Society of Family Planning Clinical Recommendation: Contraceptive considerations for individuals with cancer and cancer survivors part 2 - Breast, ovarian, uterine, and cervical cancer.

Abstract

This Clinical Recommendation provides evidence-informed, person-centered, and equity-driven recommendations to facilitate the management of and access to contraceptive care for individuals who are diagnosed with, being actively treated for, or who have previously been treated for breast, ovarian, uterine, or cervical cancer. For individuals with a history of breast cancer, we recommend nonhormonal contraceptives as the first-line option (GRADE 1B); additional guidance is provided for hormonal contraception depending on breast cancer hormone receptor status. For individuals with a history of or active ovarian cancer, we recommend clinicians provide access to all available contraceptive methods utilizing a person-centered approach (GRADE 1B); in individuals diagnosed with hormonally-sensitive ovarian malignancies, such as adult granulosa cell tumors, low-grade serous, and endometrioid adenocarcinomas, who are considering hormonal contraception, we suggest shared decision-making with the individual and their oncologist (GRADE 2C). Estrogen-containing contraceptives should be avoided by individuals treated with estrogen-blocking therapy (BEST PRACTICE). For individuals with a history of endometrial cancer, we recommend clinicians provide access to all available contraceptive methods utilizing a person-centered approach (GRADE 1B); in individuals with active endometrial cancer requesting an intrauterine device (IUD), we suggest shared decision-making with the individual and their oncologist (GRADE 1B). Recommendations for individuals with gestational trophoblastic disease are provided based on factors such as evidence of persistent intrauterine disease, human chorionic gonadotropin (hCG) levels, and the individual's preferred contraceptive method. For individuals with cervical dysplasia or a history of cervical cancer, we suggest clinicians provide access to all available contraceptive methods (GRADE 2B); we suggest against IUD placement in individuals with active cervical malignancy (GRADE 2C). This document is part 2 of a three-part series that updates the Society of Family Planning's 2012 Cancer and contraception clinical guidance. It builds upon the considerations outlined in the Society of Family Planning Committee Statement: Contraceptive considerations for individuals with cancer and cancer survivors part 1 - Key considerations for clinical care and parallels recommendations outlined in the Society of Family Planning Clinical Recommendation: Contraceptive considerations for individuals with cancer and cancer survivors part 3 - Skin, blood, gastrointestinal, liver, lung, central nervous system, and other cancers. Readers are encouraged to review parts 1 and 3 for this additional context.