206917 Use of Contraception by Women with Breast Cancer

Tuesday, November 10, 2009

Debbie A. Postlethwaite, RNP, MPH , Division of Research, Kaiser Permanente, Northern California, Oakland, CA
Yun-Yi Hung, PhD , Division of Research, Kaiser Permanente, Oakland, CA
MaryAnne Armstrong, MA , Division of Research, Kaiser Permanente, Oakland, CA
Michael Horberg, MD, MAS, FACP, A , Division of Research, Kaiser Permanente, Oakland, CA
Fiona Sinclair, PA-C, MHS , Women's Health Research Institute, Kaiser Permanente, Oakland, CA
Eric Lantzman, MD , Department of Ob-Gyn, Kaiser Permanente, San Francisco, CA
Eleanor Bimla Schwartz, MD, MS , Center for Research on Health Care, University of Pittsburgh, Pittsburgh, PA
Clinicians caring for reproductive-aged women with a history of breast cancer are faced with complex clinical decisions about contraception safety and effectiveness, in addition to possible risks from an unplanned pregnancy. A retrospective study was conducted in Kaiser Permanente, Northern California from 2006-2007 on 449,181 reproductive age women. Evidence of contraception and counseling (contraception and preconception) was captured through electronic data from clinical and pharmacy databases. Women with breast cancer (931) were compared to women with other chronic medical conditions (OCMC=24,184) and to women without any chronic medical conditions (“healthy”=122,921). A detailed chart review was included for 240 randomly selected women without evidence of contraception or counseling. Highly effective contraception (primarily permanent sterilization) was used by 26.0% of women with breast cancer compared to 22.3% of OCMC women and 10.6% of “healthy” women (breast cancer vs healthy p=<0.001; breast cancer vs OCMC p=0.02). Reversible contraception was found in 11.8% (intrauterine contraception [IUC]: 7.6%) of women with breast cancer compared to 40.7% (IUC: 6.5%) of healthy women (p-value <0.001: reversible contraception; p=0.18 for IUC). The chart review found 12.5% of women with breast cancer using abstinence compared to 13% for OCMC and 0% for “healthy” women. Many women with breast cancer, OCMC and “healthy”, had no database documentation of contraception (62% breast cancer vs. 49% OCMC vs, 38% “healthy”, p<0.001). A significant proportion of women with breast cancer used reversible contraception. IUC was their primary form of reversible contraception, with similar rates to those used by healthy women.

Learning Objectives:
Discuss and compare contraception use by women with a history of breast cancer to women without chronic medical conditions and how contraception use impacts their preconception health.

Keywords: Chronic Diseases, Family Planning

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Principal investigator of study and co-author of abstract
Any relevant financial relationships? Yes

Name of Organization Clinical/Research Area Type of relationship
Bayer Pharmaceutical Contraception and women with chronic diseases, investigator initiated study research funding support

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.