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DOI: 10.1055/a-0821-7931
Hormonelle Kontrazeption und Krebs
Publikationsverlauf
Publikationsdatum:
03. Juni 2020 (online)
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Die International Agency for Research on Cancer (IARC) erachtet kombinierte orale Kontrazeptiva für Menschen als karzinogen, da sie das Risiko für Mamma-, Zervix- und Leberzellkarzinome erhöhen. Gleichzeitig betont die IARC jedoch, dass orale Kontrazeptiva gegen einige Arten von Karzinomen (Endometrium-, Ovarialkarzinom) protektiv wirken [1]. Dieser Beitrag beleuchtet die Problematik anhand der aktuellen Literatur.
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Das Mammakarzinomrisiko wird durch kombinierte orale Kontrazeptiva (COC) und Kontrazeption mit reinen Gestagenen (POC; oral oder als IUP) vorübergehend leicht erhöht.
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Dieser Effekt ist deutlicher bei jüngeren Frauen und Nulligravidae.
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Das leicht erhöhte Mammakarzinomrisiko normalisiert sich nach Absetzen der hormonellen Kontrazeption wieder.
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In absoluten Zahlen ist die Erhöhung der Brustkrebsinzidenz gering.
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Die Einnahme von COC verdoppelt vorübergehend das Zervixkarzinomrisiko.
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Die Einnahme von COC reduziert deutlich und langfristig das Ovarialkarzinomrisiko.
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Die Anwendung von COC und POC reduziert deutlich und langfristig das Endometriumkarzinomrisiko.
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In der Summe führt die Einnahme von COC zu keiner erhöhten Krebssterblichkeit.
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Bei BRCA1/2-Mutationsträgerinnen sind die Effekte vergleichbar: Reduktion des Ovarialkarzinomrisikos und vorübergehende leichte Erhöhung des Mammakarzinomrisikos bei Einnahmebeginn vor dem 25. Lebensjahr.
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Bei BRCA1/2-Mutationsträgerinnen besteht keine Kontraindikation für die Einnahme von COC zum Zwecke der Kontrazeption. Eine Beratung über das mögliche Risiko ist erforderlich.
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Bei BRCA1/2-Mutationträgerinnen besteht keine Indikation für die Einnahme von COC nur zum Zwecke der Chemoprävention von Ovarialkarzinomen.
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