Abstract
There is a steady global rise in the use of progestin subdermal implants, where use has increased by more than 20 times in the past two decades. BC risk has been reported with the older progestin only methods such as oral pills, injectables, and intrauterine devices, however, little is known about the risk with subdermal implants. In this review, we aim to update clinicians and researchers on the current evidence to support patient counseling and to inform future research directions. The available evidence of the association between the use of progestin subdermal implants and BC risk is discussed. We provide an overview of the potential role of endogenous progesterone in BC development. The chemical structure and molecular targets of synthetic progestins of relevance are summarized together with the preclinical and clinical evidence on their association with BC risk. We review all studies that investigated the action of the specific progestins included in subdermal implants. As well, we discuss the potential effect of the use of subdermal implants in women at increased BC risk, including carriers of BC susceptibility genetic mutations.
Highlights
Hormonal contraception is widely used by women of reproductive age, and its association with breast cancer (BC) risk has been investigated for decades
This risk can be explained by the evidence of significant systemic LNG concentration, reaching roughly half the level achieved with oral formulations [88, 89]. These studies carry limitations including the relatively small number of users and the consideration of the confounding factors such as the prior use of combined oral contraceptives (COCs) [90]. When it comes to progestin-only subdermal implants, scarce data is available on their association with BC risk
There is an obvious lack of clinical guidelines or solid research data on the safety of progestin subdermal implants
Summary
Hormonal contraception is widely used by women of reproductive age, and its association with breast cancer (BC) risk has been investigated for decades. According to the National Institute for Health and Care Excellence (NICE), subdermal implants have a very low failure rate (less than 1 pregnancy per 1000 implants fitted over 3 years) [7]. With their increasing popularity, clinicians are facing a challenge in counseling patients about the risk of BC associated with these methods. The current clinical guidelines do not provide adequate information to support clinicians or patients to make decisions regarding the use of these methods
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