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Fertility drug--ovarian cancer risk link unclear.(NEWS)
SAN ANTONIO -- Ovarian stimulation for in vitro fertilization was linked to an increased risk of ovarian cancer 15 years later in a large cohort study that followed thousands of women in the Netherlands.
However, another study that looked specifically at use of particular fertility drugs found no overall risk of ovarian cancer in a large cohort (BMJ 2009 Feb. 5; [doi:10.1136/bmj.b249]).
Compared with a control group of women who had fertility problems but did not undergo in vitro fertilization (IVF), women who underwent IVF were more than four times (relative risk 4.40) as likely to develop "borderline" tumors and 1.5 times (RR 1.51) more likely to develop invasive ovarian cancer. Overall, IVF conferred a relative risk of 2.05 for all ovarian malignancies.
The "borderline" tumors, also known as low-malignant-potential tumors, tended to occur earlier than the invasive ovarian cancers--for which an increase in incidence did not become apparent until 15 years after treatment, Dr. Curt W. Burger reported at the Society of Gynecologic Oncologists' annual meeting.
Whether borderline tumors eventually become invasive is subject to debate, noted Dr. Burger, a gynecologist at Erasmus University Medical Center in Rotterdam, the Netherlands. Some clinicians believe such tumors will develop into ovarian cancer, he said, putting himself in the group that believes borderline and invasive ovarian tumors are "two different entities."
"The clinical implications are modest," he said, estimating the cumulative individual risk of developing an ovarian tumor before age 55 years as 0.45% for the general population and 0.71% for women who have undergone IVF.
Dr. Wendy R. Brewster of the University of North Carolina, Chapel Hill, called the results "quite troubling" in a discussion of the study. "We have to advise our patients that there is some risk of ovarian cancer," she said. The risk of developing breast cancer may be greater, "but, still, to develop ovarian cancer, your life is much more at risk."
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