Should women at high risk for cancer use oral contraceptive pills?

Oral contraceptive pills (OCPs) are the most commonly used reversible method of contraception in the USA, and more than 80% of women aged 15–44 years report having taken them at some time [1]. Most women considering their contraceptive options base their decision to use OCPs on the effectiveness, convenience and tolerability of the method. For women with a family history of hormonally influenced cancers, whether or not they decide to use OCPs is further influenced by the effect of these pills on their risk for cancer.

The decision to use OCPs entails complex considerations for women at high risk for cancer. High-risk women are a heterogeneous group, at increased risk for different cancers depending on their family history or the specific genetic mutation they carry. Furthermore, the effect of OCPs depends on the specific cancer site, with increased risks reported for some sites (e.g., breast) [2] and decreased risks for others (e.g., ovarian, endometrium) [2,3]. Therefore, the question of whether women at high risk for cancer should use OCPs does not have a simple answer and is certainly not a ‘one-size-fits-all’ situation.