Use of contraception decreases after breast cancer diagnosis
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Contraceptive use significantly decreased 1 year after first-line treatment and at 2-year follow-up among premenopausal women diagnosed with breast cancer, according to study results published in JAMA Network Open.
Contraceptive use at diagnosis, being younger, having better sexual function, having children and receipt of tamoxifen treatment alone all appeared associated with greater odds of contraceptive use after diagnosis, researchers noted.
Background and methods
Survivorship has become a key component of breast cancer care as the lifespan of patients with cancer has increased, according to study background.
“Contraception is a topic that is not often discussed by oncologists with our patients, and there are a lot of misconceptions by the oncology community. Hence, it is not unlikely to have pregnancies in patients neither willing nor trying to get pregnant,” Matteo Lambertini, MD, PhD, assistant professor and consultant medical oncologist at the IRCCS Ospedale Policlinico San Martino at University of Genova, Italy, told Healio.
The multicenter, nationwide, prospective Cancer Toxicity (CANTO) cohort study included 2,900 premenopausal women (mean age, 43.1 years) diagnosed with stage I to stage III breast cancer in France between March 2012 and December 2017.
Researchers examined contraceptive use at the end of first-line treatment and again at 2-year follow-up. They also assessed chosen contraceptive methods and factors associated with contraceptive use throughout time.
Researchers then used multivariable logistic regression models to assess associations of clinical, socioeconomic, treatment, adverse effect and patient-reported outcome variables with contraceptive use after diagnosis.
Findings
Overall, 70.8% of women underwent chemotherapy and 80% underwent endocrine therapy. Forty-five percent of women reported a consultation with a gynecologist at 1 year after diagnosis and 65.7% reported a consultation 2 years after diagnosis.
Researchers found that more than half (54.2%) of women reported contraceptive use at the time of diagnosis, and the majority (62.7%) of them used hormonal methods.
However, contraceptive use significantly decreased 1 year after breast cancer treatment (38.9%) and at 2-year follow-up (41.2%; P < .001 for trend), with most women reporting use of nonhormonal methods at year 1 (94.2%) and year 2 (95.3%).
The most common contraception methods included reversible mechanical approaches, such as copper intrauterine devices at year 1 (77.4%) and year 2 (75.2%). Use of male condoms were also reported among 13.6% of women at year 1 and 14.3% at year 2.
Results of multivariable models showed common factors associated with contraceptive use at year 1 included contraceptive use at diagnosis (adjusted OR = 4.02; 95% CI, 3.15-5.14), younger age (adjusted OR = 1.09; 95% CI, 1.07-1.13 per decreasing year), better sexual function (adjusted OR = 1.13; 95% CI, 1.07-1.19 per 10-point increment) and having children (adjusted OR = 4.21; 95% CI, 1.8-9.86).
Additional factors included reporting the presence of leukorrhea (adjusted OR = 1.32; 95% CI, 1.03-1.7), receipt of tamoxifen therapy alone (adjusted OR = 1.39; 95% CI, 1.01-1.92) and consultation with a gynecologist within the previous year (adjusted OR = 1.29; 95% CI, 1.02-1.63). Researchers identified similar factors associated with contraceptive use at year 2, in addition to partnered status (adjusted OR = 1.61; 95% CI, 1.07-2.44).
Implications
The findings support the need to raise awareness and improve targeted contraceptive counseling for premenopausal women at breast cancer diagnosis and follow-up, the researchers wrote.
“To properly manage this issue, it is key to have a close collaboration with gynecologists and build the oncofertility unit,” Lambertini said. “The link between oncologists and gynecologists is relevant not only for offering fertility preservation strategies at diagnosis but also during treatment and follow-up to properly manage other gynecological-related issues among young patients with breast cancer, such as contraception and the gynecological side effects of adjuvant endocrine therapy.”
The study highlighted several unmet needs of breast cancer survivors, according to a related editorial in JAMA Oncology by Maryam B. Lustberg, MD, MPH, associate professor in the department of internal medicine in the division of medical oncology at Yale Cancer Center.
“Patients diagnosed with breast cancer face a myriad of survivorship issues throughout their lifespan,” Lustberg wrote. “Among these are reproductive health concerns, which are encountered by an increasing number of younger breast cancer survivors and include issues surrounding fertility, pregnancy, and contraception. A particular gap in care is the limited access to evidence-based gynecological care, including contraceptive counseling for those not desiring pregnancy.
A coordinated, comprehensive biopsychosocial model that addresses biological, psychological, interpersonal and sociocultural factors is needed to address cancer-associated sexual and reproductive concerns, according to Lustberg.
“These items would ideally be able to be personalized and delivered via close partnerships between cancer survivors and multidisciplinary teams using an integrated approach,” she wrote. “Such coordinated efforts often require access to specialists in women’s health, pelvic floor rehabilitation, and psychosocial oncology working closely with oncologists and primary care clinicians. All individuals diagnosed with cancer need to have the opportunity to make the most informed decisions about reproductive and sexual health before, during and after cancer treatment.”
References :
- Lambertini M, et al. JAMA Netw Open. 2022;doi:10.1001/jamanetowrkopen.2022.33137.
- Lustberg MB. JAMA Netw Open. 2022;doi:10.1001/jamanetworkopen.2022.33147.
For more information:
Matteo Lambertini, MD, PhD, can be reached at matteo.lambertini@unige.it.
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