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Farland LV, Lind KE, Thomson CA, Saquib N, Shadyab AH, Schnatz PF, Robles-Morales R, Qi L, Strickler H, Lane DS, Murugappan G, Roe DJ, Harris HR. Infertility and risk of postmenopausal breast cancer in the women's health initiative. Breast Cancer Res Treat 2024; 205:497-506. [PMID: 38459395 DOI: 10.1007/s10549-024-07257-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 01/18/2024] [Indexed: 03/10/2024]
Abstract
PURPOSE Although infertility (i.e., failure to conceive after ≥ 12 months of trying) is strongly correlated with established breast cancer risk factors (e.g., nulliparity, number of pregnancies, and age at first pregnancy), its association with breast cancer incidence is not fully understood. Previous studies were primarily small clinic-based or registry studies with short follow-up and predominantly focused on premenopausal breast cancer. The objective of this study was to assess the relationship between infertility and postmenopausal breast cancer risk among participants in the Women's Health Initiative (analytic sample = 131,784; > 25 years of follow-up). METHODS At study entry, participants were asked about their pregnancy history, infertility history, and diagnosed reasons for infertility. Incident breast cancers were self-reported with adjudication by trained physicians reviewing medical records. Cox proportional hazards models were used to estimate risk of incident postmenopausal breast cancer for women with infertility (overall and specific infertility diagnoses) compared to parous women with no history of infertility. We examined mediation of these associations by parity, age at first term pregnancy, postmenopausal hormone therapy use at baseline, age at menopause, breastfeeding, and oophorectomy. RESULTS We observed a modest association between infertility (n = 23,406) and risk of postmenopausal breast cancer (HR = 1.07; 95% CI 1.02-1.13). The association was largely mediated by age at first term pregnancy (natural indirect effect: 46.4% mediated, CI 12.2-84.3%). CONCLUSION These findings suggest that infertility may be modestly associated with future risk of postmenopausal breast cancer due to age at first pregnancy and highlight the importance of incorporating reproductive history across the life course into breast cancer analyses.
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Affiliation(s)
- Leslie V Farland
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N Martin Ave, Tucson, AZ, 85724, USA.
- Department of Obstetrics and Gynecology, College of Medicine - Tucson, University of Arizona, Tucson, AZ, USA.
| | - Kimberly E Lind
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Cynthia A Thomson
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Nazmus Saquib
- College of Medicine, Sulaiman Al Rajhi University, Al Bukayriyah, Kingdom of Saudi Arabia
| | - Aladdin H Shadyab
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, CA, USA
| | - Peter F Schnatz
- Departments of Obstetrics and Gynecology and Internal Medicine, Reading Hospital and Drexel University, Reading, PA, USA
| | - Rogelio Robles-Morales
- Clinical and Translational Sciences, College of Medicine - Tucson, University of Arizona, Tucson, AZ, USA
| | - Lihong Qi
- Department of Public Health Sciences, School of Medicine, University of California, Davis, Davis, CA, USA
| | - Howard Strickler
- Department of Epidemiology and Biostatistics, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Dorothy S Lane
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA
| | | | - Denise J Roe
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N Martin Ave, Tucson, AZ, 85724, USA
- University of Arizona Cancer Center, University of Arizona, Tucson, AZ, USA
| | - Holly R Harris
- Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, USA
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
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Fertility drugs and cancer: a guideline. Fertil Steril 2024:S0015-0282(24)00201-2. [PMID: 38703170 DOI: 10.1016/j.fertnstert.2024.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 03/28/2024] [Indexed: 05/06/2024]
Abstract
Methodological limitations in studying the association between the use of fertility drugs and cancer include the inherent increased risk of cancer in women who never conceive, the increased risk of cancer because of factors (endometriosis and unopposed estrogen) associated with infertility, the low incidence of most of these cancers, and that the diagnosis of cancer is typically several years after fertility drug use. On the basis of available data, there does not appear to be an association between fertility drugs and breast, colon, or cervical cancer. There is no conclusive evidence that fertility drugs increase the risk of uterine cancer, although women with infertility are at higher risk of uterine cancer. There are insufficient data to comment on the risk of melanoma and non-Hodgkin lymphoma associated with fertility drug use. Women should be informed that there may be an increased risk of invasive and borderline ovarian cancers and thyroid cancer associated with fertility treatment. It is difficult to determine whether this risk is related to underlying endometriosis, female infertility, or nulliparity.
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Chen C, Shi H, Yang J, Bao X, Sun Y. The risk of breast cancer and gynecologic malignancies after ovarian stimulation: Meta-analysis of cohort study. Crit Rev Oncol Hematol 2024; 197:104320. [PMID: 38479585 DOI: 10.1016/j.critrevonc.2024.104320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 01/31/2024] [Accepted: 03/01/2024] [Indexed: 03/25/2024] Open
Abstract
The effects of ovarian stimulation on breast and gynecological tumor incidence remain controversial. Therefore, the aim of this meta-analysis was to study the risk of cancer in ovarian stimulation. Of the 22713 studies initially identified, 28 were eligible for inclusion. The results revealed that the impact of ovarian cancer (RR = 1.33, [1.05; 1.69]) and cervical cancer (RR = 0.67, [0.46; 0.97]) is significant among the overall effects. In subgroup analysis, in the nulliparous population (RR = 0.81 [0.68; 0.96]) was the protective factor for the breast cancer. In the Caucasians subgroup (RR = 1.45, [1.12; 1.88]), the ovarian cancer incidence was statistically significant. In the Asian subgroup (RR = 1.51, [1.00; 2.28]), the endometrial cancer incidence was statistically significant. In the subgroup of Asians (RR = 0.55 [0.44; 0.68]) and the multiparous population (RR = 0.31, [0.21; 0.46]), them can be the statistically protective factor for the cervical cancer.
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Affiliation(s)
- Chuanju Chen
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China; Henan Key Laboratory of Reproduction and Cenetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China; Henan Provincial Obstetrical and Gynecological Diseases (Reproductive Medicine) Clinical Research Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China; Henan Engineering Laboratory of Preimplantation Genetic Diagnosis and Screening, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Hao Shi
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China; Henan Key Laboratory of Reproduction and Cenetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China; Henan Provincial Obstetrical and Gynecological Diseases (Reproductive Medicine) Clinical Research Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China; Henan Engineering Laboratory of Preimplantation Genetic Diagnosis and Screening, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Jingya Yang
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China; Henan Key Laboratory of Reproduction and Cenetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China; Henan Provincial Obstetrical and Gynecological Diseases (Reproductive Medicine) Clinical Research Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China; Henan Engineering Laboratory of Preimplantation Genetic Diagnosis and Screening, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Xiao Bao
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China; Henan Key Laboratory of Reproduction and Cenetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China; Henan Provincial Obstetrical and Gynecological Diseases (Reproductive Medicine) Clinical Research Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China; Henan Engineering Laboratory of Preimplantation Genetic Diagnosis and Screening, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Yingpu Sun
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China; Henan Key Laboratory of Reproduction and Cenetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China; Henan Provincial Obstetrical and Gynecological Diseases (Reproductive Medicine) Clinical Research Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China; Henan Engineering Laboratory of Preimplantation Genetic Diagnosis and Screening, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China.
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Naghizadeh S, Faroughi F, Mirghafourvand M. Investigating the relationship between breast and gynecological cancers and infertility and its treatments: a case-control study. Eur J Cancer Prev 2023; 32:600-607. [PMID: 37283054 DOI: 10.1097/cej.0000000000000815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Due to the high prevalence of breast and gynecological cancers among women, it is crucial to identify the risk factors of these cancers. Thus, the present study aimed to evaluate the relationship between breast and gynecological cancers and infertility and its treatments in women suffering from these cancers. METHODS This case-control study was conducted with the participation of 400 people (200 women with breast and gynecological cancers and 200 healthy women without a history of cancer) in hospitals and health centers in Tabriz, Iran, in 2022. Data were collected using a four-part researcher-made questionnaire including sociodemographic characteristics, obstetric characteristics, information related to cancer, and information related to infertility and its treatments. RESULT s Based on the multivariable logistic regression model and by controlling sociodemographic and obstetric characteristics as possible confounding variables, women with cancer had an infertility history almost four times more than women who did not have a history of cancer (OR = 3.56; 95% CI: 1.36-9.33; P = 0.010). Women with breast cancer had an infertility history five times more than women without a history of breast cancer (OR = 5.11; 95% CI: 1.68-15.50; P = 0.004). The infertility history of women with gynecological cancer was more than three times that of the control group. However, there was no statistically significant difference between the two groups (OR = 3.36; 95% CI: 0.99-11.47; P = 0.053). CONCLUSION Infertility and its treatments may be involved in increasing the risk of breast and gynecological cancers.
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Affiliation(s)
- Somayyeh Naghizadeh
- Department of Midwifery, Faculty of Medical, Tabriz Medical Sciences, Islamic Azad University, Tabriz
| | - Farnaz Faroughi
- Department of Midwifery, Maragheh Branch, Islamic Azad University, Maragheh and
| | - Mojgan Mirghafourvand
- Social Determinants of Health Research Centre, Faculty of Nusrsing and Midwifery, Department of Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
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Tsarouchi MI, Hoxhaj A, Mann RM. New Approaches and Recommendations for Risk-Adapted Breast Cancer Screening. J Magn Reson Imaging 2023; 58:987-1010. [PMID: 37040474 DOI: 10.1002/jmri.28731] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/23/2023] [Accepted: 03/24/2023] [Indexed: 04/13/2023] Open
Abstract
Population-based breast cancer screening using mammography as the gold standard imaging modality has been in clinical practice for over 40 years. However, the limitations of mammography in terms of sensitivity and high false-positive rates, particularly in high-risk women, challenge the indiscriminate nature of population-based screening. Additionally, in light of expanding research on new breast cancer risk factors, there is a growing consensus that breast cancer screening should move toward a risk-adapted approach. Recent advancements in breast imaging technology, including contrast material-enhanced mammography (CEM), ultrasound (US) (automated-breast US, Doppler, elastography US), and especially magnetic resonance imaging (MRI) (abbreviated, ultrafast, and contrast-agent free), may provide new opportunities for risk-adapted personalized screening strategies. Moreover, the integration of artificial intelligence and radiomics techniques has the potential to enhance the performance of risk-adapted screening. This review article summarizes the current evidence and challenges in breast cancer screening and highlights potential future perspectives for various imaging techniques in a risk-adapted breast cancer screening approach. EVIDENCE LEVEL: 1. TECHNICAL EFFICACY: Stage 5.
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Affiliation(s)
- Marialena I Tsarouchi
- Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Nijmegen, the Netherlands
- Department of Radiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Alma Hoxhaj
- Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Nijmegen, the Netherlands
- Department of Radiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Ritse M Mann
- Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Nijmegen, the Netherlands
- Department of Radiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
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Farland LV, Wang S, Rich-Edwards JW, Gaskins AJ, Chavarro JE, Wang YX, Tamimi RM, Missmer SA. History of infertility and risk of breast cancer: a prospective cohort study. Breast Cancer Res Treat 2023; 199:185-193. [PMID: 36928623 PMCID: PMC10695171 DOI: 10.1007/s10549-023-06907-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 02/24/2023] [Indexed: 03/18/2023]
Abstract
PURPOSE Research on infertility and risk of breast cancer has been conflicting, potentially because many well-established breast cancer risk factors, such as pregnancy history, are strongly correlated with infertility. METHODS We followed participants in the Nurses' Health Study II from 1989 to 2015 (n = 103,080) for the development of invasive breast cancer and calculated Hazard Ratios (HR) and 95% confidence intervals (CI) using Cox regression. Participants with a self-reported history of infertility (12 months of trying without conception) were compared to gravid women with no history of infertility. We classified breast cancer by menopausal status and investigated mediation by reproductive factors. RESULTS Over 26 years of follow-up, 26,208 (25.4%) women reported a history of infertility, and 3,201 women were newly diagnosed with invasive breast cancer. We observed no association between infertility history and risk of overall breast cancer (HR: 1.05, 95% CI: 0.97-1.14) or premenopausal breast cancer (RR: 0.93, 95% CI: 0.83-1.03). However, we observed a modest association between history of infertility and risk of postmenopausal breast cancer (HR: 1.13, 95% CI: 1.00-1.28), approximately 50% of which could be attributed to lower total parity and later age at first birth (95% CI: 8.2%-91.0%). CONCLUSIONS Women with a history of infertility were at increased risk of postmenopausal breast cancer. Older age at first birth and lower total parity explained approximately half of the association between infertility and risk of postmenopausal breast cancer.
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Affiliation(s)
- Leslie V Farland
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, 1295 N. Martin Ave, Tucson, AZ, 85724, USA.
- University of Arizona Cancer Center, University of Arizona, Tucson, USA.
| | - Siwen Wang
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Janet W Rich-Edwards
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Division of Women's Health, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Audrey J Gaskins
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Jorge E Chavarro
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Yi-Xin Wang
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Rulla M Tamimi
- Department of Population Health Sciences, Weill Cornell College of Medicine, NewYork, NY, USA
| | - Stacey A Missmer
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Obstetrics and Gynecology and Reproductive Biology, College of Human Medicine, Michigan State University, Grand Rapids, MI, USA
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7
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Current Considerations in Surgical Treatment for Adolescents and Young Women with Breast Cancer. Healthcare (Basel) 2022; 10:healthcare10122542. [PMID: 36554065 PMCID: PMC9777860 DOI: 10.3390/healthcare10122542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 12/06/2022] [Accepted: 12/09/2022] [Indexed: 12/23/2022] Open
Abstract
Adolescents and young women (AYA) with breast cancer represent a unique patient population, compared to the general population with breast cancer. We performed a literature review to evaluate the factors that influenced the surgical outcomes in this patient population. Fifty-two studies were identified, which evaluated breast surgery type, axillary surgery, contralateral prophylactic mastectomy (CPM), surgical timing, psychological factors, disparities, and imaging use. AYA patients had equivalent oncologic outcomes with breast conserving surgery (BCS) or mastectomy. CPM did not improve survival. There are limited data on axillary management in the AYA population, and while more data would be beneficial, this is currently extrapolated from the general breast cancer population. A shorter time to initiate treatment correlated to better outcomes, and disparities need to be overcome for optimal outcomes. AYA patients appreciated involvement in clinical decisions, and shared decision making should be considered whenever possible. Providers must keep these factors in mind when counseling AYA patients, regarding the surgical management of breast cancer.
