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    Breast cancer and the combined pill

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      If you have a family history of breast cancer, ovarian cancer or prostate cancer, the combined pill might increase this risk. In this article we’re going to look at why that is and if you’re at particular risk. 

      Should I take the pill if I have a family history of breast cancer? 

      If you have a family history of breast cancer you should tell your clinician when you’re requesting the pill. This is to make sure it’s safe for you.

      If your family is known to carry a faulty BRCA gene, the combined pill may possibly increase this risk further and is best avoided. 

      BRCA genes and cancer 

      The BRCA1 and BRCA2 genes are 2 genes that everybody has. These genes usually protect us from breast and ovarian cancers. If you get a mutation (when the structure inside a gene is changed permanently) in one of these genes they no longer give us that protection.

      The risk is highest for breast cancer in women, but it’s also above average for ovarian cancer, prostate cancer, breast cancer in men and pancreatic cancer. 

      Do faulty BRCA genes run in families? 

      Our genes are inherited from our parents. So if your parents have the BRCA gene mutations there’s a chance you will inherit these, and if so, you could pass them onto any of your children. 

      A woman who inherits a BRCA1 or BRCA2 gene mutation will have a high risk of breast and ovarian cancer, and has a 50% chance of passing this mutation onto each of her children.  

      A man who inherits a BRCA1 or BRCA2 gene mutation may have a small increased risk of male breast cancer. They also may have an increased risk of prostate or pancreatic cancer, and has a 50% chance of passing this mutation onto each of his children.  

      But it’s important to mention that not everyone with a BRCA1 or BRCA2 mutation has a family history of cancer. 

      How can the combined pill increase my risk of cancer? 

      Taking the combined pill is associated with an increased risk in some cancers, such as breast and cervical cancer. But taking the combined pill can reduce the risk of other cancers, such as ovarian, womb and bowel cancer.

      Those taking the combined contraceptive pill over long periods of time may have a slightly increased risk of breast cancer and cervical cancer. According to Breast Cancer Now, in a group of 10,000 women who do not use the combined pill, about 40 will probably develop breast cancer between the ages of 30 and 39. 

      In a group of 10,000 women who do use the combined pill for most of their 30s, about 54 will develop breast cancer between the ages of 30 and 39. So using the combined pill during this time causes about 14 extra cases of breast cancer in every 10,000 women. 

      The link between the pill and breast cancer risk is not yet clear, but it is thought the hormones in the combined contraceptive pill (oestrogen and progestogen) can increase the growth of some breast cancers. 

      This risk falls again once you stop taking the combined contraceptive pill, and 10 years after stopping, the person’s risk is no longer increased. 

      If you have the faulty BRCA genes, you are already at high risk of breast and ovarian cancer, so taking the combined pill is an added risk.

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      Does taking the mini-pill affect cancer risk? 

      Research is ongoing into any relationship between breast cancer and the progestogen-only pill (mini-pill), such as Cerazette. There is not enough evidence to suggest a link between the mini pill and breast cancer. If there is any increased risk, it's likely to be very small and disappear with time when you stop taking it. 

      There is no evidence to suggest the mini-pill is linked to an increased ovarian cancer risk. 

      Are you at risk? 

      Breast cancer is very common and most of us will know at least one person who’s been affected by it. It can happen unexpectedly, but if you have a faulty BRCA gene you’re more at risk of cancer. The faulty gene is more likely in those with a family history of cancer. 

      Examples of patterns of cancer in the family include: 

      • A first degree relative had breast cancer before the age of 40 (first-degree relatives are parents, brothers, sisters and children) 
      • Several family members have been diagnosed with breast or ovarian cancer 
      • A relative had breast cancer in both breasts (bilateral breast cancer). 
      • A male relative with breast cancer 

      You might also be at risk if you have an Eastern European or Ashkenazi Jewish (Eastern European Jewish) background.  

      If you have any of the above patterns in your family, or fall into any of these groups, you should speak to your GP before requesting the combined pill.  

      What should you do if you're at risk? 

      If you fall into any of the patterns or groups above, then you should have a chat with your GP to discuss whether a referral to a breast or genetic clinic is worthwhile. This is especially important if you are over 35 years of age.

      You should not request the combined pill from us until you’re happy about your own risk of breast cancer.

      If you are currently taking the pill but are in one of the at-risk groups; please don’t just stop the combined pill. Talk to your GP first, as it may be fine for you to continue.. 

      References 

      https://www.cancerresearchuk.org/about-cancer/causes-of-cancer/hormones-and-cancer/does-the-contraceptive-pill-increase-cancer-risk
      https://breastcancernow.org/information-support/have-i-got-breast-cancer/breast-cancer-causes/pill-breast-cancer-risk
      https://www.macmillan.org.uk/cancer-information-and-support/worried-about-cancer/causes-and-risk-factors/brca-gene
      https://www.nhs.uk/conditions/contraception/combined-contraceptive-pill/
      https://www.nhs.uk/conditions/contraception/the-pill-progestogen-only/

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