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?
Apffelstaedt: An observational population-wide cohort study conducted in Finland and published in Obstetrics & Gynecology 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  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) and lobular carcinomas (which constitutes approximately 10% of all breast cancers) 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
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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