Ovarian cancer risk associated with varying causes of infertility

Brinton, Louise A; Lamb, Emmet J; Moghissi, Kamran S; Scoccia, Bert; Althuis, Michelle D; Mabie, Jerome E; Westhoff, Carolyn L

doi:10.1016/j.fertnstert.2004.02.109

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Volume 82, Issue 2 , Pages 405-414, August 2004

Ovarian cancer risk associated with varying causes of infertility☆

Presented at the 59th Annual Meeting of the American Society for Reproductive Medicine, which was held in San Antonio, Texas, October 11–15, 2003.

Louise A Brinton, Ph.D.
- Hormonal and Reproductive Epidemiology Branch, National Cancer Institute, Bethesda, Maryland, USA
- Reprint requests: Louise A. Brinton, Ph.D., National Cancer Institute, 6120 Executive Blvd., Room 7068, Rockville, Maryland 20852-7234, USA (FAX: 301-402-0916).
Emmet J Lamb, M.D.
- Department of Obstetrics and Gynecology, Stanford University, Stanford, California, USA.
Kamran S Moghissi, M.D.
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan, USA
Bert Scoccia, M.D.
- Department of Obstetrics and Gynecology, University of Illinois at Chicago, Chicago, Illinois, USA
Michelle D Althuis, Ph.D.
- Hormonal and Reproductive Epidemiology Branch, National Cancer Institute, Bethesda, Maryland, USA
Jerome E Mabie, B.S.
- Information Management Services, Inc Rockville, Maryland, USA
Carolyn L Westhoff, Ph.D.
- Department of Obstetrics and Gynecology, Columbia University, New York, New York, USA

Received 2 October 2003; received in revised form 12 February 2004; accepted 12 February 2004.

Abstract

Objective

To evaluate the risk of ovarian cancer as related to underlying causes of infertility.

Design

Retrospective observational cohort study.

Setting

Five large reproductive endocrinology practices.

Patient(s)

A total of 12,193 women evaluated for infertility between 1965 and 1988.

Intervention(s)

None.

Main outcome measure(s)

Ovarian cancer ascertained through 1999.

Result(s)

With 45 identified ovarian cancers, this cohort of infertility patients demonstrated a significantly higher rate of ovarian cancer than the general female population (standardized incidence ratio [SIR] = 1.98; 95% confidence interval [CI], 1.4–2.6). The risk was higher for patients with primary infertility (SIR = 2.73) than for those with secondary infertility (SIR = 1.44), and it was particularly high for patients who never subsequently conceived (SIR = 3.33). Women with endometriosis had the highest risk (SIR = 2.48; 95% CI, 1.3–4.2), with a further elevated risk among those with primary infertility (4.19, 2.0–7.7). Comparisons among the infertile women, which allowed calculation of rate ratios (RRs) after adjustment for multiple factors, also showed links with endometriosis. Compared with women with secondary infertility without endometriosis, patients with primary infertility and endometriosis had a RR of 2.72 (95% CI, 1.1–6.7).

Conclusion(s)

Determination of ovarian cancer risk should take into account the type of infertility (primary vs. secondary) and underlying causes. Further study of endometriosis may provide insights into ovarian carcinogenesis.

Keywords: Ovarian cancer, risk, epidemiology, infertility, endometriosis, anovulation