We had the opportunity to ask specialist surgeon Dr Justus Apffelstaedt if there is a link between breast cancer and birth control…

“Women living in the 21st century are blessed with many modern medical options of which our female ancestors would be envious, with birth control being one of the first that comes to mind,” says Dr Justus Apffelstaedt, a specialist surgeon with an interest in breast, thyroid and parathyroid health as well as soft tissue oncology. 

He says that many women opt for hormonal birth control methods such as the pill, patch or progestogen-releasing Intrauterine Devices (IUDs) due to the numerous lifestyle and medicinal advantages associated with them; including effective pregnancy prevention, reduced menstruation and known links to a risk reduction of ovarian, endometrial and colon cancers. 

We had to the opportunity to ask him if there is a link between breast cancer and birth control. 

Could your birth control device or medication be increasing your risk of breast cancer? 

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Apffelstaedt: An observational population-wide cohort study conducted in Finland and published in Obstetrics & Gynecology[1] in August 2014, made startling links between the use of progestogen containing IUDs, such as the popular Mirena, and an increased risk of developing breast cancer. The study collected data from 93 843 Finnish women between the ages of 30 to 49 years old, who, from 1994 – 2007 had received a progestogen-releasing IUD. The resultant database was then linked to the Finnish Cancer Registry data in order to compare the incidence of cancers from progestogen-releasing IUD users with cancer incidences in the general population.

As the Mirena and other hormone-releasing IUDs are popular and effective forms of birth control.

Did this study find links between hormone-releasing IUDs and breast cancer? 

Dr Apffelstaedt: Yes, the Cancer Risk in Women Using the Levonorgestrel-Releasing Intrauterine System in Finland [2] study published in Obstetrics & Gynecology (August 2014) did find links between hormone-releasing IUDs and breast cancer.

The risk of ductal carcinomas (the most common form of breast cancer which accounts for approximately 80% of all breast cancers[3]) and lobular carcinomas (which constitutes approximately 10% of all breast cancers[4]) increased.

The study states, “the finding of an increased standardised incidence ration for breast cancer after five or more years of follow-up may reflect causality between extended progestin exposure and cancer risk, but the results should be interpreted with caution in light of the limitations of the study[5].”

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What are the key insights from this study?

Dr Apffelstaedt: The most important points to consider are:

  • The breast cancer risk is time-dependent and only increases after five years of using a hormone-releasing IUD.
  • If you are above the age of 40, even if you have no significant risk factors such as cancer in your family, you should go for mammographic screening.
  • If you have breast cancer in your family, speak to your gynaecologist about exploring non-hormonal contraceptive options.
  • There is currently no concrete data on whether removing the device will return the risk profile to normal. While the risk may subside, it will still remain elevated in comparison with pre-insertion levels. 

There is no such thing as a 100% risk-free contraceptive. Realistically, if you are changing your internal hormonal environment for an extended period of time (between 10 – 30 years), there are bound to be consequences.

What should women who have progestogen-releasing Intrauterine Devices (IUD) do?

Dr Apffelstaedt: There’s no need to schedule an emergency appointment to have your IUD removed.

Any form of medical intervention carries risks and benefits which one needs to consider holistically. Does one trade-off of a small increase in breast cancer risk versus the lifestyle benefits these devices offer? This is an informed decision each woman should make for themselves in consultation with their doctor, preferably a gynaecologist.

There is no such thing as a 100% risk-free contraceptive. Realistically, if you are changing your internal hormonal environment for an extended period of time (between 10 – 30 years), there are bound to be consequences.

Therefore, I do not recommend the use of a hormone-releasing IUD for more five years. If you wish to extend use for longer than that, it is wise to discuss the risks with your gynaecologist.

There are, however, numerous lifestyle changes one can make to decrease the risk of developing breast cancer without changing their birth control.  

Why should I consider this study if other studies have found no link?

Dr Apffelstaedt: As a surgeon and researcher, I look critically at how studies are conducted.

In my opinion, this study is excellent in comparison to the prior, smaller studies which did not have the level of statistical power necessary to detect the links between hormone-releasing IUDs and an increased breast cancer risk.

This was a large-scale study which covered the entire population of the country. It was able to track how many women in the population are on hormone-releasing IUDs based on data extracted from the national Reimbursement Register of the Social Insurance Institution which contains data on purchases of the IUDs since 1994. This could then be isolated to determine the influence in relation to the breast cancer development rate – something they can do with ease as Finland has complete records of breast cancer cases since the 1970s to date.

If one looks at how post-menopausal hormone replacement therapy, which contains pure oestrogen, decreases the risk of breast cancer in comparison with how combined hormone replacement therapy increases the risk of breast cancer, it would be surprising if a progestogen-releasing IUD did not increase the breast cancer risk. Whilst there are some shortcomings in the study, I believe that this is a practice-changing study that more will be drawn from in future. 

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While All4Women endeavours to ensure health articles are based on scientific research, health articles should not be considered as a replacement for professional medical advice. Should you have concerns related to this content, it is advised that you discuss them with your personal healthcare provider.