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Kristensen AK, Frandsen CLB, Nøhr B, Viuff JH, Hargreave M, Frederiksen K, Kjær SK, Jensen A. Risk of borderline ovarian tumors after fertility treatment - Results from a Danish cohort of infertile women. Gynecol Oncol 2024; 185:108-115. [PMID: 38382167 DOI: 10.1016/j.ygyno.2024.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 01/29/2024] [Accepted: 02/08/2024] [Indexed: 02/23/2024]
Abstract
OBJECTIVE Results from previous studies examining the association between fertility treatment and borderline ovarian tumors are inconsistent. The aim of this study was to investigate the association between fertility treatment and borderline ovarian tumors in a cohort of infertile women. METHODS This cohort study was based on the Danish Infertility Cohort and included all infertile women aged 20-45 years living in Denmark between 1 January 1995 and 31 December 2017 (n = 146,891). Information on use of fertility drugs, borderline ovarian tumors and cancer diagnoses, covariates, emigration, and vital status was obtained by linkage to national registers. Cox proportional hazard models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) with adjustment for potential confounders for overall borderline ovarian tumors and for serous- and mucinous borderline ovarian tumors separately. RESULTS During a median 11.3 years of follow-up, 144 women developed a borderline ovarian tumor. No marked associations between ever use of clomiphene citrate, gonadotropins, gonadotropin-releasing hormone receptor modulators, human chorionic gonadotropin or progesterone and borderline ovarian tumors were observed, neither overall nor for serous and mucinous borderline ovarian tumors analysed separately. Further, no clear associations with borderline ovarian tumors were found according to cumulative dose, time since first use or parity status for any fertility drugs. CONCLUSIONS No marked associations between use of fertility drugs and borderline ovarian tumors were observed. However, the cohort's relatively young age at end of follow-up emphasizes the importance of extending the follow-up period for women who have used fertility drugs.
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Affiliation(s)
| | - Clarissa Lima Brown Frandsen
- Virus, Lifestyle and Genes, Danish Cancer Institute, 2100 Copenhagen, Denmark; Department of Obstetrics and Gynecology, Herlev University Hospital, 2730 Herlev, Denmark
| | - Bugge Nøhr
- Virus, Lifestyle and Genes, Danish Cancer Institute, 2100 Copenhagen, Denmark; Department of Obstetrics and Gynecology, Herlev University Hospital, 2730 Herlev, Denmark
| | - Jakob Hansen Viuff
- Diet, Cancer and Health, Danish Cancer Institute, 2100 Copenhagen, Denmark
| | - Marie Hargreave
- Virus, Lifestyle and Genes, Danish Cancer Institute, 2100 Copenhagen, Denmark
| | - Kirsten Frederiksen
- Statistics and Data Analysis, Danish Cancer Institute, 2100 Copenhagen, Denmark
| | - Susanne K Kjær
- Virus, Lifestyle and Genes, Danish Cancer Institute, 2100 Copenhagen, Denmark; Department of Gynecology, Rigshospitalet, University of Copenhagen, 2100 Copenhagen, Denmark
| | - Allan Jensen
- Virus, Lifestyle and Genes, Danish Cancer Institute, 2100 Copenhagen, Denmark.
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2
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Fertility drugs and cancer: a guideline. Fertil Steril 2024:S0015-0282(24)00201-2. [PMID: 38703170 DOI: 10.1016/j.fertnstert.2024.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 03/28/2024] [Indexed: 05/06/2024]
Abstract
Methodological limitations in studying the association between the use of fertility drugs and cancer include the inherent increased risk of cancer in women who never conceive, the increased risk of cancer because of factors (endometriosis and unopposed estrogen) associated with infertility, the low incidence of most of these cancers, and that the diagnosis of cancer is typically several years after fertility drug use. On the basis of available data, there does not appear to be an association between fertility drugs and breast, colon, or cervical cancer. There is no conclusive evidence that fertility drugs increase the risk of uterine cancer, although women with infertility are at higher risk of uterine cancer. There are insufficient data to comment on the risk of melanoma and non-Hodgkin lymphoma associated with fertility drug use. Women should be informed that there may be an increased risk of invasive and borderline ovarian cancers and thyroid cancer associated with fertility treatment. It is difficult to determine whether this risk is related to underlying endometriosis, female infertility, or nulliparity.
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3
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Si M, Wang X, Song X, Long X, Qiao J. Effects of Infertility Drug Exposure on the Risk of Borderline Ovarian Tumors: A Systematic Review and Meta-Analysis. Biomedicines 2023; 11:1835. [PMID: 37509474 PMCID: PMC10376814 DOI: 10.3390/biomedicines11071835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/10/2023] [Accepted: 06/23/2023] [Indexed: 07/30/2023] Open
Abstract
Whether infertility drug exposure increases the risk of borderline ovarian tumors (BOTs) remains controversial. The present study was conducted with a comprehensive search for studies published from January 1990 to December 2021 in the online databases Cochrane Library, PubMed, Web of Science and EMBASE. We considered the first diagnosis of a BOT as the primary outcome. The odds ratio (OR) was calculated with corresponding 95% confidence intervals (CIs) for the risk of BOTs in patients who were treated with infertility drugs. Ten studies, a total of 2,779,511 women, qualified for inclusion in this meta-analysis. The pooled OR of 1.56 (95% CI: 1.09-2.22) revealed a significant positive association between infertility drugs and an increased risk for BOTs, but for specific drugs, only CC plus Gn had statistical significance. No publication bias was detected using the Egger and Begg tests (p > 0.05). A significant difference in BOT incidence was observed among infertile women and nulliparous women who were treated with or without infertility drugs. In conclusion, the use of infertility drugs may increase the risk of BOTs, but a dose-dependent relationship was not observed between the number of assisted reproduction technology cycles and the risk of BOTs, and infertile women who successfully became pregnant might have a reduced risk. Registration: PROSPERO, CRD42022330775.
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Affiliation(s)
- Manfei Si
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China
- National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China
- Key Laboratory of Assisted Reproduction, Peking University, Ministry of Education, Beijing 100191, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing 100191, China
| | - Xiaoxiao Wang
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing 100191, China
| | - Xueling Song
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China
- National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China
- Key Laboratory of Assisted Reproduction, Peking University, Ministry of Education, Beijing 100191, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing 100191, China
| | - Xiaoyu Long
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China
- National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China
- Key Laboratory of Assisted Reproduction, Peking University, Ministry of Education, Beijing 100191, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing 100191, China
| | - Jie Qiao
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China
- National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China
- Key Laboratory of Assisted Reproduction, Peking University, Ministry of Education, Beijing 100191, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing 100191, China
- Beijing Advanced Innovation Center for Genomics, Beijing 100191, China
- Peking-Tsinghua Center for Life Sciences, Peking University, Beijing 100191, China
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Santulli P, Blockeel C, Bourdon M, Coticchio G, Campbell A, De Vos M, Macklon KT, Pinborg A, Garcia-Velasco JA. Fertility preservation in women with benign gynaecological conditions. Hum Reprod Open 2023; 2023:hoad012. [PMID: 37124950 PMCID: PMC10130191 DOI: 10.1093/hropen/hoad012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 03/23/2023] [Indexed: 05/02/2023] Open
Abstract
Although a wealth of data has been published regarding fertility preservation (FP) in women with malignant diseases who receive gonadotoxic treatment, the role of FP in non-malignant conditions has been studied to a much lesser extent. These include benign haematological, autoimmune, and genetic disorders, as well as a multitude of benign gynaecological conditions (BGCs) that may compromise ovarian reserve and/or reproductive potential due to pathogenic mechanisms or as a result of medical or surgical treatments. Alongside accumulating data that document the reproductive potential of cryopreserved oocytes and ovarian tissue, there is potential interest in FP for women with BGCs at risk of infertility; however, there are currently insufficient data about FP in women with BGCs to develop guidelines for clinical practice. The purpose of this article is to appraise the available evidence regarding FP for BGC and discuss potential strategies for FP based on estimated ovarian impairment and on short-term and long-term reproductive goals of patients. Cost-effectiveness considerations and patients' perspectives will also be discussed.
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Affiliation(s)
- Pietro Santulli
- Correspondence address. Service de Gynécologie-Obstétrique II et Médecine de la Reproduction, CHU Cochin—Bâtiment Port Royal, 123 Boulevard de Port-Royal 75679 Paris 14, France. E-mail:
| | | | | | | | | | - Michel De Vos
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Kirsten Tryde Macklon
- Fertility Clinic, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anja Pinborg
- Fertility Clinic, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Juan A Garcia-Velasco
- Instituto Valenciano de Infertilidad (IVI-RMA), Madrid, Spain
- Department of Obstetrics and Gynecology, Rey Juan Carlos University, Madrid, Spain
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5
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Calleja C. Injustices Implied in the Assisted Reproductive Technologies Market. LINACRE QUARTERLY 2022; 89:455-467. [PMID: 36518709 PMCID: PMC9743035 DOI: 10.1177/00243639221119317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
This article critiques the current theological basis that deems assisted reproductive technologies (ART) as immoral, namely that it dissociates the unitive act from procreation, and that it violates the dignity of the embryo. It is argued that notwithstanding the validity of these moral truths, these issues are of little relevance to couples facing childlessness. Three alternative views are then presented, all based on the injustices related to the ART market: (a) injustices that directly affect the couple and their offspring, (b) unfairness related to the commercial aspect of ART markets, and (c) the overall effects that impinge on society at large. Therefore, instead of burdening childless couples wanting to have children of their own with the culpability of sin for resorting to ART, one must rather make them aware that they are prey to the ART market while calling for better regulation of this system in order to mitigate these injustices. The article ends with some recommendations on how to address these injustices.
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Affiliation(s)
- Carlo Calleja
- Department of Moral Theology, Faculty of Theology, University of Malta, Msida, Malta
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6
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Barcroft JF, Galazis N, Jones BP, Getreu N, Bracewell-Milnes T, Grewal KJ, Sorbi F, Yazbek J, Lathouras K, Smith JR, Hardiman P, Thum MY, Ben-Nagi J, Ghaem-Maghami S, Verbakel J, Saso S. Fertility treatment and cancers-the eternal conundrum: a systematic review and meta-analysis. Hum Reprod 2021; 36:1093-1107. [PMID: 33586777 DOI: 10.1093/humrep/deaa293] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 09/28/2020] [Indexed: 12/29/2022] Open
Abstract
STUDY QUESTION Does fertility treatment (FT) significantly increase the incidence of breast, ovarian, endometrial or cervical cancer? SUMMARY ANSWER Overall, FT does not significantly increase the incidence of breast, ovarian or endometrial cancer and may even reduce the incidence of cervical cancer. WHAT IS KNOWN ALREADY Infertility affects more than 14% of couples. Infertility and nulliparity are established risk factors for endometrial, ovarian and breast cancer, yet the association with FT is more contentious. STUDY DESIGN, SIZE, DURATION A literature search was carried out using Cochrane Library, EMBASE, Medline and Google Scholar up to December 2019. Peer-reviewed studies stating cancer incidence (breast, ovarian, endometrial or cervical) in FT and no-FT groups were identified. Out of 128 studies identified, 29 retrospective studies fulfilled the criteria and were included (n = 21 070 337). PARTICIPANTS/MATERIALS, SETTING, METHODS In the final meta-analysis, 29 studies were included: breast (n = 19), ovarian (n = 19), endometrial (n = 15) and cervical (n = 13), 17 studies involved multiple cancer types and so were included in each individual cancer meta-analysis. Primary outcome of interest was cancer incidence (breast, ovarian, endometrial and cervical) in FT and no-FT groups. Secondary outcome was cancer incidence according to specific fertility drug exposure. Odds ratio (OR) and random effects model were used to demonstrate treatment effect and calculate pooled treatment effect, respectively. A meta-regression and eight sub-group analyses were performed to assess the impact of the following variables, maternal age, infertility, study size, outliers and specific FT sub-types, on cancer incidence. MAIN RESULTS AND THE ROLE OF CHANCE Cervical cancer incidence was significantly lower in the FT group compared with the no-FT group: OR 0.68 (95% CI 0.46-0.99). The incidences of breast (OR 0.86; 95% CI 0.73-1.01) and endometrial (OR 1.28; 95% CI 0.92-1.79) cancers were not found to be significantly different between the FT and no-FT groups. Whilst overall ovarian cancer incidence was not significantly different between the FT and no-FT groups (OR 1.19; 95% CI 0.98-1.46), separate analysis of borderline ovarian tumours (BOT) revealed a significant association (OR 1.69; 95% CI 1.27-2.25). In further sub-group analyses, ovarian cancer incidence was shown to be significantly higher in the IVF (OR 1.32; 95% CI 1.03-1.69) and clomiphene citrate (CC) treatment group (OR 1.40; 95% CI 1.10-1.77), respectively when compared with the no-FT group. Conversely, the incidences of breast (OR 0.75; 95% CI 0.61-0.92) and cervical cancer (OR 0.58; 95% CI 0.38-0.89) were significantly lower in the IVF treatment sub-group compared to the no-FT group. LIMITATIONS, REASONS FOR CAUTION The large, varied dataset spanning a wide study period introduced significant clinical heterogeneity. Thus, results have to be interpreted with an element of caution. Exclusion of non-English citations, unpublished work and abstracts, in order to ensure data accuracy and reliability was maintained, may have introduced a degree of selection bias. WIDER IMPLICATIONS OF THE FINDINGS The results for breast, ovarian, endometrial and cervical cancer are reassuring, in line with previously published meta-analyses for individual cancers but the association between IVF and CC treatment and an increase in ovarian cancer incidence requires additional work to understand the potential mechanism driving this association. In particular, focusing on (i) discriminating specific treatments effects from an inherent risk of malignancy; (ii) differential risk profiles among specific patient sub-groups (refractory treatment and obesity); and (iii) understanding the impact of FT outcomes on cancer incidence. STUDY FUNDING/COMPETING INTEREST(S) This study did not receive any funding. The authors have no financial, personal, intellectual and professional conflicts of interest to declare. PROSPERO REGISTRATION NUMBER CRD42019153404.
