Breast Cancer Prevention and FABMs: A Personal Story

Breast Cancer Prevention and FABMs: A Personal Story

By Pamela H. Pilch, JD
October 24, 2018

Editor’s Note: During Breast Cancer Awareness Month, we are highlighting the value of knowing all your options for family planning in light of possible risks of hormone therapies, especially for people with a significant family history of cancer. We hope this compelling story of the impact of education on a woman’s decisions about family planning will encourage others to seek evidence-based sources like FACTS that enable more comprehensive and informed choices about their health.

“Like Most Young Women”
My mother was diagnosed with breast cancer when she was just 54 years old. When she was first diagnosed, I was only 28 years old and had been married for five years. I was a young lawyer and had been on the pill since college, like most young women I knew. At that time, I had no plans to ever become a mother, so effective birth control was extremely important to me, especially in light of my career aspirations.

Breast Cancer Impacts a Family
My mother was highly educated and well read. When she was diagnosed, she calmly noted she had a “clear” mammogram just eight months earlier. Despite this, her cancer at diagnosis was classified as Stage 3, and it was estrogen-receptor positive. Since she had been taking artificial hormones (Hormone Replacement Therapy, or HRT) to relieve symptoms of menopause, she explained the estrogen in her HRT probably made the cancer grow faster.

As usual, my mom was more worried about how this would affect me (an only child) than about its impact on her. She asked me to read and educate myself so I would understand what was happening and know what to expect. After preparing myself for what would come next, I started to study about estrogen-receptor positive cancers. I learned that in this type, cancer cells grow in response to estrogen. I suddenly grasped that adding more estrogen to my mother’s body had made the cancer worse.

This new knowledge immediately made me question my decision to use hormonal birth control. Learning about my mom’s breast cancer made me wish to avoid using hormones in my body, even for the very important purpose of preventing pregnancy.

Seeking Safe Alternatives
Therefore, I made an appointment with my gynecologist at a major university medical center and asked what options I had for birth control that did not include hormones. I was assured oral contraceptive pills (OCPs) carried no risks and encouraged to simply remain on course. Yet, when pressed, the doctor explained that if I were to have a small breast cancer, the estrogen in OCPs could be feeding it.

This was decisive for me. I was not going to use the pill any longer.

I asked the doctor about fertility awareness or natural family planning (NFP) as a possible reliable alternative to hormonal birth control, and she laughed at me. She assured me that FABMs do not work, and that the pill was safe. On the way out, she joked that if I really wanted to learn NFP, I should call the Catholic Church.

A Hormone-Free Option
I felt so angry that I had requested legitimate medical information about my fertility and had been dismissed. Although I was not a religious person, I called the local Catholic Church and was promptly referred to the Couple to Couple League (CCL). Through CCL, I learned the Sympto-Thermal Method of family planning. It was a revelation for me to learn all about normal fertility and how it worked, and my husband and I learned to use the method.

A few years later, when we changed our minds and decided to have children, the Sympto-Thermal Method helped us conceive. Subsequently, the use of ecological breastfeeding helped us space our babies in a hormone-free, safe, and effective way.

To this day, I am grateful that I was able to avoid the use of artificial hormones, especially because of the breast cancer risk I carry due to my mother’s disease. While my mom remained in remission for almost 12 years, her greatest regret in her final days was that she would not live to see her three young grandsons grow up. Her diagnosis and death were heartbreaking, and I learned the importance of knowing the research about breast cancer and understanding statistics so frequently quoted and misunderstood.

Fertility Awareness As Prevention
As a woman whose risk for breast cancer is elevated due to my mother’s experience, I want to lower my risk any way possible so I will be around for my kids and grandkids—a privilege my mother was denied. I am glad I avoided long-term estrogen use by discovering fertility awareness, which helped decrease my risk rather than raise it higher.

In addition, using ecological breastfeeding with all three children likely reduced my risk as well.[i] Studies show breastfeeding is protective against breast cancer, but no one on my medical team ever mentioned that either. In the end, that timely call to the “Catholic Church” suggested by my doctor brought many blessings and, with respect to breast cancer, that call may have even saved my life.

I hope many young women will take the potential risks of hormonal birth control seriously and learn sooner that fertility is a sign of health, not something to be feared, and that it can be managed in natural and healthy ways in every stage of life.

Editor’s Note: When considering the health benefits of any intervention, one must take into account the condition’s incidence relative to the intervention. Although the birth control pill may reduce the incidence of ovarian and endometrial cancer, many more women develop invasive breast cancer each year (242,476 in 2015)[ii] than ovarian[iii] and endometrial cancer[iv] combined (21,429 in 2015 and 63,230 in 2018 respectively).

Therefore, even if hormonal birth control decreases the risk of these less common types of female cancer, the more common result may still be an increase in cancer risk, since breast cancer is so much more prevalent, and an association between the pill and certain types of breast cancer has been established.[v] In fact, the World Health Organization classifies the combined oral contraceptive pill as a Group 1 carcinogen, which means the agent is “definitely carcinogenic to humans” due to the increased risk of breast, cervical, and liver cancers associated with its use.[vi]

Women with a family history of breast cancer should consider FABMs as a viable option for family planning that helps them avoid risks that, in their case, may very well outweigh any benefits from hormonal birth control. Beyond the prudent avoidance of artificial hormones, and estrogens in particular, women at higher than average risk for breast cancer should discuss with their physicians the possibility of adding breast MRI’s to their surveillance strategy.[vii]

Author Bio: Pamela H. Pilch is a wife, mother of 3, midwife apprentice, breastfeeding counselor, and birth rights lawyer in Richmond, VA. She has taught, lectured, and written on natural family planning and ecological breastfeeding for more than twenty years.

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References
[i] A 2015 meta-analysis showed “a protective effect of ever breastfeeding against hormone receptor-negative breast cancers, which are more common in younger women and generally have a poorer prognosis than other subtypes of breast cancer.” The authors suggest the relationship between breastfeeding and receptor-positive breast cancers is in need of further investigation.
[ii] https://www.cdc.gov/cancer/uscs/pdf/USCS-DataBrief-No3-June2018-508.pdf.
[iii] https://www.cdc.gov/cancer/uscs/pdf/USCS-DataBrief-No3-June2018-508.pdf.
[iv] https://www.cancer.org/cancer/endometrial-cancer/about/key-statistics.html.
[v] Beaber, Elisabeth F., et al. “Recent Oral Contraceptive Use by Formulation and Breast Cancer Risk among Women 20-49 Years of Age.” Cancer Research, U.S. National Library of Medicine, 1 Aug. 2014, www.ncbi.nlm.nih.gov/pmc/articles/PMC4154499/.
[vi] https://monographs.iarc.fr/list-of-classifications-volumes/.
[vii] Raikhlin, Antony, et al. “Breast MRI as an Adjunct to Mammography for Breast Cancer Screening in High-Risk Patients: Retrospective Review.” American Journal of Roentgenology, vol. 204, no. 4, Apr. 2015, pp. 889–897., doi:10.2214/ajr.13.12264.