DR. SHAZIA MALIK: The risks of the pill are tiny…no need to panic

The first thing I would say is “don’t panic”. The headlines may sound alarming, but when you look at the numbers, it’s clear that your risk of breast cancer under the age of 50 is still low, no matter what form of birth control you use. And in your 20s and 30s it’s tiny.

When reading cancer risk statistics like these, it’s important to remember that increases are expressed as percentages of existing numbers, which are actually very low.

For example, a 30-year-old woman’s chance of developing breast cancer in the next 10 years is less than 1 percent, a 26 percent increase — the increase associated with taking the progestogen-only pill for five years in this study – will still be tiny. The figure for a 40-year-old is about 1.6 percent. So if her risk also increases by 26 percent, she sees an overall risk of 2 percent instead. Still very small.

I’m surprised we haven’t looked at progestin-only birth control as extensively, but I don’t think we can blame a more general neglect of women’s health. For years we simply focused on estrogen as a potential risk driver for breast cancer — but now we know that’s only part of the picture.

The research is also catching up with changing prescription trends. In the past ten to 15 years, women have increasingly discontinued the combined estrogen-progestin pill, mainly because of undesirable side effects, and switched to pure progestin contraceptives instead. Today almost as many women in the UK are taking the progestogen-only minipill as the combined pill.

DR. SHAZIA MALIK: The first thing I would say is don’t panic. The headlines may sound alarming, but when you look at the numbers, it’s clear that your risk of breast cancer under the age of 50 is still low, no matter what form of birth control you use. And in your 20s and 30s, it’s tiny (Pictured Consultant Obstetrician-Gynecologist Dr. Shazia Malik)

When reading cancer risk statistics like these, it’s important to remember that increases are expressed as percentages of existing numbers, which are actually very low (file photo).

What surprises me is the finding of this study that the risk for the progestogen-releasing IUD is higher than for the combined or the progestogen-only pill. We don’t understand this at all as the levels of circulating hormone are much lower with an IUD than with oral contraception. In theory, the risk should also be lower. It’s an anomaly that needs to be investigated.

It is undeniable that the pill and the IUD in all forms can have a tremendously positive impact on a woman’s quality of life in her reproductive years. Doctors see the relief they bring all the time. They can end the misery of heavy, debilitating periods or chronic pelvic pain, and of course, they prevent unwanted pregnancies. Most importantly, hormonal birth control has reversed the previously high rate of teenage pregnancy. The progestogen-only pill or IUD can be used by mothers who are breastfeeding, and the combination pill is known to reduce the risk of ovarian, endometrial and colon cancer.

It would be a tragedy if all the achievements of hormonal contraception were to be wiped out because women are afraid of the still small risk.

The research is also catching up with changing prescription trends. In the last 10 to 15 years, women have increasingly stopped using the oestrogen-progestin combined pill, mainly because of undesirable side effects, and switched to progestin-only contraceptives instead (File Photo)

For me, this study is just information to advise women on what form of contraception is best for them. It’s important to treat women as individuals and to assess their lifestyle and overall health before helping them make a decision. Since 2021, the progestogen-only pill can be bought in pharmacies without a prescription, which means that pharmacists also play a crucial role in women’s reproductive health.

Breast cancer in young women is still not well understood. But if a woman is concerned about her risk, there are things she can do, including not drinking more than one unit of alcohol a week, watching her weight, and trying to breastfeed if she’s having a baby — one known protective effect. Women need not be alarmed but should work with a family doctor, family planning clinic, or gynecologist to have the best chance of making the most of their reproductive years, whether it involves a family or not.

shaziamalik.co.uk