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Affiliation(s)
- Jennifer Frances Barcroft
- Division of Surgery and Cancer, Institute of Reproductive & Developmental Biology, Imperial College London, Hammersmith Hospital Campus, London, UK
| | - Nicolas Galazis
- Division of Surgery and Cancer, Institute of Reproductive & Developmental Biology, Imperial College London, Hammersmith Hospital Campus, London, UK
| | - Benjamin P Jones
- Division of Surgery and Cancer, Institute of Reproductive & Developmental Biology, Imperial College London, Hammersmith Hospital Campus, London, UK
| | - Natalie Getreu
- Institute of Women's Health, University College London, London, UK
| | - Timothy Bracewell-Milnes
- Department of Obstetrics and Gynaecology, Chelsea and Westminster Hospital, Imperial College London, London, UK
| | - Karen J Grewal
- Division of Surgery and Cancer, Institute of Reproductive & Developmental Biology, Imperial College London, Hammersmith Hospital Campus, London, UK
| | - Flavia Sorbi
- Division of Obstetrics and Gynaecology, Department of Biomedical, Experimental and Clinical Sciences, University of Florence, Florence, Italy
| | - Joseph Yazbek
- West London Gynaecological Cancer Centre, Queen Charlotte's Hospital, Imperial College London, Hammersmith Hospital Campus, London, UK
| | - Kostas Lathouras
- West London Gynaecological Cancer Centre, Queen Charlotte's Hospital, Imperial College London, Hammersmith Hospital Campus, London, UK
| | - J Richard Smith
- West London Gynaecological Cancer Centre, Queen Charlotte's Hospital, Imperial College London, Hammersmith Hospital Campus, London, UK
| | - Paul Hardiman
- Department of Obstetrics and Gynaecology, Royal Free and University College Medical School, NW3 2PF London, UK
| | - Meen-Yau Thum
- The Lister Fertility Clinic, Chelsea Bridge Road, London, UK
| | - Jara Ben-Nagi
- Centre for Reproductive and Genetic Health, London, UK
| | - Sadaf Ghaem-Maghami
- West London Gynaecological Cancer Centre, Queen Charlotte's Hospital, Imperial College London, Hammersmith Hospital Campus, London, UK
| | - Jan Verbakel
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Srdjan Saso
- Division of Surgery and Cancer, Institute of Reproductive & Developmental Biology, Imperial College London, Hammersmith Hospital Campus, London, UK
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7
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Muzii L, DI Tucci C, Galati G, Mattei G, Chinè A, Cascialli G, Palaia I, Benedetti Panici P. Endometriosis-associated infertility: surgery or IVF? Minerva Obstet Gynecol 2021; 73:226-232. [PMID: 33435663 DOI: 10.23736/s2724-606x.20.04765-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Endometriosis is a chronic disease frequently associated with female infertility. The choice of treatment in case of endometriosis is one of the most discussed topics in Reproductive Medicine. The approach to the patient with endometriosis and infertility should be tailored based on different parameters. The localization of the disease, the severity of symptoms and the age of the patient are just some of them. Management options include surgery, in-vitro fertilization (IVF), or a combination of both. Data, mostly uncontrolled, would favor surgery at any stage of endometriosis, increasing the chances of natural conception compared to expectant management. Laparoscopic excision of the ovarian endometrioma should be the treatment of choice when there is associated pain. Surgery should be performed following appropriate techniques to reduce the possible damage to the ovarian reserve. Pregnancy rates around 50% have been consistently reported after surgery, which compare favorably with those obtained with IVF. IVF, on the other hand, may be preferred in case of associated male or tubal factor, in case of a reduced ovarian reserve, or if previous surgery has failed, particularly if there is no associated pain, and when the ultrasonographic features of the ovarian cyst are reassuring. Sometimes IVF may be preceded by surgery, when a difficult access to follicles at pick-up, due to the size and location of the ovarian cyst, or to severe adhesions, is anticipated. Due to the lack of solid evidence in the scenario of endometriosis-associated infertility, robust data from randomized clinical trials (RCTs) are strongly needed.
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Affiliation(s)
- Ludovico Muzii
- Department of Obstetrics and Gynecology, Sapienza University, Rome, Italy -
| | - Chiara DI Tucci
- Department of Obstetrics and Gynecology, Sapienza University, Rome, Italy
| | - Giulia Galati
- Department of Obstetrics and Gynecology, Sapienza University, Rome, Italy
| | - Giulia Mattei
- Department of Obstetrics and Gynecology, Sapienza University, Rome, Italy
| | - Alessandra Chinè
- Department of Obstetrics and Gynecology, Sapienza University, Rome, Italy
| | - Gianluca Cascialli
- Department of Obstetrics and Gynecology, Sapienza University, Rome, Italy
| | - Innocenza Palaia
- Department of Obstetrics and Gynecology, Sapienza University, Rome, Italy
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8
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Kvaskoff M, Mahamat-Saleh Y, Farland LV, Shigesi N, Terry KL, Harris HR, Roman H, Becker CM, As-Sanie S, Zondervan KT, Horne AW, Missmer SA. Endometriosis and cancer: a systematic review and meta-analysis. Hum Reprod Update 2020; 27:393-420. [PMID: 33202017 DOI: 10.1093/humupd/dmaa045] [Citation(s) in RCA: 90] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 07/16/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Endometriosis is an often chronic, inflammatory gynaecologic condition affecting 190 million women worldwide. Studies have reported an elevated cancer risk among patients with endometriosis. However, prior research has included methodologic issues that impede valid and robust interpretation. OBJECTIVE AND RATIONALE We conducted a meta-analysis of studies investigating the association between endometriosis and cancer risk and analysed the results by methodologic characteristics. We discuss the implications of cancer screening in patients and management challenges faced by clinicians. SEARCH METHODS We searched PubMed and Embase databases for eligible studies from inception through 24 October 2019. We included cohort and case-control studies examining the association between endometriosis and cancer risk; cross-sectional studies and case reports were excluded. Publications had to present risk/rate/odds estimates with 95% CI. Random effects meta-analysis was used to estimate summary relative risks (SRR) and CIs. Heterogeneity across studies was assessed by the Q test and I2 statistics, and publication bias using Egger's and Begg's tests. Risk of bias and quality of the included studies were assessed using the risk of bias in non-randomized studies of interventions (ROBINS-I) tool. OUTCOMES Forty-nine population-based case-control and cohort studies were included. Twenty-six studies were scored as having a 'serious'/'critical' risk of bias, and the remaining 23 'low'/'moderate'. Cancer-specific analyses showed a positive association between endometriosis and ovarian cancer risk (SRR = 1.93, 95% CI = 1.68-2.22; n = 24 studies) that was strongest for clear cell (SRR = 3.44, 95% CI = 2.82-4.42; n = 5 studies) and endometrioid (SRR = 2.33, 95% CI = 1.82-2.98; n = 5 studies) histotypes (Pheterogeneity < 0.0001), although with significant evidence of both heterogeneity across studies and publication bias (Egger's and Begg's P-values < 0.01). A robust association was observed between endometriosis and thyroid cancer (SRR = 1.39, 95% CI =1.24-1.57; n = 5 studies), a very small association with breast cancer (SRR = 1.04, 95% CI =1.00-1.09; n = 20 studies) and no association with colorectal cancer (SRR = 1.00, 95% CI =0.87-1.16; n = 5 studies). The association with endometrial cancer was not statistically significant (SRR = 1.23, 95% CI =0.97-1.57; n = 17 studies) overall and wholly null when restricted to prospective cohort studies (SRR = 0.99, 95% CI =0.72-1.37; n = 5 studies). The association with cutaneous melanoma was also non-significant (SRR = 1.17, 95% CI =0.97-1.41; n = 7 studies) but increased in magnitude and was statistically significant when restricted to studies with low/moderate risk of bias (SRR = 1.71, 95% CI = 1.24-2.36, n = 2 studies). The most robust finding both in terms of statistical significance and magnitude of effect was an inverse association with cervical cancer (SRR = 0.68, 95% CI =0.56-0.82; n = 4 studies); however, this result has a high potential to reflect heightened access to detection of dysplasia for women who reached an endometriosis diagnosis and is thus likely not causal. Several additional cancer types were explored based on <4 studies. WIDER IMPLICATIONS Endometriosis was associated with a higher risk of ovarian and thyroid, and minimally (only 4% greater risk) with breast cancer, and with a lower risk of cervical cancer. However, this meta-analysis confirms that: a majority of studies had severe/critical risk of bias; there is impactful heterogeneity across studies-and for ovarian cancer, publication bias; and causal inference requires temporality, which in many studies was not considered. We discuss the implications of these potential associations from the perspectives of patients with endometriosis, clinicians involved in their care, and scientists investigating their long-term health risks.
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Affiliation(s)
- Marina Kvaskoff
- CESP, Fac. de médecine - Univ. Paris-Sud, Fac. de médecine - UVSQ, INSERM, Université Paris-Saclay, Villejuif 94805, France.,Gustave Roussy, Villejuif F-94805, France
| | - Yahya Mahamat-Saleh
- CESP, Fac. de médecine - Univ. Paris-Sud, Fac. de médecine - UVSQ, INSERM, Université Paris-Saclay, Villejuif 94805, France.,Gustave Roussy, Villejuif F-94805, France
| | - Leslie V Farland
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Nina Shigesi
- Oxford Endometriosis CaRe Centre, Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
| | - Kathryn L Terry
- Obstetrics and Gynecology Epidemiology Center, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Holly R Harris
- Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Horace Roman
- Endometriosis Centre, Tivoli-Ducos Clinic, Bordeaux, France.,Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark
| | - Christian M Becker
- Oxford Endometriosis CaRe Centre, Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
| | - Sawsan As-Sanie
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
| | - Krina T Zondervan
- Oxford Endometriosis CaRe Centre, Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK.,Wellcome Centre for Human Genetics, University of Oxford, UK
| | - Andrew W Horne
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh EH16 4TJ, UK
| | - Stacey A Missmer
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Obstetrics, Gynecology and Reproductive Biology, College of Human Medicine, Michigan State University, Grand Rapids, MI, USA
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9
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Spaan M, van den Belt-Dusebout AW, Lambalk CB, van Boven HH, Schats R, Kortman M, Broekmans FJM, Laven JSE, van Santbrink EJP, Braat DDM, van der Westerlaken LAJ, Cohlen BJ, Cantineau AEP, Smeenk JMJ, van Rumste MM, Goddijn M, van Golde RJT, Meeuwissen PAM, Hamilton CJCM, Ouwens GM, Gerritsma MA, Schaapveld M, Burger CW, van Leeuwen FE. Long-Term Risk of Ovarian Cancer and Borderline Tumors After Assisted Reproductive Technology. J Natl Cancer Inst 2020; 113:699-709. [PMID: 33769500 DOI: 10.1093/jnci/djaa163] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 09/11/2020] [Accepted: 09/25/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Long-term effects of assisted reproductive technology (ART) on ovarian tumor risk are unknown. METHODS This nationwide cohort study comprises 30 625 women who received ovarian stimulation for ART in 1983-2000 and 9988 subfertile women not treated with ART. Incident invasive and borderline ovarian tumors were ascertained through linkage with the Netherlands Cancer Registry and the Dutch Pathology Registry until July 2018. Ovarian tumor risk in ART-treated women was compared with risks in the general population and the subfertile non-ART group. Statistical tests were 2-sided. RESULTS After a median follow-up of 24 years, 158 invasive and 100 borderline ovarian tumors were observed. Ovarian cancer risk in the ART group was increased compared with the general population (standardized incidence ratio [SIR] = 1.43, 95% confidence interval [CI] = 1.18 to 1.71) but not when compared with the non-ART group (age- and parity-adjusted hazard ratio [HR] = 1.02, 95% CI = 0.70 to 1.50). Risk decreased with higher parity and with a larger number of successful ART cycles (resulting in childbirth, Ptrend = .001) but was not associated with the number of unsuccessful ART cycles. Borderline ovarian tumor risk was increased in ART-treated women compared with the general population (SIR = 2.20, 95% CI = 1.66 to 2.86) and with non-ART women (HR = 1.84, 95% CI = 1.08 to 3.14). Risk did not increase with more ART cycles or longer follow-up time. CONCLUSIONS Increased ovarian cancer risk in ART-treated women compared with the general population is likely explained by nulliparity rather than ART treatment. The increased risk of borderline ovarian tumors after ART must be interpreted with caution because no dose-response relationship was observed.
