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Hormonal contraceptive options carry a small excess risk for breast cancer, but it’s unclear whether the risk varies by contraceptive type, duration of use, and route of administration. To address this gap, researchers assessed risk for breast cancer associated with hormonal contraceptive use in a cohort of Swedish adolescents and women (ages 13–49) and followed them for up to 13 years (until the end of the study or age 50, whichever came first).
Among 2 million women, there were 16,385 cases of breast cancer.
Use of hormonal contraceptives was linked to a very small excess risk (roughly 13 additional cases per 100,000 users per year). Risk increased with duration of use.
Excess risk was similar across most contraceptive methods. The largest relative increase was observed with desogestrel-containing combined pills (hazard ratio, 1.19), progestin-only desogestrel pills (HR, 1.18), and the etonogestrel implant (HR, 1.22), though the absolute increase in risk remained low.
Several methods (drospirenone-containing combined pills, depot medroxyprogesterone acetate injection, and the etonogestrel vaginal ring) showed no measurable excess risk.
Hadizadeh F, et al. Hormonal contraceptive formulations and breast cancer risk in adolescents and premenopausal women. JAMA Oncol 2025 Oct 30; [e-pub] 10.1001/jamaoncol.2025.4480.41165687
Comment
When counseling my patients on hormonal contraception, I clarify that there is a small excess breast cancer risk associated with most options. It can be helpful to note that combined oral contraceptives have benefits in reducing risk for ovarian, endometrial, and colorectal cancers, and that levonorgestrel intrauterine systems can reduce risk for endometrial cancer. For those at high risk for breast cancer, it seems sensible to focus on the options with no observed excess risk in this study: the vaginal ring, drospirenone-based combinations, or depot medroxyprogesterone acetate. As each option comes with its own risks and benefits, providing balanced information allows patients to select the one that best fits their needs.