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Fertility Drugs Are Not Associated with Ovarian Cancer

No relation was found between use of fertility drugs and risk for ovarian cancer in Danish women.

Nulliparity and infertility are risk factors for ovarian cancer. Previous epidemiologic and cohort studies have suggested that treatment with fertility drugs might impart risk for ovarian cancer in nulliparous women. To evaluate risk associated with fertility drugs, researchers evaluated data from 54,362 Danish women (156 ovarian cancer cases, 1380 controls without ovarian cancer) who attended fertility clinics from 1963 through 1998.

Median follow-up was 16 years, and median age at ovarian cancer diagnosis was 46 (range, 25–68). Approximately one third of cases and controls used clomiphene, and another one third used human chorionic gonadotrophins; gonadotrophins and gonadotrophin-releasing hormone were used by about 15% and 10% of participants, respectively. No association was found between use of these drugs (whether individually or in 5 common combinations) and overall risk for ovarian cancer. Risk was unaffected by parity, number of cycles of drug use, or length of follow-up since first drug use. Adjusting for oral contraceptive use and causes of infertility did not change risk estimates. Secondary analysis by histologic subtype revealed a 67% greater relative risk for serous cancer after use of clomiphene versus other or no medications.

Comment: A previous analysis showed that Danish women who were referred to fertility clinics had almost 50% greater risk for ovarian cancer than did the general population (after adjusting for parity). Therefore, baseline risk was elevated for many women in this study, allowing the effects of fertility drugs to be isolated from risks conferred by infertility itself. One study limitation is young median age at diagnosis, as ovarian cancer incidence peaks in women in their 60s. However, this large study presents the best evidence to date that fertility drugs do not raise incidence of ovarian cancer; thus, clinicians can reassure infertile patients that they will not open themselves to excess ovarian cancer risk by using these drugs.

— Wendy S. Biggs, MD

Published in Journal Watch Women's Health March 5, 2009

Citation(s):

Jensen A et al. Use of fertility drugs and risk of ovarian cancer: Danish population based cohort study. BMJ 2009 Feb 5; 338:b249. (http://dx.doi.org/10.1136/bmj.b249)

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