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Affiliation(s)
- Mandy Spaan
- Department of Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | | | - Cornelis B Lambalk
- Department of Obstetrics & Gynecology, Amsterdam University Medical Center (UMC) Location, VU University Medical Center, Amsterdam, the Netherlands
| | - Hester H van Boven
- Department of Pathology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Roel Schats
- Department of Obstetrics & Gynecology, Amsterdam University Medical Center (UMC) Location, VU University Medical Center, Amsterdam, the Netherlands
| | - Marian Kortman
- Department of Reproductive Medicine and Gynecology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Frank J M Broekmans
- Department of Reproductive Medicine and Gynecology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Joop S E Laven
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Erasmus Medical Center, Rotterdam, the Netherlands
| | | | - Didi D M Braat
- Department of Obstetrics and Gynecology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
| | | | - Ben J Cohlen
- Department of Obstetrics and Gynecology, Isala Clinics, Zwolle, the Netherlands
| | - Astrid E P Cantineau
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University Groningen, Groningen, the Netherlands
| | - Jesper M J Smeenk
- Department of Obstetrics and Gynecology, St Elisabeth Hospital, Tilburg, the Netherlands
| | - Minouche M van Rumste
- Department of Obstetrics and Gynecology, Catharina Hospital, Eindhoven, the Netherlands
| | - Mariëtte Goddijn
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Amsterdam UMC Location, Academic Medical Center, Amsterdam, the Netherlands
| | - Ron J T van Golde
- Department of Obstetrics and Gynecology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Paul A M Meeuwissen
- Department of Obstetrics and Gynecology, Admiraal de Ruyter Hospital, Vlissingen, the Netherlands
| | - Carl J C M Hamilton
- Department of Obstetrics and Gynecology, Jeroen Bosch Ziekenhuis, 's-Hertogenbosch, the Netherlands
| | - Gabriële M Ouwens
- Department of Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Miranda A Gerritsma
- Department of Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Michael Schaapveld
- Department of Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Curt W Burger
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Flora E van Leeuwen
- Department of Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
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10
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Ye Z. Editorial for "Histogram Analysis Comparison of Monoexponential, Advanced Diffusion- Weighted Imaging, and Dynamic Contrast-Enhanced MRI for Differentiating Borderline From Malignant Epithelial Ovarian Tumors". J Magn Reson Imaging 2020; 52:269-270. [PMID: 32134534 DOI: 10.1002/jmri.27120] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 02/20/2020] [Indexed: 11/11/2022] Open
Abstract
LEVEL OF EVIDENCE 4 TECHNICAL EFFICACY: Stage 2 J. Magn. Reson. Imaging 2020;52:269-270.
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Affiliation(s)
- Zezhong Ye
- Department of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
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11
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Ouldamer L, Body G, Daraï E, Bendifallah S. [Borderline Ovarian Tumours: CNGOF Guidelines for Clinical Practice - Epidemiological Aspects and Risk Factors]. ACTA ACUST UNITED AC 2020; 48:239-247. [PMID: 32004787 DOI: 10.1016/j.gofs.2020.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The incidence (rate/100,000) of BOT gradually increases with age from 15-19 years of age and peaks at nearly 4.5 cases/100,000 for the 55-59 year age group (NP3). In the presence of a benign ovarian mass, the standardized risk ratio of serous and mucinous BOT is 1.69, (95% CI 1.39-2.03) and 1.75, (95% CI 1.45-2.10), respectively (NP2). At diagnosis, a median age of diagnosis of OFA is 46 years, unilateral forms (79.7% of cases) are predominant compared to cancers (45.3%) (<0.001) and FIGO I stages represent nearly 63.7% of cases (NP3). The 5-year survival rates for FIGO I, II, III, IV stages are: 99.7% (95% CI: 96.2-100%), 99.6% (95% CI: 92.6-100%), 95.3% (95% CI: 91.8-97.4%), 77.1% (95% CI: 58.0-88.3%), respectively (NP3). Survivors at 5 years for serous and mucinous tumours are 99.7% (95% CI: 99.2-99.9%), 98.5% (95% CI: 96.9-99.3%), respectively (NP3). An epidemiological association exists between personal BOT risk and: (1) a familial history of BOT/certain cancers (pancreas, lung, bone, leukemia) (NP3), (2) a personal history of benign ovarian cyst (NP2), (3) a personal history of pelvic inflammatory disease (IGH), (4) the use of intrauterine device levonorgestrel (NP3), (5) the use of oral contraceptive pills (NP3), (6) multiparity (NP3), (7) hormone replacement therapy (NP3), (8) high consumption of coumestrol (NP4), (9) medical treatment of infertility with progesterone (NP3), (10) non-steroidal anti-inflammatory drug (NSAID). An epidemiological association exists between previous/actual tabacco consumption and the risk of mucinous ovarian BOT (NP2). Relative risk (RR) varies between 2.2 and 2.7, however the relationship is not necessarily a causal one. An epidemiological association exists between overweight/obesity and the risk of serous BOT (NP2). RR varies between 1.2 to 1.8. The high Vitamin D was inversely associated to the risk of serous BOT (NP4). The risk of mucinous BOT was lowered with paracetamol use (OR=0.77; 95% CI: 0.60-0.98) (NP3). However, the relationship between these factors and BOT is not necessarily a causal one and no screening modality can be proposed in the general population (gradeC).
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Affiliation(s)
- L Ouldamer
- Département de gynécologie, centre hospitalier régional universitaire de Tours, hôpital Bretonneau, 37044 Tours, France; Unité Inserm 1069, 10, boulevard Tonnellé, 37044 Tours, France
| | - G Body
- Département de gynécologie, centre hospitalier régional universitaire de Tours, hôpital Bretonneau, 37044 Tours, France; Unité Inserm 1069, 10, boulevard Tonnellé, 37044 Tours, France
| | - E Daraï
- Département de gynécologie et d'obstétrique et médecine de la reproduction, Sorbonne université, hôpital universitaire Tenon, Assistance publique-hôpitaux de Paris (AP-HP), 4, rue de la Chine, 75020 Paris, France; UMR_S938, centre de recherche de Saint-Antoine, université Sorbonne, 75006 Paris, France
| | - S Bendifallah
- Département de gynécologie et d'obstétrique et médecine de la reproduction, Sorbonne université, hôpital universitaire Tenon, Assistance publique-hôpitaux de Paris (AP-HP), 4, rue de la Chine, 75020 Paris, France; UMR_S938, centre de recherche de Saint-Antoine, université Sorbonne, 75006 Paris, France.
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12
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Barger MK. Current Resources for Evidence-Based Practice, November/December 2019. J Midwifery Womens Health 2019; 64:775-781. [PMID: 31691482 DOI: 10.1111/jmwh.13064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 10/10/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Mary K Barger
- Hahn School of Nursing and Health Science, Beyster Institute for Nursing Research, San Diego, California
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13
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Li H, Liu L, Dang M, Zhang W, Liu J. Increased susceptibility of mice obtained from in vitro fertilization to global cerebral ischemia-reperfusion injury: possible role of hydrogen sulphide and its biosynthetic enzymes. Int J Neurosci 2019; 130:533-540. [PMID: 31516045 DOI: 10.1080/00207454.2019.1667797] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Aim of the Study: This study was designed to explore the relative susceptibility of in vitro fertilization (IVF)-conceived mice to global cerebral ischemic injury with the possible role of hydrogen sulphide and enzymes responsible for its production.Materials and Methods: IVF was carried to obtain pups, which were allowed to grow to the age of eight weeks. Thereafter, male mice were subjected to 20 min of global ischemia and 24 h of reperfusion. The mice obtained from other groups including normal mating, superovulation but normal mating and normal mating but embryo implantation were also subjected to global ischemia-reperfusion (I/R) injury.Results: IVF-derived mice exhibited significant more injury in response to I/R injury in comparison to other groups assessed in terms of impairment in locomotor activity, development of motor in coordination, neurological severity score, cerebral infarction and apoptosis markers (caspase-3 activity and Bcl-2 expression). Moreover, there was a relative decrease in the brain levels of hydrogen sulphide (H2S) and its biosynthetic enzymes viz. cystathionine-β-synthase and cystathionine-γ-lyase. Interestingly, the levels of H2S and cystathionine-γ-lyase were significantly low in IVF-derived mice in basal conditions also, i.e. before subjecting to I/R injury and these biochemical alterations were associated with the behavioural deficits in mice, even before subjecting to I/R injury.Conclusion: It is concluded that in vitro fertilization-derived mice are more susceptible to global cerebral I/R injury, which may be possibly due to decreased levels of hydrogen sulphide and its biosynthetic enzymes viz., cystathionine-β-synthase and cystathionine-γ-lyase.
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Affiliation(s)
- Hong Li
- Department of Neurology, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Lijun Liu
- Department of Neurology, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Minyan Dang
- Innoscience Research Sdn. Bhd, Subang Jaya, Malaysia
| | - Wenzhi Zhang
- Innoscience Research Sdn. Bhd, Subang Jaya, Malaysia
| | - Jie Liu
- Department of Neurology, The Fourth Hospital of Jinan, Jinan, China
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Assisted reproductive technology and risk of ovarian cancer and borderline tumors in parous women: a population-based cohort study. Eur J Epidemiol 2019; 34:1093-1101. [PMID: 31377935 PMCID: PMC6861355 DOI: 10.1007/s10654-019-00540-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 07/19/2019] [Indexed: 11/28/2022]
Abstract
The study aimed to investigate if assisted reproductive technology (ART) treatment or a diagnosis of infertility were associated with the risk of ovarian cancer or borderline ovarian tumors (BOT) in parous women. In a population-based register study of 1,340,097 women with a first live birth in Sweden 1982–2012, the relationship between ART treatments, infertility and incidence of ovarian cancer or BOT were investigated using Cox regression analysis. In the cohort, 38,025 women gave birth following ART, 49,208 following an infertility diagnosis but no ART and 1,252,864 without infertility diagnosis or ART. During follow-up, 991 women were diagnosed with ovarian cancer and 747 with BOT. Women who gave birth following ART had higher incidence of both ovarian cancer (adjusted hazard ratio [aHR] 2.43, 95% confidence interval [CI] 1.73–3.42) and BOT (aHR 1.91, 95% CI 1.27–2.86), compared to women without infertility. Compared to women with infertility diagnoses and non-ART births, women with ART births also had a higher incidence of ovarian cancer (aHR 1.79, 95% CI 1.18–2.71) and BOT (aHR 1.48, 95% CI 0.90–2.44). Our results suggest that women who have gone through ART have a higher risk of ovarian cancer and BOT. At least part of that risk seems to be due to the underlying infertility and not the treatment per se, since the increased risk was smaller when comparing to other infertile women. As ART treatments are becoming more common and ovarian cancer usually occur in women of advanced age, larger studies with longer follow-up are needed in order to confirm or refute our findings.
