Abstract
The endocrine background of breast cancer has raised questions about the increase
in risk that might bear the use of hormonal contraceptives. This has been a particular
issue in the case of young women, who constitute the population of contraceptive consumers.
Observational studies have been the main source of evidence, which has mainly limited
to the combined estrogen-progestogen preparations, the popular pill. Studies in the
80′s and 90′s of the past century found a small, around a 20%, increase in risk. The
translation in absolute number of excess cases has been exiguous because the prevalence
of the disease is relatively small in premenopausal women. Moreover, the risk slowly
seemed to disappear after 5–10 years of use.
The more sophisticated analyses provided by new technologies, together with the powerful
central registries in some countries, has confirmed increased risk of similar size.
Recent preparations, with lower doses of estrogens and new progestogenic molecules,
have not substantially modified the risk size. The impact of progestogen only alternatives,
either pills or progestogen-loaded intrauterine devices, seems to be similar, but
the evidence is still insufficient. Whether there is a preferential effect on histological
or molecular subtypes of breast tumours is being debated yet. The data on women at
higher risk, either with mutations of the BRCA1/2 genes or with familial weight, have
not found specific response patterns, but the experience is still meagre. It is of
interest that long-term follow up data on women who enrolled in the initial cohorts,
like that of the Royal College of General Practitioners’, have shown a considerable
protection against cancer of the ovary (relative risk, RR 0.67), endometrium (RR 0.66),
or colorectum (RR 0.81).
Keywords
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Article info
Publication history
Published online: March 28, 2018
Accepted:
March 27,
2018
Received in revised form:
March 25,
2018
Received:
February 3,
2018
Identification
Copyright
© 2018 Elsevier B.V. All rights reserved.
