Implications of Contraceptive Use When Diagnosed with Oestrogen-Sensitive Breast Cancer

breast check up 1

Oestrogen-sensitive breast cancer, also known as hormone receptor-positive breast cancer, is the most common form of breast cancer. In these cases, the cancer cells have receptors that allow them to use estrogenic to grow. When diagnosed with this condition, one of the key considerations is how certain medications, particularly hormonal contraceptive use, can affect the patient’s treatment and prognosis.

Understanding Oestrogen-Sensitive Breast Cancer

Oestrogen-sensitive breast cancer accounts for about 70-80% of breast cancer cases. The cancer cells respond to the presence of oestrogen, which can stimulate their growth. Treatments for this type of cancer often focus on reducing the body’s oestrogen levels or blocking the cancer cells from utilizing oestrogen.

Hormonal contraceptives, including many birth control pills, patches, and hormonal IUDs, contain synthetic versions of hormones like oestrogen and progesterone, which can potentially fuel the growth of oestrogen-sensitive cancer cells.

Impact of Hormonal Contraceptives on Oestrogen-Sensitive Breast Cancer

1. Increased Risk of Cancer Recurrence

  • Oestrogen-containing contraceptives can increase oestrogen levels in the body, potentially stimulating the growth of hormone receptor-positive breast cancer cells.
  • Patients with oestrogen-sensitive breast cancer are typically advised to avoid hormonal contraceptives due to the risk of cancer recurrence or progression.

2. Alternatives to Hormonal Birth Control

Women diagnosed with oestrogen-sensitive breast cancer or those at high risk of developing it should consider non-hormonal contraceptive options. Some safer alternatives include:

  • Barrier Methods: Condoms, diaphragms, and cervical caps.
  • Copper IUD: A non-hormonal intrauterine device that provides long-term contraception without altering hormone levels.
  • Sterilization: Surgical options like tubal ligation can provide permanent contraception.
  • Natural Family Planning: Tracking ovulation and fertility to avoid pregnancy, although this method has higher failure rates compared to other options.

3. Progesterone-Only Contraceptives

Some patients may be curious about the safety of progesterone-only contraceptives. However, there is limited research on their use in women with hormone-sensitive cancers. While they may be a safer option compared to combined oestrogen-progesterone contraceptives, they are not entirely free of risk. Progesterone can still influence hormone levels, and caution is advised.

Factors to Consider When Choosing a Contraceptive Method

When deciding on a contraceptive method after an oestrogen-sensitive breast cancer diagnosis, the following factors should be considered:

  • Risk of Recurrence: Hormonal contraceptives, especially those containing oestrogen, are contraindicated.
  • Personal Health History: Patients with a family history of breast cancer should discuss contraceptive options with their GP or a breast surgeon, even if they do not have a diagnosis.
  • Lifestyle and Preferences: Some women may prefer non-hormonal methods like barrier methods or copper IUDs due to their low risk of affecting hormone-sensitive conditions.

Frequently Asked Questions (FAQs)

1. Can I use birth control pills after being diagnosed with oestrogen-sensitive breast cancer?

  • It is generally not recommended to use birth control pills containing oestrogen after an oestrogen-sensitive breast cancer diagnosis. These pills can increase the level of oestrogen in the body and may promote cancer recurrence.

2. What is the safest contraceptive option for women with oestrogen-sensitive breast cancer?

  • Non-hormonal options, such as copper IUDs or barrier methods like condoms and diaphragms, are considered the safest for women with this diagnosis.

3. Are progesterone-only contraceptives safe for women with oestrogen-sensitive breast cancer?

  • Progesterone-only contraceptives may be a better option than oestrogen-containing ones, but their safety in women with hormone-sensitive cancers remains uncertain. It’s important to discuss this option with your doctor.

4. Can I use hormonal IUDs if I have oestrogen-sensitive breast cancer?

  • Hormonal IUDs release a low dose of hormones, but because they still involve hormone regulation, they are typically not recommended for women with oestrogen-sensitive breast cancer.

5. What about contraceptive implants or injections?

  • Hormonal implants and injections, like Depo-Provera, contain synthetic hormones. While some only use progestin, there is still concern about their effect on hormone levels and their safety in women with hormone-sensitive cancers. Non-hormonal methods are generally safer choices.

Conclusion

Women diagnosed with oestrogen-sensitive breast cancer need to carefully consider their contraceptive options due to the potential impact of hormonal methods on cancer progression or recurrence. Non-hormonal alternatives such as copper IUDs, barrier methods, or sterilization offer safer options. Always consult with your oncologist or breast surgeon to determine the best contraceptive method for your unique situation.

Mr Senthurun (Seni) Mylvaganam

Consultant Oncoplastic Breast Surgeon

www.drseni.com

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WANT TO KNOW MORE

FAQ’s

Breast surgery as any surgery is not without risk. These risks and the relative chance of them happening for you will differ dependent on the type of surgery you have and also personal risk factors. Risks of breast surgery can be early risks related to the surgery itself or longer term risks such as cosmetic changes related to ageing.

Infection and poor wound healing are a risk in all breast procedures whether it is for breast cancer or for cosmetic reasons. Cosmetic surgery has a lower risk of this but it is increased if you are a smoker or have other medical problems which may effect healing such as diabetes. Every breast procedure will have a long list of possible risks or complications however most of them can be quite rare.

