Ovulation Induction and Risk of Ovarian Cancer: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

HE Fan , GAN Xiaoling ,  HU Lina

Obstetrics and Gynecology Department of The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China;

Corresponding author：

HU Lina, Email: cqhulina@126.com

Keywords：

Ovulation induction; Ovarian cancer; Cohort study; Case-control study; Systematic review; Meta-analysis

DOI：

10.7507/1672-2531.20120176

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective 　To systematically assess literature regarding the relationship between ovulation induction and the risk of ovarian cancer.
Methods 　We searched MEDLINE, EMbase, The Cochrane Library, CBM and CNKI (from inception to Feb, 2012). Cohort or case-control studies were identified according to the inclusion and exclusion criteria. Then the quality of the included studies was assessed, and the data was extracted. Meta-analysis was performed by RevMan 5.0 software. The incorporated RR (relative risk) and 95%CI (confidence interval) of the included cohort studies and incorporated OR (odds ratio) and 95%CI of case-control studies were calculated, respectively.
Results 　Four cohort studies and four case-control studies were included. Result of meta-analysis on cohort studies showed ovulation induction didn’t increase the risk of ovarian cancer (RR=1.07, 95%CI 0.81 to 1.42, P=0.63). Besides, result of meta-analysis on case-control studies showed ovulation induction was not associated with the incidence of ovarian cancer (OR=1.28, 95%CI 0.78 to 2.08, P=0.33). But the risk of borderline ovarian tumors increased when compared with general population controls (OR=1.71, 95%CI 1.05 to 2.79, P=0.03).
Conclusion 　Ovulation induction does not increase the risk of ovarian cancer, but may relate to the incidence of borderline ovarian cancer. However, more high-quality studies, especially perspective cohort studies are required because of the limited quantity of the included studies.

Citation： HE Fan,GAN Xiaoling,HU Lina. Ovulation Induction and Risk of Ovarian Cancer: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2012, 12(9): 1129-1134. doi: 10.7507/1672-2531.20120176 Copy

1.	Hanna L, Adams M. Prevention of ovarian cancer. Best Pract Res Clin Obstet Gynaecol, 2006, 20(2): 339-362.
2.	Jemal A, Siegel R, Ward E, et al. Cancer statistics, 2009. CA Cancer J Clin, 2009, 59(4): 225-249.
3.	何健荣, 高曦, 任泽舫, 等. 全球女性乳腺癌和卵巢癌最新发病分布特征. 中国肿瘤, 2009,18(3): 169-172.
4.	Mok SC, Kwong J, Welch WR, et al. Etiology and pathogenesis of epithelial ovarian cancer. Dis Markers, 2007, 23(5-6): 367-376.
5.	Fathalla MF. Incessant ovulation: a factor in ovarian neoplasia? [Letter]. Lancet, 1971, 298(7716): 163.
6.	Bamford PN, Steele SJ. Uterine and ovarian carcinoma in a patient receiving gonadotrophin therapy: a case report. Br J Obstet Gynecol, 1982, 89(11): 962-964.
7.	Mosher WD, Pratt WF. Fecundity and infertility in the United States: incidence and trends. Fertil Steril, 1991, 56(2): 192-198.
8.	Cetin I, Cozzi V, Antonazzo P. Infertility as a cancer risk factor-a review. Placenta, 2008, 29(Suppl BN): 169-177.
9.	Jensen A, Sharif H, Frederiksen K, et al. Use of fertility drugs and risk of ovarian cancer: Danish population based cohort study. BMJ, 2009, 338: b249.
10.	Venn A, Watson L, Bruinsma F, et al. Risk of cancer after use of fertility drugs with in-vitro fertilisation. Lancet, 1999, 354(9190): 1586-1590.
11.	Potashnik G, Lerner-Geva L, Genkin L, et al. Fertility drugs and the risk of breast and ovarian cancers: results of a long-term follow-up study. Fertil Steril, 1999, 71(5): 853-859.
12.	Modan B, Ron E, Lerner-Geva L, et al. Cancer incidence in a cohort of infertile Women. Am J Epidemiol, 1998, 147(11): 1038-1042.
13.	Cusidó M, Fábregas R, Barris SP, et al. Ovulation induction treatment and risk of borderline ovarian tumors. Gynecol Endocrinol, 2007, 23(7): 373-376.
14.	Rossing MA, Tang MC, Flagg EW, et al. A case-control study of ovarian cancer in relation to infertility and the use of ovulation-inducing drugs. Am J Epidemiol, 2004, 160(11): 1070-1078.
15.	Parazzini F, Pelucchi C, Negri E, et al. Use of fertility drugs and risk of ovarian cancer. Hum Reprod, 2001, 16(7): 1372-1375.
16.	Mosgaard BJ, Lidegaard Ø, Kjær SK, et al. Ovarian stimulation and borderline ovarian tumors: a case-control study. Fertil Steril, 1998, 70(6): 1049-1055.
17.	Wells G, Shea B, O’Connell D, et al. NEWCASTLE - OTTAWA QUALITY ASSESSMENT SCALE --COHORT STUDIES. 2010. Available from: URL: http: //www.ohri.ca/programs/clinical_epidemiology/oxford.asp.
18.	Wells G, Shea B, O’Connell D, et al. NEWCASTLE - OTTAWA QUALITY ASSESSMENT SCALE --CASE CONTROL STUDIES. 2010. Available from: URL: http: //www.ohri.ca/programs/clinical_epidemiology/oxford.asp.

