Association of Oral Contraceptive Use, Other Contraceptive Methods, and Infertility with Ovarian Cancer Risk

Tworoger, Shelley S.; Fairfield, Kathleen M.; Colditz, Graham A.; Rosner, Bernard; Hankinson, Susan E.

doi:10.1093/aje/kwm157

Cited by 132 publications

(105 citation statements)

References 44 publications

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“…We identified those risk factors to be considered: parity, oral contraceptive use, breastfeeding, tubal ligation, painful periods or endometriosis, obesity or polycystic ovarian syndrome, and talc use. These risk factors are concordant with published epidemiologic data related to reproductive factors, [15][16][17][18][19][20][21][22][23] use of talc, [17][18][19] tubal ligation, 20,24-27 endometriosis, 28 and polycystic ovarian syndrome or obesity. 29,30 It is also known that approximately 2% of Jewish women carry one of three founder mutations of BRCA1 or BRCA2.…”

Section: Discussionsupporting

confidence: 89%

Assessing Ovarian Cancer Risk When Considering Elective Oophorectomy at the Time of Hysterectomy

Cramer¹

2011

Obstetrics &Amp; Gynecology

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Objective-To develop a risk-factor score that may provide additional guidance to women and their physicians regarding elective bilateral salpingo-oophorectomy at the time of hysterectomy.Methods-From a case-control study conducted from 1992 to 2008 in women residing in eastern Massachusetts or New Hampshire, we selected 1,098 women with invasive ovarian cancer (case group) and 1,363 for the control group who were older than 40 years and had neither hysterectomy nor a personal or family history of breast or ovarian cancer. Using logistic regression, we identified key risk factors and built a risk score. The score was separately assessed in 126 women in the case group and 156 in the control group with excluded prior hysterectomy to determine whether women who developed ovarian cancer could have been distinguished.Results-Summing eight conditions found to be associated with ovarian cancer (Jewish ethnicity, less than 1 year of oral contraceptive use, nulliparity, no breastfeeding, no tubal ligation, painful periods or endometriosis, polycystic ovary syndrome or obesity, talc use), we created a five-level score. Assigning average risk to those with a score of 2, the odds ratios varied from 0.56 (95% confidence interval [CI] 0.42-0.74) for a score of 0-1 to 3.30 (95% CI 2.50-4.35) for a score of 5 or greater (P trend <.001). The risk score was higher for women who developed ovarian cancer after hysterectomy than those who did not (P=.01). Lifetime risks for ovarian cancer for a woman at age 40 years are changed from 1.2% with a 0-1 score to 6.6% with a score of 5 or higher.Conclusion-We developed a risk-assessment tool that can quantify women's risk for ovarian cancer and should be validated in other data sets.In the 1990s, there were approximately 600,000 hysterectomies performed in the United States annually and 55% of these also involved bilateral salpin-go-oophorectomy, 1 many done solely to reduce the risk for ovarian cancer. It has been suggested that elective bilateral salpingo-oophorectomy be considered for women older than 40 years, 2-4 whereas surveys in the United Kingdom revealed that 85-90% of physicians recommended bilateral salpingooophorectomy for postmenopausal women coming to hysterectomy. 5,6 However, Parker et al, 7 citing evidence that postmenopausal ovaries secrete androgens important to health, performed a risk-benefit analysis and concluded that ovarian conservation benefits longterm survival for women at "average risk" for ovarian cancer undergoing hysterectomy for benign disease. A subsequent study using observational data from the Nurses' Health Study In addressing the value of bilateral salpingo-oophorectomy, Parker et al distinguished average-risk women from those with known BRCA1 or BRCA2 mutations or a strong family history of breast and ovarian cancer. In the latter group, bilateral salpingooophorectomy may truly be beneficial in reducing risk for both breast and ovarian cancer. 9 Genetic or familial risk factors or both, however, account for a small proportion of ovarian cance...

