could be related to better access to healthcare and ensuring cervical cytology screening are up to date [18,45].
Key points
Challenge: Counseling women about the risks of cancer from ovarian stimulation.
Background:
Nulliparity is a risk factor for breast, ovarian and endometrial cancers.
Infertility and associated comorbidities may act as a risk factor for many gynecological cancers.
PCOS, a condition associated with infertility, is linked to endometrial cancer but not with breast cancer.
It is difficult to separate the cancer risks attributable to infertility from that of fertility drugs.
Most epidemiologic studies that have examined the association between fertility drugs and cancer risks have used the general population as the comparator. A more appropriate comparator is the untreated infertile population as this would allow better assessment of the cancer risk attributable to fertility drugs.
Some studies have shown a small increase in the risk of borderline ovarian tumors following the use of fertility drugs, but the evidence is insufficient to recommend against their use.
Management options:
Women should be counseled about the uncertainty in the available evidence.
Women may be counseled that there is no clear evidence that the use of fertility drugs for IVF increases the risk of cancers.
Answers to questions patients ask
1 Q1 Does IVF treatment increase the risk of cancer?A1. No it doesn’t. There were initial worries about this issue because we use hormones to stimulate the ovaries in IVF, but subsequently many studies looked at the effect of having IVF on cancers of the breast, ovary and womb, and their conclusions were that there is no increased risk.
2 Q2 My aunt had IVF in the past and now she developed cancer. Do you think it was the IVF that caused it?A2. Unfortunately, cancer is not uncommon, and it is estimated that about one in three people will develop cancer in their lifetime. The good news is that many of these cancers are diagnosed early enough to treat them, but the point is that cancer could happen whether the woman had IVF or not. Many studies looked at the effect of having IVF on cancers of the breast, ovary and womb, and their conclusions were that there is no increased risk. Sometimes, having conditions that make the woman more likely to need IVF (such as PCOS) in itself increases the risk of cancer.
References
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