Contraception in cancer survivors: Breast and gynecological cancers (Part I)


Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

Abstract

Contraception in cancer survivors has acquired its importance for various reasons. The bulk of cancers occurs in old age, but they are often diagnosed in premenopausal and reproductive-aged women. As the efficiency of antitumor therapy for many kinds of cancer has increased, so has the number of patients who have completed it favorably. Chemotherapy, radiotherapy, and ovarian surgery can negatively affect ovarian reserve. Residual ovarian function depends on age at diagnosis, type of treatment, and baseline ovarian reserve. Over the past decade, there have been significant changes in the management of patients in terms of fertility preservation and ovarian reserve assessment. In any situation, it is important to assess a patient’s need for contraception before, during, and after anticancer treatment. This paper gives the results of the work of the European Society of Contraception Expert Group that has analyzed risks for recurrence of the most common cancers in women using different contraception methods. The results are summarized and formed into recommendations for contraception for various cancer sites. Due to a large amount of information, the results are presented in two parts. Part 1 considers the contraceptives recommended for use after breast and gynecological cancers (cervical, endometrial and ovarian cancer, trophoblastic disease). Part 2 provides advice on contraception for women who have had a history of non-gynecological cancer (skin, gastrointestinal, blood, and endocrine cancers). Conclusion: The myth that the use of hormonal contraceptives is always accompanied by an increase in cancer risks, whereas pregnancy is associated with fewer risks than that of COCs has been now dispelled. Because of the high risk of fetal toxicity and the risk of recurrent cancer, the prevention of pregnancy during the f irst 2 years after chemotherapy can be considered to be a reasonable strategy to preserve and maintain women’s health.

Full Text

Restricted Access

About the authors

Oksana V. Yakushevskaya

Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia

Email: aluckyone777@gmail.com
PhD, Researcher at the Department of Gynecological Endocrinology

Svetlana V. Yureneva

Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia

Email: syureneva@gmail.com
Dr. Med. Sci., Deputy Director in Science, Institute of Oncology and Mammology

Levon A. Ashrafyan

Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia

Email: levaa2004@yahoo.com
Academician of the RAS, Dr. Med. Sci., Professor, Director of the Institute of Oncology and Mammology

Nataliya A. Babaeva

Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia

Email: natbabaeva@yandex.ru
Dr. Med. Sci., Oncologist, Oncological Department of Surgical Methods of Treatment, Leading Researcher, Institute of Oncogynecology and Mammology