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Kufel-Grabowska J, Podolak A, Maliszewski D, Bartoszkiewicz M, Ramlau R, Lukaszuk K. Fertility Counseling in BRCA1/2-Mutated Women with Breast Cancer and Healthy Individuals. J Clin Med 2022; 11:jcm11143996. [PMID: 35887761 PMCID: PMC9321124 DOI: 10.3390/jcm11143996] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 06/27/2022] [Accepted: 07/03/2022] [Indexed: 11/16/2022] Open
Abstract
Breast cancer is the most commonly diagnosed cancer worldwide and the fifth leading cause of cancer death. In 2020, there were 2.3 million new cases, and 685,000 women died from it. Breast cancer among young women under 40 years of age accounts for 5% to 10% of all cases of this cancer. The greater availability of multi-gene sequence analysis by next-generation sequencing has improved diagnosis and, consequently, the possibility of using appropriate therapeutic approaches in BRCA1/2 gene mutation carriers. Treatment of young breast cancer patients affects their reproductive potential by reducing ovarian reserve. It can lead to reversible or permanent premature menopause, decreased libido, and other symptoms of sex hormone deficiency. This requires that, in addition to oncological treatment, patients are offered genetic counseling, oncofertility, psychological assistance, and sexological counseling. Given the number of BRCA1/2 gene mutation carriers among young breast cancer patients, but also thanks to growing public awareness, among their healthy family members planning offspring, the possibility of benefiting from preimplantation testing and performing cancer-risk-reduction procedures: RRM (risk-reducing mastectomy) and RRSO (risk-reducing salpingo-oophorectomy) significantly increase the chance of a genetically burdened person living a healthy life and giving birth to a child not burdened by the parent's germline mutation. The goal of this paper is to show methods and examples of fertility counselling for BRCA1/2 gene mutation carriers, including both patients already affected by cancer and healthy individuals.
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Affiliation(s)
- Joanna Kufel-Grabowska
- Department of Oncology, Poznan University of Medical Sciences, 61-701 Poznan, Poland; (J.K.-G.); (R.R.)
| | - Amira Podolak
- Department of Obstetrics and Gynecological Nursing, Faculty of Health Sciences, Medical University of Gdansk, 80-210 Gdansk, Poland; (A.P.); (K.L.)
| | - Daniel Maliszewski
- Department of General and Oncological Surgery, Wojewódzki Szpital Specjalistyczny im. Janusza Korczaka w Słupsku Sp. z o.o., 76-200 Słupsk, Poland;
- Department of General and Oncological Surgery at Specialist Hospital in Koscierzyn, Sp.z.o.o., 83-400 Kościerzyna, Poland
- Swissmed Health Center, 80-210 Gdansk, Poland
| | - Mikołaj Bartoszkiewicz
- Department of Immunobiology, Poznan University of Medical Sciences, 60-806 Poznan, Poland
- Correspondence: ; Tel.: +48-61-854-76-53
| | - Rodryg Ramlau
- Department of Oncology, Poznan University of Medical Sciences, 61-701 Poznan, Poland; (J.K.-G.); (R.R.)
| | - Krzysztof Lukaszuk
- Department of Obstetrics and Gynecological Nursing, Faculty of Health Sciences, Medical University of Gdansk, 80-210 Gdansk, Poland; (A.P.); (K.L.)
- Invicta Research and Development Center, 81-740 Sopot, Poland
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Klyukina LA, Sosnova EA, Ishchenko AA. Carcinogenic Potential Of Ovulation Stimulation In BRCA1/2 Gene Mutation Carriers In Assisted Reproductive Technology Programs. RUSSIAN OPEN MEDICAL JOURNAL 2022. [DOI: 10.15275/rusomj.2022.0116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Mutations of the BRCA1/2 genes constitute a fundamental and independent risk factor in the genesis of both breast cancer and ovarian cancer. The specifics of the infertility treatment effect on the risk of developing cancer in carriers of mutations in the BRCA1/2 genes remain unclear and require a comprehensive investigation. In this review, we analyzed published sources on the possible relationship between the infertility treatment and the risk of ovarian and breast cancer in BRCA1/2 mutation carriers.
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Affiliation(s)
| | - Elena A. Sosnova
- I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Anton A. Ishchenko
- Federal Budgetary Institution Medical and Rehabilitation Center, Moscow, Russia
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10
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Machtinger R, Fallach N, Goldstein I, Chodick G, Schiff E, Orvieto R, Mashiach R. Ovarian stimulation for fertility treatments and risk of breast cancer: a matched cohort study. Hum Reprod 2021; 37:577-585. [PMID: 34871410 DOI: 10.1093/humrep/deab270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 10/17/2021] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION Is there a difference in the breast cancer risk among women who underwent ART treatments compared to those who underwent medically assisted reproduction (MAR) infertility treatments or women of reproductive age in the general population? SUMMARY ANSWER The risk of breast cancer among women treated by ART was similar to the risk among women treated by MAR and women who did not undergo fertility treatments. WHAT IS KNOWN ALREADY Studies investigating breast cancer risk in women who have undergone fertility treatments have provided conflicting results. STUDY DESIGN, SIZE, DURATION A retrospective, population-based cohort study included women who underwent ART or MAR treatments and women who did not undergo fertility treatments from 1994 to 2019. PARTICIPANTS/MATERIALS, SETTING, METHODS Women who underwent ART were matched one to one with women who underwent MAR treatments and one to one with woman from the general population of reproductive age, by year of birth and year of first delivery or nulliparity status. MAR women were also matched to ART women by treatment initiation calendar year. All included women were members of Maccabi Healthcare Services. Data regarding demographics, fertility treatments, BRCA mutation and possible confounders were obtained from the computerized database of electronic health records. The incidence of breast cancer after fertility treatments was compared to the matched controls. MAIN RESULTS AND THE ROLE OF CHANCE Of 8 25 721 women of reproductive age, 32 366 women who underwent ART were matched with patients treated by MAR (n = 32 366) and 32 366 women of reproductive age. A total of 984 women (1.0%) were diagnosed with breast cancer (mean follow-up period, 9.1 ± 6.3 years; interquartile range [IQR], 3.8-13.7 years). The incidence rates of breast cancer per 10 000 person-years were 11.9 (95% CI, 10.7-13.3), 10.7 (95% CI, 9.6-11.9) and 10.7 (95% CI, 9.6-12.0) in the ART group, MAR group and general population, respectively. The crude risk for breast cancer was similar in the ART group compared with the general population (hazard ratio (HR) = 1.10, 95% CI, 0.94-1.28) and in the ART group compared with the MAR group (HR = 1.00, 95% CI, 0.86-1.16). Further adjustment for age, BMI, smoking, socioeconomic status and parity did not substantially impact the hazard rates for breast cancer (ART vs general population: HR = 1.10, 95% CI, 0.94-1.28; ART vs MAR: HR = 0.99, 95% CI, 0.85-1.16). Among women diagnosed with breast cancer, the prevalence of BRCA1/2 mutations and tumour staging did not differ between the ART, MAR and general population groups. Among women who underwent ART, no correlation was found between breast cancer and the number of ART cycles or the use of recombinant medications or urine-derived medications. LIMITATIONS, REASONS FOR CAUTION The mean age of women at the end of follow-up was only 42 years thus the study was not powered to detect potential differences in the risk of postmenopausal breast cancer. In addition, we did not sub-classify the exposed patients by the reason for infertility. WIDER IMPLICATIONS OF THE FINDINGS Breast cancer incidence following ART was comparable to that in the general population or following MAR. Women undergoing fertility treatments and their clinicians may be reassured about the safety of assisted reproduction technologies in terms of premenopausal breast cancer risk. STUDY FUNDING/COMPETING INTEREST(S) No specific funding was used and there are no competing interests. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- R Machtinger
- Department of Obstetrics and Gynecology, Sheba Medical Center, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - N Fallach
- Kahn-Sagol-Maccabi Research and Innovation Institute, Maccabi Healthcare Services, Tel Aviv, Israel
| | - I Goldstein
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Kahn-Sagol-Maccabi Research and Innovation Institute, Maccabi Healthcare Services, Tel Aviv, Israel
| | - G Chodick
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Kahn-Sagol-Maccabi Research and Innovation Institute, Maccabi Healthcare Services, Tel Aviv, Israel
| | - E Schiff
- Department of Obstetrics and Gynecology, Sheba Medical Center, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - R Orvieto
- Department of Obstetrics and Gynecology, Sheba Medical Center, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - R Mashiach
- Department of Obstetrics and Gynecology, Sheba Medical Center, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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11
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Vassard D, Pinborg A, Kamper-Jørgensen M, Lyng Forman J, Glazer CH, Kroman N, Schmidt L. Assisted reproductive technology treatment and risk of breast cancer: a population-based cohort study. Hum Reprod 2021; 36:3152-3160. [PMID: 34580714 DOI: 10.1093/humrep/deab219] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 08/28/2021] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION Is there an increased risk of breast cancer among women after ART treatment including ovarian hormone stimulation? SUMMARY ANSWER The risk of breast cancer was slightly increased among women after ART treatment compared to age-matched, untreated women in the background population, and the risk was further increased among women initiating ART treatment when aged 40+ years. WHAT IS KNOWN ALREADY The majority of breast cancer cases are sensitive to oestrogen, and ovarian hormone stimulation has been suggested to increase the risk of breast cancer by influencing endogenous oestrogen levels. Previous studies on ART treatment and breast cancer have varied in their findings, but several studies have small sample sizes or lack follow-up time and/or confounder adjustment. Recent childbirth, nulliparity and higher socio-economic status are breast cancer risk factors and the latter two are also associated with initiating ART treatment. STUDY DESIGN, SIZE, DURATION The Danish National ART-Couple II (DANAC II) cohort includes women treated with ART at public and private fertility clinics in 1994-2016. PARTICIPANTS/MATERIALS, SETTING, METHODS Women with no cancer prior to ART treatment were included (n = 61 579). Women from the background population with similar age and no prior history of ART treatment were randomly selected as comparisons (n = 579 760). The baseline mean age was 33.1 years (range 18-46 years). Results are presented as hazard ratios (HRs) with corresponding CIs. MAIN RESULTS AND THE ROLE OF CHANCE During follow-up (median 9.69 years among ART-treated and 9.28 years among untreated), 5861 women were diagnosed with breast cancer, 695 among ART-treated and 5166 among untreated women (1.1% versus 0.9%, P < 0.0001). Using Cox regression analyses adjusted for nulliparity, educational level, partnership status, year, maternal breast cancer and age, the risk of breast cancer was slightly increased among women treated with ART (HR 1.14, 95% CI 1.12-1.16). All causes of infertility were slightly associated with breast cancer risk after ART treatment. The risk of breast cancer increased with higher age at ART treatment initiation and was highest among women initiating treatment at age 40+ years (HR 1.37, 95% CI 1.29-1.45). When comparing women with a first birth at age 40+ years with or without ART treatment, the increased risk among women treated with ART persisted (HR 1.51, 95% CI 1.09-2.08). LIMITATIONS, REASONS FOR CAUTION Although this study is based on a large, national cohort of women, more research with sufficient power and confounder adjustment is needed, particularly in cohorts with a broad age representation. WIDER IMPLICATIONS OF THE FINDINGS An increased risk of breast cancer associated with a higher age at ART treatment initiation has been shown. Ovarian stimulation may increase the risk of breast cancer among women initiating ART treatment when aged 40+ years. Age-related vulnerability to hormone exposure or higher hormone doses during ART treatment may explain the increased risk. STUDY FUNDING/COMPETING INTEREST(S) This work was supported by a PhD grant to D.V. from the Faculty of Health and Medical Sciences, University of Copenhagen, Denmark. Funding for establishing the DANAC II cohort was received from the Ebba Rosa Hansen Foundation. The authors report no conflict of interest. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- D Vassard
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen K, Denmark
| | - A Pinborg
- Fertility Clinic, Rigshospitalet, Copenhagen University Hospital, Copenhagen Ø, Denmark
| | - M Kamper-Jørgensen
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen K, Denmark
| | - J Lyng Forman
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen K, Denmark
| | - C H Glazer
- Department of Occupational and Environmental Medicine, Bispebjerg University Hospital, Copenhagen NV, Denmark
| | - N Kroman
- Department of Breast Surgery, Copenhagen University Hospital Herlev, Copenhagen Ø, Denmark
| | - L Schmidt
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen K, Denmark
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van Tuijl LA, Voogd AC, de Graeff A, Hoogendoorn AW, Ranchor AV, Pan KY, Basten M, Lamers F, Geerlings MI, Abell JG, Awadalla P, Bakker MF, Beekman ATF, Bjerkeset O, Boyd A, Cui Y, Galenkamp H, Garssen B, Hellingman S, Huisman M, Huss A, Keats MR, Kok AAL, Luik AI, Noisel N, Onland-Moret NC, Payette Y, Penninx BWJH, Portengen L, Rissanen I, Roest AM, Rosmalen JGM, Ruiter R, Schoevers RA, Soave DM, Spaan M, Steptoe A, Stronks K, Sund ER, Sweeney E, Teyhan A, Vaartjes I, van der Willik KD, van Leeuwen FE, van Petersen R, Verschuren WMM, Visseren F, Vermeulen R, Dekker J. Psychosocial factors and cancer incidence (PSY-CA): Protocol for individual participant data meta-analyses. Brain Behav 2021; 11:e2340. [PMID: 34473425 PMCID: PMC8553309 DOI: 10.1002/brb3.2340] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 08/12/2021] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES Psychosocial factors have been hypothesized to increase the risk of cancer. This study aims (1) to test whether psychosocial factors (depression, anxiety, recent loss events, subjective social support, relationship status, general distress, and neuroticism) are associated with the incidence of any cancer (any, breast, lung, prostate, colorectal, smoking-related, and alcohol-related); (2) to test the interaction between psychosocial factors and factors related to cancer risk (smoking, alcohol use, weight, physical activity, sedentary behavior, sleep, age, sex, education, hormone replacement therapy, and menopausal status) with regard to the incidence of cancer; and (3) to test the mediating role of health behaviors (smoking, alcohol use, weight, physical activity, sedentary behavior, and sleep) in the relationship between psychosocial factors and the incidence of cancer. METHODS The psychosocial factors and cancer incidence (PSY-CA) consortium was established involving experts in the field of (psycho-)oncology, methodology, and epidemiology. Using data collected in 18 cohorts (N = 617,355), a preplanned two-stage individual participant data (IPD) meta-analysis is proposed. Standardized analyses will be conducted on harmonized datasets for each cohort (stage 1), and meta-analyses will be performed on the risk estimates (stage 2). CONCLUSION PSY-CA aims to elucidate the relationship between psychosocial factors and cancer risk by addressing several shortcomings of prior meta-analyses.
