Fertility treatments and invasive epithelial ovarian cancer risk in Jewish Israeli BRCA1 or BRCA2 mutation carriers

In a cohort of 1,073 BRCA mutation carriers, fertility treatments were not found to be risk modifiers for invasive epithelial ovarian cancer.

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Authors

Tamar Perri, M.D., Dror Lifshitz, M.D., Siegal Sadetzki, M.D., M.P.H., Bernice Oberman, M.Sc., Dror Meirow, M.D., Gilad Ben-Baruch, M.D., Eitan Friedman, M.D., Ph.D., Jacob Korach, M.D.

Volume 103, Issue 5, Pages 1305-1312

Abstract

Objective:

To determine whether BRCA mutation carriers who undergo fertility treatments are at increased risk of developing invasive epithelial ovarian cancer (IEOC).

Design:

Historical cohort study.

Setting:

Tertiary university-affiliated medical center and the National Cancer Registry.

Patient(s):

A total of 1,073 Jewish Israeli BRCA mutation carriers diagnosed in a single institution between 1995 and 2013, including 164 carriers (15.2%) who had fertility treatments that included clomiphene citrate (n = 82), gonadotropin (n = 69), in vitro fertilization (IVF) (n = 66), or a combination (n = 50), and 909 carriers not treated for infertility.

Intervention(s):

None.

Main Outcome Measure(s):

Odds ratios (OR) and 95% confidence intervals (CI) for IEOC association with fertility treatments and other hormone and reproductive variables.

Result(s):

In 175 (16.3%) mutation carriers, IEOC was diagnosed; 139 women carried BRCA1, 33 carried BRCA2, and 3 had unknown mutations. Fertility treatments were not associated with IEOC risk (age-adjusted OR 0.63; 95% CI, 0.38–1.05) regardless of treatment type (with clomiphene citrate, OR 0.87; 95% CI, 0.46–1.63; with gonadotropin, OR 0.59; 95% CI, 0.26–1.31; with IVF, OR 1.08, 95% CI, 0.57–2.06). Multivariate analysis indicated an increased risk of IEOC with hormone-replacement therapy (OR 2.22; 95% CI, 1.33–3.69) and a reduced risk with oral contraceptives (OR 0.19; 95% CI, 0.13–0.28) in both BRCA1 and BRCA2 mutation carriers. Parity was a risk factor for IEOC by univariate but not multivariate analysis.

Conclusion(s):

According to our results, treatments for infertile BRCA mutation carriers should not be contraindicated or viewed as risk modifiers for IEOC. Parity as a risk factor in BRCA mutation carriers warrants further investigation.

Read the full text at: http://www.fertstert.org/article/S0015-0282(15)00136-3/fulltext


Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders. The journal publishes juried original scientific articles in clinical and laboratory research relevant to reproductive endocrinology, urology, andrology, physiology, immunology, genetics, contraception, and menopause. Fertility and Sterility® encourages and supports meaningful basic and clinical research, and facilitates and promotes excellence in professional education, in the field of reproductive medicine.

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