In vitro fertilization and risk of breast and gynecologic cancers A retrospective cohort study within the Israeli Maccabi Healthcare Services

Capsule:
Among 87,403 infertile women, IVF was not significantly associated with breast or gynecologic cancers. Among women receiving four or more cycles, ovarian cancer was nonsignificantly elevated, supporting further risk monitoring.

Authors:
Louise A. Brinton, Ph.D., Britton Trabert, Ph.D., Varda Shalev, M.D., Eitan Lunenfeld, M.D., M.H.A., Tal Sella, M.D., Gabriel Chodick, Ph.D.

Volume 99, Issue 5, Pages 1189-1196, April 2013

Abstract:

Objective:
To assess long-term cancer risks associated with in vitro fertilization (IVF).

Design:
Record-linkage study.

Setting:
Health maintenance organization in Israel.

Patients:
A total of 87,403 women evaluated and/or treated for infertility on or after September 25, 1994 who developed cancer through June 22, 2011: 522 breast, 41 endometrial, 45 ovarian, 311 in situ cervical and 32 invasive cervical cancers were identified.

Intervention(s):
None.

Main Outcome Measures:
Hazard ratios (HRs) for specific cancers.

Results:
We found no significant relationships of IVF exposures to the risks of breast, endometrial or ovarian cancers. Compared to women with no fertility treatment, the HR associated with IVF was 1.58 (95% CI 0.75-3.29), with higher risk among those receiving 4+ cycles (1.78, 95% CI 0.76-4.13). There was also a non-significantly elevated risk for endometrial cancer among women who received 1-3 IVF cycles (1.94, 0.73-5.12), but additional cycles were associated with lesser risk. In contrast, in situ cervical cancer was significantly reduced and invasive cervical cancer non-significantly reduced among women receiving IVF as well as other fertility treatments.

Conclusions:
Our results regarding long-term effects were largely reassuring, but women receiving IVF should continue to be monitored given that the procedures involves potent ovulation stimulators and repeated ovarian punctures.

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