Risk for borderline ovarian tumours after exposure to fertility drugs: results of a population-based cohort study

Bjørnholt, Sarah Marie; Kjær, Susanne K.; Nielsen, Thomas Theis; Jensen, Allan

doi:10.1093/humrep/deu297

Cited by 38 publications

(47 citation statements)

References 31 publications

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“…Specific subgroups of women did appear to be at higher risk for subsequent ovarian cancer. These subgroups included women with unexplained infertility, parous women with only one delivery as opposed to multiple deliveries following reproductive technology, women with PCOS, and women who had used progesterone therapy as part of their fertility treatment [8,10,15,19]. In a meta-analysis of 21 studies by Kvaskoff et al, 20 studies showed an elevated ovarian cancer risk in women with endometriosis, while one study failed to show this association [16].…”

Section: Ovarian Cancermentioning

confidence: 99%

“…An analysis of publications shows that women with infertility had higher rates of psychiatric disorders and endometrial cancer than the general population [1][2][3][4][5][6][7][8][9][10]. Data is conflicting about whether infertile women are at increased risk for breast cancer and ovarian cancer [7,8,[10][11][12][13][14][15][16][17][18][19][20]. A generalized diagnosis of infertility was not clearly associated with an increased risk of cardiovascular disease or metabolic dysfunction, but women with infertility related to polycystic ovarian syndrome (PCOS) do appear more likely to develop cardioCapsule There is a growing body of literature addressing the impact of female infertility on long-term health.…”

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confidence: 99%

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Female infertility, infertility-associated diagnoses, and comorbidities: a review

Hanson

Johnstone

Dorais

et al. 2016

J Assist Reprod Genet

227

145

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Purpose The purpose of the study is to evaluate existing literature for possible associations between female infertility, infertility-associated diagnoses, and the following areas of disease: psychiatric disorders, breast cancer, ovarian cancer, endometrial cancer, cardiovascular disease, and metabolic dysfunction. Methods The design of the study is a literature review. The patients were women included in 26 selected studies due to a diagnosis of infertility or a reproductive disorder associated with infertility. This study has no interventions, and the main outcome measure is the association between female infertility or a related diagnosis and psychiatric disorders, breast cancer, ovarian cancer, endometrial cancer, cardiovascular disease, and metabolic dysfunction. Results Female infertility and related reproductive disorders may have ramifications for women beyond reproductive health. An analysis of publications shows that women with infertility had higher rates of psychiatric disorders and endometrial cancer than the general population [1][2][3][4][5][6][7][8][9][10]. Data is conflicting about whether infertile women are at increased risk for breast cancer and ovarian cancer [7,8,[10][11][12][13][14][15][16][17][18][19][20]. A generalized diagnosis of infertility was not clearly associated with an increased risk of cardiovascular disease or metabolic dysfunction, but women with infertility related to polycystic ovarian syndrome (PCOS) do appear more likely to develop cardioCapsule There is a growing body of literature addressing the impact of female infertility on long-term health. This review evaluates 26 studies, investigating possible correlations between infertility and psychiatric illness, breast cancer, ovarian cancer, endometrial cancer, cardiovascular disease, and metabolic dysfunction. Overall, higher rates of psychiatric illness and endometrial cancer were seen in infertile women. It is unclear whether infertility results in increased rates of breast cancer and ovarian cancer, and data are conflicting regarding correlations between generalized infertility and cardiovascular disease and metabolic dysfunction. This study summarizes current literature and can guide practitioners in counseling infertile patients.

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Section: Ovarian Cancermentioning

confidence: 99%

mentioning

confidence: 99%

Female infertility, infertility-associated diagnoses, and comorbidities: a review

Hanson

Johnstone

Dorais

et al. 2016

J Assist Reprod Genet

227

145

View full text Add to dashboard Cite

show abstract

“…A recent case-cohort study of 96,545 Dutch subfertile women, including 142 cases of borderline ovarian tumors, found no association between all subtypes of ovarian borderline cancer and fertility medication use (RR: 1.00, 95% CI 0.67–1.51), which was consistent across fertility treatment cycles and follow-up duration [27]. An increased association between serous borderline ovarian tumors and progesterone use currently lacks biologic explanation.…”

Section: Ovarian Cancermentioning

confidence: 99%

“…Conversely, not all evidence demonstrates an association between fertility treatment and borderline ovarian tumors [27] [11] [28]. A recent case-cohort study of 96,545 Dutch subfertile women, including 142 cases of borderline ovarian tumors, found no association between all subtypes of ovarian borderline cancer and fertility medication use (RR: 1.00, 95% CI 0.67–1.51), which was consistent across fertility treatment cycles and follow-up duration [27].…”

Section: Ovarian Cancermentioning

confidence: 99%

Use of fertility medications and cancer risk: a review and update

Kroener

Dumesic

Al-Safi

2017

Current Opinion in Obstetrics &Amp; Gynecology

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Structured 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. While 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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“…Finally, a very recent study by Bjørnholt et al [48] analyzed data from a cohort of 96'545 women with fertility problems from all Danish fertility clinics during the years 1963-2006. They found that the overall risk for borderline ovarian tumors was not associated with the use of clomiphene citrate (RR 0.96; 95% CI 0.64-1.44).…”

Section: A C C E P T E D Accepted Manuscriptmentioning

confidence: 99%

Menstrual preconditioning for the prevention of major obstetrical syndromes in polycystic ovary syndrome

Brosens

Benagiano

2015

American Journal of Obstetrics and Gynecology

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The presence of multiple ovarian cysts, anovulation, and endometrial progesterone resistance in the neonate seems remarkably similar to ovarian and endometrial features of the polycystic ovary syndrome (PCOS) of adolescent and adult women. In fact, in the absence of cyclic menstruations after menarche, the neonatal progesterone resistance is likely to persist and adversely affect young women with PCOS at the time of pregnancy after induction of ovulation, because any persisting defect in progesterone response can interfere with the process of decidualization and trophoblast invasion. The primigravid woman with PCOS therefore is likely to be at risk of defective deep placentation as manifested by the increased risk of major obstetric syndromes. A recent, large epidemiologic study has demonstrated that the risk of preeclampsia and preterm delivery is elevated in the 13- to 15-year old group, although it does not persist in the 16- to 17-year old group. It is proposed therefore that induction of ovulation in the infertile nulligravid woman with PCOS should be preceded by a period of progesterone withdrawal bleedings to achieve full endometrial progesterone response by the time of pregnancy. The cyclic administration of clomiphene citrate for a period to be determined by vascular response may be an appropriate tool to reduce the risk of major obstetric syndromes by menstrual preconditioning.

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Risk for borderline ovarian tumours after exposure to fertility drugs: results of a population-based cohort study

Abstract: No conflict of interest was reported. S.M.B. was supported by a research scholarship from the Danish Cancer Society.

Cited by 38 publications

References 31 publications

Female infertility, infertility-associated diagnoses, and comorbidities: a review

Female infertility, infertility-associated diagnoses, and comorbidities: a review

Use of fertility medications and cancer risk: a review and update

Menstrual preconditioning for the prevention of major obstetrical syndromes in polycystic ovary syndrome

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