Hormonal Contraceptive Use for Endometrial Cancer Prevention

Abstract

INTRODUCTION: Hormonal contraception decreases the risk of both endometrial and ovarian cancer. The study objectives were to assess the prescribing patterns, counseling practices, and knowledge of primary care physicians with regard to hormonal contraceptives and cancer prevention. METHODS: A 25-question survey was mailed to 4,600 obstetrician–gynecologists and family practitioners in a single state. RESULTS: Three hundred sixty-five (8%) surveys were returned with 236 (5%) complete for analysis. Mean physician age was 56.3 years, 51.4% were male, and 93.6% of physicians prescribe hormonal contraception. Most physicians recognized decreased endometrial cancer risk associated with oral contraceptive pills (73.6%) and increased risk with obesity (95.5%); only 36.8% consistently counsel patients on obesity-associated cancer risk. Compared with family physicians, obstetrician–gynecologists were more likely to prescribe hormonal contraception (99% compared with 88.9%; P=.002), cite endometrial or ovarian cancer prevention as an indication (51.5% compared with 11.1% and 47.5% compared with 9.4%, respectively; P<.001), more often counseled patients on obesity-related cancer risk (P=.012), and were more likely to correctly identify Lynch syndrome (69.3% compared with 23.9%; P<.001), diabetes (84.2% compared with 41.9%; P<.001), and hypertension (41.6% compared with 9.4%; P<.001) as endometrial cancer risk factors. Endometrial and ovarian cancer prevention as an indication for hormonal contraception factored into less than 1% of total prescriptions. CONCLUSIONS: Although obstetrician–gynecologists had greater understanding of endometrial cancer risks than family practitioners, hormonal contraceptives were rarely prescribed for prevention. This represents a potential opportunity for both specialties to optimize primary endometrial cancer prevention in at-risk women.