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15
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Rizzuto I, Behrens RF, Smith LA. Risk of ovarian cancer in women treated with ovarian stimulating drugs for infertility. Cochrane Database Syst Rev 2019; 6:CD008215. [PMID: 31207666 PMCID: PMC6579663 DOI: 10.1002/14651858.cd008215.pub3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND This is an updated version of the original Cochrane Review published in the Cochrane Library in 2013 (Issue 8) on the risk of ovarian cancer in women using infertility drugs when compared to the general population or to infertile women not treated. The link between fertility drugs and ovarian cancer remains controversial. OBJECTIVES To evaluate the risk of invasive ovarian cancer and borderline ovarian tumours in women treated with ovarian stimulating drugs for subfertility. SEARCH METHODS The original review included published and unpublished observational studies from 1990 to February 2013. For this update, we extended the searches from February 2013 to November 2018; we evaluated the quality of the included studies and judged the certainty of evidence by using the GRADE approach. We have reported the results in a Summary of findings table to present effect sizes across all outcome types. SELECTION CRITERIA In the original review and in this update, we searched for randomised controlled trials (RCTs) and non-randomised studies and case series including more than 30 participants. DATA COLLECTION AND ANALYSIS At least two review authors independently conducted eligibility and 'Risk of bias' assessments and extracted data. We grouped studies based on the fertility drug used for two outcomes: borderline ovarian tumours and invasive ovarian cancer. We conducted no meta-analyses due to expected methodological and clinical heterogeneity. MAIN RESULTS We included 13 case-control and 24 cohort studies (an additional nine new cohort and two case-control studies), which included a total of 4,684,724 women.Two cohort studies reported an increased incidence of invasive ovarian cancer in exposed subfertile women compared with unexposed women. One reported a standardised incidence ratio (SIR) of 1.19 (95% confidence interval (CI) 0.54 to 2.25) based on 17 cancer cases. The other cohort study reported a hazard ratio (HR) of 1.93 (95% CI 1.18 to 3.18), and this risk was increased in women remaining nulligravid after using clomiphene citrate (HR 2.49, 95% CI 1.30 to 4.78) versus multiparous women (HR 1.52, 95% CI 0.67 to 3.42) (very low-certainty evidence). The slight increase in ovarian cancer risk among women having between one and three cycles of in vitro fertilisation (IVF) was reported, but this was not clinically significant (P = 0.18). There was no increase in risk of invasive ovarian cancer after use of infertility drugs in women with the BRCA mutation according to one cohort and one case-control study. The certainty of evidence as assessed using GRADE was very low.For borderline ovarian tumours, one cohort study reported increased risk in exposed women with an SIR of 3.61 (95% CI 1.45 to 7.44), and this risk was greater after treatment with clomiphene citrate (SIR 7.47, 95% CI 1.54 to 21.83) based on 12 cases. In another cohort study, the risk of a borderline ovarian tumour was increased, with an HR of 4.23 (95% CI 1.25 to 14.33), for subfertile women treated with IVF compared with a non-IVF-treated group with more than one year of follow-up. A large cohort reported increased risk of borderline ovarian tumours, with HR of 2.46 (95% CI 1.20 to 5.04), and this was based on 17 cases. A significant increase in serous borderline ovarian tumours was reported in one cohort study after the use of progesterone for more than four cycles (risk ratio (RR) 2.63, 95% CI 1.04 to 6.64). A case-control study reported increased risk after clomiphene citrate was taken, with an SIR of 2.5 (95% CI 1.3 to 4.5) based on 11 cases, and another reported an increase especially after human menopausal gonadotrophin was taken (odds ratio (OR) 9.38, 95% CI 1.66 to 52.08). Another study estimated an increased risk of borderline ovarian tumour, but this estimation was based on four cases with no control reporting use of fertility drugs. The certainty of evidence as assessed using GRADE was very low.However, although some studies suggested a slight increase in risks of ovarian cancer and borderline ovarian tumour, none provided moderate- or high-certainty evidence, as summarised in the GRADE tables. AUTHORS' CONCLUSIONS Since the last version of this review, only a few new relevant studies have provided additional findings with supporting evidence to suggest that infertility drugs may increase the risk of ovarian cancer slightly in subfertile women treated with infertility drugs when compared to the general population or to subfertile women not treated. The risk is slightly higher in nulliparous than in multiparous women treated with infertility drugs, and for borderline ovarian tumours. However, few studies have been conducted, the number of cancers is very small, and information on the dose or type of fertility drugs used is insufficient.
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Affiliation(s)
- Ivana Rizzuto
- East Suffolk and North Essex NHS Foundation TrustGynaecology Oncology DepartmentHeath RoadIpswichSuffolkUKIP4 5PD
| | - Renee F Behrens
- Hampshire Hospitals NHS Foundation TrustRoyal Hampshire HospitalRomsey RoadWinchesterHampshireUKSO23 9TE
| | - Lesley A Smith
- Institute of Clinical and Applied Health ResearchUniversity of HullHullUKHU6 7RX
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Giampaolino P, Della Corte L, Foreste V, Vitale SG, Chiofalo B, Cianci S, Zullo F, Bifulco G. Unraveling a difficult diagnosis: the tricks for early recognition of ovarian cancer. Minerva Med 2019; 110:279-291. [PMID: 31081307 DOI: 10.23736/s0026-4806.19.06086-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Epithelial ovarian cancer (EOC) is the predominant type of ovarian cancer (OC). The 5-year survival of patients has improved over the last three decades, although the overall cure rate of OC if about 30%. Despite high response rates after initial chemotherapy, most patients with advanced ovarian cancer ultimately develop the recurrent disease because of resistance to chemotherapy. A proper early diagnosis and treatment of patients with ovarian cancer are urgently needed. Nowadays the diagnosis is performed by means of clinical symptoms and signs, often indicators of a disease already at an advanced stage, tumor markers (CA125 and HE4), transvaginal ultrasonography and imaging, very useful in distinguishing adnexal masses. Understand the nature of an adnexal mass is the primary point to begin the diagnosis of OC. Validated different model to approach and characterize adnexal pathology preoperatively are described, such as the International Ovarian Tumor Analysis (IOTA) and the Assessment of Different NEoplasias in the AdneXa (ADNEX) model. New tumor markers, such as PRSS8, FOLR1, KLK6/7, GSTT1, and miRNAs, are getting ahead and are worth noting for early detection of ovarian cancer. Despite the development of numerous ultrasound models for the diagnosis of adnexal masses and the analysis of different tumor markers, the early diagnosis of ovarian cancer is still difficult to practice. Moreover, identifying genetic risk alleles, such as germline BRCA1 and BRCA2 mutations, for ovarian cancer has had a significant impact on disease prevention strategies.
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Affiliation(s)
- Pierluigi Giampaolino
- Department of Public Health, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Luigi Della Corte
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Virginia Foreste
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Salvatore G Vitale
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy -
| | - Benito Chiofalo
- Unit of Gynecologic Oncology, Department of Experimental Clinical Oncology, "Regina Elena" National Cancer Institute, Rome, Italy
| | - Stefano Cianci
- Division of Gynecologic Oncology, Department of Women and Children's Health, A. Gemelli University Hospital and Institute for Research and Care, Rome, Italy
| | - Fulvio Zullo
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Giuseppe Bifulco
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
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Infertility: a marker of future health risk in women? Fertil Steril 2019; 110:783-789. [PMID: 30316412 DOI: 10.1016/j.fertnstert.2018.08.058] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 08/26/2018] [Accepted: 08/27/2018] [Indexed: 12/28/2022]
Abstract
Infertility, may be a harbinger for future health risk in women, including early mortality. Fertility status itself could serve as an early biomarker, (present in a woman's reproductive years) for risk stratification later in life. The relationship between infertility and early mortality involves the impact of nulliparity on future adverse health events, potential sequelae from the underlying cause(s) of infertility, the risks of fertility treatments, as well as the potential for risk reduction from a healthy pregnancy. This complex interplay coupled with difficulties ascertaining infertility on a population level has presented unique challenges to assessing infertility and early mortality risk. With further study, a better understanding the role of fertility status in health at various stages of life may provide unique opportunities for surveillance and risk reduction.
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Santos-Ribeiro S, Mackens S, Racca A, Blockeel C. Towards complication-free assisted reproduction technology. Best Pract Res Clin Endocrinol Metab 2019; 33:9-19. [PMID: 30473208 DOI: 10.1016/j.beem.2018.10.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Assisted reproductive technology (ART) has vastly improved over the last 40 years, from a frequently unsuccessful and complicated procedure requiring hospital admission and routine laparoscopy to a fairly simple outpatient technique with relatively high success rates. However, it is important to stress that ART is not without risk and medical complications may still occur. The incidence of most of these ART-related complications is associated with how women undergo ovarian stimulation. For this reason, physicians should be aware that a carefully thought-out ovarian stimulation protocol and cycle monitoring are of paramount importance to maximise the success of the treatment while avoiding potentially life-threating complications to occur in this frequently otherwise healthy patient population. This review discusses the rationale and evolution of ovarian stimulation strategies over the years and the current developments towards finding a balance between the retrieval of a sufficient number of oocytes and ART-related complication prevention.
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Affiliation(s)
| | - Shari Mackens
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, Brussels 1090, Belgium.
| | - Annalisa Racca
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, Brussels 1090, Belgium; Academic Unit of Obstetrics and Gynaecology, IRCCS AOU San Martino-IST, University of Genoa, Largo Rosanna Benzi 10, Genova 16132, Italy.
| | - Christophe Blockeel
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, Brussels 1090, Belgium; Department of Obstetrics and Gynaecology, School of Medicine, University of Zagreb, Šalata 3, Zagreb 10000, Croatia.
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Momenimovahed Z, Taheri S, Tiznobaik A, Salehiniya H. Do the Fertility Drugs Increase the Risk of Cancer? A Review Study. Front Endocrinol (Lausanne) 2019; 10:313. [PMID: 31191449 PMCID: PMC6546052 DOI: 10.3389/fendo.2019.00313] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Accepted: 04/30/2019] [Indexed: 11/22/2022] Open
Abstract
Aim: All over the world, many couples cannot conceive a child and have problems with pregnancy. Ovulation-inducing drugs are among the most important drugs used for the treatment of infertility. In recent years, there have been many debates about the relationship between fertility medication and cancer. Due to the lack of comprehensive study of this matter, and as understanding the relationship between the use of fertility drugs and cancer is of importance, the present study was conducted to investigate the relationship between infertility drugs and cancer in women. Materials and Methods: To determine the relationship between infertility treatment and cancer, a comprehensive search was carried out in databases such as; Medline, Web of Science Core Collection, and Scopus using keywords words; "infertility," "ovulation induction," "cancer," "infertility treatment," "ART," "tumor," "controlled ovarian stimulation," "fertility agents," and "neoplasms." Full-text, English language, and original articles were included in this study. Results: In total, 81 articles were entered into the study. The relationship between fertility medications and breast, ovary, endometrial, uterus, colon, thyroid, skin, cervical, and non-Hodgkin's lymphoma cancers were studied. Although the relationship between fertility medications and cancer is theoretically justifiable, most studies have shown that risk of cancer will not increase after fertility treatment. Conclusion: The results of this study did not show that fertility medications increase the risk of cancer among users. In summary, the relationship between infertility treatment and cancer incidence remains an open question.
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Affiliation(s)
- Zohre Momenimovahed
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Qom University of Medical Sciences, Qom, Iran
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Safoura Taheri
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Ilam University of Medical Sciences, Ilam, Iran
| | - Azita Tiznobaik
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Hamedan University of Medical Sciences, Hamedan, Iran
| | - Hamid Salehiniya
- Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand, Iran
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- *Correspondence: Hamid Salehiniya
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Lu Y, Beeghly-Fadiel A, Wu L, Guo X, Li B, Schildkraut JM, Im HK, Chen YA, Permuth JB, Reid BM, Teer JK, Moysich KB, Andrulis IL, Anton-Culver H, Arun BK, Bandera EV, Barkardottir RB, Barnes DR, Benitez J, Bjorge L, Brenton J, Butzow R, Caldes T, Caligo MA, Campbell I, Chang-Claude J, Claes KBM, Couch FJ, Cramer DW, Daly MB, deFazio A, Dennis J, Diez O, Domchek SM, Dörk T, Easton DF, Eccles DM, Fasching PA, Fortner RT, Fountzilas G, Friedman E, Ganz PA, Garber J, Giles GG, Godwin AK, Goldgar DE, Goodman MT, Greene MH, Gronwald J, Hamann U, Heitz F, Hildebrandt MAT, Høgdall CK, Hollestelle A, Hulick PJ, Huntsman DG, Imyanitov EN, Isaacs C, Jakubowska A, James P, Karlan BY, Kelemen LE, Kiemeney LA, Kjaer SK, Kwong A, Le ND, Leslie G, Lesueur F, Levine DA, Mattiello A, May T, McGuffog L, McNeish IA, Merritt MA, Modugno F, Montagna M, Neuhausen SL, Nevanlinna H, Nielsen FC, Nikitina-Zake L, Nussbaum RL, Offit K, Olah E, Olopade OI, Olson SH, Olsson H, Osorio A, Park SK, Parsons MT, Peeters PHM, Pejovic T, Peterlongo P, Phelan CM, Pujana MA, Ramus SJ, Rennert G, Risch H, Rodriguez GC, Rodríguez-Antona C, Romieu I, Rookus MA, Rossing MA, Rzepecka IK, Sandler DP, Schmutzler RK, Setiawan VW, Sharma P, Sieh W, Simard J, Singer CF, Song H, Southey MC, Spurdle AB, Sutphen R, Swerdlow AJ, Teixeira MR, Teo SH, Thomassen M, Tischkowitz M, Toland AE, Trichopoulou A, Tung N, Tworoger SS, van Rensburg EJ, Vanderstichele A, Vega A, Edwards DV, Webb PM, Weitzel JN, Wentzensen N, White E, Wolk A, Wu AH, Yannoukakos D, Zorn KK, Gayther SA, Antoniou AC, Berchuck A, Goode EL, Chenevix-Trench G, Sellers TA, Pharoah PDP, Zheng W, Long J. A Transcriptome-Wide Association Study Among 97,898 Women to Identify Candidate Susceptibility Genes for Epithelial Ovarian Cancer Risk. Cancer Res 2018; 78:5419-5430. [PMID: 30054336 PMCID: PMC6139053 DOI: 10.1158/0008-5472.can-18-0951] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 05/17/2018] [Accepted: 07/24/2018] [Indexed: 12/29/2022]
Abstract
Large-scale genome-wide association studies (GWAS) have identified approximately 35 loci associated with epithelial ovarian cancer (EOC) risk. The majority of GWAS-identified disease susceptibility variants are located in noncoding regions, and causal genes underlying these associations remain largely unknown. Here, we performed a transcriptome-wide association study to search for novel genetic loci and plausible causal genes at known GWAS loci. We used RNA sequencing data (68 normal ovarian tissue samples from 68 individuals and 6,124 cross-tissue samples from 369 individuals) and high-density genotyping data from European descendants of the Genotype-Tissue Expression (GTEx V6) project to build ovarian and cross-tissue models of genetically regulated expression using elastic net methods. We evaluated 17,121 genes for their cis-predicted gene expression in relation to EOC risk using summary statistics data from GWAS of 97,898 women, including 29,396 EOC cases. With a Bonferroni-corrected significance level of P < 2.2 × 10-6, we identified 35 genes, including FZD4 at 11q14.2 (Z = 5.08, P = 3.83 × 10-7, the cross-tissue model; 1 Mb away from any GWAS-identified EOC risk variant), a potential novel locus for EOC risk. All other 34 significantly associated genes were located within 1 Mb of known GWAS-identified loci, including 23 genes at 6 loci not previously linked to EOC risk. Upon conditioning on nearby known EOC GWAS-identified variants, the associations for 31 genes disappeared and three genes remained (P < 1.47 × 10-3). These data identify one novel locus (FZD4) and 34 genes at 13 known EOC risk loci associated with EOC risk, providing new insights into EOC carcinogenesis.Significance: Transcriptomic analysis of a large cohort confirms earlier GWAS loci and reveals FZD4 as a novel locus associated with EOC risk. Cancer Res; 78(18); 5419-30. ©2018 AACR.
