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Fertility treatments and breast cancer risk in Jewish Israeli BRCA mutation carriers

      Objective

      To determine whether fertility treatments impact the risk of breast cancer in Jewish Israeli BRCA1/2 mutation carriers.

      Design

      Historical cohort study.

      Setting

      University-affiliated tertiary medical center.

      Patient(s)

      A total of 1,824 Jewish Israeli BRCA1/2 mutation carriers from a single center were stratified into 1,492 (81.8%) carriers who were not treated for infertility and 332 (18.2%) carriers who underwent fertility treatment with clomiphene citrate (n = 134), gonadotropin (n = 119), in vitro fertilization (n = 183), or a combination of treatments (n = 89).

      Intervention(s)

      None.

      Main Outcome Measure(s)

      Hazard ratios (HR) and 95% confidence intervals (CI) for the association of breast cancer with fertility treatment and other hormonal and reproductive variables.

      Result(s)

      Breast cancer was diagnosed in 687 BRCA1/2 mutation carriers. Multivariate analysis, either of the whole group or stratified by each gene, showed no association between fertility treatment and breast cancer risk, regardless of the type of treatment (clomiphene citrate: HR 0.77, 95% CI 0.49–1.19; gonadotropin: HR 0.54, 95% CI 0.28–1.01; in vitro fertilization: HR 0.65, 95% CI 0.39–1.08; and combined treatments: HR 1.23, 95% CI 0.49–3.06). An increased breast cancer risk was associated with paternal origin of the mutation (HR 1.43, 95% CI 1.17–1.75) and use of oral contraceptives for >5 years (HR 1.62, 95% CI 1.27–2.06) in both BRCA1 and BRCA2 mutation carriers. Ovarian cancer risk was decreased with the use of any oral contraceptive (HR 0.61; 95% CI 0.46–0.82).

      Conclusion(s)

      Fertility treatment for BRCA1/2 mutation carriers is not associated with a discernible increase in breast cancer risk.
      El riesgo de los tratamientos de fertilidad y de cáncer de mama en portadoras de mutaciones BRCA en población judía israelí.

      Objetivo

      determinar si los tratamientos de fertilidad afectan el riesgo de cáncer de mama en portadoras de la mutación BRCA1 / 2 judías israelíes.

      Diseño

      Estudio de cohorte histórica.

      Entorno

      Centro médico terciario afiliado a la universidad

      Paciente (s)

      Se ha estratificado un total de 1.824 judías israelíes portadoras de la mutación BRCA1 /2 de un solo centro en: 1.492 (81,8%) portadoras que no recibieron tratamiento por infertilidad y 332 (18,2%) portadoras que se sometieron a tratamiento de fertilidad con citrato de clomifeno (n = 134), gonadotropinas (n = 119), fertilización in vitro (n = 183) o una combinación de tratamientos (n = 89).

      Intervención (es)

      Ninguna.

      Principales medidas de resultado

      Cocientes de riesgo (HR) e intervalos de confianza (IC) del 95% para la asociación del cáncer de mama con los tratamientos de fertilidad y otras variables hormonales y reproductivas.

      Resultado (s)

      Se ha diagnosticado cáncer de mama en 687 portadoras de la mutación BRCA1 / 2. El análisis multivariado, ya sea del grupo completo o estratificado por cada gen, no mostró asociación entre el tratamiento de fertilidad y el riesgo de cáncer de mama, independientemente del tipo de tratamiento (clomifeno citrato: HR 0,77, IC del 95%: 0,49-1,19; gonadotropinas: HR 0,54, IC del 95%: 0,28 a 1,01; fertilización in vitro: HR 0,65, IC del 95%: 0,39-1,08; y tratamientos combinados: HR 1,23; IC del 95%: 0,49-3,06). Un mayor riesgo de cáncer de mama se asoció con el origen paterno de la mutación (HR 1,43; IC del 95%: 1,17–1,75) y el uso de anticonceptivos orales durante> 5 años (HR 1,62; IC del 95%: 1,27–2,06) tanto en las portadoras de la mutación BRCA1 como de BRCA2. El riesgo de cáncer de ovario se redujo con el uso de cualquier anticonceptivo oral (HR 0,61; IC del 95%: 0,46 a 0,82).

      Conclusión (es)

      El tratamiento de fertilidad para las portadoras de la mutación BRCA1 / 2 no se asocia con un aumento perceptible del riesgo de cáncer de mama.

      Key Words

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