Risk of Cancer with Hormonal Birth Control

Introduction to Cancer Risk

The American Academy of Dermatology and other guideline societies suggest that hormonal birth control is associated with a small increased risk of breast and cervical cancer, but provides substantial protection against ovarian and endometrial cancer, with the overall cancer risk-benefit profile being neutral to favorable over the long term 1, 2

Current or recent users of combined hormonal contraceptives have a relative risk of breast cancer of approximately 1.20-1.24, representing about 1 extra breast cancer per 7,690 women using hormonal contraception for 1 year, according to the American College of Obstetricians and Gynecologists 2
The Centers for Disease Control and Prevention recommends that current breast cancer is an absolute contraindication (Category 4) to hormonal contraceptives because breast cancer is hormonally sensitive and prognosis may worsen 3, 2, 4
The American College of Obstetricians and Gynecologists states that past breast cancer with no evidence of disease for 5 years is Category 3 (risks usually outweigh benefits) 3, 4

The Centers for Disease Control and Prevention indicates that long-term use (≥5 years) of combined hormonal contraceptives may increase the risk of cervical carcinoma in situ and invasive carcinoma among women with persistent HPV infection 3
The American College of Obstetricians and Gynecologists recommends that women with cervical intraepithelial neoplasia can use hormonal contraceptives (Category 2) 3

The American College of Obstetricians and Gynecologists suggests that combined oral contraceptives reduce ovarian cancer risk by 40-60%, with protection increasing with longer duration of use and persisting for at least 10 years after discontinuation, which is a critical consideration in the overall risk-benefit calculation 2
The Centers for Disease Control and Prevention states that oral contraceptives reduce endometrial cancer risk by approximately 50% in ever-users, with greater benefit with increasing duration of use 3, 2

The American Academy of Dermatology and other guideline societies indicate that long-term cohort studies with 30+ years of follow-up show an overall neutral balance between short-term cancer risks and long-term cancer benefits in past oral contraceptive users 1, 2
A study of 46,022 women in the United Kingdom demonstrated no increased overall cancer incidence or mortality among ever-users, according to the American College of Obstetricians and Gynecologists 1

Persistent infection with high‑risk human papillomavirus (HPV) is the primary cause of cervical cancer, outweighing hormonal influences. 5
HPV genotypes 16 and 18 together account for roughly 70 % of cervical cancer cases worldwide. 6

Regular cervical cancer screening (e.g., cytology and HPV testing) is the cornerstone strategy for reducing incidence, morbidity, and mortality from cervical cancer. 5
Prophylactic HPV vaccination is essential, especially for women using combined estrogen‑progestin contraceptives who have not been vaccinated. 7