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Affiliation(s)
- Yingchang Lu
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Alicia Beeghly-Fadiel
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Lang Wu
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Xingyi Guo
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Bingshan Li
- Department of Molecular Physiology and Biophysics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Joellen M Schildkraut
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia
| | - Hae Kyung Im
- Section of Genetic Medicine, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Yian A Chen
- Department of Biostatistics, Moffitt Cancer Center, Tampa, Florida
| | - Jennifer B Permuth
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, Florida
| | - Brett M Reid
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, Florida
| | - Jamie K Teer
- Department of Biostatistics, Moffitt Cancer Center, Tampa, Florida
| | - Kirsten B Moysich
- Division of Cancer Prevention and Control, Roswell Park Cancer Institute, Buffalo, New York
| | - Irene L Andrulis
- Fred A. Litwin Center for Cancer Genetics, Lunenfeld-Tanenbaum Research Institute of Mount Sinai Hospital, Toronto, Ontario, Canada
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Hoda Anton-Culver
- Department of Epidemiology, Genetic Epidemiology Research Institute, University of California Irvine, Irvine, California
| | - Banu K Arun
- Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Elisa V Bandera
- Cancer Prevention and Control Program, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Rosa B Barkardottir
- Department of Pathology, Landspitali University Hospital, Reykjavik, Iceland
- BMC (Biomedical Centre), Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Daniel R Barnes
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Javier Benitez
- Human Cancer Genetics Program, Spanish National Cancer Research Centre, Madrid, Spain
- Centro de Investigación en Red de Enfermedades Raras (CIBERER), Valencia, Spain
| | - Line Bjorge
- Department of Gynecology and Obstetrics, Haukeland University Horpital, Bergen, Norway
- Centre for Cancer Biomarkers, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - James Brenton
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, United Kingdom
| | - Ralf Butzow
- Department of Pathology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Trinidad Caldes
- Medical Oncology Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), Centro Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain
| | - Maria A Caligo
- Section of Genetic Oncology, Department of Laboratory Medicine, University and University Hospital of Pisa, Pisa, Italy
| | - Ian Campbell
- Peter MacCallum Cancer Center, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Pathology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jenny Chang-Claude
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Research Group Genetic Cancer Epidemiology, University Cancer Center Hamburg (UCCH), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Fergus J Couch
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Daniel W Cramer
- Obstetrics and Gynecology Epidemiology Center, Brigham and Women's Hospital, Boston, Massachusetts
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Mary B Daly
- Department of Clinical Genetics, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Anna deFazio
- Centre for Cancer Research, The Westmead Institute for Medical Research, The University of Sydney, Sydney, New South Wales, Australia
- Department of Gynaecological Oncology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Joe Dennis
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Orland Diez
- Oncogenetics Group, Clinical and Molecular Genetics Area, Vall d'Hebron Institute of Oncology (VHIO), University Hospital, Vall d'Hebron, Barcelona, Spain
| | - Susan M Domchek
- Department of Medicine, Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Thilo Dörk
- Gynaecology Research Unit, Hannover Medical School, Hannover, Germany
| | - Douglas F Easton
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, United Kingdom
| | - Diana M Eccles
- Cancer Sciences Academic Unit, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Peter A Fasching
- Department of Gynaecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
- David Geffen School of Medicine, Department of Medicine Division of Hematology and Oncology, University of California at Los Angeles, Los Angeles, California
| | - Renée T Fortner
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - George Fountzilas
- Department of Medical Oncology, "Papageorgiou" Hospital, Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece
| | - Eitan Friedman
- The Susanne Levy Gertner Oncogenetics Unit, Chaim Sheba Medical Center, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Patricia A Ganz
- Schools of Medicine and Public Health, Division of Cancer Prevention & Control Research, Jonsson Comprehensive Cancer Centre, UCLA, Los Angeles, California
| | - Judy Garber
- Cancer Risk and Prevention Clinic, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Graham G Giles
- Cancer Epidemiology & Intelligence Division, Cancer Council Victoria, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Andrew K Godwin
- Department of Pathology and Laboratory Medicine, Kansas University Medical Center, Kansas City, Kansas
| | - David E Goldgar
- Department of Dermatology, Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, Utah
| | - Marc T Goodman
- Cancer Prevention and Control, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California
- Community and Population Health Research Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Mark H Greene
- Clinical Genetics Branch, DCEG, National Cancer Institute, Bethesda, Maryland
| | - Jacek Gronwald
- Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland
| | - Ute Hamann
- Molecular Genetics of Breast Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Florian Heitz
- Department of Gynecology and Gynecologic Oncology, Dr. Horst Schmidt Kliniken Wiesbaden, Wiesbaden, Germany
- Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte/Evang. Huyssens-Stiftung/Knappschaft GmbH, Essen, Germany
| | | | - Claus K Høgdall
- Department of Gynecology, The Juliane Marie Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Antoinette Hollestelle
- Department of Medical Oncology, Family Cancer Clinic, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Peter J Hulick
- Center for Medical Genetics, NorthShore University HealthSystem, Evanston, Illinois
- The University of Chicago Pritzker School of Medicine, Chicago, Illinois
| | - David G Huntsman
- British Columbia's Ovarian Cancer Research (OVCARE) Program, Vancouver General Hospital, BC Cancer Agency and University of British Columbia, Vancouver, British Columbia, Canada
- Department of Molecular Oncology, BC Cancer Agency Research Centre, Vancouver, British Columbia, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Claudine Isaacs
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia
| | - Anna Jakubowska
- Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland
| | - Paul James
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Center, Melbourne, Victoria, Australia
| | - Beth Y Karlan
- Women's Cancer Program at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Linda E Kelemen
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Lambertus A Kiemeney
- Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Susanne K Kjaer
- Department of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Gynaecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Ava Kwong
- Hong Kong Hereditary Breast Cancer Family Registry, Happy Valley, Hong Kong
- Department of Surgery, The University of Hong Kong, Pok Fu Lam, Hong Kong
- Department of Surgery, Hong Kong Sanatorium and Hospital, Happy Valley, Hong Kong
| | - Nhu D Le
- Cancer Control Research, BC Cancer Agency, Vancouver, British Columbia, Canada
| | - Goska Leslie
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Fabienne Lesueur
- Genetic Epidemiology of Cancer team, Inserm U900, Paris, France
- Institut Curie, Paris, France
- PSL University, Paris, France
- Mines ParisTech, Fontainebleau, France
| | - Douglas A Levine
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
- Gynecologic Oncology, Laura and Isaac Pearlmutter Cancer Center, NYU Langone Medical Center, New York, New York
| | - Amalia Mattiello
- Dipertimento Di Medicina Clinica E Chirurgia, Federico II University, Naples, Italy
| | - Taymaa May
- Division of Gynecologic Oncology, University Health Network, Princess Margaret Hospital, Toronto, Ontario, Canada
| | - Lesley McGuffog
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Iain A McNeish
- Institute of Cancer Sciences, University of Glasgow, Wolfson Wohl Cancer Research Centre, Glasgow, United Kingdom
| | - Melissa A Merritt
- Cancer Epidemiology Program, University of Hawaii Cancer Center, Honolulu, Hawaii
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
| | - Francesmary Modugno
- Ovarian Cancer Center of Excellence, Womens Cancer Research Program, Magee-Womens Research Institute and University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Marco Montagna
- Immunology and Molecular Oncology Unit, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Susan L Neuhausen
- Department of Population Sciences, Beckman Research Institute of City of Hope, Duarte, California
| | - Heli Nevanlinna
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Finn C Nielsen
- Center for Genomic Medicine, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Robert L Nussbaum
- Cancer Genetics and Prevention Program, University of California San Francisco, San Francisco, California
| | - Kenneth Offit
- Clinical Genetics Research Lab, Department of Cancer Biology and Genetics, Memorial Sloan-Kettering Cancer Center, New York, New York
- Clinical Genetics Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Edith Olah
- Department of Molecular Genetics, National Institute of Oncology, Budapest, Hungary
| | | | - Sara H Olson
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Håkan Olsson
- Department of Cancer Epidemiology, Clinical Sciences, Lund University, Lund, Sweden
| | - Ana Osorio
- Human Cancer Genetics Program, Spanish National Cancer Research Centre, Madrid, Spain
- Biomedical Network on Rare Diseases (CIBERER), Madrid, Spain
| | - Sue K Park
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, Korea
- Cancer Research Institute, Seoul National University, Seoul, Korea
| | - Michael T Parsons
- Department of Genetics and Computational Biology, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Petra H M Peeters
- Julius Center for Health Sciences and Primary Care, UMC Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Tanja Pejovic
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon
- Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon
| | - Paolo Peterlongo
- IFOM, the FIRC (Italian Foundation for Cancer Research) Institute of Molecular Oncology, Milan, Italy
| | - Catherine M Phelan
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, Florida
| | - Miquel Angel Pujana
- Catalan Institute of Oncology, ProCURE, Oncobell, Bellvitge Biomedical Research Institute (IDIBELL). Barcelona, Spain
| | - Susan J Ramus
- School of Women's and Children's Health, University of NSW Sydney, Sydney, New South Wales, Australia
- The Kinghorn Cancer Centre, Garvan Institute of Medical Research, Sydney, New South Wales, Australia
| | - Gad Rennert
- Clalit National Cancer Control Center, Carmel Medical Center and Technion Faculty of Medicine, Haifa, Israel
| | - Harvey Risch
- School of Public Health, Yale University, New Haven, Connecticut
| | - Gustavo C Rodriguez
- Division of Gynecologic Oncology, NorthShore University HealthSystem, University of Chicago, Evanston, Illinois
| | | | - Isabelle Romieu
- Nutrition and Metabolism Section, International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - Matti A Rookus
- Department of Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Mary Anne Rossing
- Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
- Department of Epidemiology, University of Washington, Seattle, Washington
| | - Iwona K Rzepecka
- Department of Pathology and Laboratory Diagnostics, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
| | - Dale P Sandler
- Epidemiology Branch, National Institute of Environmental Health Sciences, NIH, Research Triangle Park, Maryland
| | - Rita K Schmutzler
- Center for Hereditary Breast and Ovarian Cancer, University Hospital of Cologne, Cologne, Germany
- Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
| | - Veronica W Setiawan
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Priyanka Sharma
- Department of Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Weiva Sieh
- Department of Genetics and Genomic Sciences, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jacques Simard
- Genomics Center, Centre Hospitalier Universitaire de Québec Research Center, Laval University, Québec City, Québec, Canada
| | - Christian F Singer
- Dept of OB/GYN and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Honglin Song
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, United Kingdom
| | - Melissa C Southey
- Department of Pathology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Amanda B Spurdle
- Department of Genetics and Computational Biology, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Rebecca Sutphen
- Epidemiology Center, College of Medicine, University of South Florida, Tampa, Florida
| | - Anthony J Swerdlow
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, United Kingdom
- Division of Breast Cancer Research, The Institute of Cancer Research, London, United Kingdom
| | - Manuel R Teixeira
- Department of Genetics, Portuguese Oncology Institute, Porto, Portugal
- Biomedical Sciences Institute (ICBAS), University of Porto, Porto, Portugal
| | - Soo H Teo
- Cancer Research Malaysia, Subang Jaya, Selangor, Malaysia
- Breast Cancer Research Unit, Cancer Research Institute, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Mads Thomassen
- Department of Clinical Genetics, Odense University Hospital, Odence C, Denmark
| | - Marc Tischkowitz
- Program in Cancer Genetics, Departments of Human Genetics and Oncology, McGill University, Montréal, Québec, Canada
- Department of Medical Genetics, Cambridge University, Cambridge, United Kingdom
| | - Amanda E Toland
- Department of Cancer Biology and Genetics, Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
| | - Antonia Trichopoulou
- Hellenic Health Foundation, Athens, Greece
- WHO Collaborating Center for Nutrition and Health, Unit of Nutritional Epidemiology and Nutrition in Public Health, Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece
| | - Nadine Tung
- Department of Medical Oncology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Shelley S Tworoger
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, Florida
- Research Institute and Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | | | - Adriaan Vanderstichele
- Division of Gynecologic Oncology, Department of Obstetrics and Gynaecology and Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - Ana Vega
- Fundación Pública Galega Medicina Xenómica, Santiago De Compostela, Spain
| | - Digna Velez Edwards
- Vanderbilt Epidemiology Center, Vanderbilt Genetics Institute, Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Penelope M Webb
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | | | - Nicolas Wentzensen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Emily White
- Fred Hutchinson Cancer Research Center, Seattle, Washington
- Department of Epidemiology, University of Washington, Seattle, Washington
| | - Alicja Wolk
- Department of Environmental Medicine, Division of Nutritional Epidemiology, Karolinska Institutet, Stockholm, Sweden
| | - Anna H Wu
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Drakoulis Yannoukakos
- Molecular Diagnostics Laboratory, INRASTES, National Centre for Scientific Research 'Demokritos', Athens, Greece
| | - Kristin K Zorn
- Magee-Womens Hospital, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Simon A Gayther
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
- Center for Cancer Prevention and Translational Genomics, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Antonis C Antoniou
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Andrew Berchuck
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina
| | - Ellen L Goode
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Georgia Chenevix-Trench
- Department of Genetics and Computational Biology, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Thomas A Sellers
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, Florida
| | - Paul D P Pharoah
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, United Kingdom
| | - Wei Zheng
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Jirong Long
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, Tennessee.