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Affiliation(s)
- Lonneke A van Tuijl
- Department of Internal Medicine, Maasstad Hospital, Rotterdam, The Netherlands
| | - Adri C Voogd
- Department of Internal Medicine, Division of Medical Oncology, GROW, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Epidemiology, GROW, Maastricht University, Maastricht, The Netherlands.,Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands
| | - Alexander de Graeff
- Department of Medical Oncology, Cancer Center University Medical Center, University of Utrecht, Utrecht, The Netherlands
| | - Adriaan W Hoogendoorn
- Amsterdam UMC, Department of Psychiatry, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, The Netherlands.,GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands
| | - Adelita V Ranchor
- Department of Internal Medicine, Maasstad Hospital, Rotterdam, The Netherlands
| | - Kuan-Yu Pan
- Amsterdam UMC, Department of Psychiatry, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, The Netherlands
| | - Maartje Basten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | - Femke Lamers
- Amsterdam UMC, Department of Psychiatry, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, The Netherlands
| | - Mirjam I Geerlings
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | - Jessica G Abell
- Department of Behavioural Science and Health, University College London, London, UK
| | - Philip Awadalla
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada.,Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Marije F Bakker
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | - Aartjan T F Beekman
- Amsterdam UMC, Department of Psychiatry, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, The Netherlands
| | - Ottar Bjerkeset
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway.,Faculty of Medicine and Health Sciences, Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Andy Boyd
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
| | - Yunsong Cui
- Atlantic Partnership for Tomorrow's Health, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Henrike Galenkamp
- Department of Public and Occupational Health, Amsterdam UMC, and Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, Netherlands
| | - Bert Garssen
- Department of Internal Medicine, Maasstad Hospital, Rotterdam, The Netherlands
| | - Sean Hellingman
- Department of Mathematics, Wilfrid Laurier University, Waterloo, Canada
| | - Martijn Huisman
- Amsterdam UMC, Department of Epidemiology & Data Science, Amsterdam Public Health institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Sociology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Anke Huss
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Melanie R Keats
- School of Health and Human Performance, Faculty of Health, Dalhousie University, Halifax, Canada
| | - Almar A L Kok
- Amsterdam UMC, Department of Psychiatry, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, The Netherlands.,Amsterdam UMC, Department of Epidemiology & Data Science, Amsterdam Public Health institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Annemarie I Luik
- Department of Epidemiology, Erasmus MC-University Medical Center, Rotterdam, The Netherlands.,Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-University Medical Center, Rotterdam, The Netherlands
| | - Nolwenn Noisel
- CARTaGENE, CHU Sainte-Justine, 3175, Chemin de la Côte-Sainte-Catherine, Montréal, Québec, Canada
| | - N Charlotte Onland-Moret
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | - Yves Payette
- CARTaGENE, CHU Sainte-Justine, 3175, Chemin de la Côte-Sainte-Catherine, Montréal, Québec, Canada
| | - Brenda W J H Penninx
- Amsterdam UMC, Department of Psychiatry, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, The Netherlands
| | - Lützen Portengen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Ina Rissanen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | - Annelieke M Roest
- Department of Developmental Psychology, University of Groningen, Groningen, The Netherlands
| | - Judith G M Rosmalen
- Departments of Psychiatry and Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Rikje Ruiter
- Department of Epidemiology, Erasmus MC-University Medical Center, Rotterdam, The Netherlands.,Department of Internal Medicine, Maasstad, Rotterdam, The Netherlands
| | - Robert A Schoevers
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - David M Soave
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada.,Department of Mathematics, Wilfrid Laurier University, Waterloo, Canada
| | - Mandy Spaan
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Andrew Steptoe
- Department of Behavioural Science and Health, University College London, London, UK
| | - Karien Stronks
- Department of Public and Occupational Health, Amsterdam UMC, and Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, Netherlands
| | - Erik R Sund
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway.,Department of Public Health and Nursing, HUNT Research Centre, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Levanger hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Ellen Sweeney
- Atlantic Partnership for Tomorrow's Health, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Alison Teyhan
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
| | - Ilonca Vaartjes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | - Kimberly D van der Willik
- Department of Epidemiology, Erasmus MC-University Medical Center, Rotterdam, The Netherlands.,Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Flora E van Leeuwen
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Rutger van Petersen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | - W M Monique Verschuren
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands.,Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Utrecht, the Netherlands
| | - Frank Visseren
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Roel Vermeulen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Joost Dekker
- Amsterdam Public Health Research Institute, Amsterdam, Noord-Holland, The Netherlands.,Department of Rehabilitation Medicine and Department of Psychiatry, Amsterdam UMC - VUMC, Amsterdam, Noord-Holland, The Netherlands
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13
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Wan Q, Han L, Liu J, Li H, Li Y, Long QM, Tan L, Li JJ. Fertility preservation among young breast cancer patients: A single-center experience in China. Taiwan J Obstet Gynecol 2021; 60:827-830. [PMID: 34507656 DOI: 10.1016/j.tjog.2021.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2021] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE This study aims to investigate the status of fertility preservation (FP) in young breast cancer patients. MATERIALS AND METHODS A clinical database of six women with breast cancer who wished to undergo FP before starting chemotherapy were analyzed between January 2018 and December 2019 in our hospital. Among the six women, three were unmarried and three were married. RESULTS Three patients chose oocyte preservation and obtained 23, 7, and 17 MII oocytes, respectively. One patient chose embryo freezing, and three embryos were frozen. Fertility preservation failed for two patients, one of whom had premature ovulation, while the other patient abandoned egg retrieval on the human chorionic gonadotropin (HCG) day. CONCLUSION The present results indicate that oocyte and embryo cryopreservation are effective optional methods for young breast cancer patients. However, a lack of knowledge, the urgency of cancer treatment, and financial constraints are causes for a low access rate regarding this process.
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Affiliation(s)
- Qi Wan
- Department of Reproductive Medicine, Chengdu Jinjiang Maternal and Child Health Hospital, Chengdu, 610041, Sichuan, China; Department of Gynaecology and Obstetrics, West China Second University Hospital, Sichuan University; Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Ling Han
- Department of Gynaecology and Obstetrics, West China Second University Hospital, Sichuan University; Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Jing Liu
- Department of Reproductive Medicine, Chengdu Jinjiang Maternal and Child Health Hospital, Chengdu, 610041, Sichuan, China
| | - Hui Li
- Department of Breast Surgery, Sichuan Cancer Hospital, Chengdu, 610041, Sichuan, China
| | - Ya Li
- Department of Reproductive Medicine, Chengdu Jinjiang Maternal and Child Health Hospital, Chengdu, 610041, Sichuan, China
| | - Qi-Ming Long
- Department of Breast Surgery, Sichuan Cancer Hospital, Chengdu, 610041, Sichuan, China
| | - Li Tan
- Department of Reproductive Medicine, Chengdu Jinjiang Maternal and Child Health Hospital, Chengdu, 610041, Sichuan, China
| | - Jun-Jie Li
- Department of Breast Surgery, Sichuan Cancer Hospital, Chengdu, 610041, Sichuan, China.
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14
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Fertility Preservation and Breast Cancer. CURRENT BREAST CANCER REPORTS 2021. [DOI: 10.1007/s12609-021-00420-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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15
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Barcroft JF, Galazis N, Jones BP, Getreu N, Bracewell-Milnes T, Grewal KJ, Sorbi F, Yazbek J, Lathouras K, Smith JR, Hardiman P, Thum MY, Ben-Nagi J, Ghaem-Maghami S, Verbakel J, Saso S. Fertility treatment and cancers-the eternal conundrum: a systematic review and meta-analysis. Hum Reprod 2021; 36:1093-1107. [PMID: 33586777 DOI: 10.1093/humrep/deaa293] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 09/28/2020] [Indexed: 12/29/2022] Open
Abstract
STUDY QUESTION Does fertility treatment (FT) significantly increase the incidence of breast, ovarian, endometrial or cervical cancer? SUMMARY ANSWER Overall, FT does not significantly increase the incidence of breast, ovarian or endometrial cancer and may even reduce the incidence of cervical cancer. WHAT IS KNOWN ALREADY Infertility affects more than 14% of couples. Infertility and nulliparity are established risk factors for endometrial, ovarian and breast cancer, yet the association with FT is more contentious. STUDY DESIGN, SIZE, DURATION A literature search was carried out using Cochrane Library, EMBASE, Medline and Google Scholar up to December 2019. Peer-reviewed studies stating cancer incidence (breast, ovarian, endometrial or cervical) in FT and no-FT groups were identified. Out of 128 studies identified, 29 retrospective studies fulfilled the criteria and were included (n = 21 070 337). PARTICIPANTS/MATERIALS, SETTING, METHODS In the final meta-analysis, 29 studies were included: breast (n = 19), ovarian (n = 19), endometrial (n = 15) and cervical (n = 13), 17 studies involved multiple cancer types and so were included in each individual cancer meta-analysis. Primary outcome of interest was cancer incidence (breast, ovarian, endometrial and cervical) in FT and no-FT groups. Secondary outcome was cancer incidence according to specific fertility drug exposure. Odds ratio (OR) and random effects model were used to demonstrate treatment effect and calculate pooled treatment effect, respectively. A meta-regression and eight sub-group analyses were performed to assess the impact of the following variables, maternal age, infertility, study size, outliers and specific FT sub-types, on cancer incidence. MAIN RESULTS AND THE ROLE OF CHANCE Cervical cancer incidence was significantly lower in the FT group compared with the no-FT group: OR 0.68 (95% CI 0.46-0.99). The incidences of breast (OR 0.86; 95% CI 0.73-1.01) and endometrial (OR 1.28; 95% CI 0.92-1.79) cancers were not found to be significantly different between the FT and no-FT groups. Whilst overall ovarian cancer incidence was not significantly different between the FT and no-FT groups (OR 1.19; 95% CI 0.98-1.46), separate analysis of borderline ovarian tumours (BOT) revealed a significant association (OR 1.69; 95% CI 1.27-2.25). In further sub-group analyses, ovarian cancer incidence was shown to be significantly higher in the IVF (OR 1.32; 95% CI 1.03-1.69) and clomiphene citrate (CC) treatment group (OR 1.40; 95% CI 1.10-1.77), respectively when compared with the no-FT group. Conversely, the incidences of breast (OR 0.75; 95% CI 0.61-0.92) and cervical cancer (OR 0.58; 95% CI 0.38-0.89) were significantly lower in the IVF treatment sub-group compared to the no-FT group. LIMITATIONS, REASONS FOR CAUTION The large, varied dataset spanning a wide study period introduced significant clinical heterogeneity. Thus, results have to be interpreted with an element of caution. Exclusion of non-English citations, unpublished work and abstracts, in order to ensure data accuracy and reliability was maintained, may have introduced a degree of selection bias. WIDER IMPLICATIONS OF THE FINDINGS The results for breast, ovarian, endometrial and cervical cancer are reassuring, in line with previously published meta-analyses for individual cancers but the association between IVF and CC treatment and an increase in ovarian cancer incidence requires additional work to understand the potential mechanism driving this association. In particular, focusing on (i) discriminating specific treatments effects from an inherent risk of malignancy; (ii) differential risk profiles among specific patient sub-groups (refractory treatment and obesity); and (iii) understanding the impact of FT outcomes on cancer incidence. STUDY FUNDING/COMPETING INTEREST(S) This study did not receive any funding. The authors have no financial, personal, intellectual and professional conflicts of interest to declare. PROSPERO REGISTRATION NUMBER CRD42019153404.