References

  1. World Health Organization. Medical eligibility criteria for contraceptive use; 2015. Available at: www.who.int/reproductivehealth/publications/family_planning/MEC-5/en
  2. Faculty of Sexual and Reproductive Healthcare of the Royal College of Obstetricians and Gynaecologists. UK medical eligibility criteria for contraceptive use. 2016. Available at: https://www.fsrh.org/standards-and-guidance/documents/ukmec-2016/
  3. Pompei L., Fernandes C. Hormone therapy, breast cancer risk and the collaborative group on hormonal factors in breast cancer article. Rev. Bras. Ginecol. Obstet. 2020; 42(5): 233-4. https://dx.doi.org/10.1055/s-0040-1712941.
  4. Rosenberg L., Boggs D.A., Wise L.A. Oral contraceptive use and estrogen/progesterone receptor-negative breast cancer among African American women. Cancer Epidemiol. Biomarkers Prev. 2010; 19(8): 2073-9. https://dx.doi.org/10.1158/1055-9965.EPI-10-0428.
  5. Ellingjord-Dale M. Parity, hormones and breast cancer subtypes - results from a large nested case-control study in a national screening program. Breast Can. Res. 2017; 19(1): 10. https://dx.doi.org/10.1186/s13058-016-0798-x.
  6. Cibula D., Gompel A., Mueck A.O. Hormonal contraception and risk of cancer. Hum. Reprod. Update. 2010; 16(6): 631-50. https://dx.doi.org/10.1093/humupd/dmq022.
  7. Morch L.S., Hannaford P.C., Lidegaard 0.0. Contemporary hormonal contraception and the risk of breast cancer. N. Engl. J. Med. 2018; 378(13): 1265-6. https://dx.doi.org/10.1056/NEJMc1800054.
  8. Soini T., Hurskainen R., Grenman S., Maenpaa J., Paavonen J., Joensuu H., Pukkala E. Levonorgestrel-releasing intrauterine system and the risk of breast cancer: a nationwide cohort study. Acta Oncol. 2016; 55(2): 188-92. https://dx.doi.org/10.3109/0284186X.2015.1062538.
  9. Jareid M., Thalabard J.-C., Aarflot M. Levonorgestrel-releasing intrauterine system use is associated with a decreased risk of ovarian and endometrial cancer, without increased risk of breast cancer. Results from the NOWAC Study. Gynecol. Oncol. 2018; 149(1): 127-32. https://dx.doi.org/10.1016/j.ygyno.2018.02.006.
  10. Dominick S., Hickey M., Chin J. Levonorgestrel intrauterine system for endometrial protection in women with breast cancer on adjuvant tamoxifen. Cochrane Database Syst. Rev. 2015; 12(12): CD007245. https://dx.doi.org/10.1002/14651858.CD007245.pub4.
  11. Trinh X.B., Tjalma W.A., Makar A.P. Use of the levonorgestrel-releasing intrauterine system in breast cancer patients. Fertil. Steril. 2008; 90(1): 17-22. https://dx.doi.org/10.1016/j.fertnstert.2007.05.033.
  12. Gompel A., Ramirez I., Bitzer J. Contraception in cancer survivors - an expert review Part I. Breast and gynaecological cancers. Eur. J. Contracept. Reprod. Health Care. 2019; 24(3): 167-74. https://dx.doi.org/10.1080/13625187.201.1602721.
  13. Medica A.C.O., Stark S.S., Hadnott T.N. Use of emergency contraception among female young adult cancer survivors. Fertil. Steril. 2018; 109(6): 1114-20.e1. https://dx.doi.org/10.1016/j.fertnstert.2018.02.136.
  14. National Institute of Cancer. Fertility issues in girls and women with cancer. Reviewed: February 24, 2020. Available at: https://www.cancer.gov/about-cancer/treatment/side-effects/fertility-women
  15. Rodolakis A., Biliatis I., Morice P. European Society of Gynecological Oncology Task Force for Fertility Preservation: clinical recommendations for fertility-sparing management in young endometrial cancer patients. Int. J. Gynecol. Cancer. 2015; 25(7): 1258-65. https://dx.doi.org/10.1097/IGC.0000000000000493.
  16. Pal N., Broaddus R.R., Urbauer D.L., Balakrishnan N., Milbourne A., Schmeler K.M. et al. Treatment of low-risk endometrial cancer and complex atypical hyperplasia with the levonorgestrel-releasing intrauterine device. Obstet. Gynecol. 2018; 131(1): 109-16. https://dx.doi.org/10.1097/AOG.0000000000002390.
  17. Dashti S.G., Chau R., Ouakrim D.A., Buchanan D.D., Clendenning M., Young J.P. et al. Female hormonal factors and the risk of endometrial cancer in Lynch syndrome. JAMA. 2015; 314(1): 61-71. https://dx.doi.org/10.1001/jama.2015.6789.
  18. Faubion S.S., MacLaughlin K.L., Long M.E., Pruthi S., Casey P.M. Surveillance and care of the Gyn Cancer Survivor. J. Womens Health (Larchmt). 2015; 24(11): 899-906. https://dx.doi.org/10.1089/jwh.2014.5127.
  19. Asthana S., Busa V., Labani S. Oral contraceptives use and risk of cervical cancer - A systematic review & meta-analysis. Eur. J. Obstet. Gynecol. Reprod. Biol. 2020; 247: 163-75. https://dx.doi.org/10.1016/j.ejogrb.2020.02.014.
  20. Averbach S., Silverberg M.J., Leyden W. Recent intrauterine device use and the risk of precancerous cervical lesions and cervical cancer. Contraception. 2018; April 7; S0010-7824( 18 )30144-6. https://dx.doi.org/10.1016/j.contraception.2018.04.008.
  21. Frega A., Scardamaglia P., Piazze J., Cerekja A., Pacchiarotti A., Verrico M., Moscarini M. Oral contraceptives and clinical recurrence of human papillomavirus lesions and cervical intraepithelial neoplasia following treatment. Int. J. Gynaecol. Obstet. 2008; 100(2): 175-8. https://dx.doi.org/10.1016/j.ijgo.2007.08.023.
  22. Rousset-Jablonski C., Selle F., Adda-Herzog E., Planchamp F., Selleret L., Pomel C. et al. Fertility preservation, contraception and menopause hormone therapy in women treated for rare ovarian tumors: guidelines from the French national network dedicated to rare gynaecological cancer. Bull. Cancer. 2018; 105(3): 299-314. https://dx.doi.org/10.1016/j.bulcan.2017.10.032.:299.
  23. Beral V., Doll R., Hermon C. Ovarian cancer and oral contraceptives:collaborative reanalysis of data from 45 epidemiological studies including 23,257 women with ovarian cancer and 87,303 controls. Lancet. 2008; 371(9609): 303-14. https://dx.doi.org/10.1016/S0140-6736(08)60167-1.
  24. Schrijver L.H., Antoniou A.C., Olsson H., Mooij T.M., Roos-Blom M.J., Azarang L. et al. Oral contraceptive use and ovarian cancer risk forBRCA1/2mutation carriers: an international cohort study. Am. J. Obstet. Gynecol. 2021; 225(1): 51.e1-51.e17. https://dx.doi.org/10.1016/j.ajog.2021.01.014
  25. Pragout D., Laurence V., Baffet H. Contraception and cancer: CNGOF contraception guidelines. Gynecol. Obstet. Fertil. Senol. 2018; 46(12): 834-44. https://dx.doi.org/10.1016/j.gofs.2018.10.010.
  26. Cravioto M.D. New recommendations from the World Health Organization (WHO) for the use of contraceptive methods. Gac. Med. Mex. 2016; 152(5): 601-3.
  27. Curtis K.M., Tepper N.K., Jatlaoui T.C., Berry-Bibee E., Horton L.G., Zapata L.B. et al. US medical eligibility criteria for contraceptive use, 2016. MMWR Recomm. Rep. 2016; 65(3): 1-103. https://dx.doi.org/10.15585/mmwr.rr6503a1.
  28. Management of Gestational Trophoblastic Disease: Green-top Guideline No. 38 - June 2020. BJOG. 2021; 128(3): e1-e27. https://dx.doi.org/10.1111/1471-0528.16266.
  29. Gockley A.A., Lin L.H., Davis M., Melamed A., Rizzo A., Sun S.Y. et al. Impact of clinical characteristics on human chorionic gonadotropin regression after molar pregnancy. Clinics (Sao Paulo). 2021; 76: e2830. https://dx.doi.org/10.6061/clinics/2021/e2830.
  30. Braga A., Maesta I., Short D., Savage P., Harvey R., Seckl M.J. Hormonal contraceptive use before hCG remission does not increase the risk of gestational trophoblastic neoplasia following complete hydatidiform mole: a historical database review. BJOG. 2016; 123(8): 1330-5. https://dx.doi.org/10.1111/1471-0528.13617.

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies