Hormonal contraception and risk of breast cancer: a critical look

Association of hypertension, hyperlipidemia, obesity, and demographic risk factors with breast cancer in Bangladeshi women

In recent years, breast cancer incidences and related deaths have been rising among Bangladeshi women and will be a major threat by 2040. So, conducting more population-based studies is crucial. This case-control study was designed to quantitatively evaluate potential risk factors for breast cancer. In this population-based case-control study, 52 random breast cancer cases and 59 matched healthy controls, aged between 25 and 70 years, were included. The breast cancer patient samples were collected from the National Institute of Cancer Research and Hospital (NICRH), Dhaka, Bangladesh, from December 2021 to February 2022. The study was conducted fully following the Declaration of Helsinki guidelines. The collected socio-demographic data and blood samples of the study participants were analyzed. Chi-square analysis was used to compare study characteristics between cases and controls, Odds ratios (ORs) with 95% confidence intervals (CIs) were derived by univariate-logistic regression, and models were adjusted where necessary for study characteristics. Summary demographic characteristics of the 111 study participants suggested that higher age: (≥45): [OR 4.38, 95% CI (1.94-9.89), P value <.001], height: (<1.5 m): [OR 3.01, 95% CI (1.12-8.12), P value .029], low-incomes: [OR 6.83, 95% CI (2.11-22.05), P value .001], and illiteracy: [OR 12.65, 95% CI (3.49-45.79), P value .0001] showed significant correlations with breast cancer. The patient's body mass index (BMI) (≥30) indicated an association with breast cancer: [OR 3.91, 95% CI (1.00-15.31), P value .05]. The lipid profile: [triglycerides (TG): OR = 3.20, 95% CI (1.36-7.53), P value .008; TG/high-density lipid (HDL): OR = 8.82, 95% CI (2.81-27.68), P value <.001; and a lowered HDL: OR = 3.32, 95% CI (1.38-7.98), P value .007], hypertension: [systolic: OR 4.32, 95% CI (1.71-10.93), P value .002; and diastolic: OR 7.32, 95% CI (2.51-21.34), P value <.001], and gastric issues: [OR 6.07, 95% CI (2.00-18.37), P value .001], all showed significant association with breast cancer. The ER- breast cancer subtype was significantly associated with the overweight (OW) group (P value .046) whereas the PR-patients were significantly higher in the normal BMI group (P value .013). Results from this study might aid in the prevention, management, and raising of awareness against the specific risk factors among Bangladeshi women in near future.

A Review of Breast Cancer Risk Factors in Adolescents and Young Adults

Simple Summary

Cancer diagnosed in patients between the ages of 15 and 39 deserves special consideration. Diagnoses within this cohort of adolescents and young adults include childhood cancers which present at an older age than expected, or an early presentation of cancers that are typically observed in older adults, such as breast cancer. Cancers within this age group are associated with worse disease-free and overall survival rates, and the incidence of these cases are rising. Knowing an individual’s susceptibility to disease can change their clinical management and allow for the risk-testing of relatives. This review discusses the risk factors that contribute to breast cancer in this unique cohort of patients, including inherited genetic risk factors, as well as environmental and lifestyle factors. We also describe risk models that allow clinicians to quantify a patient’s lifetime risk of developing disease.

Abstract

Cancer in adolescents and young adults (AYAs) deserves special consideration for several reasons. AYA cancers encompass paediatric malignancies that present at an older age than expected, or early-onset of cancers that are typically observed in adults. However, disease diagnosed in the AYA population is distinct to those same cancers which are diagnosed in a paediatric or older adult setting. Worse disease-free and overall survival outcomes are observed in the AYA setting, and the incidence of AYA cancers is increasing. Knowledge of an individual’s underlying cancer predisposition can influence their clinical care and may facilitate early tumour surveillance strategies and cascade testing of at-risk relatives. This information can further influence reproductive decision making. In this review we discuss the risk factors contributing to AYA breast cancer, such as heritable predisposition, environmental, and lifestyle factors. We also describe a number of risk models which incorporate genetic factors that aid clinicians in quantifying an individual’s lifetime risk of disease.

The impact of oral contraceptive use on breast cancer risk: State of the art and future perspectives in the era of 4P medicine

Breast cancer is the most commonly occurring cancer in women, the second most frequent cancer overall, and it causes the greatest number of cancer-related deaths among women. The significant increased concern of breast cancer worldwide may be attributed to the prolonged life expectancy and the adoption of the western lifestyle with its related risks factors. A woman's risk for breast cancer is linked to her reproductive history and with her lifetime hormonal exposure. Among the known risk factors for breast cancer, several studies investigated the possible role of the assumption of hormonal "pills" in both breast cancer incidence and development. Nevertheless, data about the association between the assumption of oral contraceptives and breast cancer incidence are still controversial and not conclusive. Given the public health importance of breast cancer and the popularity of hormonal "pills" as contraceptive, the impact of oral contraceptive use on breast cancer risk assumes relevance from both a clinical and a social point of view. Therefore, in this review we wanted to illustrate this issue by addressing the following major themes: a) the role of sex steroid hormones in female breast development and carcinogenesis; b) the clinical impact of hormonal oral contraception according to the state of the art literature; c) the actual scientific debate and future perspectives.

Contraception in chronic kidney disease: a best practice position statement by the Kidney and Pregnancy Group of the Italian Society of Nephrology

Even though fertility is reduced, conception and delivery are possible in all stages of CKD. While successful planned pregnancies are increasing, an unwanted pregnancy may have long-lasting deleterious effects, hence the importance of birth control, an issue often disregarded in clinical practice. The evidence summarized in this position statement is mainly derived from the overall population, or other patient categories, in the lack of guidelines specifically addressed to CKD. Oestroprogestagents can be used in early, non-proteinuric CKD, excluding SLE and immunologic disorders, at high risk of thromboembolism and hypertension. Conversely, progestin only is generally safe and its main side effect is intramestrual spotting. Non-medicated intrauterine devices are a good alternative; their use needs to be carefully evaluated in patients at a high risk of pelvic infection, even though the degree of risk remains controversial. Barrier methods, relatively efficacious when correctly used, have few risks, and condoms are the only contraceptives that protect against sexually transmitted diseases. Surgical sterilization is rarely used also because of the risks surgery involves; it is not definitely contraindicated, and may be considered in selected cases. Emergency contraception with high-dose progestins or intrauterine devices is not contraindicated but should be avoided whenever possible, even if far preferable to abortion. Surgical abortion is invasive, but experience with medical abortion in CKD is still limited, especially in the late stages of the disease. In summary, personalized contraception is feasible, safe and should be offered to all CKD women of childbearing age who do not want to get pregnant.