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Affiliation(s)
- Jennifer Frances Barcroft
- Division of Surgery and Cancer, Institute of Reproductive & Developmental Biology, Imperial College London, Hammersmith Hospital Campus, London, UK
| | - Nicolas Galazis
- Division of Surgery and Cancer, Institute of Reproductive & Developmental Biology, Imperial College London, Hammersmith Hospital Campus, London, UK
| | - Benjamin P Jones
- Division of Surgery and Cancer, Institute of Reproductive & Developmental Biology, Imperial College London, Hammersmith Hospital Campus, London, UK
| | - Natalie Getreu
- Institute of Women's Health, University College London, London, UK
| | - Timothy Bracewell-Milnes
- Department of Obstetrics and Gynaecology, Chelsea and Westminster Hospital, Imperial College London, London, UK
| | - Karen J Grewal
- Division of Surgery and Cancer, Institute of Reproductive & Developmental Biology, Imperial College London, Hammersmith Hospital Campus, London, UK
| | - Flavia Sorbi
- Division of Obstetrics and Gynaecology, Department of Biomedical, Experimental and Clinical Sciences, University of Florence, Florence, Italy
| | - Joseph Yazbek
- West London Gynaecological Cancer Centre, Queen Charlotte's Hospital, Imperial College London, Hammersmith Hospital Campus, London, UK
| | - Kostas Lathouras
- West London Gynaecological Cancer Centre, Queen Charlotte's Hospital, Imperial College London, Hammersmith Hospital Campus, London, UK
| | - J Richard Smith
- West London Gynaecological Cancer Centre, Queen Charlotte's Hospital, Imperial College London, Hammersmith Hospital Campus, London, UK
| | - Paul Hardiman
- Department of Obstetrics and Gynaecology, Royal Free and University College Medical School, NW3 2PF London, UK
| | - Meen-Yau Thum
- The Lister Fertility Clinic, Chelsea Bridge Road, London, UK
| | - Jara Ben-Nagi
- Centre for Reproductive and Genetic Health, London, UK
| | - Sadaf Ghaem-Maghami
- West London Gynaecological Cancer Centre, Queen Charlotte's Hospital, Imperial College London, Hammersmith Hospital Campus, London, UK
| | - Jan Verbakel
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Srdjan Saso
- Division of Surgery and Cancer, Institute of Reproductive & Developmental Biology, Imperial College London, Hammersmith Hospital Campus, London, UK
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16
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Blumenfeld Z, Gleicher N, Adashi EY. Transiently increased risk of breast cancer after childbirth: implications for fertility treatments and surrogacy. Hum Reprod 2021; 35:1253-1255. [PMID: 32472674 DOI: 10.1093/humrep/deaa102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 04/15/2020] [Indexed: 11/13/2022] Open
Abstract
Whereas longstanding dogma has purported that pregnancies protect women from breast cancer, a recent meta-analysis now mandates reconsideration since it reported an actual higher breast cancer risk for more than two decades after childbirth before the relative risk turns negative. Moreover, the risk of breast cancer appears higher for women having their first birth at an older age and with a family history and it is not reduced by breastfeeding. The process of obtaining informed consent for all fertility treatments, therefore, must make patients aware of the facts that every pregnancy, to a small degree, will increase the short-term breast cancer risk. This observation may be even more relevant in cases of surrogacy where women agree to conceive without deriving benefits of offspring from assuming the risk, thus creating a substantially different risk-benefit ratio. Consequently, it appears prudent for professional societies in the field to update recommendations regarding consent information for all fertility treatments but especially for treatments involving surrogacy.
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Affiliation(s)
- Zeev Blumenfeld
- Department of Obstetrics and Gynecology, Reproductive Endocrinology, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, 31096 Haifa, Israel
| | - Norbert Gleicher
- The Center for Human Reproduction, New York, NY 10021, USA.,The Foundation for Reproductive Medicine, New York, NY 10022, USA.,Stem Cell Biology and Molecular Embryology Laboratory, Rockefeller University, New York, NY 10016, USA.,Department of Obstetrics and Gynecology, Medical University of Vienna, 1090 Vienna, Austria
| | - Eli Y Adashi
- Warren Alpert Medical School of Brown University, Providence, RI, USA
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Singh V, Reddy R, Sinha A, Marturi V, Panditharadyula SS, Bala A. A Review on Phytopharmaceuticals having Concomitant Experimental Anti-diabetic and Anti-cancer Effects as Potential Sources for Targeted Therapies Against Insulin-mediated Breast Cancer Cell Invasion and Migration. CURRENT CANCER THERAPY REVIEWS 2021. [DOI: 10.2174/1573394716999200831113335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Diabetes and breast cancer are pathophysiologically similar and clinically established
diseases that co-exist with a wider complex similar molecular signalling and having a similar set of
risk factors. Insulin plays a pivotal role in the invasion and migration of breast cancer cells. Several
ethnopharmacological evidences shed light on the concomitant anti-diabetic and anti-cancer activity
of medicinal plant and phytochemicals against breast tumors of patients with diabetes. This present
article reviewed the findings on medicinal plants and phytochemicals with concomitant antidiabetic
and anti-cancer effects reported in scientific literature to facilitate the development of dual-
acting therapies against diabetes and breast cancer. The schematic tabular form of published literature
on medicinal plants (63 plants belongs to 45 families) concluded the dynamics of phytochemicals
against diabetes and breast tumors that could be explored further for the discovery of therapies
for controlling of breast cancer cell invasion and migration in patients with diabetes.
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Affiliation(s)
- Vibhavana Singh
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research, (NIPER) Hajipur, Export Promotion Industrial Park (EPIP) Hajipur, Bihar 844102, India
| | - Rakesh Reddy
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research, (NIPER) Hajipur, Export Promotion Industrial Park (EPIP) Hajipur, Bihar 844102, India
| | - Antarip Sinha
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research, (NIPER) Hajipur, Export Promotion Industrial Park (EPIP) Hajipur, Bihar 844102, India
| | - Venkatesh Marturi
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research, (NIPER) Hajipur, Export Promotion Industrial Park (EPIP) Hajipur, Bihar 844102, India
| | - Shravani S. Panditharadyula
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research, (NIPER) Hajipur, Export Promotion Industrial Park (EPIP) Hajipur, Bihar 844102, India
| | - Asis Bala
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research, (NIPER) Hajipur, Export Promotion Industrial Park (EPIP) Hajipur, Bihar 844102, India
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18
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Perri T, Naor-Revel S, Eliassi-Revivo P, Lifshitz D, Friedman E, Korach J. Fertility treatments and breast cancer risk in Jewish Israeli BRCA mutation carriers. Fertil Steril 2021; 116:538-545. [PMID: 33823990 DOI: 10.1016/j.fertnstert.2021.02.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 02/13/2021] [Accepted: 02/16/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To determine whether fertility treatments impact the risk of breast cancer in Jewish Israeli BRCA1/2 mutation carriers. DESIGN Historical cohort study. SETTING University-affiliated tertiary medical center. PATIENT(S) A total of 1,824 Jewish Israeli BRCA1/2 mutation carriers from a single center were stratified into 1,492 (81.8%) carriers who were not treated for infertility and 332 (18.2%) carriers who underwent fertility treatment with clomiphene citrate (n = 134), gonadotropin (n = 119), in vitro fertilization (n = 183), or a combination of treatments (n = 89). INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Hazard ratios (HR) and 95% confidence intervals (CI) for the association of breast cancer with fertility treatment and other hormonal and reproductive variables. RESULT(S) Breast cancer was diagnosed in 687 BRCA1/2 mutation carriers. Multivariate analysis, either of the whole group or stratified by each gene, showed no association between fertility treatment and breast cancer risk, regardless of the type of treatment (clomiphene citrate: HR 0.77, 95% CI 0.49-1.19; gonadotropin: HR 0.54, 95% CI 0.28-1.01; in vitro fertilization: HR 0.65, 95% CI 0.39-1.08; and combined treatments: HR 1.23, 95% CI 0.49-3.06). An increased breast cancer risk was associated with paternal origin of the mutation (HR 1.43, 95% CI 1.17-1.75) and use of oral contraceptives for >5 years (HR 1.62, 95% CI 1.27-2.06) in both BRCA1 and BRCA2 mutation carriers. Ovarian cancer risk was decreased with the use of any oral contraceptive (HR 0.61; 95% CI 0.46-0.82). CONCLUSION(S) Fertility treatment for BRCA1/2 mutation carriers is not associated with a discernible increase in breast cancer risk.
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Affiliation(s)
- Tamar Perri
- Department of Gynecologic Oncology, Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Israel.
| | - Shani Naor-Revel
- Department of Gynecologic Oncology, Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Israel
| | - Perry Eliassi-Revivo
- Department of Gynecologic Oncology, Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Israel
| | - Dror Lifshitz
- Department of Gynecologic Oncology, Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Israel
| | - Eitan Friedman
- Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Israel; Susanne Levy-Gertner Oncogenetics Unit, Institute of Human Genetics, Sheba Medical Center, Tel Hashomer, Israel
| | - Jacob Korach
- Department of Gynecologic Oncology, Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Israel
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19
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La Marca A, Mastellari E. Fertility preservation for genetic diseases leading to premature ovarian insufficiency (POI). J Assist Reprod Genet 2021; 38:759-777. [PMID: 33495935 DOI: 10.1007/s10815-021-02067-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 01/07/2021] [Indexed: 12/13/2022] Open
Abstract
PURPOSE The current review aims to summarize the data available concerning the applicability of fertility preservation techniques to genetic conditions at risk of premature ovarian insufficiency (POI). METHODS A literature review through the PubMed Database was carried out. RESULTS About 10% of cases of POI is related to genetic diseases. The most frequent conditions associated with POI are Turner syndrome and fragile X pre-mutation; mutation of BRCA 1-2 genes and several other mutations and genetic syndromes have recently been highlighted, although they rarely occur. If a diagnosis is issued before POI onset, counseling on currently available fertility preservation techniques is advisable. In case of spontaneous menarche (this can occur variably depending on the mutation) established techniques like embryo or oocyte cryopreservation can be proposed, even if, in some cases, their effectiveness may be reduced by ovarian alterations connected to the mutation. Ovarian tissue cryopreservation has recently been defined as an established medical procedure for fertility preservation in young cancer patients and may be an option for prepubertal patients. However, it is still experimental in special populations with genetic diseases causing POI. New innovative experimental techniques, like in vitro maturation of immature oocytes (IVM) and vitro activation (IVA) of immature follicles on ovarian tissue, have shown limited but encouraging data and they will be probably available in the near future. For a correct risk-benefit evaluation, the following aspects should be considered: actual knowledge about the pathology-specific efficacy of the various techniques, the average age of onset of POI, the possible risks associated with the procedure in relation to the underlying pathology, the probability of spontaneous conception, as well as the health implications of a possible future pregnancy.. CONCLUSIONS Fertility preservation techniques represent a crucial opportunity for patients with genetic risk of POI. Early diagnosis increases the chances to apply these techniques. No specific recommendations concerning fertility preservation for each genetic pathology are available, and clinicians should first counsel the patient and her relatives about known risks and benefits of the available techniques, both those established and those considered as experimental.
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Affiliation(s)
- Antonio La Marca
- Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy. .,Clinica Eugin Modena, Modena, Italy.
| | - Elisa Mastellari
- Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy
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20
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Spaan M, van den Belt-Dusebout AW, Lambalk CB, van Boven HH, Schats R, Kortman M, Broekmans FJM, Laven JSE, van Santbrink EJP, Braat DDM, van der Westerlaken LAJ, Cohlen BJ, Cantineau AEP, Smeenk JMJ, van Rumste MM, Goddijn M, van Golde RJT, Meeuwissen PAM, Hamilton CJCM, Ouwens GM, Gerritsma MA, Schaapveld M, Burger CW, van Leeuwen FE. Long-Term Risk of Ovarian Cancer and Borderline Tumors After Assisted Reproductive Technology. J Natl Cancer Inst 2020; 113:699-709. [PMID: 33769500 DOI: 10.1093/jnci/djaa163] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 09/11/2020] [Accepted: 09/25/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Long-term effects of assisted reproductive technology (ART) on ovarian tumor risk are unknown. METHODS This nationwide cohort study comprises 30 625 women who received ovarian stimulation for ART in 1983-2000 and 9988 subfertile women not treated with ART. Incident invasive and borderline ovarian tumors were ascertained through linkage with the Netherlands Cancer Registry and the Dutch Pathology Registry until July 2018. Ovarian tumor risk in ART-treated women was compared with risks in the general population and the subfertile non-ART group. Statistical tests were 2-sided. RESULTS After a median follow-up of 24 years, 158 invasive and 100 borderline ovarian tumors were observed. Ovarian cancer risk in the ART group was increased compared with the general population (standardized incidence ratio [SIR] = 1.43, 95% confidence interval [CI] = 1.18 to 1.71) but not when compared with the non-ART group (age- and parity-adjusted hazard ratio [HR] = 1.02, 95% CI = 0.70 to 1.50). Risk decreased with higher parity and with a larger number of successful ART cycles (resulting in childbirth, Ptrend = .001) but was not associated with the number of unsuccessful ART cycles. Borderline ovarian tumor risk was increased in ART-treated women compared with the general population (SIR = 2.20, 95% CI = 1.66 to 2.86) and with non-ART women (HR = 1.84, 95% CI = 1.08 to 3.14). Risk did not increase with more ART cycles or longer follow-up time. CONCLUSIONS Increased ovarian cancer risk in ART-treated women compared with the general population is likely explained by nulliparity rather than ART treatment. The increased risk of borderline ovarian tumors after ART must be interpreted with caution because no dose-response relationship was observed.
