Survivorship is an increasingly important component of care for patients with breast cancer, as life spans have increased. For premenopausal women with breast cancer, contraception is an important aspect to consider, and some researchers have speculated that misunderstandings about their fertility and a lack of adequate contraceptive counseling may have led to greater use of emergency contraception and a high rate of induced abortions.
Therefore, a team of researchers evaluated the methods and factors of contraceptive use in premenopausal women with early breast cancer. Their findings were published in JAMA Network Open.
The researchers analyzed data from 2900 premenopausal patients, aged 50 years and younger at diagnosis, who were part of the Cancer Toxicity (CANTO) study, a multicenter prospective cohort study in France that enrolled patients with stage I, II, and III breast cancer from 2012 to 2017. They evaluated contraceptive use and methods at diagnosis, year 1 (approximately 1 year after diagnosis and 3 to 6 months after primary treatment), and year 2 (approximately 2 years after diagnosis and 1 year after primary treatment).
Study findings showed that more women consulted with their gynecologist at some point during the past year in the second year than in the first (1182 of 2625 patients [45.0%] at year 1 and 1553 of 2363 patients [65.7%] at year 2.
At diagnosis, 1487 of 2744 patients (54.2%) reported using contraception, with most (921/1470; 62.7%) opting for hormonal methods. Contraception use decreased significantly after diagnosis (911/2342 patients [38.9%] at year 1 and 808/1961 patients [41.2%] at year 2).
Their chosen methods of contraception also changed over time. At year 1, 94.2% (848/900 women) reported using nonhormonal methods of contraception, a percentage that increased slightly to 95.3% (767/805 women) at year 2.
Most of those using nonhormonal methods had chosen the copper intrauterine device (656/848 [77.4%] at year 1 and 577/767 [75.2%] at year 2). Only a small number had opted for nonreversible procedures such as hysterectomy, salpingectomy, or other procedure: 36 of 848 women (4.2%) at year 1 and 28 of 767 women (3.7%) at year 2.
Participants using contraception at year 1 were more likely to be younger, have a higher socioeconomic status, have a partner, and have children. They also were more likely to have consulted with a gynecologist in the previous year.
Patients with breast cancer could benefit from targeted contraceptive counseling at diagnosis and follow-up, noted the researchers. Targeted counseling should help patients choose a reliable method that is most appropriate for them. This is a particularly sensitive issue for patients with hormonally based tumors, such as breast cancer.
The researchers also suggest promoting long-term follow-up care by oncofertility units, which can provide access to fertility preservation strategies, promote reproductive health care, and provide contraceptive counseling to this expanding and vulnerable patient population.
The findings are limited because the CANTO study only reflects the practices of 1 country, and data on pregnancy intentions and attempts weren’t collected, nor was information about sexual orientation.
Disclosures: Some authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.
Lambertini M, Massarotti C, Havas J, et al. Contraceptive use in premenopausal women with early breast cancer. JAMA Netw Open. 2022;5(9):e2233137. doi:10.1001/jamanetworkopen.2022.33137