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Williams CL, Jones ME, Swerdlow AJ, Botting BJ, Davies MC, Jacobs I, Bunch KJ, Murphy MFG, Sutcliffe AG. Risks of ovarian, breast, and corpus uteri cancer in women treated with assisted reproductive technology in Great Britain, 1991-2010: data linkage study including 2.2 million person years of observation. BMJ 2018; 362:k2644. [PMID: 29997145 PMCID: PMC6039832 DOI: 10.1136/bmj.k2644] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To investigate the risks of ovarian, breast, and corpus uteri cancer in women who have had assisted reproduction. DESIGN Large, population based, data linkage cohort study. SETTING AND PARTICIPANTS All women who had assisted reproduction in Great Britain, 1991-2010, as recorded by the Human Fertilisation and Embryology Authority (HFEA). INTERVENTIONS HFEA fertility records for cohort members were linked to national cancer registrations. MAIN OUTCOME MEASURES Observed first diagnosis of ovarian, breast, and corpus uteri cancer in cohort members were compared with age, sex, and period specific expectation. Standardised incidence ratios (SIRs) were calculated by use of age, sex, and period specific national incidence rates. RESULTS 255 786 women contributed 2 257 789 person years' follow-up. No significant increased risk of corpus uteri cancer (164 cancers observed v 146.9 cancers expected; SIR 1.12, 95% confidence interval 0.95 to 1.30) was found during an average of 8.8 years' follow-up. This study found no significantly increased risks of breast cancer overall (2578 v 2641.2; SIR 0.98, 0.94 to 1.01) or invasive breast cancer (2272 v 2371.4; SIR 0.96, 0.92 to 1.00). An increased risk of in situ breast cancer (291 v 253.5; SIR 1.15, 1.02 to 1.29; absolute excess risk (AER) 1.7 cases per 100 000 person years, 95% confidence interval 0.2 to 3.2) was detected, associated with an increasing number of treatment cycles (P=0.03). There was an increased risk of ovarian cancer (405 v 291.82; SIR 1.39, 1.26 to 1.53; AER 5.0 cases per 100 000 person years, 3.3 to 6.9), both invasive (264 v 188.1; SIR 1.40, 1.24 to 1.58; AER 3.4 cases per 100 000 person years, 2.0 to 4.9) and borderline (141 v 103.7; SIR 1.36, 1.15 to 1.60; AER 1.7 cases per 100 000 person years, 0.7 to 2.8). Increased risks of ovarian tumours were limited to women with endometriosis, low parity, or both. This study found no increased risk of any ovarian tumour in women treated because of only male factor or unexplained infertility. CONCLUSIONS No increased risk of corpus uteri or invasive breast cancer was detected in women who had had assisted reproduction, but increased risks of in situ breast cancer and invasive and borderline ovarian tumours were found in this study. Our results suggest that ovarian tumour risks could be due to patient characteristics, rather than assisted reproduction itself, although both surveillance bias and the effect of treatment are also possibilities. Ongoing monitoring of this population is essential.
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Affiliation(s)
| | | | | | | | - Melanie C Davies
- Institute for Women's Health, University College London Hospitals, London, UK
| | - Ian Jacobs
- Institute for Women's Health, University College London Hospitals, London, UK
- University of New South Wales, Sydney, NSW, Australia
| | - Kathryn J Bunch
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
| | - Michael F G Murphy
- Nuffield Department of Obstetrics and Gynaecology, University of Oxford, Oxford, UK
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Oral E, Aydin O, Kumbak BA, İlvan S, Yilmaz H, Tustas E, Bese T, Demirkiran F, Arvas M. Concomitant endometriosis in malignant and borderline ovarian tumours. J OBSTET GYNAECOL 2018; 38:1104-1109. [DOI: 10.1080/01443615.2018.1441815] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Engin Oral
- Department of Obstetrics and Gynecology, Cerrahpasa Medical School, İstanbul University, İstanbul, Turkey
| | - Ovgu Aydin
- Department of Pathology, Cerrahpasa Medical School, İstanbul University, İstanbul, Turkey
| | - Banu Aygun Kumbak
- Department of Obstetrics and Gynecology, İstanbul Aydin University, İstanbul, Turkey
| | - Sennur İlvan
- Department of Pathology, Cerrahpasa Medical School, İstanbul University, İstanbul, Turkey
| | - Handan Yilmaz
- Department of Obstetrics and Gynecology, Cerrahpasa Medical School, İstanbul University, İstanbul, Turkey
| | - Esra Tustas
- Umraniye Education and Research Hospital, İstanbul, Turkey
| | - Tugan Bese
- Department of Obstetrics and Gynecology, Cerrahpasa Medical School, İstanbul University, İstanbul, Turkey
| | - Fuat Demirkiran
- Department of Obstetrics and Gynecology, Cerrahpasa Medical School, İstanbul University, İstanbul, Turkey
| | - Macit Arvas
- Department of Obstetrics and Gynecology, Cerrahpasa Medical School, İstanbul University, İstanbul, Turkey
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Abstract
PURPOSE OF REVIEW There is increasing use of fertility medications for ovulation induction and ovarian stimulation for in-vitro fertilization in the treatment of female infertility. In this review, recent literature regarding the association between fertility medication and cancer risk is reviewed. RECENT FINDINGS Several important publications have recently addressed the relationship between use of fertility medications and cancer risk. There are methodological limitations to many of these studies, including unique challenges in studying rare cancers that often develop several years after the time of fertility medication exposure. Although infertility per se is a risk factor for some female cancers, including breast, endometrial and ovarian cancer, most studies do not show a significant risk of these cancers with the use of fertility medications. Some studies, however, have shown a possible increased relative risk of borderline ovarian cancer, although the increased absolute risk is small without a clear causal relationship. SUMMARY The collective data regarding the risk of developing cancer from use of fertility medications are reassuring, although several methodological issues in these studies limit definitive conclusions.
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Pan Z, Xie X. BRCA mutations in the manifestation and treatment of ovarian cancer. Oncotarget 2017; 8:97657-97670. [PMID: 29228641 PMCID: PMC5722593 DOI: 10.18632/oncotarget.18280] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 04/28/2017] [Indexed: 12/20/2022] Open
Abstract
BRCA genes are important for the integrity and stability of genetic material and play key roles in repairing DNA breaks via high fidelity homologous recombination. BRCA mutations are known to predispose carriers to gynecological malignancies, accounting for a majority of hereditary OC cases. Known to be lethal, OC is difficult to detect and control. Testing for BRCA mutations is a key step in the risk assessment, prognosis, treatment and prevention of OC and current clinical guidelines recommend BRCA mutation testing for all OCs of epithelial origin. Studies have established that ovarian tumors harboring BRCA mutations have distinct molecular and histo-pathological features that can be exploited for effective, targeted treatment. Deficiencies in DNA repair pathways that arise as a result of BRCA mutations make them hypersensitive to DNA-damaging treatments such as platinum chemotherapy and PARP inhibitors. Different combinations of treatment regimens which have the potential to greatly improve prognosis and disease outcomes are currently being evaluated. However, the issue of developing resistance to these treatments remains unresolved. This review emphasizes unique features of BRCA mutated OC and outlines the lay of the land in terms of diagnosis and treatment, while aiming to unravel the challenges that are part of its management.
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Affiliation(s)
- Zimin Pan
- Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, People's Republic of China
| | - Xing Xie
- Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, People's Republic of China
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Nayyar N, Lakhwani P, Goel A, Pande PK, Kumar K. Management of Borderline Ovarian Tumors-Still a Gray Zone. Indian J Surg Oncol 2017; 8:607-614. [PMID: 29203995 DOI: 10.1007/s13193-017-0697-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 08/14/2017] [Indexed: 11/30/2022] Open
Abstract
Borderline ovarian tumors (BOTs) are a heterogeneous group of non-invasive epithelial ovarian tumors that occur at a younger age, present in early stage, frequently associated with infertility but are easily curable. Although they may have symptomatic long-term recurrences, they have an excellent prognosis in spite of peritoneal spread. Among the epithelial tumors of the ovary, BOTs fall in the spectrum lying between cystadenomas (benign) and cystadenocarcinomas (malignant). Their oncological behavior is more aggressive than benign ovarian tumors but relatively less than that of malignant ovarian tumors. Since the age group affected is usually young females, preservation of fertility is an important aspect of treatment protocol. Although the management of these tumors has been extensively discussed, it still remains a controversial gray zone. In this review, epidemiology, pathogenesis, histologic subtypes, various surgical approaches, follow-up, and management of recurrence have been discussed. Choosing the best treatment still poses a challenge for the treating oncosurgeon.
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Affiliation(s)
- Nidhi Nayyar
- Department of Surgical Oncology, BLK Cancer Centre, BLK Super Speciality Hospital, New Delhi, India
| | - Prerna Lakhwani
- Department of Surgical Oncology, BLK Cancer Centre, BLK Super Speciality Hospital, New Delhi, India
| | - Ashish Goel
- Department of Surgical Oncology, BLK Cancer Centre, BLK Super Speciality Hospital, New Delhi, India
| | - Pankaj Kr Pande
- Department of Surgical Oncology, BLK Cancer Centre, BLK Super Speciality Hospital, New Delhi, India
| | - Kapil Kumar
- Department of Surgical Oncology, BLK Cancer Centre, BLK Super Speciality Hospital, New Delhi, India
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27
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Schwarze JE, Valdebenito P, Ortega C, Villa S, Crosby J, Pommer R. Do women offered assisted reproduction technologies have a higher incidence of gynecologic cancer? A systematic review and meta-analysis. JBRA Assist Reprod 2017; 21:115-119. [PMID: 28609278 PMCID: PMC5473704 DOI: 10.5935/1518-0557.20170026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The last two decades have seen an increase in the number of women diagnosed with
infertility. The consequent growth in the use of assisted reproductive
technologies (ART) calls for the determination of its long-term effects,
including the risk of cancer. Many studies have attempted to answer this
question, albeit with contradictory results. This review aimed to assess whether
assisted reproductive technologies are associated with an increased risk of
gynecological cancer. A search for papers in the literature was carried out on
MEDLINE, TRIP DATABASE and NICE, resulting in 11 studies enrolling 3,900,231
patients altogether. Of these, 118,320 were offered ART. The incidence of
gynecological cancer in the group offered ART was 0.6%, while the incidence in
the group not offered ART was 2.1%. Taking all the studies into consideration,
women offered ART were not at greater risk of having gynecological cancer;
instead, a protective association was found.
