contraception

1. Contracep*on+
Best+for+Breast+
+

2. Areas+of+Discussion+
• Effect+*ssue+
• Effect+of+hormones++of+hormonal+
contracep*on+on+breast+on+pre+
exis*ng+breast+disease+
• Best+contracep*ve+Method+in+
exis*ng+or+women+with+a+high+
risk+of+Breast+Cancer++
• Changes+of+benign+breast+disease+
with+hormonal+contracep*on++

3. Clinical+Case+1+
• A+23yr+old+newly+married+
woman+is+on+OC+pills+for+birth+
control+for+the+last+one+year.+
• She+is+concerned+about+her+
breast+cancer+risks+on+the+pill+
and+wants+to+discuss+the+issue++
• How+will+you+counsel+her?+

4. Breast+Cancer+with++
COCPs+
Counselling+Points+
• Reproduc*ve+Life+Plan+to+be+
assessed+
• Slight+increase+in+cancer+risk+
while+on+the+pills+which+
decreases+aLer+stopping++
• Risk+increases+with+longer+
dura*on+of+use+esp.+>5years+
• Absolute+increases+in+risk+very+
small+

5. Breast+Cancer+with++
COCPs+
Counselling+Points+
• Balanced+with+the+posi*ve+effects+
of+COCPs+on+cancer+protec*on+
and+on+menses+
• Other+posi*ve+effects+on+PMS,+
PCO+etc.+
• Preven*on+of+an+unwanted+
pregnancy+vs.+poor+efficacy+of+
other+contracep*ve+methods+

7. Discussion+Point+
+1+
• Is+it+oestrogen+or+proges*ns+
in+COCPs+which+are+
responsible+for+increased+
breast+cancer+risk?+

8. Discussion+Point++
1+
• Higher+oestrogen+dose+has+
higher+risk+
• Complex+associa*on+of+
proges*n++
• WHI+raised+more+doubts++

10. ACOG+Prac*ce++
Advisory++
2017+
• Compared+to+women+who+never+used+hormonal+
contracep*on,+the+overall+rela*ve+risk+of+invasive+
breast+cancer+among+women+who+were+current+
or+recent+users+of+hormonal+contracep*on+was+
1.20+(95%+CI+1.14+Z+1.26)+++
• RR+increased+with+dura*on+of+use+
ranging+from+1.09+to+less+than+a+
year+of+use+to+1.38+for+us+longer+
than+10yrs+
• Risk+similar+with+different+
formula*ons+of+COCPs+

11. ACOG+Prac*ce+
+Advisory++
2017+
• Results+among+proges*nZonly+methods+was+
inconsistent+(With+LNG+IUS+the+RR+was+1.21)+
• Because+of+the+low+baseline+risks+of+breast+cancer+
in+the+age+group+using+hormonal+contracep*on,+in+
real+numbers+the+actual+difference+is+small+
• Current+study+translates+into+1+extra+case+of+
invasive+breast+cancer+for+every+7690+women+
using+hormonal+contracep*on++

12. ACOG+Prac*ce+Advisory++
2017+
• Hormonal+Contracep*ves+have+other+
significant+health+benefits+and+well+
established+decreased+risk+of+ovarian,+
endometrial+and+colon+cancer+
• Overall+Ca+risk+is+less+in+hormonal+
contracep*on+users+vs.+nonZusers++
• Limita*ons+of+the+study+Z+did+not+account+
for+breast+feeding,+alcohol+consump*on+
and+physical+ac*vity;+being+limited+to+the+
Danish+popula*on+limits+the+poten*al+for+
it’s+results+to+be+generalised++

13. Clinical+Case+2+
• A+23yr+old+unmarried+woman+but+
sexually+ac*ve+is+suffering+from+
intense+preZmenstrual+symptoms+
along+with+severe+breast+
discomfort+affec*ng+her+QOL+
• What+treatment+can+you+offer+
her?+

14. Pre+menstrual+Mastalgia+
Choice+of+Hormonal+Contracep*on+
• A+DRSP+containing+pill+administered+
at+a+24+4+regime+may+be+more+
helpful+than+others+
• She+may+be+offered+the+medica*on+
for+three+to+six+months+ini*ally+to+
assess+efficacy+
• May+con*nue+for+a+longer+*me+to+
also+take+care+of+the+contracep*ve+
requirement++

15. Hormonal+Fluctua*ons++
21/7+vs.+24/4+

16. Clinical+Case+3+
• A+19yr+old+lady+with+PCO+is+
started+on+a+COCP+containing+
EE+and+CPA+for+grossly+
irregular+cycles++
• She+also+has+a+fibroadenoma+
and+is+concerned+of+the+
effects+of+the+hormonal+
medica*on++
• How+can+you+counsel+her?+

17. Fibroadenoma,+Breast+
Effect+of+Hormonal+Contracep*on+
• Fibroadenomas+are+benign+breast+
tumours+not+related+to+cancer++
• They+can+increase+in+size+during+
pregnancy,+breast+feeding+or+hormone+
therapy+temporarily+
• Suspicious+tumours+need+imaging+and+a+
needle+biopsy+to+rule+out+malignancy++
• Fibroadenomas+may+recur+irrespec*ve+of+
hormonal+contracep*on+and+surgery+is+
for+cosmesis++

19. Clinical+Case+4+
• A+39yr+old+lady+is+prescribed+
cyclical+COCPs+for+AUBZO+
• Her+mother+died+last+year+from+
Ca+breast++
• Is+the+Rx+a+good+choice+for+her?++

20. Family+H/O+Cancer+
• She+has+a+higher+background+risk+of+
Ca+Breast+
• Long+term+OC+use+has+a+temporary+
increase+in+Ca+Breast+risk+(same+for+
LNGZIUS)+
• She+may+have+other+nonZhormonal+
op*ons+of+managing+AUBZO+to+
consider+
• She+could+consider+a+change+in+Rx+
in+the+long+run+

22. Take+Home+Messages+
• The+glandular+component+of+the+breast+
*ssue+does+respond+to+exogenous+
hormones+of+hormonal+contracep*on+
• All+hormonal+therapy+Z+OCs+and+HT+
should+be+used+assessing+the+riskZbenefit+
ra*o+and+must+be+individualised++
• The+WHO+MEC+is+helpful+in+assessing+risk+
before+offering+hormonal+contracep*on+
to+women+with+pre+exis*ng+breast+
disease+or+risk+

23. Thank+You+