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2018 ; 362
(ä): k2644
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English Wikipedia
Risks of ovarian, breast, and corpus uteri cancer in women treated with assisted
reproductive technology in Great Britain, 1991-2010: data linkage study including
2 2 million person years of observation
#MMPMID29997145
Williams CL
; Jones ME
; Swerdlow AJ
; Botting BJ
; Davies MC
; Jacobs I
; Bunch KJ
; Murphy MFG
; Sutcliffe AG
BMJ
2018[Jul]; 362
(ä): k2644
PMID29997145
show ga
OBJECTIVE: To investigate the risks of ovarian, breast, and corpus uteri cancer
in women who have had assisted reproduction. DESIGN: Large, population based,
data linkage cohort study. SETTING AND PARTICIPANTS: All women who had assisted
reproduction in Great Britain, 1991-2010, as recorded by the Human Fertilisation
and Embryology Authority (HFEA). INTERVENTIONS: HFEA fertility records for cohort
members were linked to national cancer registrations. MAIN OUTCOME MEASURES:
Observed first diagnosis of ovarian, breast, and corpus uteri cancer in cohort
members were compared with age, sex, and period specific expectation.
Standardised incidence ratios (SIRs) were calculated by use of age, sex, and
period specific national incidence rates. RESULTS: 255?786 women contributed
2?257?789 person years' follow-up. No significant increased risk of corpus uteri
cancer (164 cancers observed v 146.9 cancers expected; SIR 1.12, 95% confidence
interval 0.95 to 1.30) was found during an average of 8.8 years' follow-up. This
study found no significantly increased risks of breast cancer overall (2578 v
2641.2; SIR 0.98, 0.94 to 1.01) or invasive breast cancer (2272 v 2371.4; SIR
0.96, 0.92 to 1.00). An increased risk of in situ breast cancer (291 v 253.5; SIR
1.15, 1.02 to 1.29; absolute excess risk (AER) 1.7 cases per 100?000 person
years, 95% confidence interval 0.2 to 3.2) was detected, associated with an
increasing number of treatment cycles (P=0.03). There was an increased risk of
ovarian cancer (405 v 291.82; SIR 1.39, 1.26 to 1.53; AER 5.0 cases per 100?000
person years, 3.3 to 6.9), both invasive (264 v 188.1; SIR 1.40, 1.24 to 1.58;
AER 3.4 cases per 100?000 person years, 2.0 to 4.9) and borderline (141 v 103.7;
SIR 1.36, 1.15 to 1.60; AER 1.7 cases per 100?000 person years, 0.7 to 2.8).
Increased risks of ovarian tumours were limited to women with endometriosis, low
parity, or both. This study found no increased risk of any ovarian tumour in
women treated because of only male factor or unexplained infertility.
CONCLUSIONS: No increased risk of corpus uteri or invasive breast cancer was
detected in women who had had assisted reproduction, but increased risks of in
situ breast cancer and invasive and borderline ovarian tumours were found in this
study. Our results suggest that ovarian tumour risks could be due to patient
characteristics, rather than assisted reproduction itself, although both
surveillance bias and the effect of treatment are also possibilities. Ongoing
monitoring of this population is essential.