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Affiliation(s)
- Mandy Spaan
- Department of Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | | | - Cornelis B Lambalk
- Department of Obstetrics & Gynecology, Amsterdam University Medical Center (UMC) Location, VU University Medical Center, Amsterdam, the Netherlands
| | - Hester H van Boven
- Department of Pathology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Roel Schats
- Department of Obstetrics & Gynecology, Amsterdam University Medical Center (UMC) Location, VU University Medical Center, Amsterdam, the Netherlands
| | - Marian Kortman
- Department of Reproductive Medicine and Gynecology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Frank J M Broekmans
- Department of Reproductive Medicine and Gynecology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Joop S E Laven
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Erasmus Medical Center, Rotterdam, the Netherlands
| | | | - Didi D M Braat
- Department of Obstetrics and Gynecology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
| | | | - Ben J Cohlen
- Department of Obstetrics and Gynecology, Isala Clinics, Zwolle, the Netherlands
| | - Astrid E P Cantineau
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University Groningen, Groningen, the Netherlands
| | - Jesper M J Smeenk
- Department of Obstetrics and Gynecology, St Elisabeth Hospital, Tilburg, the Netherlands
| | - Minouche M van Rumste
- Department of Obstetrics and Gynecology, Catharina Hospital, Eindhoven, the Netherlands
| | - Mariëtte Goddijn
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Amsterdam UMC Location, Academic Medical Center, Amsterdam, the Netherlands
| | - Ron J T van Golde
- Department of Obstetrics and Gynecology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Paul A M Meeuwissen
- Department of Obstetrics and Gynecology, Admiraal de Ruyter Hospital, Vlissingen, the Netherlands
| | - Carl J C M Hamilton
- Department of Obstetrics and Gynecology, Jeroen Bosch Ziekenhuis, 's-Hertogenbosch, the Netherlands
| | - Gabriële M Ouwens
- Department of Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Miranda A Gerritsma
- Department of Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Michael Schaapveld
- Department of Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Curt W Burger
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Flora E van Leeuwen
- Department of Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
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21
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Spaan M, van den Belt-Dusebout AW, van den Heuvel-Eibrink MM, Hauptmann M, Lambalk CB, Burger CW, van Leeuwen FE. Risk of cancer in children and young adults conceived by assisted reproductive technology. Hum Reprod 2020; 34:740-750. [PMID: 30715305 PMCID: PMC6443110 DOI: 10.1093/humrep/dey394] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 12/06/2018] [Accepted: 12/22/2018] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION Do children conceived by ART have an increased risk of cancer? SUMMARY ANSWER Overall, ART-conceived children do not appear to have an increased risk of cancer. WHAT IS KNOWN ALREADY Despite the increasing use of ART, i.e. IVF or ICSI worldwide, information about possible long-term health risks for children conceived by these techniques is scarce. STUDY DESIGN, SIZE, DURATION A nationwide historical cohort study with prospective follow-up (median 21 years), including all live-born offspring from women treated with subfertility treatments between 1980 and 2001. PARTICIPANTS/MATERIALS, SETTING, METHODS All offspring of a nationwide cohort of subfertile women (OMEGA study) treated in one of the 12 Dutch IVF clinics or two fertility clinics. Of 47 690 live-born children, 24 269 were ART-conceived, 13 761 naturally conceived and 9660 were conceived naturally or through fertility drugs, but not by ART. Information on the conception method of each child and potential confounders were collected through the mothers’ questionnaires and medical records. Cancer incidence was ascertained through linkage with The Netherlands Cancer Registry from 1 January 1989 until 1 November 2016. Cancer risk in ART-conceived children was compared with risks in naturally conceived children from subfertile women (hazard ratios [HRs]) and with the general population (standardized incidence ratios [SIRs]). MAIN RESULTS AND THE ROLE OF CHANCE The median follow-up was 21 years (interquartile range (IQR): 17–25) and was shorter in ART-conceived children (20 years, IQR: 17–23) compared with naturally conceived children (24 years, IQR: 20–30). In total, 231 cancers were observed. Overall cancer risk was not increased in ART-conceived children, neither compared with naturally conceived children from subfertile women (HR: 1.00, 95% CI 0.72–1.38) nor compared with the general population (SIR = 1.11, 95% CI: 0.90–1.36). From 18 years of age onwards, the HR of cancer in ART-conceived versus naturally conceived individuals was 1.25 (95% CI: 0.73–2.13). Slightly but non-significantly increased risks were observed in children conceived by ICSI or cryopreservation (HR = 1.52, 95% CI: 0.81–2.85; 1.80, 95% CI: 0.65–4.95, respectively). Risks of lymphoblastic leukemia (HR = 2.44, 95% CI: 0.81–7.37) and melanoma (HR = 1.86, 95% CI: 0.66–5.27) were non-significantly increased for ART-conceived compared with naturally conceived children. LIMITATIONS, REASONS FOR CAUTION Despite the large size and long follow-up of the cohort, the number of cancers was rather small for subgroup analyses as cancer in children and young adults is rare. WIDER IMPLICATIONS OF THE FINDINGS Overall, ART-conceived children do not appear to have an increased cancer risk after a median follow-up of 21 years. This large study provides important results, enabling physicians to better inform couples considering ART about the long-term safety of ART for their children. However, larger studies with prolonged follow-up are needed to investigate cancer risk in adults and in children conceived by ICSI and/or from cryopreserved embryos. STUDY FUNDING/COMPETING INTEREST(S) This work was supported by The Dutch Cancer Society (NKI 2006-3631) which funded the OMEGA-women’s cohort and Children Cancer Free (KIKA;147) which funded the OMEGA-offspring cohort. We declare no competing interests.
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Affiliation(s)
- Mandy Spaan
- Department of Epidemiology and Biostatistics, The Netherlands Cancer Institute, Plesmanlaan, Amsterdam, The Netherlands
| | | | | | - Michael Hauptmann
- Department of Epidemiology and Biostatistics, The Netherlands Cancer Institute, Plesmanlaan, Amsterdam, The Netherlands
| | - Cornelis B Lambalk
- Department of Obstetrics & Gynecology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan, Amsterdam, The Netherlands
| | - Curt W Burger
- Department of Gynecologic Oncology, Erasmus University Medical Center. Wytemaweg, Rotterdam, The Netherlands
| | - Flora E van Leeuwen
- Department of Epidemiology and Biostatistics, The Netherlands Cancer Institute, Plesmanlaan, Amsterdam, The Netherlands
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Abstract
Breast cancer affects about 3,000 new women of childbearing age each year. The desire for pregnancy is therefore a frequent issue in the management of breast cancer. We reviewed the current state of knowledge and recommendations in high-risk women, on the consideration of this desire for pregnancy in therapeutic management, the way to approach it, the preservation of fertility in the care process and finally on the outcomes of pregnancy after breast cancer. We evaluated the desire for pregnancy, qualitatively and quantitatively, after breast cancer through a literature review.
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Affiliation(s)
- Antoine Elies
- Département d'oncologie chirurgicale, hôpital René-Huguenin, Institut Curie, 35, rue Dailly, 92210 Saint-Cloud, France
| | - Eleonora Salakos
- Département d'oncologie chirurgicale, hôpital René-Huguenin, Institut Curie, 35, rue Dailly, 92210 Saint-Cloud, France
| | - Roman Rouzier
- Département d'oncologie chirurgicale, hôpital René-Huguenin, Institut Curie, 35, rue Dailly, 92210 Saint-Cloud, France; Université Versailles-Saint-Quentin-en-Yvelines, 78180 Montigny-le-Bretonneux, France.
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23
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Tsafrir A, Lerner-Geva L, Zaslavsky-Paltiel I, Laufer N, Simon A, Einav S, Eldar-Geva T, Holzer H, Gal M, Hirsh-Yechezkel G. Cancer in IVF patients treated at age 40 years and older: long term follow-up. Reprod Biomed Online 2020; 40:369-373. [PMID: 32008887 DOI: 10.1016/j.rbmo.2019.11.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 11/22/2019] [Accepted: 11/25/2019] [Indexed: 11/26/2022]
Abstract
RESEARCH QUESTION Current knowledge of cancer risk among women who undergo IVF is based mainly on studies of women treated in their thirties, frequently with short follow-up periods. Therefore, information about cancer risk among infertile menopausal women is limited. We aimed to evaluate the risk of cancer among IVF patients treated at age 40 years and older, followed up for an extended period. DESIGN Historical cohort study of all IVF patients treated at the age of 40 years or older at two university-affiliated IVF units in Jerusalem, Israel, between 1994 and 2002. Data were cross-linked with the Israel National Cancer Registry to 2016. Standardized incidence ratios (SIR) and 95% confidence intervals were computed by comparing the observed number of cancer cases with the expected cancer rate in the general Israeli population adjusted for age and year of birth. In addition, Kaplan-Meier analysis was conducted to account for the length of follow-up. RESULTS A total of 501 patients were included in the analysis, with mean follow-up of 16.7 ± 3.7 years (range 2-22 years). Mean age at first IVF cycle was 42.3 years (±2.1). Mean number of IVF cycles was 3.2 ± 2.6 (range 1-15). Thirty-six women (7.2%) developed invasive cancer, compared with 47.2 expected cases; SIR 0.76 (95% CI 0.53 to 1.06); 22 women were diagnosed with invasive breast cancer, compared with 19.84 expected; SIR 1.11 (95% CI 0.69 to 1.68). CONCLUSIONS Older women undergoing IVF treatment were not significantly associated with an excess risk of cancer at long-term follow up. Further studies, however, are needed to confirm these findings.
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Affiliation(s)
- Avi Tsafrir
- IVF Unit, Department of Obstetrics and Gynecology, Shaare-Zedek Medical Center, Hebrew University of Jerusalem, The Faculty of Medicine.
| | - Liat Lerner-Geva
- Woman and Children's Health Research Unit, Gertner Institute for Epidemiology and Health Policy Research, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University
| | - Inna Zaslavsky-Paltiel
- Woman and Children's Health Research Unit, Gertner Institute for Epidemiology and Health Policy Research, Tel Hashomer, Israel
| | - Neri Laufer
- IVF Unit, Hadassah Medical Center, Ein Kerem, Hebrew University of Jerusalem Faculty of Medicine
| | - Alex Simon
- IVF Unit, Hadassah Medical Center, Ein Kerem, Hebrew University of Jerusalem Faculty of Medicine
| | - Sharon Einav
- Surgical Intensive Care Unit, Shaare Zedek Medical Center, Hebrew University of Jerusalem Faculty of Medicine
| | - Talia Eldar-Geva
- IVF Unit, Department of Obstetrics and Gynecology, Shaare-Zedek Medical Center, Hebrew University of Jerusalem, The Faculty of Medicine
| | - Hananel Holzer
- IVF Unit, Department of Obstetrics and Gynecology, Shaare-Zedek Medical Center, Hebrew University of Jerusalem, The Faculty of Medicine
| | - Michael Gal
- IVF Unit, Department of Obstetrics and Gynecology, Shaare-Zedek Medical Center, Hebrew University of Jerusalem, The Faculty of Medicine
| | - Galit Hirsh-Yechezkel
- Woman and Children's Health Research Unit, Gertner Institute for Epidemiology and Health Policy Research, Tel Hashomer, Israel
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24
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Abramova N, Hubbard J, Schertz J, Richter E. Safety of Follitropin Alfa/Lutropin Alfa for Stimulation of Follicular Development. Drug Saf 2020; 42:453-461. [PMID: 30341677 PMCID: PMC6426819 DOI: 10.1007/s40264-018-0742-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Introduction Recombinant human luteinizing hormone (r-hLH) is used in a fixed-ratio combination with recombinant human follicle-stimulating hormone (r-hFSH) for the stimulation of follicular development. Objective The objective of this article was to conduct a review of safety data to evaluate the risks of r-hFSH/r-hLH treatment. Methods Data were retrieved from the Global Safety Database (Merck KGaA, Darmstadt, Germany) including reports from healthcare professionals, patients, health authorities, clinical trials, non-interventional studies, and the literature. Reports of important risks (identified and potential) as per the risk management plan applicable at the time of data retrieval were obtained up to December 2017. The estimated patient exposure to r-hFSH/r-hLH in the post-marketing setting was 427,012 treatment cycles. Nine hundred patients received r-hFSH/r-hLH during company-sponsored clinical trials (pre- and post-marketing). Results We identified 72 case reports describing important risks related to r-hFSH/r-hLH use, including 46 cases of ovarian hyperstimulation syndrome (10.8 per 100,000 treatment cycles) and 24 of hypersensitivity reaction (5.6 per 100,000 treatment cycles). No thromboembolic events were reported. One congenital anomaly, not suspected to be related to r-hFSH/r-hLH use, was reported during a clinical trial; the event was resolved by corrective surgery. Two fatal cases were identified; one case of recurrent malignant melanoma (suspected to be related to r-hFSH/r-hLH use) and one case resulting from complications of ovarian hyperstimulation syndrome. Conclusion Cumulative reporting rates of important identified and potential risks of r-hFSH/r-hLH during a 10-year surveillance period demonstrate the benefit–risk balance is positive. This post-marketing surveillance and continued surveillance of safety events should provide reassurance about the use of r-hFSH/r-hLH in clinical practice. Electronic supplementary material The online version of this article (10.1007/s40264-018-0742-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Julie Hubbard
- EMD Serono Research and Development Institute, Billerica, MA, USA
| | - Joan Schertz
- EMD Serono Research and Development Institute, Billerica, MA, USA
| | - Emilia Richter
- Merck KGaA, Frankfurter Strasse 250, 64293, Darmstadt, Germany
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25
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Ter Welle-Butalid MEE, Vriens IJHI, Derhaag JGJ, Leter EME, de Die-Smulders CEC, Smidt MM, van Golde RJTR, Tjan-Heijnen VCGV. Counseling young women with early breast cancer on fertility preservation. J Assist Reprod Genet 2019; 36:2593-2604. [PMID: 31760547 PMCID: PMC6910894 DOI: 10.1007/s10815-019-01615-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 10/18/2019] [Indexed: 02/07/2023] Open
Abstract
PURPOSE Women with early-stage breast cancer may still have a future child wish, while chemotherapy may impair fertility. To pursue on fertility preservation shortly after breast cancer diagnosis is complex. This review holds a critical reflection on all topics that need to be counseled to give them the opportunity to make a well-informed decision before starting any oncological treatment. METHODS A comprehensive literature review was performed on papers published in English language on breast cancer in young women, risk of chemotherapy-induced infertility, fertility preservation techniques, impact of possible mutation carriership, and future pregnancy outcome. RESULTS Below 40 years of age, the risk of permanent chemotherapy-induced ovarian function failure is approximately 20%, where taxanes do not significantly add to this risk. Overall, 23% of reported women who performed fertility preservation by cryopreserving oocytes or embryos returned for embryo transfer. Of these, 40% gave live birth. Both fertility preservation in women diagnosed with breast cancer and pregnancy after treatment seem safe with respect to breast cancer survival. Women who have a genetic predisposition for breast cancer like BRCA gene mutation should also be informed about the possibility of pre-implantation genetic diagnosis. CONCLUSIONS Women with an early stage of breast cancer and a possible future child wish should be referred to an expertise center in breast cancer, fertility preservation, and genetics in this complex decision-making process, shortly after diagnosis.
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Affiliation(s)
- M E Elena Ter Welle-Butalid
- Department of Obstetrics and Gynaecology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
- GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - I J H Ingeborg Vriens
- GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
- Department of Internal Medicine, division of Medical Oncology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - J G Josien Derhaag
- Department of Obstetrics and Gynaecology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
- GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - E M Edward Leter
- GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
- Department of Clinical Genetics, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, the Netherlands
| | - C E Christine de Die-Smulders
- GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
- Department of Clinical Genetics, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, the Netherlands
| | - M Marjolein Smidt
- GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
- Department of Surgery, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, the Netherlands
| | - R J T Ron van Golde
- Department of Obstetrics and Gynaecology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
- GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - V C G Vivianne Tjan-Heijnen
- GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.
- Department of Internal Medicine, division of Medical Oncology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.
