Only about half of all breast cancer survivors seek gynecological care

Contraception is a challenge after breast cancer, since traditional hormone-based treatments are not an option. But the limited choices in birth control aren’t the only things keeping breast cancer survivors from effective contraception.

The belief that cancer treatments can cause infertility, as well as an overall decline in sexual satisfaction are both big deterrents in seeking effective birth control for many women who have beat breast cancer, a new study reveals. And the consequence isn’t just a lower quality of life. Premenopausal breast cancer survivors often turn to induced abortions or emergency contraceptives to handle unintended pregnancies, the study reveals. This problem highlights the need for more attention on the sexual and reproductive health of women with a history of breast cancer.

As cancer treatments improve and lifespans for cancer survivors are increasing, these and other new challenges are becoming more clear.

Although there is clear guidance on managing fertility associated with cancer treatment, there is less evidence to support decision-making about reproductive health issues like pregnancy prevention.

The new report, published in JAMA Open Network by a research team in Italy, reveals that many premenopausal women that survive breast cancer find themselves faced with unplanned pregnancies after using ineffective contraceptive methods or mistakenly assuming their oncology treatments had left them infertile. The goal of the report, according to the research team was to identify how women use birth control after breast cancer, what barriers they face, and how to make contraception a bigger part of the post-cancer discussion.

Better contraceptive counseling is needed for women who survive breast cancer and want to prevent pregnancy, the report states. This issue may become even more important as the duration of some teratogenic breast cancer treatments like tamoxifen may be extended for as long as five to 10 years after diagnosis.

The research team used data from the Cancer Toxicity (CANTO) cohort study to assess the use of birth control in premenopausal women who had survived breast cancer. The cohort was made up of almost 3,000 survivors of stages I, II, and III breast cancer in France over a five-year period. Among these study participants, researchers specifically examined their contraceptive use and the quality of their sexual health before menopause and in the first two years after cancer treatment.

The report found that about 78.5% of the group studied reported being in a partnership or relationahip at the time of their cancer diagnosis, and 96% already had children. In terms of treatment types, nearly 71% of participants received chemotherapy, and 80% received endocrine therapy. Most of the cohort—80%—that was treated with endocrine therapies were administered tamoxifen alone, while the other 20% were treated with other hormonal therapies like ovarian suppression treatments.

Despite these treatment results, the study revealed that just 54% of the women were using contraception at the time of their cancer diagnosis, and that number dropped to about 40% in the two years after breast cancer treatment.

The type of birth control used after breast cancer treatment also changed. Even though nearly 63% were using hormonal contraceptives at the time of their diagnosis, only 5% to 6% were still using these types of birth control after treatment. Instead, 95% of the breast cancer survivors polled turned to non-hormonal birth control options like:

• reversible mechanical methods (89%-91%)
• intrauterine devices (75%-77%)
• male condoms (13%-14%)

Some participants reported using a combination of non-hormonal contraceptive strategies, and about 4% sought out nonreversible procedures such as hysterectomy to prevent pregnancy, according to the report.

Meanwhile, the study notes that only about 45% of participants in the first year and 65% of participants in the second year after cancer treatment consulted with a gynecologist.

The majority of the women the research team identified as using contraception after breast cancer treatment generally fell into the following demographic groups:

1. younger age (41 compared to 43)
2. higher monthly household incomes
3. in a partnership or relationship
4. already have children
5. still experienced leukorrhea
6. fewer reports of menopausal symptoms like hot flashes

Participants who sought contraceptive guidance also reported more positive perceptions of their body image, physical and emotional health, social functions, and sexual health and enjoyment, according to the report.

Generally, the report concluded, participants who already had children and were in a partnership, and who were still sexually functional with assumed signs of fertility were most likely to seek the help of a gynecologist and pursue contraception.

Some deterrents to gynecological guidance and birth control use most often appeared to be impacted by things like a lack of interest or engagement in sex after cancer treatment, or changes in menopausal signs.

Chemotherapy and adjuvant endocrine therapies also have been associated with adverse sexual health effects, including decreased libido and increased vaginal dryness, according to the report.

This brings light to a separate issue concerning the sexual health of women after breast cancer treatment, the researchers add.
“Patients with cancer often report low rates of overall sexual satisfaction, and these problems are not always properly addressed,” the report states. This lack of sexual satisfaction is likely a factor in lower rates of contraceptive use, since contraceptive use and better sexual health appear to have a positive association.

Whether better contraception leads to a better sex life, or a better sex life increases the desire for reliable contraception after cancer treatment remains debatable, but the research team stresses that in either case, gynecological support and follow-up care appears to be the strongest link to both sexual fulfillment and birth control use in premenopausal breast cancer survivors. Moving forward, the authors suggest that gynecological, contraceptive, and sexual health counseling become a larger part of the overall plan for living a full life after breast cancer.

Reference

1. Lambertini M, Massarotti C, Havas J, et al. Contraceptive Use in Premenopausal Women With Early Breast Cancer. JAMA Netw Open. 2022;5(9):e2233137. doi:10.1001/jamanetworkopen.2022.33137