Oral contraception use in BRCA gene mutation carriers: information for counselling in routine clinical practice

Abstract

The objective of this narrative review is to put risks and benefits for the use of oral contraception (OC) into perspective in counselling high-risk carriers of BRCA1 or BRCA2 gene mutations. We searched PubMed, Embase, and the Cochrane Library for studies that evaluated associations between OC use and breast or ovarian cancer among women who are carriers of BRCA1/2 mutations. All studies concordantly demonstrated an inverse correlation between OC and ovarian cancer risk in BRCA mutated women. Regarding breast cancer risk, results are conflicting with some studies reporting a slightly increased risk associated with OC use, whereas others reveal no evidence of a significant association in carriers. Numerous potential cancer risk modifiers and the modern evolution of OC can partly explain these results. OC use may also reduce the risk of extra-ovarian cancers such as those of the colon and endometrium, as observed in the general population. BRCA1/2 carriers should always receive a sensible and patient-centered contraceptive counselling because current evidence does not support recommendation against OC use, taking into account the individual profile.