Discussion between Mark Perloe, MD, and Bruno Lunefeld, MD, on the risks associated with ovulation induction in breast cancer and ovarian cancer.
Mark Perloe, MD: “I’m here with Dr. Bruno Lunenfeld who presented an eloquent discussion on the risks associated with ovulation induction in breast cancer and ovarian cancer. We’ve seen data back and forth that have suggested that this is a potential concern. In your analysis, do you believe that is associated with the underlying condition of infertility for ovulation problems or related to the medical treatment?”
Bruno Lunenfeld, MD: “In the first paper, which we published in 1978 with Alean Ron who is now at the NIH demonstrated that there was no association between treatment for ovulation induction with gonadotropins and breast cancer, ovarian cancer, or even endometrial cancer.In this study performed in partial fulfillment of the requirement for a Ph.D. degree of Liat Lerner-Geva, M.D., Sackler Faculty of Medicine, Tel Aviv University, Israel and funded in part by the Israel-US BiNational Scientific Foundation (BSF) we confirmed the previous work and showed that infertility by itself might be a risk factorNot just infertility but infertility in ovulating women . We must take into consideration that every ovulation is a trauma to the ovary. Fathala in 1971 was the first to suggest the relationship between ovarian cancer and “incessant ovulation”. With each ovulation the ovarian epithelium was thought to incur minor trauma. The cumulative effect of repetitive surface injury was hypothesized to contribute to the development of ovarian neoplasms ( Lancet 1971;ii:163). Pregnancy protects. If you have an infertility problem where you ovulate but you’re infertile, your risk of ovarian cancer is increased, and that means in patients with mechanical problems who have blocked tubes, in patients with endometriosis who ovulate, and in ovulating women with infertility due to a male factor. If is the patient is infertile because she doesn’t ovulate her risk of ovarian cancer is not increased.”
Mark Perloe, MD: “So there’s protection for those who are anovulatory?”
Bruno Lunenfeld, MD: Yes for ovarian cancer. Now for breast cancer this is different. For breast cancer pregnancy protects, and only in the group of unexplained infertility do we get an increase of breast cancer rate but since it is unexplained infertility I don’t understand the reason Now when we look at gonadotrophin therapy, and here we can only talk about urinary gonadotrophins because this is a study that is a follow-up where our first patient became pregnant in 1961. These patients are about fifty today and it’s more than a twenty year follow-up. It’s a mean twenty year follow-up but some patients have been in this study for forty years. When we look at these and we compare treatment to no treatment, treatment does not increase either the breast cancer or ovarian cancer rate in any of these groups. One important part of the study that I showed yesterday, and this has to be taken into consideration in all studies that look at cancer or in any study which includes different ethnic groups , is that we looked at the cancer rate and related it to the ethnic group. We specifically looked where the woman was born - Europeans, Americans, Asians, or Africans. Again, when you now compare also to African born, Asian, American, and European born the same results remain true.
Mark Perloe, MD: “But the results were lower in a specific population and the incidence is varied.”
Bruno Lunenfeld, MD: “This is interesting because this can be an artifact too because the Mediterranean population, the Africans, and Asians have many children in a young population so they are very well protected so the ovarian and breast cancer rate is lowerr
Mark Perloe, MD: “For those people who are concerned, is successful fertility treatment lowering their risk?”
Bruno Lunenfeld, MD: “Yes, there’s no doubt about this pregnancy protects.”
Mark Perloe, MD: “For women who are concerned about this, do you recommend the use of a birth control pill following or between conceptions?”
Bruno Lunenfeld, MD: “For ovarian cancer contraception protects for sure.”
Mark Perloe, MD: “Great, are you continuing in this study? I think it’s interesting with your group with the longer follow-up in the older women. We really need this information before we could analyze the effectiveness.”
Bruno Lunenfeld, MD: “The Mean age at the end of follow-up 49.9+8.2 years andwe used a Linkage to the National Cancer Registry updated to 31.12.1996 We will look at them again in 10 years and then the mean age of the patients will be sixty.”
Mark Perloe, MD: “Great, thank you very much. We appreciate it.”