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Breast cancer incidence after hormonal treatments for infertility: systematic review and meta-analysis of population-based studies

  • Epidemiology
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Abstract

The increasing practice of hormonal infertility treatments (HITs) raised concerns about their effects on breast cancer (BC) risk. Available evidence reported conflicting results. The aim of this study was to assess the potential association between HITs and BC risk. The literature was searched through November 2014. Eligible studies included cohort studies reporting BC incidence in women undergone HITs. Data were analyzed with standard meta-analytic techniques. Subgroup analyses were performed by type of intervention (IVF vs. NO IVF), follow-up duration (<10 vs. >10 years), and type of control (population vs. infertile). 20 eligible studies (207.914 women, 2347 BC) were retrieved: no increased risk was detected (SRR = 1.05, 95 % CI 0.96–1.14), with a significant heterogeneity (I 2 = 59 %, p = 0.001) among studies. In the seven studies with the in vitro fertilization (IVF) procedure, no increase in BC risk was observed (SRR = 0.96, 95 % CI 0.80–1.14); in the three NO IVF studies, an increased BC risk was identified (SRR = 1.26, 95 %CI 1.06–1.50). A borderline interaction between type of intervention (IVF vs. NO IVF) and BC risk was observed (p = 0.06). An increased risk with longer follow-up (≥10 vs. <10 years) was detected (SRR = 1.13, 95 % CI 1.02–1.26 vs. SRR = 0.95, 95 % CI 0.85–1.06). Overall, HITs are not associated with an increased BC risk. In particular, no increased risk was observed in women undergoing IVF. Conversely, an increased in BC risk cannot be ruled out with older treatment protocols based on clomiphene. The long-term administration of clomiphene outside the current indications should be discouraged because of a possible increase in BC risk.

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Acknowledgments

This work was supported by the Italian Ministry of Health (RF 2009-1494489) and by the Italian Association for Cancer Research (AIRC).

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. S.C. Oncologia Medica, E.O. Ospedali Galliera, Via Volta 6, 16128, Genoa, Italy

    Alessandra Gennari, Matteo Puntoni, Laura Paleari, Andrea De Censi & Nicoletta Provinciali

  2. S.S.D. Medicina della Riproduzione, Ospedale Evangelico Internazionale, Corso Solferino 1A, 16122, Genoa, Italy

    Mauro Costa

  3. DISSAL, Università di Genova, Largo R Benzi 10, 16132, Genoa, Italy

    Maria Pia Sormani

  4. S.C. Epidemiologia Clinica, IRCCS A.O.U. San Martino - IST, Largo R Benzi 10, 16132, Genoa, Italy

    Paolo Bruzzi

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  1. Alessandra Gennari
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Correspondence to Alessandra Gennari.

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Gennari, A., Costa, M., Puntoni, M. et al. Breast cancer incidence after hormonal treatments for infertility: systematic review and meta-analysis of population-based studies. Breast Cancer Res Treat 150, 405–413 (2015). https://doi.org/10.1007/s10549-015-3328-0

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