Your surgeon will be able to guide you through the individual risks for your chosen procedure explaining about likelihood of occurrence and what that could mean for you if the complication occurs.

This can be a difficult question to answer. In the cosmetic setting your surgeon will listen to you about what you wish to achieve focusing on shape and volume. They will then examine and assess your chest frame to determine what range of implants are suitable for you to compliment your body shape without risk of long term poor cosmetic results.

Implants vary by brand, surface texture, volume and projection. The choices available within each of these categories can be extensive. The right implant for you will be based on a collaborative discussion between you and your surgeon to select the right implant, volume, shape and projection to be the best fit to meet your cosmetic needs.

Same day cosmetic surgery is generally very safe. Your surgeon will discuss with you specific risks which will be related to the surgery that is to be undertaken and the individual risks that may be more specific to you. This can often be related to any other medical conditions you have or if you are a smoker.

Following surgery you are observed for 2-4 hours afterwards to ensure you have recovered from the anaesthetic and there are no immediate post operative complications. If you are then deemed fit to be discharged you will be able to leave with further post operative instructions to guide you at home and also contact details should you experience any problems at home and need further medical advice. You will be required to have a responsible adult stay with you for the first night after surgery to be eligible to be discharged on the same day of your surgery.

The purpose of cosmetic and reconstructive surgery is different. Cosmetic surgery has a goal of improving the cosmetic appearance by complimenting and modifying the shape and/or size of your natural breasts. Reconstructive surgery is primarily considered for patients who may require or have a mastectomy(removal of all breast tissue). This can be for a number of reasons but primarily is for the treatment of breast cancer or risk reduction if patients have a gene defect making them much more at risk of developing breast cancer. Reconstructive surgery involves the recreating of a breast mound and shape. The cosmetic goals in reconstructive surgery can be quite different to cosmetic breast surgery due to the effects of cancer treatments and the loss of all breast tissue often preventing an optimal natural appearance to be achieved.

Both types of surgery can use implants and fat grafting but reconstructive surgery can also be undertaken by moving your own tissue from another area to recreate the breast.

If you are experiencing a breast symptom such as a new lump, skin or nipple change, nipple discharge, breast shape change, armpit lumps or breast/chest swelling in men then this clinic appointment will aim to address these and other breast symptoms. I will undertake a detailed assessment of the symptoms, screen for the need for genetic risk assessment and examine you. Based on this I will give you a clear explanation of that assessment.

I will inform you as to any diagnosis reached or the need for any imaging, which could be a breast ultrasound or mammogram to help reach that diagnosis. This may also be complimented by a tissue biopsy to confirm any diagnosis. Following any diagnosis I will discuss with you a plan of treatment or reassurance as necessary.

Breast symptoms are extremely common and can range from noticing a difference in the appearance or texture of your breasts to new lumps, nipple changes and breast pain. All breast symptoms should be reviewed by either your GP or a breast surgeon. However this does not mean to say that your symptom is likely to represent a worrying change such as cancer.

MOST breast symptoms are either the result of a normal variation in the tissues that comprise your breast or to a family of conditions that are collectively called benign breast disease. In my breast reassurance clinic I will be able to assess you and provide a diagnosis and explanation for your symptoms or if necessary, further assess the symptoms if a cancer is suspected. It is much more likely your breast symptoms are not due to breast cancer but please do be assessed for any new symptoms.

Choosing to have breast augmentation is a very personal decision. Your surgeon should guide you through this process. By doing this they should help you to decide firstly whether it is right for you and then guide you through your vision for the final look and how to achieve it. I always aim to really understand what the final desired appearance is wanted right up to the smallest detail. We discuss this based on the shape including cleavage, appearance in and out of clothes and then also volume. Following this discussion to achieve your look we may also discuss performing a small uplift as well as the use of implants.

I will always be honest about what can be expected and whether your vision of the final look is possible and responsible to achieve whilst respecting your body shape and frame. A library of my work will also be available for you to view. Beyond this it is also crucial that your surgeon discusses with you the potential risks of the surgery which should include short term and what may happen in the long term. With this entire discussion you will develop a rapport and relationship with your surgeon. You can then decide if that surgeon is the right one for you or not.

Breast augmentation surgery can be undertaken as a day case procedure. Hence you can go home the same day once you have had a period of observation after surgery. You will be fitted with a surgical bra and a binder which can be purchased by yourself or provided at the hospital. The binder provides gentle pressure from above the implants ensuring they remain in the optimal position whilst healing occurs. Please aim for about 4-6 weeks of recovery before getting back to anything strenuous such as the gym or long runs. If returning to work this can be done after 1-2 weeks but ensure you only undertake light manual labour activities.

I will ask you to wear the surgical bra as much each day and night as possible for 6 weeks to provide the best cosmetic result. Upon review during your recovery I will inform you as to when to remove the binder.

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Treatments

Breast Reassurance

Breast symptom assessment utilising the national standard of triple assessment (clinical hist...

Breast Cancer Care

Treatment of breast cancer including a full range of oncoplastic and breast reconstruction techniques.

Cosmetic Breast Surgery

Surgery to change the appearance of your breasts adjusting volume, shape and cleavage.

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