The level of evidence (I-III) and classification of recommendations (A-E) are defined at the end of the "Major Recommendations" field.
In-Vitro and Animal Data
Summary Statement
Progesterone and progestins can have a proliferative, antiproliferative, or neutral effect on breast tissue, depending on the type, timing, and dose of progestin used. (I)
Human Data
Depot Medroxyprogesterone Acetate (DMPA)
Summary Statement
Use of DMPA does not increase the risk of breast cancer in the general population. (II-2)
Recommendation
DMPA use in a breast cancer survivor can be considered in circumstances where contraceptive or non-contraceptive benefits outweigh any unknown potential increase in recurrence risk. (III-C)
Progestin-Only Oral Contraceptives
Summary Statement
Although not as well-studied as the combined oral contraceptive pill, progestin-only pills (POPs) do not appear to increase the risk of breast cancer in the general population. (II-2)
Recommendation
Use of POPs in a breast cancer survivor may be considered in a situation where known benefits outweigh any unknown potential increase in recurrence risk. (III-C)
Contraceptive Implants
Summary Statement
There is insufficient evidence to comment on risk or recurrence risk of breast cancer with contraceptive implants in the general population (II-2C) or among breast cancer survivors. (III)
Levonorgestrel-Releasing Intrauterine System (LNG-IUS)
Summary Statement
The limited data available suggest that the LNG-IUS does not seem to increase breast cancer risk in the general population. (II-2)
Recommendation
Use of the LNG-IUS in the breast cancer survivor can be considered if the unique contraceptive or non-contraceptive benefits outweigh the risk of an unknown effect on recurrence. (III-C)
Conclusions
Summary Statements
Sterilization and the copper intrauterine device (IUD) are the most reliable non-hormonal contraceptive methods. (II-1)
Other non-hormonal methods may also be appropriate given decreased fertility with advancing age and after chemotherapy. (III)
Further research into progestin-only contraception in the breast cancer survivor is needed. (III)
Recommendation
Non-hormonal contraceptive methods should be used as first-line options in the breast cancer survivor. (III-C)
Definitions:
Level of Evidence*
I: Evidence obtained from at least one properly designed randomized controlled trial.
II-1: Evidence from well-designed controlled trials without randomization.
II-2: Evidence from well-designed cohort (prospective or retrospective) or case–control analytic studies, preferably from more than one centre or research group.
II-3: Evidence from comparisons between times or places with or without the intervention. Dramatic results in uncontrolled experiments (such as the results of treatment with penicillin in the 1940s) could also be included in this category.
III: Opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees.
Classification of Recommendations**
- There is good evidence to support the recommendation that the condition be specifically considered in a periodic health examination.
- There is fair evidence to support the recommendation that the condition be specifically considered in a periodic health examination.
- There is poor evidence regarding the inclusion or exclusion of the condition in a periodic health examination.
- There is fair evidence to support the recommendation that the condition not be considered in a periodic health examination.
- There is good evidence to support the recommendation that the condition be excluded from consideration in a periodic health examination.
*The quality of evidence reported in these guidelines has been adapted from the Evaluation of Evidence criteria described in the Canadian Task Force on the Periodic Health Exam.
**Recommendations included in these guidelines have been adapted from the Classification of Recommendations criteria described in the Canadian Task Force on the Periodic Health Exam.