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Section: Discussionsupporting

confidence: 89%

Assessing Ovarian Cancer Risk When Considering Elective Oophorectomy at the Time of Hysterectomy

Cramer¹

2011

Obstetrics &Amp; Gynecology

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“…The possible link between exposure to ovulation induction drugs and ovarian cancer development has biological credibility, given that "incessant ovulation" and associated alternation in endogenous hormones during reproductive years are plausible explanations for several factors that alter ovarian cancer risk [1,9,10]. This association was investigated in numerous case-control [11][12][13][14][15][16][17][18] and cohort studies [7,8,[19][20][21][22][23][24][25][26][27][28][29][30]. As for invasive ovarian cancer development, all but one case-control study [11] failed to demonstrate a significant excess risk of invasive ovarian cancer following treatments for infertility.…”

Section: Ovarian Cancermentioning

confidence: 99%

Are infertility treatments a potential risk factor for cancer development? Perspective of 30 years of follow-up

Lerner‐Geva¹,

Rabinovici²,

Olmer³

et al. 2012

Gynecological Endocrinology

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The aim of the present study was to evaluate the possible risk for cancer development in infertile women with over 30 years of follow-up. Cancer development was assessed through linkage with the National Cancer Registry updated to 31 December 2005 in a cohort of 2431 women who were treated for infertility at the Sheba Medical Center in Israel during the period 1964-1974 and contributed more than 84,000 women years of follow-up. Standardized incidence ratios (SIR) were calculated between the observed cancer cases and the expected cancer rates in the general population. The mean age at the end of follow-up was 62.7 years. Eighteen cases of ovarian cancer were observed as compared to 18.1 expected (SIR = 1.0; 95% CI = 0.59-1.57). For breast cancer, 153 cases were observed as compared to 131.9 expected (SIR = 1.16; 95% CI = 0.98-1.36), and for endometrial cancer, 30 cases were observed as compared to 17.8 expected cases (SIR = 1.69; 95% CI = 1.14-2.41). No excess risk associated with exposure to gonadotropins was observed. Infertility was found to be associated with significant increased risk for endometrial cancer and borderline increased risk for breast cancer. Ovarian cancer risk was not found to be elevated. No significant excess risk was associated with treatment with ovulation induction.

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“…In a recent update from the Nurses Health Study, Tworoger et al [9 ] found that women who used oral contraceptives for more than 5 years had a reduced risk of ovarian cancer (rate ratio 0.58; 95% CI, 0.39-0.87), whereas a 38% reduction in incident ovarian cancer risk was observed with at least 10 years of oral contraceptive use. This protective effect attenuates after 20 years since last use.…”

Section: Incessant Ovulation As a Risk Factor For Ovarian Cancermentioning

confidence: 99%

Fertility drugs and risk of ovarian cancer: dispelling the myth

Zreik

Ayoub²,

Hannoun³

et al. 2008

Current Opinion in Obstetrics &Amp; Gynecology

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As long as doubt persists, it might be advisable to reflect on a few clinical recommendations: identify high-risk infertile patients for ovarian cancer, investigate preexisting cancer before fertility treatment, inform patients regarding potential risks, obtain an informed consent, avoid exposure to long periods of ovulation induction cycles that are given before patients are referred for in-vitro fertilization and embryo transfer for women at greater risk and monitor women who have been treated with these drugs, especially those who failed to conceive, regularly and thoroughly.

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Association of Oral Contraceptive Use, Other Contraceptive Methods, and Infertility with Ovarian Cancer Risk

Cited by 132 publications

References 44 publications

Assessing Ovarian Cancer Risk When Considering Elective Oophorectomy at the Time of Hysterectomy

Assessing Ovarian Cancer Risk When Considering Elective Oophorectomy at the Time of Hysterectomy

Are infertility treatments a potential risk factor for cancer development? Perspective of 30 years of follow-up

Fertility drugs and risk of ovarian cancer: dispelling the myth

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