Is Hormonal Birth Control Safe If You Have a Family History of Breast Cancer?

For most women, a family history of breast cancer is not a reason to avoid hormonal birth control. That is one of the most common worries I hear in the exam room. A patient will tell me her mother, aunt, or sister had breast cancer, and then ask whether the pill is “safe for someone like me.” 

Here is what the evidence shows, where the real limits are, and how the experienced clinicians at FPA can help you choose a method with confidence.

A Family History of Breast Cancer

The CDC's U.S. Medical Eligibility Criteria for Contraceptive Use (U.S. MEC), the guideline clinicians use to judge which methods are safe for which patients, places a family history of breast cancer in Category 1. That is the lowest-risk category, which means there is no restriction on use. 

That applies to every hormonal method, including: 

• Combined pills, patches, and vaginal rings (estrogen plus progestin) 
• Progestin-only pills 
• The hormonal IUD 
• The implant and the injection 

Modern pills also contain much lower hormone doses than the pills of the 1960s and early 1970s, which is where many long-standing worries began. 

What if You Carry a BRCA1 or BRCA2 Mutation? 

Even for women with a BRCA1 or BRCA2 mutation, the best available evidence has not shown that modern birth control pills increase breast cancer risk. A 2010 meta-analysis pooling 18 studies of BRCA carriers found no significant link between pill use and breast cancer, and no link with how long the pill was used. The only clear increase was seen with older, high-dose pills used before 1975. 

There is also a real upside for BRCA carriers. In the same analysis, pill use cut the risk of ovarian cancer roughly in half, and the protection grew the longer the pill was used. Ovarian cancer is a major concern for BRCA carriers because it is hard to detect early.

When Hormonal Birth Control is Not Recommended: Your Own History of Breast Cancer 

A personal history of breast cancer is different. Many breast cancers are hormone-sensitive, meaning they are estrogen receptor (ER) or progesterone receptor (PR) positive. In those cancers, estrogen and progesterone can fuel tumor growth, so adding hormones from birth control could raise the risk of the cancer returning. 

For that reason, hormonal methods are not recommended for women who have had breast cancer. Current breast cancer is U.S. MEC Category 4, which the CDC defines as an unacceptable health risk. A past breast cancer with no evidence of disease for five years is Category 3, meaning the risks usually outweigh the benefits. 

The good news is that highly effective non-hormonal options exist: 

• Copper IUD: more than 99% effective, hormone-free, and approved for up to 10 years 
• Barrier methods: condoms or a diaphragm, best combined with another method 
• Permanent options: tubal surgery or vasectomy for a partner, when your family is complete 

If you are a breast cancer survivor, please do not stop using contraception just because you cannot take hormones. Cancer treatment does not reliably prevent pregnancy, and we can help you find a safe, effective option.

The Bottom Line 

• Family history of breast cancer: Hormonal birth control is considered safe. 
• BRCA1 or BRCA2 mutation: Most research shows no increase in breast cancer risk with modern pills, plus a meaningful reduction in ovarian cancer risk. Decide together with your care team. 
• Personal history of breast cancer: Hormonal birth control is not recommended, and effective hormone-free options are available. 

Every woman's risk picture is different. At FPA Women's Health, we will review your personal and family history, talk through genetic testing if it makes sense for you, and help you choose a method that fits your health and your plans. Book a birth control consultation to review your family history with a provider.