Objective To assess long-term cancer risks associated with in vitro fertilization (IVF). Design Record-linkage study Setting Health maintenance organization in Israel Patients 87,403 women evaluated and/or treated for infertility on or after September 25, 1994 who were followed for cancer development through June 22, 2011: 522 breast, 41 endometrial, 45 ovarian, 311 in situ cervical and 32 invasive cervical cancers were identified. Intervention(s) None Main Outcome Measures Hazard ratios (HRs) for specific cancers Results We found no significant relationships of IVF exposures to the risks of breast, endometrial or ovarian cancers. Compared to women with no fertility treatment, the HR for ovarian cancer associated with IVF was 1.58 (95% CI 0.75–3.29), with higher risk among those receiving 4+ cycles (1.78, 95% CI 0.76–4.13). There was also a non-significantly elevated risk for endometrial cancer among women who received 1–3 IVF cycles (1.94, 0.73–5.12), but additional cycles were associated with lesser risk. In contrast, the risk of in situ cervical cancer was significantly reduced and invasive cervical cancer non-significantly reduced among women receiving IVF as well as other fertility treatments. Conclusions Our results regarding long-term effects were largely reassuring, but women receiving IVF should continue to be monitored given that the procedures involves potent ovulation stimulators and repeated ovarian punctures.

Three or four abnormal OGTT values and GDM requiring insulin or oral hypoglycaemic medications are important predictors of postpartum diabetes risk in women with a history of GDM.

Background:BRCA1/BRCA2 germ line (GL) mutation carriers with pancreatic adenocarcinoma (PDAC) may have distinct outcomes. We recently described an apparent more favourable prognosis of surgically resected BRCA-associated PDAC patients in a single-arm, uncontrolled, retrospective study. However, the prognostic impact of GL BRCA1/2 mutations in surgically resected PDAC has not been compared with a matched control population.Methods:A larger multi-centre, case–control retrospective analysis was performed. Cases were patients with surgically resected, BRCA1/2-associated PDAC from 2004 to 2013. Controls included surgically resected PDAC cases treated during the same time period that were either BRCA non-carriers, or had no family history of breast, ovarian or pancreatic cancers. Cases and controls were matched by: age at diagnosis (within ±5-year period) and institution. Demographics, clinical history, overall survival (OS) and disease-free survival (DFS) were abstracted from patient records. Statistical comparisons were assessed using χ2- and Fisher's exact test, and median DFS/OS using Kaplan–Meier method and log-rank testing.Results:Twenty-five patients with BRCA1-(n=4) or BRCA2 (N=21)-associated resectable PDAC were identified. Mean age was 55.7 years (range, 34–78 years), 48% (n=12) were females and 76% (n=19) were Jewish. Cases were compared (1 : 2) with 49 resectable PDAC controls, and were balanced for age, ethnicity and other relevant clinical and pathological features. BRCA-associated PDAC patients received neoadjuvant, or adjuvant platinum-based treatment more frequently than controls (7 out of 8 vs 6 out of 14) and (7 out of 21 vs 3 out of 44), respectively. No significant difference in median OS (37.06 vs 38.77 months, P=0.838) and in DFS (14.3 vs 12.0 months, P=0.303) could be demonstrated between cases and controls. A trend to increased DFS was observed among BRCA-positive cases treated with neoadjuvant/adjuvant platinum-containing regimens (n=10) compared with similarly treated controls (n=7) (39.1 vs 12.4 months, P=0.255).Conclusions:In this retrospective analysis, the prognosis of surgically resectable BRCA-associated PDAC is no different than that of sporadic PDAC from the same institution. The role of platinum-based adjuvant therapy in this setting requires prospective investigation.