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Affiliation(s)
| | | | | | - Sonia Villa
- Reproductive Medicine Unit at Clinica Monteblanco
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28
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Li HM, Zhao SH, Qiang JW, Zhang GF, Feng F, Ma FH, Li YA, Gu WY. Diffusion kurtosis imaging for differentiating borderline from malignant epithelial ovarian tumors: A correlation with Ki-67 expression. J Magn Reson Imaging 2017; 46:1499-1506. [PMID: 28295854 DOI: 10.1002/jmri.25696] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 02/15/2017] [Indexed: 12/17/2022] Open
Affiliation(s)
- Hai Ming Li
- Department of Radiology, Jinshan Hospital, Shanghai Medical College; Fudan University; Shanghai P.R. China
- Department of Radiology, Nantong Cancer Hospital; Nantong University; Nantong Jiangsu P.R. China
| | - Shu Hui Zhao
- Department of Radiology, Xinhua Hospital; Shanghai Jiao Tong University School of Medicine; Shanghai P.R. China
| | - Jin Wei Qiang
- Department of Radiology, Jinshan Hospital, Shanghai Medical College; Fudan University; Shanghai P.R. China
| | - Guo Fu Zhang
- Department of Radiology, Obstetrics & Gynecology Hospital, Shanghai Medical College; Fudan University; Shanghai P.R. China
| | - Feng Feng
- Department of Radiology, Nantong Cancer Hospital; Nantong University; Nantong Jiangsu P.R. China
| | - Feng Hua Ma
- Department of Radiology, Obstetrics & Gynecology Hospital, Shanghai Medical College; Fudan University; Shanghai P.R. China
| | - Yong Ai Li
- Department of Radiology, Jinshan Hospital, Shanghai Medical College; Fudan University; Shanghai P.R. China
| | - Wei Yong Gu
- Department of Pathology, Obstetrics & Gynecology Hospital, Shanghai Medical College; Fudan University; Shanghai 200011 P.R. China
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Santulli P, Somigliana E, Bourdon M, Maignien C, Marcellin L, Gayet V, Chapron C. [Conservative management of endometrioma in women undergoing in vitro fertilization]. J Gynecol Obstet Hum Reprod 2017; 46:203-209. [PMID: 28403916 DOI: 10.1016/j.jogoh.2016.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 09/10/2016] [Accepted: 09/29/2016] [Indexed: 11/15/2022]
Abstract
Endometriosis is a chronic disease. The pathogenesis is actually still unclear. Endometriosis is responsible for infertility and/or pelvic pain. One of the most important features of the disease is the heterogeneity (clinical and anatomical). Among the different phenotypes of endometriosis, the ovarian endometrioma seems to most important lesion in the management of endometriosis-related infertility. Surgical treatment is associated to a decrease of the ovarian reserve and a potential detrimental effect on in vitro fecondation (IVF) outcomes. Thus, the choice between conservative or surgical management of endometrioma before IVF is actually debated. The advantages and drawback of surgical and conservative management should be discussed before to plan the treatment. In the present review, we aimed at assessing the risks of a conservative management of endometrioma as compared to surgery before IVF.
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Affiliation(s)
- P Santulli
- Service de gynécologie-obstétrique II et médecine de la reproduction, hôpital universitaire Paris Centre, centre hospitalier universitaire (CHU) Cochin, Assistance publique-Hôpitaux de Paris (AP-HP), faculté de médecine, université Paris Descartes, Sorbonne Paris Cité, bâtiment Port Royal, 53, avenue de l'Observatoire, 75679 Paris 14, France; Inserm U1016, laboratoire d'immunologie, institut Cochin, université Paris Descartes, Sorbonne Paris Cité, Paris 14, France; Inserm U1016, département de génétique, développement et cancer, institut Cochin, université Paris Descartes, Sorbonne Paris Cité, Paris 14, France.
| | - E Somigliana
- Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italie
| | - M Bourdon
- Service de gynécologie-obstétrique II et médecine de la reproduction, hôpital universitaire Paris Centre, centre hospitalier universitaire (CHU) Cochin, Assistance publique-Hôpitaux de Paris (AP-HP), faculté de médecine, université Paris Descartes, Sorbonne Paris Cité, bâtiment Port Royal, 53, avenue de l'Observatoire, 75679 Paris 14, France; Inserm U1016, laboratoire d'immunologie, institut Cochin, université Paris Descartes, Sorbonne Paris Cité, Paris 14, France
| | - C Maignien
- Service de gynécologie-obstétrique II et médecine de la reproduction, hôpital universitaire Paris Centre, centre hospitalier universitaire (CHU) Cochin, Assistance publique-Hôpitaux de Paris (AP-HP), faculté de médecine, université Paris Descartes, Sorbonne Paris Cité, bâtiment Port Royal, 53, avenue de l'Observatoire, 75679 Paris 14, France
| | - L Marcellin
- Service de gynécologie-obstétrique II et médecine de la reproduction, hôpital universitaire Paris Centre, centre hospitalier universitaire (CHU) Cochin, Assistance publique-Hôpitaux de Paris (AP-HP), faculté de médecine, université Paris Descartes, Sorbonne Paris Cité, bâtiment Port Royal, 53, avenue de l'Observatoire, 75679 Paris 14, France; Inserm U1016, laboratoire d'immunologie, institut Cochin, université Paris Descartes, Sorbonne Paris Cité, Paris 14, France; Inserm U1016, département de génétique, développement et cancer, institut Cochin, université Paris Descartes, Sorbonne Paris Cité, Paris 14, France
| | - V Gayet
- Service de gynécologie-obstétrique II et médecine de la reproduction, hôpital universitaire Paris Centre, centre hospitalier universitaire (CHU) Cochin, Assistance publique-Hôpitaux de Paris (AP-HP), faculté de médecine, université Paris Descartes, Sorbonne Paris Cité, bâtiment Port Royal, 53, avenue de l'Observatoire, 75679 Paris 14, France
| | - C Chapron
- Service de gynécologie-obstétrique II et médecine de la reproduction, hôpital universitaire Paris Centre, centre hospitalier universitaire (CHU) Cochin, Assistance publique-Hôpitaux de Paris (AP-HP), faculté de médecine, université Paris Descartes, Sorbonne Paris Cité, bâtiment Port Royal, 53, avenue de l'Observatoire, 75679 Paris 14, France; Inserm U1016, département de génétique, développement et cancer, institut Cochin, université Paris Descartes, Sorbonne Paris Cité, Paris 14, France
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Reigstad MM, Storeng R, Myklebust TÅ, Oldereid NB, Omland AK, Robsahm TE, Brinton LA, Vangen S, Furu K, Larsen IK. Cancer Risk in Women Treated with Fertility Drugs According to Parity Status-A Registry-based Cohort Study. Cancer Epidemiol Biomarkers Prev 2017; 26:953-962. [PMID: 28108444 DOI: 10.1158/1055-9965.epi-16-0809] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 12/21/2016] [Accepted: 12/22/2016] [Indexed: 11/16/2022] Open
Abstract
Background: Long-term safety of assisted reproductive techniques (ART) is of interest as their use is increasing. Cancer risk is known to be affected by parity. This study examined the risk of cancer after fertility treatment, stratified by women's parity.Methods: Data were obtained from all women (n = 1,353,724) born in Norway between 1960 and 1996. Drug exposure data (2004-2014) were obtained from the Norwegian Prescription Database (drugs used in ART and clomiphene citrate). The Medical Birth Registry of Norway provided parity status. HRs were calculated for all site cancer, breast, cervical, endometrial, ovarian, colorectal, central nervous system, thyroid cancer, and malignant melanoma.Results: In 12,354,392 person-years of follow-up, 20,128 women were diagnosed with cancer. All-site cancer risk was 1.14 [95% confidence interval (95% CI), 1.03-1.26] and 1.10 (95% CI, 0.98-1.23) after clomiphene citrate and ART exposure, respectively. For ovarian cancer, a stronger association was observed for both exposures in nulliparous (HR, 2.49; 95% CI, 1.30-4.78; and HR, 1.62; 95% CI, 0.78-3.35) versus parous women (HR, 1.37; 95% CI, 0.64-2.96; and HR, 0.87; 95% CI, 0.33-2.27). Elevated risk of endometrial cancers was observed for clomiphene citrate exposure in nulliparous women (HR, 4.49; 95% CI, 2.66-7.60 vs. HR, 1.52; 95% CI, 0.67-3.42). Risk was elevated for breast cancer in parous women exposed to clomiphene citrate (HR, 1.26; 95% CI, 1.03-1.54) for thyroid cancer and among nulliparous women after ART treatment (HR, 2.19; 95% CI, 1.08-4.44).Conclusions: Clomiphene citrate appears associated with increased risk of ovarian and endometrial cancer. Elevations in risks of breast and thyroid cancer were less consistent across type of drug exposure and parity.Impact: Continued monitoring of fertility treatments is warranted. Cancer Epidemiol Biomarkers Prev; 26(6); 953-62. ©2017 AACR.
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Affiliation(s)
- Marte Myhre Reigstad
- Norwegian National Advisory Unit on Women's Health, Oslo University Hospital, Oslo, Norway. .,Cancer Registry of Norway, Institute of Population-based Cancer Research, Oslo, Norway
| | - Ritsa Storeng
- Norwegian National Advisory Unit on Women's Health, Oslo University Hospital, Oslo, Norway
| | - Tor Åge Myklebust
- Cancer Registry of Norway, Institute of Population-based Cancer Research, Oslo, Norway
| | - Nan Birgitte Oldereid
- Section for Reproductive Medicine, Department of Gynecology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Anne Katerine Omland
- Section for Reproductive Medicine, Department of Gynecology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Trude Eid Robsahm
- Cancer Registry of Norway, Institute of Population-based Cancer Research, Oslo, Norway
| | - Louise Annette Brinton
- Division of Cancer Epidemiology & Genetics, National Cancer Institute, Bethesda, Maryland
| | - Siri Vangen
- Norwegian National Advisory Unit on Women's Health, Oslo University Hospital, Oslo, Norway
| | - Kari Furu
- Department of Pharmacoepidemiology, Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Inger Kristin Larsen
- Cancer Registry of Norway, Institute of Population-based Cancer Research, Oslo, Norway
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31
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Webb PM, Jordan SJ. Epidemiology of epithelial ovarian cancer. Best Pract Res Clin Obstet Gynaecol 2016; 41:3-14. [PMID: 27743768 DOI: 10.1016/j.bpobgyn.2016.08.006] [Citation(s) in RCA: 556] [Impact Index Per Article: 69.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 08/17/2016] [Indexed: 02/08/2023]
Abstract
Globally, ovarian cancer is the seventh most common cancer in women and the eighth most common cause of cancer death, with five-year survival rates below 45%. Although age-standardised rates are stable or falling in most high-income countries, they are rising in many low and middle income countries. Furthermore, with increasing life-expectancy, the number of cases diagnosed each year is increasing. To control ovarian cancer we need to understand the causes. This will allow better prediction of those at greatest risk for whom screening might be appropriate, while identification of potentially modifable causes provides an opportunity for intervention to reduce rates. In this paper we will summarise the current state of knowledge regarding the known and possible causes of epithelial ovarian cancer and discuss some of the main theories of ovarian carcinogenesis. We will also briefly review the relationship between lifestyle and survival after a diagnosis of ovarian cancer.
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Affiliation(s)
- Penelope M Webb
- QIMR Berghofer Medical Research Institute, Locked Bag 2000 Royal Brisbane Hospital, Brisbane, Queensland 4029, Australia; School of Public Health, The University of Queensland, Public Health Building, Corner of Herston Road & Wyndham Street, Herston, Queensland 4006, Australia.
| | - Susan J Jordan
- QIMR Berghofer Medical Research Institute, Locked Bag 2000 Royal Brisbane Hospital, Brisbane, Queensland 4029, Australia; School of Public Health, The University of Queensland, Public Health Building, Corner of Herston Road & Wyndham Street, Herston, Queensland 4006, Australia.
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32
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Fertility preservation in women with borderline ovarian tumours. Cancer Treat Rev 2016; 49:13-24. [DOI: 10.1016/j.ctrv.2016.06.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 06/29/2016] [Accepted: 06/30/2016] [Indexed: 12/15/2022]
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Abstract
Methodological limitations in studying the association between the use of fertility drugs and cancer include the inherent increased risk of cancer in women who never conceive, the low incidence of most of these cancers, and that the age of diagnosis of cancer typically is many years after fertility drug use. Based on available data, there does not appear to be a meaningful increased risk of invasive ovarian cancer, breast cancer, or endometrial cancer following the use of fertility drugs. Several studies have shown a small increased risk of borderline ovarian tumors; however, there is insufficient consistent evidence that a particular fertility drug increases the risk of borderline ovarian tumors, and any absolute risk is small. Given the available literature, patients should be counseled that infertile women may be at an increased risk of invasive ovarian, endometrial, and breast cancer; however, use of fertility drugs does not appear to increase this risk.
