A 29-year-old, married woman, G1 P1, wants to take oral contraceptives (OCs). She is obese (BMI 34) and has huge breasts. Her mother was diagnosed with estrogen sensitive breast cancer at age 46. I have recommended weight loss and annual breast exams as well as monthly self-exam. When should I order a baseline mammogram? Is a progestin-only OC the safer option for this patient?
—Ivanka Vassileva, MD, Lawton, Okla.

There are many conflicting studies about the use of OCs and the risk of breast cancer, including those in which there was a family history of breast cancer. The risks of OCs may be greater with higher doses of estrogen and progestin and in high-risk families. However, there are also studies showing no increased risk of breast cancer with OC use. Reducing other risk factors, as suggested for this patient, is clearly the best approach. A baseline mammogram should be done when the patient is 10 years younger than the age at which the first family member was diagnosed with breast cancer.
—Gwen L. Nichols, MD (105-2)

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