Fertility treatment and cancers—the eternal conundrum: a systematic review and meta-analysis

نویسندگان

چکیده

Abstract STUDY QUESTION Does fertility treatment (FT) significantly increase the incidence of breast, ovarian, endometrial or cervical cancer? SUMMARY ANSWER Overall, FT does not ovarian cancer and may even reduce cancer. WHAT IS KNOWN ALREADY Infertility affects more than 14% couples. nulliparity are established risk factors for endometrial, breast cancer, yet association with is contentious. DESIGN, SIZE, DURATION A literature search was carried out using Cochrane Library, EMBASE, Medline Google Scholar up to December 2019. Peer-reviewed studies stating (breast, cervical) in no-FT groups were identified. Out 128 identified, 29 retrospective fulfilled criteria included (n = 21 070 337). PARTICIPANTS/MATERIALS, SETTING, METHODS In final meta-analysis, included: 19), 15) 13), 17 involved multiple types so each individual meta-analysis. Primary outcome interest groups. Secondary according specific drug exposure. Odds ratio (OR) random effects model used demonstrate effect calculate pooled effect, respectively. meta-regression eight sub-group analyses performed assess impact following variables, maternal age, infertility, study size, outliers sub-types, on incidence. MAIN RESULTS AND THE ROLE OF CHANCE Cervical lower group compared group: OR 0.68 (95% CI 0.46–0.99). The incidences (OR 0.86; 95% 0.73–1.01) 1.28; 0.92–1.79) cancers found be different between Whilst overall 1.19; 0.98–1.46), separate analysis borderline tumours (BOT) revealed a significant 1.69; 1.27–2.25). further analyses, shown higher IVF 1.32; 1.03–1.69) clomiphene citrate (CC) 1.40; 1.10–1.77), respectively when group. Conversely, 0.75; 0.61–0.92) 0.58; 0.38–0.89) LIMITATIONS, REASONS FOR CAUTION large, varied dataset spanning wide period introduced clinical heterogeneity. Thus, results have interpreted an element caution. Exclusion non-English citations, unpublished work abstracts, order ensure data accuracy reliability maintained, degree selection bias. WIDER IMPLICATIONS FINDINGS reassuring, line previously published meta-analyses but CC requires additional understand potential mechanism driving this association. particular, focusing (i) discriminating treatments from inherent malignancy; (ii) differential profiles among patient sub-groups (refractory obesity); (iii) understanding outcomes FUNDING/COMPETING INTEREST(S) This did receive any funding. authors no financial, personal, intellectual professional conflicts declare. PROSPERO REGISTRATION NUMBER CRD42019153404.

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ژورنال

عنوان ژورنال: Human Reproduction

سال: 2021

ISSN: ['1460-2350', '0268-1161']

DOI: https://doi.org/10.1093/humrep/deaa293