Use of oral contraceptives in BRCA mutation carriers and risk for ovarian and breast cancer: a systematic review

D Huber,K Kast,G Emons,S Seitz,O Ortmann

doi:10.1007/s00404-020-05458-w

Abstract

PurposeBRCA mutation carriers have an increased risk of developing breast or ovarian cancer. Oral contraception (OC) is known to increase breast cancer and reduce ovarian cancer risk in the general population. This review analyses the published data on OC and risk of cancer in BRCA mutation carriers.MethodsWe included all relevant articles published in English from 1995 to 2018. Literature was identified through a search on PubMed and Cochrane Library.ResultsWe included four meta-analyses, one review, one case–control study and one retrospective cohort study on the association between ovarian cancer and OC in BRCA mutation carriers. All report a risk reduction for the OC users and several also describe an inverse correlation with duration of use. Regarding breast cancer, we included four meta-analyses, one review, one case–control study, two case-only studies, one prospective and one retrospective cohort study. Some studies report a risk elevation, while others did not find an association between OC use and breast cancer in BRCA mutation carriers. In other studies, the association was limited to early-onset breast cancer and/or associated with young age at first start of OC.ConclusionOral contraception leads to a risk reduction of ovarian cancer also in BRCA mutation carriers. An increase in breast cancer risk due to OC cannot be excluded. Women with BRCA mutation who consider OC use have to be informed about possible increase in breast cancer risk and alternative contraceptive methods. OC should not be used for the prevention of ovarian cancer in this population.

Highlights

Mutations in BRCA1/2 genes represent significant risk factors for breast and ovarian cancer
All of them report a risk reduction for the oral contraception (OC) users and several describe an inverse correlation with ovarian cancer risk and duration of OC use (Table 1)
The risk reduction was present in BRCA1 (OR = 0.5; 95% CI 0.3–0.9) and BRCA2 (OR = 0.4; 95% CI 0.2–1.1) mutation carriers, with a limited number of BRCA2 mutation carriers included in the study

Summary

Introduction

Mutations in BRCA1/2 genes represent significant risk factors for breast and ovarian cancer. A recent prospective study suggests a cumulative risk to the age of 80 years in BRCA1 mutation carriers of up to 72% for breast cancer and up to. In BRCA2 mutation carriers, the cumulative breast cancer risk to the age of 80 years according to this data is increased up to 69% and for ovarian cancer up to 17%, respectively [1]. Current or recent use of oral contraceptives leads to an increased risk for breast cancer (RR = 1.20; 95% CI 1.14–1.2). Use of OC leads to a profound decrease of ovarian cancer risk by 20% RR reduction for every 5 years of use. This effect persists for many years after cessation of use

Methods

Results

Conclusion