From the Guidelines
The use of a progesterone (progestin) intrauterine device (IUD) does not significantly increase the risk of breast cancer, as evidenced by the U.S. Medical Eligibility Criteria for Contraceptive Use, 2010 1. When considering the risk of breast cancer associated with the use of hormonal IUDs, it's essential to weigh this against the benefits and other risks. The U.S. Medical Eligibility Criteria for Contraceptive Use, 2010, provides classifications for various conditions, including breast disease, in relation to different contraceptive methods 1. Key points to consider include:
- The classifications for breast disease indicate that the use of a levonorgestrel-releasing intrauterine system (LNG-IUD) is categorized as 2 for undiagnosed breast mass, 1 for benign breast disease, and 1 for family history of cancer, suggesting that the risk associated with LNG-IUDs is not significantly higher than other hormonal contraceptives 1.
- For current breast cancer, the classification is 4, indicating that the use of hormonal IUDs is not recommended, but for past breast cancer with no evidence of current disease for 5 years, the classification is 3, suggesting caution but not an absolute contraindication 1.
- The benefits of progesterone IUDs, such as reduced menstrual bleeding and protection against endometrial cancer, should be considered alongside the potential risks.
- For women with a strong family history of breast cancer or other risk factors, discussing alternative non-hormonal contraceptive options with a healthcare provider is advisable. Given the information from the U.S. Medical Eligibility Criteria for Contraceptive Use, 2010 1, and considering the principles of minimizing morbidity, mortality, and maximizing quality of life, the decision to use a progesterone IUD should be made on an individual basis, taking into account the woman's medical history, risk factors, and personal preferences, with careful consideration of the potential benefits and risks.
From the Research
Association Between Progesterone IUD and Breast Cancer Risk
- The use of a levonorgestrel-releasing intrauterine device (LNG-IUD) has been associated with a slightly increased risk of breast cancer in some studies 2, 3.
- A national cohort study in Sweden found that LNG-IUD use was associated with a 13% higher risk of breast cancer (adjusted HR, 1.13; 95% CI, 1.10-1.17) 2.
- A systematic review and meta-analysis found that LNG-IUS users had an increased breast cancer risk, with an odds ratio of 1.16 (95% CI 1.06-1.28) for all women 3.
- However, another study found no increased risk of breast cancer for users of LNG-IUD compared to copper IUDs (adjusted OR, 0.99; 95% CI, 0.88-1.12) 4.
Factors Influencing Breast Cancer Risk
- Family history of cancer may interact with LNG-IUD use to increase breast cancer risk, with a significant additive interaction observed in one study 2.
- Age may also be a factor, with one study suggesting that the effect of LNG-IUS on breast cancer risk may be larger in older users 3.
- Other risk factors for breast cancer, such as obesity and familial predisposition, may also be relevant when considering the use of LNG-IUDs 3.
Clinical Implications
- Clinical recommendations regarding the use of LNG-IUD should carefully weigh its potential benefits and risks, particularly for women with a family history of breast cancer 2.
- Close monitoring is advisable for the potential development of breast cancer, particularly among women with a family history of breast cancer 2.
- Breast cancer screening guidelines recommend biennial screening mammography for average-risk women 50 to 74 years of age, but individualized decision-making is recommended for women 40 to 49 years of age 5.