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Carvalho MJ, Subtil S, Rodrigues Â, Oliveira J, Figueiredo-Dias M. Controversial association between polycystic ovary syndrome and breast cancer. Eur J Obstet Gynecol Reprod Biol 2019; 243:125-132. [PMID: 31693949 DOI: 10.1016/j.ejogrb.2019.10.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 09/07/2019] [Accepted: 10/14/2019] [Indexed: 12/15/2022]
Abstract
Polycystic ovary syndrome (PCOS) risk factors overlap with breast cancer, and the hormonal profile may be implicated in breast cancer pathogenesis. This study aims to report a literature review considering epidemiological and molecular mechanisms that correlate PCOS and breast cancer, as well as the influence of PCOS treatment on the incidence of breast cancer. Epidemiological studies failed to adjust potential variables that affect the risk and have thus provided inconclusive results. Molecular effects of androgenic pathways in breast cancer have been studied and androgens seem to have an inhibitory effect on mammary epithelial proliferation. However, increased bioavailable androgens were associated with recurrence of breast cancer due to conversion to oestrogens. Sex hormone-binding globulin has a role in hormone-dependent cancers and can be considered a marker for PCOS; a gene profile has already been linked to breast cancer risk in these patients. PCOS medical treatment is a promising tool for stratifying breast cancer risk due to the metabolic influence and hormonal environment. Clinical reports are inconsistent, emphasizing the need for further studies with a prospective design. In the future, the role of pharmacological interventions in PCOS will increase knowledge and awareness of breast cancer pathogenesis and will help to refine breast cancer risk stratification.
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Affiliation(s)
- Maria João Carvalho
- University Clinic of Gynaecology, Faculty of Medicine, University of Coimbra, Clinical Academic Centre of Coimbra, CACC, Coimbra, Portugal; Gynaecology Service, Coimbra Hospital and University Centre, Coimbra, Portugal.
| | - Simone Subtil
- University Clinic of Gynaecology, Faculty of Medicine, University of Coimbra, Clinical Academic Centre of Coimbra, CACC, Coimbra, Portugal; Gynaecology Service, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - Ângela Rodrigues
- University Clinic of Gynaecology, Faculty of Medicine, University of Coimbra, Clinical Academic Centre of Coimbra, CACC, Coimbra, Portugal; Gynaecology Service, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - Joana Oliveira
- University Clinic of Gynaecology, Faculty of Medicine, University of Coimbra, Clinical Academic Centre of Coimbra, CACC, Coimbra, Portugal; Gynaecology Service, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - Margarida Figueiredo-Dias
- University Clinic of Gynaecology, Faculty of Medicine, University of Coimbra, Clinical Academic Centre of Coimbra, CACC, Coimbra, Portugal; Gynaecology Service, Coimbra Hospital and University Centre, Coimbra, Portugal
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Guleria S, Kjær SK, Albieri V, Frederiksen K, Jensen A. A Cohort Study of Breast Cancer Risk after 20 Years of Follow-Up of Women Treated with Fertility Drugs. Cancer Epidemiol Biomarkers Prev 2019; 28:1986-1992. [PMID: 31533944 DOI: 10.1158/1055-9965.epi-19-0652] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 08/12/2019] [Accepted: 09/12/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Using a nationwide cohort of Danish women, we investigated the association between use of fertility drugs and risk of breast cancer. METHODS The study cohort included women ages 20 to 44 years and living in Denmark between January 1, 1995 and December 31, 2011. Information on fertility status, use of fertility drugs, breast cancer, covariates, and vital status was obtained from the Danish Infertility Cohort and various Danish national registers. Cox proportional hazard regression models were applied to estimate hazard ratios (HR) and 95% confidence intervals (CI), adjusted for potential confounders. RESULTS Of the 1,330,852 women included, 96,782 (7.3%) were infertile, and 20,567 (1.5%) were diagnosed with breast cancer during a median follow-up of 20.9 years. Compared with fertile women, infertile women who had used any fertility drugs did not have an increased hazard for breast cancer overall (HR = 1.02; 95% CI, 0.95-1.10), or for any of the histologic types (ductal, lobular, or mucinous) of breast cancer. Furthermore, no associations were observed between use of specific types of fertility drugs and breast cancer. CONCLUSIONS No convincing associations between use of fertility drugs and breast cancer were observed after two decades of follow-up. IMPACT Our results do not support a marked association between fertility drugs and breast cancer and are therefore reassuring for infertile women treated with fertility drugs.
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Affiliation(s)
- Sonia Guleria
- Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Susanne K Kjær
- Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
- Statistics and Pharmacoepidemiology, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Vanna Albieri
- Department of Gynecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Kirsten Frederiksen
- Department of Gynecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Allan Jensen
- Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark.
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28
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Allen C. Health and Disease After Assisted Reproductive Technology. FERTILITY & REPRODUCTION 2019. [DOI: 10.1142/s2661318219300095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Long-term health outcomes after ART have largely focused on offspring health and perinatal parameters. Longer-term health outcomes in female patients remain difficult to fully assess. Hypothetical concerns about the effects of endocrine manipulation on hormone-sensitive conditions, e.g. breast disease, are confounded by variable factors in patients and treatments. Obstetric and perinatal factors endow an additional layer of complexity to the overall analysis and more research is required to appreciate all aspects of ART. Notwithstanding the knowledge gap, clinicians must endeavour to individualise management plans, taking into account the pros and cons of ART in the context of immediate, maternity-related and long-term health risks for their patients.This review of recent literature examines current ART practice in terms of female health and disease as we strive for best practice in an ever-changing clinical and demographic fertility landscape.
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Affiliation(s)
- Cathy Allen
- National Maternity Hospital and Merrion Fertility Clinic, Dublin, Ireland
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29
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Nuñez O, Baldi BG, Radzikowska E, Carvalho CRR, Herranz C, Sobiecka M, Torre O, Harari S, Vergeer MAMH, Kolbe J, Pollán M, Pujana MA. Risk of breast cancer in patients with lymphangioleiomyomatosis. Cancer Epidemiol 2019; 61:154-156. [PMID: 31260937 DOI: 10.1016/j.canep.2019.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 05/03/2019] [Accepted: 06/11/2019] [Indexed: 10/26/2022]
Abstract
Lymphangioleiomyomatosis (LAM) is a rare metastasizing pulmonary disease that shares some clinical, cellular, and molecular similarities with metastatic breast cancer to lung. LAM cells have been identified circulating in various body fluids of patients and, intriguingly, diverse evidence indicates that these cells may originate from a different organ to the lung. Following on from these observations, we hypothesized the existence of a common risk basis between LAM and breast cancer, and suggested increased risk of breast cancer among LAM patients. Here, by studying two additional LAM cohorts with more detailed epidemiological, life-style, and disease-related data, we show consistent results; a potential excess of estrogen-receptor-positive young breast cancer cases in LAM. This observation further suggests the need of prospective studies to precisely assess the association between both diseases.
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Affiliation(s)
- Olivier Nuñez
- Cancer and Environmental Epidemiology Unit, National Center for Epidemiology, Carlos III Institute of Health, and Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Bruno G Baldi
- Pulmonary Division, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Elżbieta Radzikowska
- Department of Lung Diseases III, National Tuberculosis and Lung Disease Research Institute, Warsaw, Poland
| | - Carlos R R Carvalho
- Pulmonary Division, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Carmen Herranz
- ProCURE, Catalan Institute of Oncology (ICO), Bellvitge Institute for Biomedical Research (IDIBELL), L'Hospitalet del Llobregat, Barcelona, Catalonia, Spain
| | - Malgorzata Sobiecka
- Department of Lung Diseases I, National Tuberculosis and Lung Diseases Research Institute, Poland
| | - Olga Torre
- U.O. di Pneumologia e Terapia Semi-Intensiva Respiratoria, Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare, Ospedale San Giuseppe, MultiMedica IRCCS, Milan, Italy
| | - Sergio Harari
- U.O. di Pneumologia e Terapia Semi-Intensiva Respiratoria, Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare, Ospedale San Giuseppe, MultiMedica IRCCS, Milan, Italy
| | - Menno A M H Vergeer
- Department of Internal Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
| | - John Kolbe
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Marina Pollán
- Cancer and Environmental Epidemiology Unit, National Center for Epidemiology, Carlos III Institute of Health, and Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain.
| | - Miquel Angel Pujana
- ProCURE, Catalan Institute of Oncology (ICO), Bellvitge Institute for Biomedical Research (IDIBELL), L'Hospitalet del Llobregat, Barcelona, Catalonia, Spain.
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Cobo A, García-Velasco J, Domingo J, Pellicer A, Remohí J. Elective and Onco-fertility preservation: factors related to IVF outcomes. Hum Reprod 2019; 33:2222-2231. [PMID: 30383235 DOI: 10.1093/humrep/dey321] [Citation(s) in RCA: 163] [Impact Index Per Article: 32.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 10/22/2018] [Indexed: 12/25/2022] Open
Abstract
STUDY QUESTION Is the indication for fertility preservation (FP) related to success in IVF cycles after elective-FP (EFP) for age-related fertility decline and FP before cancer treatment (Onco-FP)? SUMMARY ANSWER Although success rates were lower in cancer patients, there was no statistically significant association between malignant disease and reproductive outcome after correction for age and controlled-ovarian stimulation (COS) regime. WHAT IS KNOWN ALREADY FP is increasingly applied in assisted reproduction, but little is known about the outcome of IVF cycles with vitrified oocytes in FP patients. STUDY DESIGN, SIZE, DURATION Retrospective, observational multicenter study of vitrification cycles for FP and of the warming cycles of women who returned to attempt pregnancy from January 2007 to May 2018. PARTICIPANTS/MATERIALS, SETTING, METHODS In all, 6362 women (EFP = 5289 patients; 7044 cycles + Onco-FP = 1073 patients; 1172 cycles) had their oocytes vitrified for FP. A logistic regression analysis was performed to examine the impact of indication for FP corrected for age at vitrification. The protocol used for COS was also included as a possible confounder. The main outcome measures were oocyte survival and live birth. A detailed description of the baseline and clinical data is provided, with comparisons between EFP and Onco-FP. The cumulative live birth rate (CLBR) per utilized oocyte according to age at vitrification was analyzed in those patients returning to use their oocytes. MAIN RESULTS AND ROLE OF CHANCE Age at vitrification was significantly older in EFP patients (37.2 ± 4.9 vs. 32.3 ± 3.5 year; P < 0.0001). Fewer oocytes were retrieved and vitrified per cycle in EFP (9.6 ± 8.4 vs. 11.4 ± 3.5 and 7.3 ± 11.3 vs. 8.7 ± 2.1, respectively; P < 0.05), but numbers became comparable when analyzed per patient (12.8 ± 7.4 vs. 12.5 ± 3.2 and 9.8 ± 6.4 vs. 9.5 ± 2.6). Storage time was shorter in EFP (2.1 ± 1.6 vs. 4.1 ± 0.9 years; P < 0.0001). In all, 641 (12.1%) EFP and 80 (7.4%) Onco-FP patients returned to attempt pregnancy (P < 0.05). Overall oocyte survival was comparable (83.9% vs. 81.8%; NS), but lower for onco-FP patients among younger (≤35 year) subjects (81.2% vs. 91.4%; P > 0.05). Fewer EFP cycles finished in embryo transfer (50.2% vs. 72.5%) (P < 0.05). The implantation rate was 42.6% and 32.5% in EFP versus Onco-FP (P < 0.05). Ongoing pregnancy (57.7% vs. 35.7%) and live birth rates (68.8% vs. 41.1%) were higher in EFP patients aged ≤35 than the Onco-FP matching age patients (P < 0.05). The reason for FP per se had no effect on oocyte survival (OR = 1.484 [95%CI = 0.876-2.252]; P = 0.202) or the CLBR (OR = 1.275 [95%CI = 0.711-2.284]; P = 0.414). Conversely, age (<36 vs. ≥36 y) impacted oocyte survival (adj.OR = 1.922 [95%CI = 1.274-2.900]; P = 0.025) and the CLBR (adj.OR= 3.106 [95%CI = 2.039-4.733]; P < 0.0001). The Kaplan-Meier analysis showed a significantly higher cumulative probability of live birth in patients <36 versus >36 in EFP (P < 0.0001), with improved outcomes when more oocytes were available for IVF. LIMITATIONS, REASONS FOR CAUTION Statistical power to compare IVF outcomes is limited by the few women who came to use their oocytes in the Onco-FP group. The patients' ages and the COS protocols used were significantly different between the EFP and ONCO-PP groups. WIDER IMPLICATIONS OF THE FINDINGS Although the implantation rate was significantly lower in the Onco-FP patients the impact of cancer disease per se was not proven'. EFP patients should be counseled according to their age and number of available oocytes. STUDY FUNDING/COMPETING INTEREST(S) No external funding was used for this study. The authors have no conflicts of interest. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- A Cobo
- IVIRMA-Valencia, Plaza de la Policía Local 3, Valencia, Spain
| | | | - J Domingo
- IVIRMA-Las Palmas, Av. Juan Carlos I, 17, Edificio Corona, Las Palmas de Gran Canaria, Las Palmas, Spain
| | - A Pellicer
- IVIRMA-Valencia, Plaza de la Policía Local 3, Valencia, Spain
| | - J Remohí
- IVIRMA-Valencia, Plaza de la Policía Local 3, Valencia, Spain
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Murugappan G, Li S, Lathi RB, Baker VL, Eisenberg ML. Risk of cancer in infertile women: analysis of US claims data. Hum Reprod 2019; 34:894-902. [DOI: 10.1093/humrep/dez018] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 01/11/2019] [Accepted: 02/08/2019] [Indexed: 12/19/2022] Open
Affiliation(s)
- Gayathree Murugappan
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Stanford Hospital and Clinics, Stanford, CA, USA
| | - Shufeng Li
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA
| | - Ruth B Lathi
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Stanford Hospital and Clinics, Stanford, CA, USA
| | - Valerie L Baker
- Division of Reproductive and Endocrinology, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael L Eisenberg
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Stanford Hospital and Clinics, Stanford, CA, USA
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA
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Santos-Ribeiro S, Mackens S, Racca A, Blockeel C. Towards complication-free assisted reproduction technology. Best Pract Res Clin Endocrinol Metab 2019; 33:9-19. [PMID: 30473208 DOI: 10.1016/j.beem.2018.10.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Assisted reproductive technology (ART) has vastly improved over the last 40 years, from a frequently unsuccessful and complicated procedure requiring hospital admission and routine laparoscopy to a fairly simple outpatient technique with relatively high success rates. However, it is important to stress that ART is not without risk and medical complications may still occur. The incidence of most of these ART-related complications is associated with how women undergo ovarian stimulation. For this reason, physicians should be aware that a carefully thought-out ovarian stimulation protocol and cycle monitoring are of paramount importance to maximise the success of the treatment while avoiding potentially life-threating complications to occur in this frequently otherwise healthy patient population. This review discusses the rationale and evolution of ovarian stimulation strategies over the years and the current developments towards finding a balance between the retrieval of a sufficient number of oocytes and ART-related complication prevention.
