Hormonal birth control may reduce ovarian cancer risk in people with BRCA mutations
Full article: https://www.gynecologiconcology-online.net/article/S0090-8258(22)00022-1/fulltext#articleInformation
Hormonal birth control pill is linked to reduced ovarian cancer among people with an inherited BRCA mutation. Longer-acting forms of birth control given by implant, injection or as an intrauterine device may be associated with lower ovarian cancer risk for people with an inherited BRCA mutation. (Posted 4/28/23)
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Questions To Ask Your Health Care Provider
If you have a BRCA1/2 mutation and you need birth control:
- What ovarian cancer risk reduction approaches should I consider?
- How should I weigh the effectiveness of different types of birth control and their effects on ovarian cancer risk with other factors, such as convenience and side effects?
Open Clinical Trials
The National Comprehensive Cancer Network (NCCN) provides guidelines for management of gynecologic cancer risk in people with BRCA1 and BRCA2 mutations.
- Risk-reducing removal of ovaries and fallopian tubes, (known as salpingo-oophorectomy) is recommended between ages 35-40 for BRCA1 and 40-45 for BRCA2 and upon completion of childbearing.
- Research studies show that removing the ovaries can increase survival for women with BRCA1 mutations.
- Women should talk with their doctors about the effects of early menopause and options for managing them.
- Women should talk with their doctors about the risks and benefits of keeping or removing their uterus (hysterectomy), including:
- Women with a BRCA1 mutation have an increased risk for a rare form of aggressive uterine cancer; hysterectomy removes this risk.
- For women considering hormone replacement after surgery, the presence or absence of a uterus can affect the choice of hormones used.
- Estrogen-only hormone replacement is less likely to increase the risk for breast cancer, although it increases the risk for uterine cancer. Women who still have their uterus are typically given hormone replacement with both estrogen and progesterone.
- Adding progesterone to estrogen hormone replacement can protect against uterine cancer. However, the combination of these hormones may increase the risk for breast cancer more than estrogen alone.
- A medical history of fibroids or other uterine or cervical issues may justify a hysterectomy.
- Oral contraceptives (birth control pills) have been shown to lower the risk for ovarian cancer in women with BRCA1 mutations. Research on the effect of oral contraceptives on breast cancer risk has been mixed. Women should discuss the benefits and risks of oral contraceptives for lowering ovarian cancer risk with their doctors.
- Removal of the fallopian tubes only (salpingectomy) is being studied as an option for lowering risk in high-risk women who are not ready to remove their ovaries. Studies on the effects of salpingectomy are ongoing. At this time whether salpingectomy lowers the risk for ovarian cancer in high-risk women remains unknown.
- Consider enrolling in a research study looking at this procedure to lower cancer risk.
- There are no proven benefits to routine ovarian cancer screening using transvaginal and a CA-125 blood test. However, some doctors still recommend this screening, starting at ages 30-35.
- Women should be aware of the symptoms of gynecologic cancer and report abnormalities to their doctors.
The following are studies looking at ovarian cancer screening or prevention.
Additional clinical trials for ovarian cancer screening and prevention may be found here.
The following resources focus on BRCA1 and BRCA2 mutations.
- FORCE resources:
- Resources from other organizations:
- Genetics Home Reference is a site from the U.S. Library of Medicine that provides consumer-friendly information about the effects of a BRCA1 or BRCA2 mutation on people's health.
- Basser Center for BRCA
FORCE is a national nonprofit organization, established in 1999. Our mission is to improve the lives of individuals and families affected by adult hereditary cancers.