Overall, no. The contraceptive pill slightly raises the risk of breast cancer and cervical cancer while it is being taken and for a few years after stopping, but it lowers the risk of ovarian, womb (endometrial) and bowel cancer, and this protection lasts 30 years or more after the pill is stopped [4, 5, 7]. In a British study that followed more than 46,000 women for up to 44 years, women who had used the pill did not develop more cancers over their lifetime than other women [7].
Key points
- Overall, cancer risk does not rise: in a study with 44 years of follow-up, using the pill did not increase the overall lifetime risk of cancer [7].
- Breast cancer: the risk is slightly higher during use and for a while afterwards; about one extra case for every 7,700 women who use a hormonal method for one year [1].
- Progestogen-only methods (pills, injections, implants and hormonal IUDs) carry a similar small increase [2].
- Ovarian and womb cancer: the risk falls; the longer the use, the greater the protection, and the effect lasts more than 30 years after stopping [4, 5].
- Cervical cancer: use for 5 years or more raises the risk slightly; after stopping, the risk falls and returns to normal after about 10 years [6].
- Bowel cancer: the risk is slightly lower [7, 8].
How does the pill affect cancer risk?
Most contraceptive pills contain two hormones: oestrogen and a progestogen (progesterone or a similar medicine). These are called "combined" pills. Some pills, injections, implants and hormonal IUDs (coils) contain only a progestogen [2, 8].
These hormones can stimulate the growth of some cancers, such as breast cancer [8]. On the other hand, the pill stops ovulation and reduces the growth of the lining of the womb; these are the likely reasons for the lower rates of ovarian and womb cancer [8]. This is why the pill does not affect all cancers in the same way (for hormones taken around the menopause, see: Does menopausal hormone therapy (HRT) increase the risk of breast cancer?):
| Cancer | While taking the pill | After stopping the pill |
|---|---|---|
| Breast | Slightly higher [1, 3] | Falls; no excess risk was seen 10 years after stopping [3] |
| Cervix | Higher with 5 years of use or more [6] | Returns to normal after about 10 years [6] |
| Ovary | Lower [4] | Stays lower; more than 30 years [4] |
| Womb (endometrium) | Lower [5] | Stays lower; more than 30 years [5] |
| Bowel | Lower [7, 8] | Stays lower; at least 30 years [7] |
These results mostly concern the combined pill. In a Danish study, women who had used a hormonal method for 5 years or more kept a small part of the breast cancer risk after stopping [1].
The pill and breast cancer
In a study of 1.8 million Danish women aged 15 to 49, the risk of breast cancer was slightly higher in women who were using a hormonal method at the time or had used one recently; with more than 10 years of use, the increase was a little larger [1]. Because breast cancer is uncommon in young women, this increase is small in practice: about one extra case for every 7,700 women who use a hormonal method for one year [1].
In a large British study, the combined pill, the progestogen-only pill, injections and hormonal IUDs all carried a similar small increase [2]. The absolute risk depends on age, because breast cancer becomes more common as women get older [2]:
- 5 years of use between ages 16 and 20: about 8 extra cases per 100,000 women over the next 15 years [2].
- 5 years of use between ages 35 and 39: about 265 extra cases per 100,000 women, that is fewer than 3 in every 1,000 women [2].
This risk falls after the pill is stopped; in one large review, no excess risk was seen 10 years or more after stopping the combined pill [3]. For early detection, see symptoms of breast cancer and At what age should mammograms start?
Protection against ovarian, womb and bowel cancer
Ovarian cancer: in a review of 45 studies including more than 23,000 women with the disease, the longer women had used the pill, the lower their risk of ovarian cancer, and this protection lasted more than 30 years after stopping [4]. In high-income countries, 10 years of pill use spares about 4 in every 1,000 women from ovarian cancer before the age of 75 [4]. This protection has also been seen in women who carry a BRCA1 or BRCA2 gene mutation [8]. See: Symptoms of ovarian cancer.
Womb (endometrial) cancer: in a review of 36 studies including more than 27,000 women with the disease, every 5 years of pill use lowered the risk of womb cancer by about a quarter, and this effect also lasted more than 30 years [5]. In high-income countries, 10 years of use spares about 10 in every 1,000 women from womb cancer before the age of 75 [5].
Bowel cancer: women who had used the pill developed bowel cancer slightly less often [7, 8].
The pill and cervical cancer
Almost all cervical cancers are caused by long-lasting infection with high-risk types of the HPV virus [8]. In a review of 24 studies including more than 16,000 women with the disease, the risk of this cancer was higher in women who had taken the pill for 5 years or more; after stopping, it fell, and after 10 years it was the same as in women who had never taken the pill [6].
In numbers: 10 years of pill use between ages 20 and 30 increases the number of women with cervical cancer by age 50 by less than one in every 1,000 in more developed countries and by about one in every 1,000 in less developed countries [6]. The best protection against this cancer is the HPV vaccine and regular screening: HPV vaccine, cancer screening and symptoms of cervical cancer.
The lifetime balance: benefits and risks
In a British study that followed more than 46,000 women from 1968 for up to 44 years, women who had used the pill did not develop more cancers overall than other women [7]. The higher rates of breast and cervical cancer during use disappeared about 5 years after stopping, no new risks appeared later in life, and the lower rates of ovarian, womb and bowel cancer lasted at least 30 years [7]. A higher rate of lung cancer was seen only in pill users who smoked [7]; see: How much does quitting smoking lower cancer risk?
