years had a 90% reduction in ovarian cancer risk. Most studies have found that women with BRCA1 mutations have similar protection from ovarian cancer with COC use, although one study found that increased duration of COC use did not reduce further the risk of ovarian cancer in BRCA1 or BRCA2 mutation carriers and cautioned against routine use of COCs for chemoprevention. Longer term experience will be needed to resolve this issue.

2. Endometrial cancer risk reduction. COC use for at least 12 months reduces a woman’s risk of developing endometrial cancer by about 40%. In women who use COCs for at least a decade, the risk of developing endometrial cancer is only one fifth of that of non-pill users (an 80% reduction). The protection that pills offer against endometrial cancer protection also endures for up to 20 years after COC discontinuation. This feature is particularly important in women who have risk factors for developing endometrial hyperplasia and carcinoma, such as anovulatory cycling due to PCOS or obesity. The incidence of endometrial cancer is increasing in the United States because of an increasing lifespan among women and an epidemic of obesity. Over 40,000 women develop this cancer each year. Women who are 50 pounds or more overweight have almost a 10-fold increased risk of developing endometrial cancer compared to normal weight controls.

Now, February 2, Did you recieve my first response and what did you decide to do about birth control pills?

Key words: fertility, surgery, ovary, tube, appendix, cysts, endometriosis, tumor, non-cancerous, ovarian cancer, birth control pills, pregnant, menopause, dramatic protection, Contraceptive Technology, Dr. Anita L. Nelson, risk reduction

Reference:

Nelson AL. Combined oral contraceptives IN Hatcher RA, Trussell J, Cates Jr. W, Stewart F. et al Contraceptive Technology 19^th edition, pages 204 and 205: Ardent Media Inc. 2008

[i][i]. Vessey MP, Painter R. Endometrial and ovarian cancer and oral contraceptives--findings in a large cohort study. Br J Cancer 1995;71(6):1340-1342.

[ii][ii]. Rosenberg L, Palmer JR, Zauber AG, Warshauer ME, et al. A case-control study of oral contraceptive use and invasive epithelial ovarian cancer. Am J Epidemiol 1994;139(7):654-661.

[iii][iii]. Ness RB, Grisso JA, Klapper J, Schlesselman JJ, et al. Risk of ovarian cancer in relation to estrogen and progestin dose and use characteristics of oral contraceptives. SHARE Study Group. Steroid Hormones and Reproductions. Am J Epidemiol 2000;152(3):233-241.

[iv][iv]. Schildkraut JM, Calingaert B, Marchbanks PA, Moorman PG, Rodriguez GC. Impact of progestin and estrogen potency in oral contraceptives on ovarian cancer risk. J Natl Cancer Inst 2002;94(1):32-38.

[v][v]. Jensen JT, Speroff L. Health benefits of oral contraceptives. Obstet Gynecol Clin North Am 2000;27(4):705-721.

[vi][vi]. Gross TP, Schlesselman JJ. The estimated effect of oral contraceptive use on the cumulative risk of epithelial ovarian cancer. Obstet Gynecol 1994;83(3):419-424.

[vii][vii]. Walker GR, Schlesselman JJ, Ness RB. Family history of cancer, oral contraceptive use, and ovarian cancer risk. Am J Obstet Gynecol 2002;186(1):8-14.

[viii][viii]. Narod SA, Risch H, Moslehi R, Dorum A, et al. Oral contraceptives and the risk of hereditary ovarian cancer. Hereditary Ovarian Cancer Clinical Study Group. N Engl J Med 1998;339(7):424-428.

[ix][ix]. Modan B, Hartge P, Hirsh-Yechezkel G, Chetrit A, et al; National Israel Ovarian Cancer Study Group. Parity, oral contraceptives, and the risk of ovarian cancer among carriers and noncarriers of a BRCA1 or BRCA2 mutation. N Engl J Med 2001;345(4):235-240.

[x][x]. Combination oral contraceptive use and the risk of endometrial cancer. The Cancer and Steroid Hormone Study of the Centers for Disease Control and the National Institute of Child Health and Human Development. JAMA 1987;257(6):796-800.

[xi][xi]. Schlesselman JJ. Risk of endometrial cancer in relation to use of combined oral contraceptives. A practitioner’s guide to meta-analysis. Hum Reprod 1997;12(9):1851-1863.

General Health Benefits