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Affiliation(s)
| | - Shari Mackens
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, Brussels 1090, Belgium.
| | - Annalisa Racca
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, Brussels 1090, Belgium; Academic Unit of Obstetrics and Gynaecology, IRCCS AOU San Martino-IST, University of Genoa, Largo Rosanna Benzi 10, Genova 16132, Italy.
| | - Christophe Blockeel
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, Brussels 1090, Belgium; Department of Obstetrics and Gynaecology, School of Medicine, University of Zagreb, Šalata 3, Zagreb 10000, Croatia.
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Shiloh SR, Sheiner E, Wainstock T, Walfisch A, Segal I, Landau D, Harlev A. Long-Term Cardiovascular Morbidity in Children Born Following Fertility Treatment. J Pediatr 2019; 204:84-88.e2. [PMID: 30291022 DOI: 10.1016/j.jpeds.2018.08.070] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 08/01/2018] [Accepted: 08/28/2018] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To determine the risk of long-term cardiovascular disease (CVD) among children born following in vitro fertilization (IVF) and compared with spontaneous pregnancies. STUDY DESIGN A population-based cohort study including all singleton deliveries occurring between 1991and 2014 at a tertiary medical center was performed. Hospitalizations up to the age of 18 years involving CVD were evaluated in children delivered following IVF, ovulation induction, and spontaneous pregnancies. CVD included valvular disorders, hypertension, arrhythmias, rheumatic disease, cardiomyopathy, ischemic heart disease, and heart failure. Kaplan-Meier survival curves were used to compare cumulative morbidity incidence, and a Cox regression model controlled for confounders. RESULTS During the study period, 242 187 singleton deliveries met the inclusion criteria; 1.1% following IVF (n = 2603), and 0.7% following ovulation induction (n = 1721). Hospitalizations up to the age of 18 years involving CVD (n = 1503) were comparable in children delivered following IVF (0.6%), ovulation induction (0.7%), and spontaneous pregnancies (0.6%; P = .884). No significant difference in the cumulative incidence of CVD was noted between the groups (log rank P = .781). Controlling for maternal age, gestational age, birthweight, maternal diabetes, and hypertensive disorders in pregnancy, fertility treatment was not noted as a risk factor for long-term pediatric CVD (IVF adjusted hazard ratio 1.05, 95% CI 0.63-1.74, P = .86; ovulation induction adjusted hazard ratio 0.97, CI 95% 0.55-1.71, P = .92). CONCLUSIONS Singletons conceived via fertility treatments do not appear to be at an increased risk of long-term pediatric CVD.
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Affiliation(s)
- Sivan Reut Shiloh
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Eyal Sheiner
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Tamar Wainstock
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Asnat Walfisch
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | | | - Daniella Landau
- Department of Neonatology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Avi Harlev
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
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Berk-Krauss J, Bieber AK, Criscito MC, Grant-Kels JM, Driscoll MS, Keltz M, Pomeranz MK, Martires KJ, Liebman TN, Stein JA. Melanoma risk after in vitro fertilization: A review of the literature. J Am Acad Dermatol 2018; 79:1133-1140.e3. [DOI: 10.1016/j.jaad.2018.07.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 07/02/2018] [Accepted: 07/07/2018] [Indexed: 01/07/2023]
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Lebovitz O, Haas J, James KE, Seidman DS, Orvieto R, Hourvitz A. The expected cumulative incidence of live birth for patients starting IVF treatment at age 41 years or older. Reprod Biomed Online 2018; 37:533-541. [PMID: 30297113 DOI: 10.1016/j.rbmo.2018.08.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 08/16/2018] [Accepted: 08/17/2018] [Indexed: 11/28/2022]
Abstract
RESEARCH QUESTION What is the cumulative incidence of live birth (CILB) for high-order consecutive IVF cycles, and which factors are associated with live birth in women aged ≥41 years using autologous oocytes? DESIGN A retrospective cohort study including 146 patients aged 41 years to <44 years who started their first IVF cycle attempt using autologous oocytes, between January 2006 and December 2013. RESULTS After 13 IVF cycles, CILB reached up to 33.6%. After six IVF cycles, 42 (28.8%) women delivered a live infant (85.7% of the total live birth). Mean live birth rate per cycle declined with age at the initial cycle (8% at 41 years; 5.8% at 42 years; and 4.1% at 43 years). Multivariable modified Poisson regression models identified patient's age (RR for 41 years versus 43 years: 0.47; 95% CI 0.25 to 0.87; P = 0.01), smoking status (RR 0.21; 95% CI 0.05 to 0.08; P = 0.02), and mean number of fertilized oocytes (RR 1.23; 95% CI 1.08 to 1.39; P < 0.01) as factors significantly associated with the probability of a live birth. CONCLUSIONS Multiple repeat IVF cycles in women aged 41-44 years offers a reasonable long-term success rate. After six cycles of treatment, about 29% of women of advanced reproductive age using autologous oocytes expected to achieve a live birth. This information might assist in fertility counselling and managing patients' expectations by adjusting the appropriate treatment strategy and number of IVF cycle attempts, especially in countries in which egg donation is prohibited or when multiple repeated IVF cycles attempts are financially affordable.
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Affiliation(s)
- Oshrit Lebovitz
- IVF Unit, Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel- Hashomer 52621, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel.
| | - Jigal Haas
- IVF Unit, Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel- Hashomer 52621, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | | | - Daniel S Seidman
- IVF Unit, Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel- Hashomer 52621, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Raoul Orvieto
- IVF Unit, Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel- Hashomer 52621, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Ariel Hourvitz
- IVF Unit, Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel- Hashomer 52621, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
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Vassard D, Schmidt L, Pinborg A, Petersen GL, Forman JL, Hageman I, Glazer CH, Kamper-Jørgensen M. Mortality in Women Treated With Assisted Reproductive Technology-Addressing the Healthy Patient Effect. Am J Epidemiol 2018; 187:1889-1895. [PMID: 29846493 DOI: 10.1093/aje/kwy085] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 04/09/2018] [Indexed: 11/12/2022] Open
Abstract
In previous studies, investigators have reported reduced mortality among women undergoing assisted reproductive technology (ART) treatment, possibly related to selection of healthy women into ART treatment. Our aim in this study was to explore the impact of relevant selection factors on the association between ART treatment and mortality and to explore effect modification by parity. Women treated with ART in fertility clinics in Denmark during 1994-2009 (n = 42,897) were age-matched with untreated women from the background population (n = 204,514) and followed until December 31, 2010. With adjustment for relevant confounders, the risk of death was lower among ART-treated women during the first 2 years after ART treatment (hazard ratio (HR) = 0.68, 95% confidence interval (CI): 0.63, 0.74), but there was no apparent difference after 10 years (HR = 0.92, 95% CI: 0.79, 1.07). Having children prior to ART treatment was associated with markedly reduced mortality (HR = 0.45, 95% CI: 0.38, 0.53), possibly due to better health among fertile women. While the frequencies of previous medical and psychiatric diagnoses among ART-treated and untreated women were similar, differences in disease severity could explain the reduced mortality among ART-treated women, as poor prognosis would make initiation of ART treatment unlikely. The survival advantage among ART-treated women is likely a selection phenomenon rather than a biological phenomenon.
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Affiliation(s)
- Ditte Vassard
- Section of Social Medicine, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Lone Schmidt
- Section of Social Medicine, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anja Pinborg
- Fertility Clinic, Department of Obstetrics/Gynecology, Hvidovre Hospital, Copenhagen University Hospital, Hvidovre, Denmark
| | - Gitte Lindved Petersen
- Section of Social Medicine, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Julie Lyng Forman
- Section of Biostatistics, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ida Hageman
- Psychiatric Center Copenhagen, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Clara Helene Glazer
- Department of Occupational and Environmental Medicine, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Mads Kamper-Jørgensen
- Section of Epidemiology, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Derks-Smeets IAP, Schrijver LH, de Die-Smulders CEM, Tjan-Heijnen VCG, van Golde RJT, Smits LJ, Caanen B, van Asperen CJ, Ausems M, Collée M, van Engelen K, Kets CM, van der Kolk L, Oosterwijk JC, van Os TAM, Rookus MA, van Leeuwen FE, Gómez García EB. Ovarian stimulation for IVF and risk of primary breast cancer in BRCA1/2 mutation carriers. Br J Cancer 2018; 119:357-363. [PMID: 29937543 PMCID: PMC6068188 DOI: 10.1038/s41416-018-0139-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 04/23/2018] [Accepted: 05/14/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The effect of in vitro fertilisation (IVF) on breast cancer risk for BRCA1/2 mutation carriers is rarely examined. As carriers may increasingly undergo IVF as part of preimplantation genetic diagnosis (PGD), we examined the impact of ovarian stimulation for IVF on breast cancer risk in BRCA1/2 mutation carriers. METHODS The study population consisted of 1550 BRCA1 and 964 BRCA2 mutation carriers, derived from the nationwide HEBON study and the nationwide PGD registry. Questionnaires, clinical records and linkages with the Netherlands Cancer Registry were used to collect data on IVF exposure, risk-reducing surgeries and cancer diagnosis, respectively. Time-dependent Cox regression analyses were conducted, stratified for birth cohort and adjusted for subfertility. RESULTS Of the 2514 BRCA1/2 mutation carriers, 3% (n = 76) were exposed to ovarian stimulation for IVF. In total, 938 BRCA1/2 mutation carriers (37.3%) were diagnosed with breast cancer. IVF exposure was not associated with risk of breast cancer (HR: 0.79, 95% CI: 0.46-1.36). Similar results were found for the subgroups of subfertile women (n = 232; HR: 0.73, 95% CI: 0.39-1.37) and BRCA1 mutation carriers (HR: 1.12, 95% CI: 0.60-2.09). In addition, age at and recency of first IVF treatment were not associated with breast cancer risk. CONCLUSION No evidence was found for an association between ovarian stimulation for IVF and breast cancer risk in BRCA1/2 mutation carriers.
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Affiliation(s)
- Inge A P Derks-Smeets
- Department of Clinical Genetics, Maastricht University Medical Centre+, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.,GROW - School for Oncology and Developmental Biology, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Lieske H Schrijver
- Department of Epidemiology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, Netherlands
| | - Christine E M de Die-Smulders
- Department of Clinical Genetics, Maastricht University Medical Centre+, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.,GROW - School for Oncology and Developmental Biology, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Vivianne C G Tjan-Heijnen
- GROW - School for Oncology and Developmental Biology, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.,Department of Internal Medicine, Division of Medical Oncology, Maastricht University Medical Centre+, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Ron J T van Golde
- GROW - School for Oncology and Developmental Biology, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.,Department of Obstetrics and Gynaecology, Maastricht University Medical Centre+, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Luc J Smits
- Department of Epidemiology, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Beppy Caanen
- Department of Clinical Genetics, Maastricht University Medical Centre+, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Christi J van Asperen
- Department of Clinical Genetics, Leiden University Medical Centre Leiden, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - Margreet Ausems
- Department of Genetics, University Medical Centre Utrecht, P.O. 85500, 3508 GA, Utrecht, The Netherlands
| | - Margriet Collée
- Department of Clinical Genetics, Erasmus University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Klaartje van Engelen
- Department of Clinical Genetics, VU University Medical Centre, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - C Marleen Kets
- Department of Human Genetics, Radboud University Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Lizet van der Kolk
- Family Cancer Clinic, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Jan C Oosterwijk
- Department of Genetics, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Theo A M van Os
- Department of Clinical Genetics, Academic Medical Centre, P.O. Box 22700, 1100 DE, Amsterdam, The Netherlands
| | | | - Matti A Rookus
- Department of Epidemiology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, Netherlands
| | - Flora E van Leeuwen
- Department of Epidemiology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, Netherlands.
| | - Encarna B Gómez García
- Department of Clinical Genetics, Maastricht University Medical Centre+, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.,GROW - School for Oncology and Developmental Biology, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
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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. Although 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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Schneider J, Lahl J, Kramer W. Long-term breast cancer risk following ovarian stimulation in young egg donors: a call for follow-up, research and informed consent. Reprod Biomed Online 2018; 34:480-485. [PMID: 28473127 DOI: 10.1016/j.rbmo.2017.02.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 02/07/2017] [Accepted: 02/07/2017] [Indexed: 11/26/2022]
Abstract
In the USA and other countries, oocyte donation is gaining increasing importance. Although sufficient data exist on procedure-associated short-term risks for oocyte donors, such as ovarian hyperstimulation syndrome, long-term follow-up studies of egg donors are lacking and their health risks are unknown. The lack of information may be misleadingly interpreted as lack of risk. Long-term hormone replacement therapy is recognized as a risk factor for breast cancer; the breast cancer risk of ovarian stimulation for egg donors is unknown but is a possibility. This commentary describes five individual cases of egg donors who developed breast cancer (four out of five women in their 30s) despite negative genetic testing results. Additionally, we summarize available studies of breast cancer in infertile women who experienced IVF. We emphasize the need to create egg donor registries that will facilitate long-term studies on egg donors. Until this information is available, we call for more realistic explanations to egg donors about the lack of knowledge of long-term risks as well as more transparent informed consent documents.