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Affiliation(s)
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- American Society for Reproductive Medicine, Birmingham, Alabama
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34
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Cai G, Ma X, Chen B, Huang Y, Liu S, Yang H, Zou W. Galectin-3 induces ovarian cancer cell survival and chemoresistance via TLR4 signaling activation. Tumour Biol 2016; 37:11883-11891. [DOI: 10.1007/s13277-016-5038-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 03/28/2016] [Indexed: 02/07/2023] Open
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Zapardiel I, Cruz M, Diestro MD, Requena A, Garcia-Velasco JA. Assisted reproductive techniques after fertility-sparing treatments in gynaecological cancers. Hum Reprod Update 2016; 22:281-305. [PMID: 26759231 DOI: 10.1093/humupd/dmv066] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 12/18/2015] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The trend toward late childbearing has made fertility preservation a major issue for women who face gynecological cancer. New techniques in assisted reproductive medicine enable conception after primary treatment of these cancers. Here, we aimed to review the efficacy and safety of assisted reproductive techniques (ART) after fertility-preserving treatment of gynaecological cancers. METHODS We conducted a systematic literature review of both prospective and retrospective studies in the PubMed, EMBASE, CENTRAL and SciSearch databases. In the retrieved studies, we evaluated live births, clinical pregnancies, overall survival and disease-free survival. RESULTS We identified many prospective and retrospective studies on this topic, but no relevant randomized clinical trials. Fertility-sparing treatments with safe oncological outcomes are feasible in endometrial, cervical and ovarian cancer cases. After cancer treatment, ART seem safe and show variable obstetrical outcomes. CONCLUSIONS After fertility-preserving treatment for gynaecological cancers, ART can enable pregnancy to be achieved with apparent oncological safety. The success of such procedures should directly impact clinical practice and management of those patients who require fertility-sparing treatment.
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Affiliation(s)
- Ignacio Zapardiel
- Gynaecologic Oncology Unit, La Paz University Hospital - IdiPAZ, Madrid, Spain
| | | | - Maria D Diestro
- Gynaecologic Oncology Unit, La Paz University Hospital - IdiPAZ, Madrid, Spain
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Zhao J, Li Y, Zhang Q, Wang Y. Does ovarian stimulation for IVF increase gynaecological cancer risk? A systematic review and meta-analysis. Reprod Biomed Online 2015; 31:20-9. [PMID: 26003452 DOI: 10.1016/j.rbmo.2015.03.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Revised: 03/19/2015] [Accepted: 03/20/2015] [Indexed: 12/12/2022]
Abstract
The aim of this study was to evaluate whether ovarian stimulation for IVF increases the risk of gynaecological cancer, including ovarian, endometrial, cervical and breast cancers, as an independent risk factor. A systematic review and meta-analysis was conducted. Clinical trials that examined the association between ovarian stimulation for IVF and gynaecologic cancers were included. The outcomes of interest were incidence rate of gynaecologic cancers. Twelve cohort studies with 178,396 women exposed to IVF were included; 10 studies were used to analyse ovarian (167,640 women) and breast (151,702 women) cancers, and six studies were identified in the analysis of endometrial (116,672 women) and cervical cancer (114,799 women). Among these studies, 175 ovarian, 48 endometrial, 502 cervical and 866 cases of breast cancer were reported. The meta-analysis found no significant association between ovarian stimulation for IVF and increased ovarian, endometrial, cervical and breast cancer risk (odds ratio [OR] 1.06, 95% confidence interval [CI] 0.85 to 1.32; OR 0.97, 95% CI 0.58 to 1.63; OR 0.43, 95% CI 0.30 to 0.60; OR 0.69, 95% CI 0.63 to 0.76, respectively). Ovarian stimulation for IVF, therefore, does not increase the gynaecologic cancer risk, whether hormone-dependent endometrial and breast cancer or non-hormone-dependent ovarian and cervical cancer.
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Affiliation(s)
- Jing Zhao
- Reproductive Medicine Center, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yanping Li
- Reproductive Medicine Center, Xiangya Hospital, Central South University, Changsha, Hunan, China.
| | - Qiong Zhang
- Reproductive Medicine Center, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yonggang Wang
- Reproductive Medicine Center, Xiangya Hospital, Central South University, Changsha, Hunan, China
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Stewart LM, Holman CDJ, Semmens JB, Preen D, Mai Q, Hart R. Hospital mental health admissions in women after unsuccessful infertility treatment and in vitro fertilization: an Australian population-based cohort study. PLoS One 2015; 10:e0120076. [PMID: 25807258 PMCID: PMC4373915 DOI: 10.1371/journal.pone.0120076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 01/19/2015] [Indexed: 11/18/2022] Open
Abstract
Objective To examine the association between in vitro fertilization (IVF) and later admission to hospital with a mental health diagnosis in women who remained childless after infertility treatment. Methods This was a population-based cohort study using linked administrative hospital and registry data. The study population included all women commencing hospital treatment for infertility in Western Australia between the years 1982 and 2002 aged 20–44 years at treatment commencement who did not have a recorded birth by the end of follow-up (15 August 2010) and did not have a hospital mental health admission prior to the first infertility admission (n=6,567). Of these, 2,623 women had IVF and 3,944 did not. We used multivariate Cox regression modeling of mental health admissions and compared women undergoing IVF treatment with women having infertility treatment but not IVF. Results Over an average of 17 years of follow-up, 411 women in the cohort were admitted to hospital with a mental health diagnosis; 93 who had IVF and 318 who did not. The unadjusted hazard ratio (HR) for a hospital mental health admission comparing women who had IVF with those receiving other infertility treatment was 0.50 (95% confidence interval [CI] 0.40–0.63). After adjustment for age, calendar year and socio-economic status the HR was 0.56 (95% CI 0.44–0.71). Conclusions IVF treatment is associated with a reduced risk of hospital mental health admissions in women after unsuccessful infertility treatment. This may be explained by the healthy cohort effect.
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Affiliation(s)
- Louise M. Stewart
- Centre for Population Health Research, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia
- * E-mail:
| | - C. D’Arcy J. Holman
- School of Population Health, The University of Western Australia, Crawley, Western Australia, Australia
| | - James B. Semmens
- Centre for Population Health Research, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia
| | - David Preen
- School of Population Health, The University of Western Australia, Crawley, Western Australia, Australia
| | - Qun Mai
- School of Population Health, The University of Western Australia, Crawley, Western Australia, Australia
| | - Roger Hart
- School of Women’s and Infants’ Health, The University of Western Australia, King Edward Memorial Hospital, Subiaco, Western Australia, Australia, and Fertility Specialists of Western Australia, Bethesda Hospital, Claremont, Western Australia, Australia
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Somigliana E, Benaglia L, Paffoni A, Busnelli A, Vigano P, Vercellini P. Risks of conservative management in women with ovarian endometriomas undergoing IVF. Hum Reprod Update 2015; 21:486-99. [DOI: 10.1093/humupd/dmv012] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 02/16/2015] [Indexed: 12/14/2022] Open
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Stewart LM, Hart R. Long-term cancer risks in women after treatment with IVF: do we have any answers yet? WOMENS HEALTH 2015; 11:7-10. [PMID: 25581049 DOI: 10.2217/whe.14.58] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Louise M Stewart
- Centre for Population Health Research, Faculty of Health Sciences, Curtin University, GPO Box U1987, Perth, Western Australia, Australia
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Abstract
PURPOSE OF REVIEW The purpose of this review is to highlight recent research and insights into the relationship between fertility drug use and ovarian cancer risk. RECENT FINDINGS Results from two large case-control studies provided further evidence that fertility drug use does not significantly contribute to risk of ovarian cancer among the majority of women when adjusting for known confounding factors. However, questions regarding the effect on certain subgroups, including long-term fertility drug users, women who remain nulligravid after fertility treatment, women with BRCA1 or BRCA2 mutations and borderline ovarian tumours, still remain. In addition, it may currently just be too early to determine whether there is an association between fertility drug use and ovarian cancer risk given that many of the exposed women are only now beginning to reach the ovarian cancer age range. SUMMARY Whether use of fertility drugs increases the risk of ovarian cancer is an important question that requires further investigation, in particular given the large number of women utilizing fertility treatments. Fortunately, results from recent studies have been mainly reassuring. Large well designed studies with sufficient follow-up time are needed to further evaluate the effects of fertility treatments within subgroups defined by patient and tumour characteristics.
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Abstract
Epithelial ovarian cancer is the commonest cause of gynaecological cancer-associated death. The disease typically presents in postmenopausal women, with a few months of abdominal pain and distension. Most women have advanced disease (International Federation of Gynecology and Obstetrics [FIGO] stage III), for which the standard of care remains surgery and platinum-based cytotoxic chemotherapy. Although this treatment can be curative for most patients with early stage disease, most women with advanced disease will develop many episodes of recurrent disease with progressively shorter disease-free intervals. These episodes culminate in chemoresistance and ultimately bowel obstruction, the most frequent cause of death. For women whose disease continues to respond to platinum-based drugs, the disease can often be controlled for 5 years or more. Targeted treatments such as antiangiogenic drugs or poly (ADP-ribose) polymerase inhibitors offer potential for improved survival. The efficacy of screening, designed to detect the disease at an earlier and curable stage remains unproven, with key results expected in 2015.
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Affiliation(s)
- Gordon C Jayson
- Institute of Cancer Studies, Christie Hospital and University of Manchester, Wilmslow Road, Withington, Manchester, UK.
| | - Elise C Kohn
- Center for Cancer Research, National Cancer Institute, Bethesda MD, USA
| | - Henry C Kitchener
- Institute of Cancer Studies, St Marys Hospital and University of Manchester, Manchester, UK
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Kirby J. Transnational gestational surrogacy: does it have to be exploitative? THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2014; 14:24-32. [PMID: 24766117 DOI: 10.1080/15265161.2014.892169] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
This article explores the controversial practice of transnational gestational surrogacy and poses a provocative question: Does it have to be exploitative? Various existing models of exploitation are considered and a novel exploitation-evaluation heuristic is introduced to assist in the analysis of the potentially exploitative dimensions/elements of complex health-related practices. On the basis of application of the heuristic, I conclude that transnational gestational surrogacy, as currently practiced in low-income country settings (such as rural, western India), is exploitative of surrogate women. Arising out of consideration of the heuristic's exploitation conditions, a set of public education and enabled choice, enhanced protections, and empowerment reforms to transnational gestational surrogacy practice is proposed that, if incorporated into a national regulatory framework and actualized within a low income country, could possibly render such practice nonexploitative.
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Stewart LM, Holman CDJ, Finn JC, Preen DB, Hart R. Association between in-vitro fertilization, birth and melanoma. Melanoma Res 2013; 23:489-95. [PMID: 24048222 DOI: 10.1097/cmr.0000000000000019] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A link between reproductive hormones and melanoma has long been suspected, and has been examined for numerous hormonal exposures, but the association between in-vitro fertilization (IVF) and melanoma has not been studied in depth. We used whole-population linked hospital and registry data to carry out a cohort study of women aged 20-44 years seeking hospital investigation and treatment for infertility in Western Australia from 1982 to 2002 with follow-up to 2010. The cohort comprised a total of 21 604 women followed for an average of 17.2 years. Of these, 7524 had IVF treatment, 14 870 gave birth and 149 women were diagnosed with an incident invasive melanoma. Using Cox regression analysis, we estimated hazard ratios (HRs) for melanoma associated with IVF and parity. Women who had IVF and gave birth had an increased rate of invasive melanoma compared with women who had IVF and remained nulliparous (HR 3.61; 95% confidence interval 1.79-7.26). There was little or no increase in the rate of invasive melanoma associated with giving birth in women who had non-IVF infertility treatment (HR 1.39; 95% confidence interval 0.88-2.20). These results suggest an association between reproductive factors and melanoma in the subgroup of women undergoing IVF treatment.
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Affiliation(s)
- Louise M Stewart
- aSchool of Population Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia, Crawley bSchool of Women's and Infant's Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia, Subiaco cFaculty of Health Sciences, Curtin University, Perth dFertility Specialists of Western Australia, Bethesda Hospital, Claremont, Western Australia eDepartment of Epidemiology and Preventive Medicine, The Alfred Centre, Monash University, Melbourne, Victoria, Australia
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Mneimneh AS, Boulet SL, Sunderam S, Zhang Y, Jamieson DJ, Crawford S, McKane P, Copeland G, Mersol-Barg M, Grigorescu V, Cohen B, Steele J, Sappenfield W, Diop H, Kirby RS, Kissin, for the States Monitoring A DM. States Monitoring Assisted Reproductive Technology (SMART) Collaborative: Data Collection, Linkage, Dissemination, and Use. J Womens Health (Larchmt) 2013; 22:571-7. [DOI: 10.1089/jwh.2013.4452] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Allison S. Mneimneh
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sheree L. Boulet
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Saswati Sunderam
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Yujia Zhang
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Denise J. Jamieson
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sara Crawford
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Glenn Copeland
- Michigan Department of Community Health, Lansing, Michigan
| | | | - Violanda Grigorescu
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Bruce Cohen
- Massachusetts Department of Public Health, Boston, Massachusetts
| | - JoAnn Steele
- Florida Department of Health, Tallahassee, Florida
| | - William Sappenfield
- Department of Community and Family Health, College of Public Health, University of South Florida, Tampa, Florida
| | - Hafsatou Diop
- Massachusetts Department of Public Health, Boston, Massachusetts
| | - Russell S. Kirby
- Department of Community and Family Health, College of Public Health, University of South Florida, Tampa, Florida
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