DR SHAZIA MALIK: The risks of the Pill are tiny… there’s no need to panic

The first thing I’d say is ‘Don’t panic’. The headlines might sound alarming but when you dig down into the figures, it’s clear that your risk of breast cancer below the age of 50 is still small, no matter what form of contraception you’re on. And in your 20s and 30s, it’s minuscule.

What’s important to remember when reading cancer-risk statistics like these is that increases are expressed as percentages of existing numbers that are in fact very low.

A 30-year-old woman’s likelihood of getting breast cancer in the next ten years, for example, is less than one per cent, so a 26 per cent increase on that — the rise 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 roughly 1.6 per cent, so if her risk also goes up by 26 per cent, she’s looking at a two per cent overall risk instead. Still very small.

I’m surprised that we haven’t looked at progestogen-only contraception in such depth until now, but I don’t think we can blame it on a more general neglect of women’s health. For years we’ve simply focused on oestrogen as a potential driver of risk for breast cancer — but now we know that’s only part of the picture.

Research is also catching up with changing prescription trends. In the past ten to 15 years, women have increasingly stopped using the combined oestrogen and progestogen pill, largely due to unwanted side-effects, and instead turned to progestogen-only contraceptives. Today, almost as many women in the UK are on the progestogen-only mini pill as the combined pill.

What’s important to remember when reading cancer-risk statistics like these is that increases are expressed as percentages of existing numbers that are in fact very low (file photo)

What does surprise me is the finding in this study that the risk for the progestogen-releasing coil is higher than for either the combined or progestogen-only pill. We don’t understand that at all, as the levels of circulating hormone are far lower with a coil than with oral contraception. The risk theoretically should be lower, too. It’s an anomaly that needs investigating.

What’s undeniable is that the Pill and the coil in all forms can have a hugely beneficial 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 stop unwanted pregnancies. Especially important is that hormonal contraception has reversed the high rate of pregnancy we used to see in teenagers. The progestogen-only pill or coil can be used by breastfeeding mothers, and the combined pill is known to reduce the risk of ovarian, endometrial and colon cancers.

It would be a tragedy if all the gains of hormonal contraception were undone because women are frightened of what’s still a tiny risk.

Research is also catching up with changing prescription trends. In the past ten to 15 years, women have increasingly stopped using the combined oestrogen and progestogen pill, largely due to unwanted side-effects, and instead turned to progestogen-only contraceptives (file photo)

For me, this study is just one piece of information to use when advising women about what form of contraception is best for them. It’s vital to treat women as individuals and assess their lifestyle and overall health before helping them make a decision. Since 2021, the progestogen-only pill can be bought at pharmacies without a prescription, handing pharmacists a crucial role in women’s reproductive health, too.

Breast cancer in young women is still not well understood. But if a woman is worried 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 has a baby — a known protective effect. Women mustn’t be alarmed, but should work with a GP, family-planning clinic or a gynaecologist for the best chance of getting what they want out of their fertile years, whether it’s a family or not.

shaziamalik.co.uk