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Affiliation(s)
- Jennifer Schneider
- Professional Boundaries, Inc, 3052 N Palomino Park Loop, Tucson, AZ 85712, USA.
| | - Jennifer Lahl
- Center for Bioethics and Culture, 3380 Vincent Road, Pleasant Hill, CA 94523, USA
| | - Wendy Kramer
- Donor Sibling Registry, P.O. Box 1571, Nederland, CO 80466, USA
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40
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Vaz-Luis I, Partridge AH. Exogenous reproductive hormone use in breast cancer survivors and previvors. Nat Rev Clin Oncol 2018; 15:249-261. [DOI: 10.1038/nrclinonc.2017.207] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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41
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Grynberg M, Raad J, Comtet M, Vinolas C, Cédrin-Durnerin I, Sonigo C. Fertility preservation in BRCA-mutated women: when and how? Future Oncol 2018; 14:483-490. [PMID: 29327596 DOI: 10.2217/fon-2017-0415] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BRCA 1 and 2 genes play a critical role in the safeguarding of DNA integrity. It is now well established that BRCA1 and BRCA2-mutated women are at increased risk of breast and ovarian cancers. However, several lines of evidence indicate that this genetic status may also be associated with ovarian dysfunction, in particular a reduced ovarian reserve. Considering the gonadal toxicity of cancer treatments and the recommendation of prophylactic bilateral salpingo-oophorectomy around 40 years, young BRCA mutation carriers are confronted with difficult family planning decisions. Recent development in fertility preservation offers new possibilities for these women, not only before a potential cancer treatment, but also in healthy carriers. If the pregnancy seems to be safe in this population, oocyte vitrification following ovarian stimulation might help BRCA-mutated patients to conceive after cancer treatment or to undergo prenatal genetic diagnosis in order to avoid the risk of transmitting the genetic abnormality to their offspring. The present article aims to extensively discuss the fertility issues related to BRCA gene mutations and the questions raised by the possibility of fertility in this population.
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Affiliation(s)
- Michaël Grynberg
- Department of Reproductive Medicine & Fertility Preservation, Hôpital Antoine Béclère, 157 rue de la Porte de Trivaux, 92140 Clamart, France.,University Paris Sud XI, 94276, Le Kremlin Bicêtre, France.,Unité Inserm U1133, Université Paris-Diderot, 75013 Paris, France
| | - Jade Raad
- Department of Reproductive Medicine & Fertility Preservation, Hôpital Antoine Béclère, 157 rue de la Porte de Trivaux, 92140 Clamart, France
| | - Marjorie Comtet
- Department of Reproductive Medicine & Fertility Preservation, Hôpital Jean Verdier, Avenue du 14 Juillet, 93140 Bondy, France.,University Paris XIII, 93017, Bobigny, France
| | - Claire Vinolas
- Department of Reproductive Medicine & Fertility Preservation, Hôpital Jean Verdier, Avenue du 14 Juillet, 93140 Bondy, France
| | - Isabelle Cédrin-Durnerin
- Department of Reproductive Medicine & Fertility Preservation, Hôpital Jean Verdier, Avenue du 14 Juillet, 93140 Bondy, France
| | - Charlotte Sonigo
- Department of Reproductive Medicine & Fertility Preservation, Hôpital Antoine Béclère, 157 rue de la Porte de Trivaux, 92140 Clamart, France.,Inserm U1185, Univ Paris-Sud, Université Paris Saclay, Le Kremlin Bicêtre, 94276, France
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42
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Fertility and pregnancy issues in BRCA -mutated breast cancer patients. Cancer Treat Rev 2017; 59:61-70. [DOI: 10.1016/j.ctrv.2017.07.001] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 07/04/2017] [Accepted: 07/05/2017] [Indexed: 01/08/2023]
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43
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Lundberg FE, Iliadou AN, Rodriguez-Wallberg K, Bergh C, Gemzell-Danielsson K, Johansson ALV. Ovarian stimulation and risk of breast cancer in Swedish women. Fertil Steril 2017; 108:137-144. [PMID: 28600105 DOI: 10.1016/j.fertnstert.2017.05.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 05/04/2017] [Accepted: 05/04/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate whether ovarian stimulation for treating infertility is associated with the risk of breast cancer. DESIGN Nationwide register-based cohort study. SETTING Not applicable. PATIENT(S) In a cohort of 1,340,211 women who gave birth 1982-2012, we investigated the relationship between assisted reproductive technology (ART) and incidence of breast cancer. Associations between any ovarian stimulation since 2005 and breast cancer incidence were studied in a separate cohort of 1,877,140 women born 1960-92. Both cohorts were followed through 2012. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Hazard ratios (HRs) and 95% confidence intervals (CIs) for breast cancer. RESULT(S) There was no increased risk of breast cancer in women who gave birth after ART compared with women who gave birth after spontaneous conception (adjusted HR, 0.84; 95% CI, 0.74-0.95). The incidence of breast cancer was not increased among women who received controlled ovarian stimulation or among women who received other hormonal fertility treatments since 2005, regardless of live birth (adjusted HR, 0.86; 95% CI, 0.69-1.07; and adjusted HR, 0.79; 95% CI, 0.60-1.05, respectively). CONCLUSION(S) No increased incidence of breast cancer was found among women who had gone through ovarian stimulations, including ART. These results are consistent with other studies and reassuring given the widespread and increasing use of ART.
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Affiliation(s)
- Frida E Lundberg
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
| | - Anastasia N Iliadou
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Kenny Rodriguez-Wallberg
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden; Department of Obstetrics and Gynecology, Division of Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Christina Bergh
- Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Kristina Gemzell-Danielsson
- Department of Women's and Children's Health, Division of Obstetrics and Gynecology, Karolinska Institutet and Karolinska University Hospital, WHO Collaborating Centre, Stockholm, Sweden
| | - Anna L V Johansson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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44
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Fauser BCJM, Garcia Velasco J. Breast cancer risk after oocyte donation: should we really be concerned? Reprod Biomed Online 2017; 34:439-440. [DOI: 10.1016/j.rbmo.2017.03.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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45
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Gabriele V, Benabu JC, Ohl J, Youssef CA, Mathelin C. [Does fertility treatment increase the risk of breast cancer? Current knowledge and meta-analysis]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2017; 45:299-308. [PMID: 28473195 DOI: 10.1016/j.gofs.2017.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Accepted: 03/14/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE The objective of this review was to assess the level of risk of breast cancer for women exposed to ovulation-inducing therapy (OIT). METHODS The 25 selected studies were extracted from the PUBMED database from January 2000 until March 2016 with the following key-words: "fertility agents", "infertility treatments", "clomiphene citrate", "buserelin", "ovarian stimulation", "assisted reproductive technology" and "breast cancer". Our meta-analysis was performed using Review Manager software, Cochrane Collaboration, 2014. The results were calculated by type of OIT, as well as globally. RESULTS The analysis of these published epidemiological studies confirms that exposition to OIT is not a breast cancer risk factor, but the results are contradictory. Two studies have shown a significantly increased risk of breast cancer in a population of infertile women, while two others have found a significant decrease of this risk. The twenty others did not show any impact of IOT over this risk. Our meta-analysis of 20 selected studies has not identified a significant association between exposition to OIT and breast cancer risk (relative risk=0,96; IC 95: (0,81-1,14) for cohort studies and odds ratio=0,94; IC 95% (0,81-1,10) for case-control studies). CONCLUSION Exposition to OIT is not an identified risk factor for breast cancer. A message reassuring about a possible risk of OIT-related breast cancer should be given to these women. Exposition to OIT is therefore not an indication of increased breast surveillance.
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Affiliation(s)
- V Gabriele
- Unité de sénologie, hôpital de Hautepierre, CHRU de Strasbourg, avenue Molière, 67200 Strasbourg cedex, France.
| | - J-C Benabu
- Unité de sénologie, hôpital de Hautepierre, CHRU de Strasbourg, avenue Molière, 67200 Strasbourg cedex, France
| | - J Ohl
- Centre médico-chirurgical et obstétrical (CMCO), 19, rue Louis-Pasteur, 67303 Schiltigheim, France
| | - C Akladios Youssef
- Unité de sénologie, hôpital de Hautepierre, CHRU de Strasbourg, avenue Molière, 67200 Strasbourg cedex, France
| | - C Mathelin
- Unité de sénologie, hôpital de Hautepierre, CHRU de Strasbourg, avenue Molière, 67200 Strasbourg cedex, France; Institut de génétique et de biologie moléculaire et cellulaire (IGBMC), biologie du cancer, 1, rue Laurent-Fries, 67400 Illkirch-Graffenstaden, France
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46
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Codacci-Pisanelli G, Del Pup L, Del Grande M, Peccatori FA. Mechanisms of chemotherapy-induced ovarian damage in breast cancer patients. Crit Rev Oncol Hematol 2017; 113:90-96. [PMID: 28427528 DOI: 10.1016/j.critrevonc.2017.03.009] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 02/23/2017] [Accepted: 03/08/2017] [Indexed: 01/25/2023] Open
Abstract
Fertility preservation in breast cancer patients is an increasingly relevant topic. In the present paper we review available data on the mechanism of ovarian damage caused by anticancer agents currently used for the treatment of breast cancer. We also describe current methods to preserve fertility including oocytes or ovarian tissue freezing and administration of LH-RHa during chemotherapy. The aim of the paper is to provide clinical oncologists with an adequate knowledge of the subject to enable them to give a correct counselling to young women that must receive chemotherapy and want to increase their possibilities of maintaining fertility.
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Affiliation(s)
- Giovanni Codacci-Pisanelli
- University of Rome "la Sapienza", Department of Medical and Surgical Sciences and Biotechnology, Corso della Repubblica, 79 Latina, 04100, Italy.
| | - Lino Del Pup
- Department of Gynaecological Oncology, National Cancer Institute, Via Franco Gallini, 2, Aviano (Pordenone) 33170 Italy.
| | - Maria Del Grande
- Istituto Oncologico della Svizzera Italiana, Ente Ospedaliero Cantonale, Via Ospedale, Ospedale San Giovanni, 6500 Bellinzona, Switzerland.
| | - Fedro A Peccatori
- Department of Gynaecological Oncology, European Institute of Oncology, Via Ripamonti, 435 Milano 20141, Italy.
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Wainstock T, Walfisch A, Shoham-Vardi I, Segal I, Harlev A, Sergienko R, Landau D, Sheiner E. Fertility treatments and pediatric neoplasms of the offspring: results of a population-based cohort with a median follow-up of 10 years. Am J Obstet Gynecol 2017; 216:314.e1-314.e14. [PMID: 28153657 DOI: 10.1016/j.ajog.2017.01.015] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 12/19/2016] [Accepted: 01/13/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Studies have questioned the long-term health effects of offspring conceived after fertility treatments. METHODS We aimed to evaluate whether an association exists between mode of conception (in vitro fertilization, ovulation induction, or spontaneous pregnancy) and neoplasm risk (both benign and malignant tumors) among the offspring; we observed the offspring for up to 18 years. STUDY DESIGN A population-based cohort analysis was performed that compared the risk for neoplasms among children (up to the age of 18 years) based on mode of conception. Neoplasm diagnoses were based on hospital records of the same single tertiary center in the region. All singletons born during from 1991-2013 and discharged alive were included in the study. Offspring with congenital malformations were excluded from the analysis. Kaplan-Meier survival curves were constructed to compare cumulative neoplasms incidence; multivariable survival analyses were used to control for confounders that included gestational age, pregnancy complications, and maternal factors. RESULTS During the study period, 242,187 newborn infants met the inclusion criteria: 2603 (1.1%) were conceived after in vitro fertilization; 1721 (0.7%) were conceived after ovulation induction treatments, and 237,863 (98.3%) were conceived spontaneously. During the follow-up period (median, 10.55 years), 1498 neoplasms(0.6%) were diagnosed. Incidence density rate for neoplasms was higher among children conceived either after in vitro fertilization (1.5/1000 person years) or ovulation induction treatments (1.0/1000 person years), as compared with naturally conceived children (0.59/1000 person years; Kaplan-Meier log rank, P<.001). The association between in vitro fertilization and total pediatric neoplasms and the association between any fertility treatments and malignancies remained significant; we controlled for confounders such as gestational diabetes mellitus, hypertensive disorders, preterm birth, and maternal age (adjusted hazard ratio, 2.48; 95% confidence interval, 1.71-3.50; and adjusted hazard ratio, 1.96; 95% confidence interval, 1.14-3.36, for all neoplasms and all malignancies, respectively). CONCLUSION Children conceived after fertility treatments are at an increased risk for pediatric neoplasms.
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48
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Vaughan DA, Leung A, Resetkova N, Ruthazer R, Penzias AS, Sakkas D, Alper MM. How many oocytes are optimal to achieve multiple live births with one stimulation cycle? The one-and-done approach. Fertil Steril 2017; 107:397-404.e3. [DOI: 10.1016/j.fertnstert.2016.10.037] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 10/26/2016] [Accepted: 10/26/2016] [Indexed: 11/24/2022]
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49
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Lambertini M, Pescio MC, Viglietti G, Goldrat O, Del Mastro L, Anserini P, Demeestere I. Methods of controlled ovarian stimulation for embryo/oocyte cryopreservation in breast cancer patients. ACTA ACUST UNITED AC 2016. [DOI: 10.1080/23809000.2017.1270760] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Matteo Lambertini
- Breast Cancer Translational Research Laboratory, Institut Jules Bordet, Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
- Breast Data Centre, Department of Medicine, Institut Jules Bordet, Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| | - Maria Carolina Pescio
- Department of Gynecology, U.O. di Ginecologia, Università di Genova, IRCCS AOU San Martino-IST, Genova, Italy
| | - Giulia Viglietti
- Breast Cancer Translational Research Laboratory, Institut Jules Bordet, Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| | - Oranite Goldrat
- Fertility Clinic, Research Laboratory on Human Reproduction Erasme and l’Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| | - Lucia Del Mastro
- Department of Medical Oncology, U.O. Sviluppo Terapie Innovative, IRCCS AOU San Martino-IST, Genova, Italy
| | - Paola Anserini
- Department of Gynecology, U.O. di Ginecologia, Università di Genova, IRCCS AOU San Martino-IST, Genova, Italy
| | - Isabelle Demeestere
- Fertility Clinic, Research Laboratory on Human Reproduction Erasme and l’Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
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