Birth Control Pills in Patients with a Strong Family History of Breast Cancer

Risk Assessment and Clinical Decision Making

• The use of oral contraceptives in patients with a strong family history of breast cancer can be considered as the evidence shows no significant increase in breast cancer risk, while providing substantial reduction in ovarian cancer risk, according to the National Comprehensive Cancer Network 1, 2, 3
• Meta-analyses show oral contraceptives significantly reduce ovarian cancer risk by approximately 50% in both BRCA1 carriers and BRCA2 carriers, with longer duration of use further decreasing risk 1, 2
• The National Comprehensive Cancer Network recommends considering oral contraceptive use in BRCA1/2 mutation carriers due to the substantial ovarian cancer risk reduction benefit 1, 2
• A meta-analysis of women with family history of breast/ovarian cancer found oral contraceptive use decreased ovarian cancer risk (OR 0.58) with no significant impact on breast cancer risk (OR 1.21) 3, 6
• Low-dose oral contraceptives may have more favorable risk profiles, according to the National Comprehensive Cancer Network 4
• Significant ovarian cancer risk reduction (45-60%) is associated with oral contraceptive use, with no consistent evidence of increased breast cancer risk in recent meta-analyses 1, 2, 3
• Women with a strong family history should undergo appropriate genetic counseling and testing before making decisions about oral contraceptive use, as recommended by the National Comprehensive Cancer Network 8, 9
• Regular breast cancer screening is essential for women with family history regardless of oral contraceptive use, according to the National Comprehensive Cancer Network 6, 10
• Alternative contraceptive methods should be discussed for women uncomfortable with any potential risk, as recommended by the National Comprehensive Cancer Network 8

Important Considerations

• Overlooking the substantial ovarian cancer risk reduction benefit when focusing solely on breast cancer risk should be avoided, as emphasized by the National Comprehensive Cancer Network 1, 2
• The National Comprehensive Cancer Network acknowledges that larger prospective trials are needed to fully elucidate the impact of oral contraceptives on breast cancer risk in women with familial predisposition, but current evidence supports their use with appropriate monitoring 2, 4