Semin Reprod Med 2003; 21(1): 065-072
DOI: 10.1055/s-2003-39996
Copyright © 2003 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Ovarian Cancer and Fertility Medications: A Critical Appraisal

S. Kashyap, O. K. Davis
  • Center for Reproductive Medicine, Weill Cornell School of Medicine, Cornell University, New York, New York
Further Information

Publication History

Publication Date:
12 June 2003 (online)

ABSTRACT

Ovarian cancer is the fifth most common cancer in the Western world. Infertility and nulliparity are independent risk factors for this disease. The possible link between fertility drugs and ovarian cancer remains controversial. Despite concern regarding increasing use of fertility therapy, the incidence of ovarian cancer in the Western world has remained stable for several decades. Evaluation of the literature requires assessment of the validity, importance, and applicability of the study to your particular patient. The following article demonstrates how to conduct such an assessment. The data to date do not support a causal relationship between fertility drugs and ovarian cancer. In fact, infertility therapy may confer protection for those patients who conceive. Further prospective, long-term data are needed to further delineate this relationship.

REFERENCES

  • 1 Levine M, Walter S, Lee H. et al . User's guide to the medical literature IV: how to use an article about harm.  JAMA . 1994;  271 1616-1619
  • 2 Whittemore A S, Harris R, Itnyre J, and the Collaborative Cancer Group. Characteristics relating to ovarian cancer risk-collaborative analysis of 12 US case-control studies II: invasive epithelial cancers in white women.  Am J Epidemiol . 1992;  136 1184-1203
  • 3 Shapiro S. Risk of ovarian cancer after treatment for infertility [letter].  N Engl J Med . 1995;  332 1301
  • 4 Spritas R, Kaufman S C, Alexander N J. Fertility drugs and ovarian cancer: red alert or red herring?.  Fertil Steril . 1993;  59 291-293
  • 5 Rosen B, Irvine J, Ritvo P. et al . The feasibility of assessing women's perceptions of the risks and benefits of fertility drug therapy in relation to ovarian cancer risk.  Fertil Steril . 1997;  68 90-94
  • 6 Venn A, Watson L, Bruinsma F. et al . Risk of cancer after use of fertility drugs with in-vitro fertilization.  Lancet . 1999;  354 1586-1590
  • 7 Venn A, Watson L, Lumley J. et al . Breast and ovarian cancer incidence after infertility and in vitro fertilization.  Lancet . 1995;  346 995-1000
  • 8 Stern R C, Dash R, Bentley R C. et al . Malignancy in endometriosis: frequency and comparison of ovarian and extraovarian types.  Int J Gynecol Path . 2001;  20 133-139
  • 9 Takahashi K, Kurioka H, Irikoma M. et al . Benign or malignant ovarian neoplasm and ovarian endometriomas.  J Am Assoc Gynecol Laparosc . 2001;  8 278-284
  • 10 Nishida M, Wantanabe K, Sato N. et al . Malignant transformation of ovarian endometriosis.  Gynecol Obstet Inv . 2000;  50 18-25
  • 11 Rossing M A, Daling J R, Weiss N S. et al . Ovarian tumors in a cohort of infertile women.  N Engl J Med . 1994;  331 771-776
  • 12 Ness R B, Cramer D W, Goodman M T. et al . Infertility, fertility drugs , and ovarian cancer: a pooled analysis of case-control studies.  Am J Epidemiol . 2002;  155 217-224
  • 13 Potashnik G, Lerner-Geva L, Genkin L. et al . Fertility drugs and the risk of breast and ovarian cancers: results of a long-term follow-up study.  Fertil Steril . 1999;  71 853-859
  • 14 Modan B, Ron E, Lerner-Geva L. et al . Cancer incidence in a cohort of infertile women.  Am J Epidemiol . 1998;  147 1030-1042
  • 15 Fathalla M F. Incessant ovulation: a factor in ovarian neoplasia [letter]?.  Lancet . 1971;  2 163
  • 16 Biskind M S, Biskind G R. Development of tumors in the rat ovary after transplantation into the spleen.  Proc Soc Exp Biol Med . 1944;  55 176
  • 17 Land J A. Ovulation, ovulation induction and ovarian carcinoma.  Baillieres Clin Obstet Gynaecol . 1993;  7 455-472
  • 18 Glud E, Kjaer S K, Troisi R, Brinton L A. Fertility drugs and ovarian cancer.  Epidemiol Rev . 1998;  20 237-257
  • 19 Kuroda H, Konishi I, Mandai M. Ovarian cancer in infertile women, during or after ovulation induction therapy: expression of LH-hCG receptors and sex steroid receptors.  Intl J Gynecol Cancer . 1997;  7 451-457
  • 20 Reis L AG, Kosary C T, Hankey B F. et al .SEER Cancer Statistics Review, 1973-95. Bethesda, MD: National Cancer Institute; 1998
  • 21 DiSaia P J. Ovarian disorders. In: Scott JR, DiSaia PJ, Hammond CB, Spellacy WN, eds. Danforths Obstetrics and Gynecology 6th ed. Philadelphia: JB Lippincott 1990: 1067-1120
  • 22 Marrs R P, Hartz S C. Comments on the Possible Association between Ovulation Inducing Agents and Ovarian Cancer. Birmingham, AL: The American Fertility Society; 1993
  • 23 Whittemore A S, Wu M L, Paffenbarger R S. et al . Epithelial ovarian cancer and the ability to conceive.  Cancer Res . 1989;  60 592-560
  • 24 Joly D J, Lillienfield A M, Diamond E L. et al . An epidemiologic study of the relationship between reproductive experience to cancer of the ovary.  Am J Epidemiol . 1974;  99 190-209
  • 25 Nasca P C, Greenwald P, Chorost S. et al . An epidemiologic case-control study of ovarian cancer and reproductive risk factors.  Am J Epidemiol . 1984;  119 705-713
  • 26 Wu M L, Whittemore A S, Paffenbarger R S. et al . Personal and environmental characteristics related to epithelial ovarian cancer I: reproductive and menstrual events and oral contraceptive use.  Am J Epidemiol . 1988;  128 1216-1227
  • 27 Mosgaard B J, Lidegaard Ø, Kjaer S. et al . Ovarian stimulation and borderline ovarian tumors: a case-control study.  Fertil Steril . 1998;  70 1049-1055
  • 28 Mosgaard B J, Lidegaard Ø, Kjaer S K. et al . Infertility, fertility drugs, and invasive ovarian cancer: a case-control study.  Fertil Steril . 1997;  67 1005-1012
  • 29 Narod S, Risch H, Moslehi R. et al . Oral contraceptives and the risk of hereditary ovarian cancer.  N Engl J Med . 1998;  339 424-428
  • 30 Ron E, Lunenfeld B, Menczer J. et al . Cancer incidence in a cohort of infertile women.  Am J Epidemiol . 1987;  125 780-790
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