What should I do? One important step: choose your contraception with your doctor, based on your own health
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Tell your doctor about your family history
If breast or ovarian cancer runs in your family, or you carry a BRCA mutation, talk to your doctor about the best method for you [3, 8]. See: Is cancer hereditary?
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Do not forget cervical screening
Have your HPV test or smear test on time, and ask about the HPV vaccine for girls and young women: cancer screening and HPV vaccine.
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Do not smoke
Among women who used the pill, a higher rate of lung cancer was seen only in smokers [7].
Frequently asked questions
Does the pill cause breast cancer?
Are newer, lower-dose pills safer?
Not clearly. In the Danish study, newer combined pills also carried a small increase [1], and in the British study, progestogen-only methods carried an increase similar to the combined pill [2]. In the large older review, the dose and type of hormone made little difference; what mattered was how recently the pill had been used [3].
Does a hormonal IUD (coil) also carry a breast cancer risk?
How many years after stopping the pill does the risk return to normal?
Breast cancer runs in my family. Can I take the pill?
In the large worldwide review, the increase in risk in women with a family history of breast cancer did not differ much from that in other women [3]. But because your starting risk is higher, choose your contraception with your doctor. The pill has also lowered the risk of ovarian cancer in women who carry a BRCA mutation [8].
Does the pill prevent ovarian cancer?
Yes. The longer the pill is used, the lower the risk of ovarian cancer, and this effect lasts more than 30 years after stopping [4]. But the pill is not prescribed just to prevent cancer; decide about it with your doctor.
Details of the evidence (for physicians)
For physicians
Breast cancer. Danish nationwide cohort (Mørch, NEJM 2017; 1.8 million women aged 15 to 49, mean follow-up 10.9 years, 19.6 million person-years, 11,517 cases): current or recent use of any hormonal method RR 1.20 (1.14 to 1.26); from 1.09 (0.96 to 1.23) with less than 1 year of use to 1.38 (1.26 to 1.51) with more than 10 years; after stopping, risk was still higher with 5 years of use or more; various combined pills 1.0 to 1.6; levonorgestrel IUD 1.21 (1.11 to 1.33); absolute increase 13 (10 to 16) per 100,000 person-years, about 1 extra case per 7,690 woman-years of use [1]. UK CPRD (Fitzpatrick, PLoS Med 2023; nested case-control, 9,498 cases under 50 and 18,171 controls): OR by last prescription, oral combined 1.23 (1.14 to 1.32), oral progestagen-only 1.26 (1.16 to 1.37), injected 1.25 (1.07 to 1.45) and IUD 1.32 (1.17 to 1.49); meta-analysis of progestagen-only methods: oral RR 1.29, injected 1.18, implanted 1.28 and IUD 1.21; 15-year absolute excess risk for 5 years of use: 8 per 100,000 (ages 16 to 20) and 265 per 100,000 (ages 35 to 39) [2]. Collaborative Group 1996 (54 studies, 53,297 cases): combined pill, current use RR 1.24 (1.15 to 1.33), 1–4 years after stopping 1.16, 5–9 years 1.07 and 10 years or more 1.01 (0.96 to 1.05); tumours clinically less advanced (RR for spread beyond the breast vs localised 0.88); no marked variation by family history; dose and type of hormone had little additional effect once recency of use was taken into account [3].
Ovary and endometrium. Ovary (45 studies, 23,257 cases and 87,303 controls): proportional risk reduction per 5 years of use 29% (23 to 34%) if use ceased less than 10 years earlier, 19% after 10–19 years and 15% after 20–29 years; mucinous tumours little affected; 10 years of use reduces incidence before age 75 from 1.2 to 0.8 and mortality from 0.7 to 0.5 per 100 users [4]. Endometrium (36 studies, 27,276 cases): RR 0.76 (0.73 to 0.78) per 5 years of use, persisting for more than 30 years; carcinomas 0.69 vs sarcomas 0.83; 10 years of use reduces the risk before age 75 from 2.3 to 1.3 per 100 women [5]. A protective effect on the ovary has also been reported in BRCA1/2 mutation carriers [8].
Cervix. 24 studies (16,573 cases): current use for 5 years or more RR 1.90 (1.69 to 2.13); risk declines after stopping and returns to that of never users after 10 years or more; similar pattern in high-risk HPV-positive women; 10 years of use from about age 20 to 30 increases the cumulative incidence by age 50 from 7.3 to 8.3 (less developed countries) and from 3.8 to 4.5 (more developed countries) per 1,000 women [6].
Lifetime balance (RCGP Oral Contraception Study; 46,022 women recruited in 1968–1969, followed for up to 44 years). Ever vs never use: IRR colorectal 0.81 (99% CI 0.66 to 0.99), endometrial 0.66 (0.48 to 0.89), ovarian 0.67 (0.50 to 0.89) and lymphatic and haematopoietic 0.74 (0.58 to 0.94); increased lung cancer only among women who smoked at recruitment; the breast and cervical cancer excess in current and recent users was lost within about 5 years of stopping; no new risks appeared later in life; the overall cancer balance among past users was neutral [7].
Related cancer types
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References
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Numbers in the text, such as [1], refer to these sources. Sources with a “Study card” button are summarised in the site’s evidence library.
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