1. Hanna L, Adams M. Prevention of ovarian cancer. Best Pract Res Clin Obstet Gynaecol, 2006, 20(2): 339-362.
2. Jemal A, Siegel R, Ward E, et al. Cancer statistics, 2009. CA Cancer J Clin, 2009, 59(4): 225-249.
3. 何健荣, 高曦, 任泽舫, 等. 全球女性乳腺癌和卵巢癌最新发病分布特征. 中国肿瘤, 2009,18(3): 169-172.
4. Mok SC, Kwong J, Welch WR, et al. Etiology and pathogenesis of epithelial ovarian cancer. Dis Markers, 2007, 23(5-6): 367-376.
5. Fathalla MF. Incessant ovulation: a factor in ovarian neoplasia? [Letter]. Lancet, 1971, 298(7716): 163.
6. Bamford PN, Steele SJ. Uterine and ovarian carcinoma in a patient receiving gonadotrophin therapy: a case report. Br J Obstet Gynecol, 1982, 89(11): 962-964.
7. Mosher WD, Pratt WF. Fecundity and infertility in the United States: incidence and trends. Fertil Steril, 1991, 56(2): 192-198.
8. Cetin I, Cozzi V, Antonazzo P. Infertility as a cancer risk factor-a review. Placenta, 2008, 29(Suppl BN): 169-177.
9. Jensen A, Sharif H, Frederiksen K, et al. Use of fertility drugs and risk of ovarian cancer: Danish population based cohort study. BMJ, 2009, 338: b249.
10. Venn A, Watson L, Bruinsma F, et al. Risk of cancer after use of fertility drugs with in-vitro fertilisation. Lancet, 1999, 354(9190): 1586-1590.
11. Potashnik G, Lerner-Geva L, Genkin L, et al. Fertility drugs and the risk of breast and ovarian cancers: results of a long-term follow-up study. Fertil Steril, 1999, 71(5): 853-859.
12. Modan B, Ron E, Lerner-Geva L, et al. Cancer incidence in a cohort of infertile Women. Am J Epidemiol, 1998, 147(11): 1038-1042.
13. Cusidó M, Fábregas R, Barris SP, et al. Ovulation induction treatment and risk of borderline ovarian tumors. Gynecol Endocrinol, 2007, 23(7): 373-376.
14. Rossing MA, Tang MC, Flagg EW, et al. A case-control study of ovarian cancer in relation to infertility and the use of ovulation-inducing drugs. Am J Epidemiol, 2004, 160(11): 1070-1078.
15. Parazzini F, Pelucchi C, Negri E, et al. Use of fertility drugs and risk of ovarian cancer. Hum Reprod, 2001, 16(7): 1372-1375.
16. Mosgaard BJ, Lidegaard Ø, Kjær SK, et al. Ovarian stimulation and borderline ovarian tumors: a case-control study. Fertil Steril, 1998, 70(6): 1049-1055.
17. Wells G, Shea B, O’Connell D, et al. NEWCASTLE - OTTAWA QUALITY ASSESSMENT SCALE --COHORT STUDIES. 2010. Available from: URL: http: //www.ohri.ca/programs/clinical_epidemiology/oxford.asp.
18. Wells G, Shea B, O’Connell D, et al. NEWCASTLE - OTTAWA QUALITY ASSESSMENT SCALE --CASE CONTROL STUDIES. 2010. Available from: URL: http: //www.ohri.ca/programs/clinical_epidemiology/oxford.asp.

Chinese Journal of Evidence-Based Medicine

Ovulation Induction and Risk of Ovarian Cancer: A Systematic Review

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