Question: In a 45 year old, who has recently finished chemotherapy and radiotherapy for ER/PR NEGATIVE breast cancer, and who has heavy bleeding with the non-hormonal IUD, can MIRENA IUS be used instead?
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Answer: No information was found on the use of Mirena IUS in women with estrogen receptor negative or progestogen receptor negative breast cancer.
A Faculty of Family Planning and Reproductive Health Care Members Enquiry Response(1) says that:
" No direct evidence was identified to suggest that progestogen receptor status influences the risk of breast cancer in women with past history of breast cancer or influences the contraceptive options for these women."
The UK medical eligibility criteria for contraceptive use(2) classifies the LNG-IUD as "CATEGORY 4 - A condition which represents an unacceptable health risk if the contraceptive method is used" in women with current breast cancer. The additional comments add " Breast cancer is a hormonally sensitive tumour. Concerns about progression of the disease may be less with LNG-IUDs than with COCs or higher-dose POCs. The LNG-IUS may be considered individually, and in consultation with the woman’s breast surgeon."
(Evidence level IV)
References:
- For women with a past history of progestogen receptor negative breast cancer, is it safe to use Progestogen only contraception? Faculty of Family Planning and Reproductive Health Care Members Enquiry No 2115, November 2007.
- UK medical eligibility criteria for contraceptive use / Faculty of Sexual and Reproductive Healthcare. 2009
Search date: August 2010
Classification of evidence levels
Ia Evidence obtained from meta-analysis of randomised controlled trials.
Ib Evidence obtained from at least one randomised controlled trial.
IIa Evidence obtained from at least one well-designed controlled study without randomisation.
IIb Evidence obtained from at least one other type of well-designed quasi-experimental study.
III Evidence obtained from well-designed non-experimental descriptive studies, such as comparative studies, correlation studies and case studies.
IV Evidence obtained from expert committee reports or opinions and/or clinical experience of respected authorities.
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