Question:Amy Demma, Esq. at "Prospective Families Egg Donation Agency" was recently contacted by a woman currently undergoing breast cancer treatment urging Amy to inform both her recipient clients and the donors registered with Prospective Families of a claimed correlation between the medications prescribed for ART and a diagnosis of breast cancer. Amy contacted me to discuss this issue:
Good Morning, Dr. Ramirez,
Recently I was contacted by a woman who was urging me to share with my clients her story of undergoing multiple IVFs and then later being diagnosed with breast cancer. She shared with me the history of her IVF attempts and feels certain that there is a correlation between her experience with IVF and her current condition. I am wondering if there has been any recent research addressing a possible link b/w medicines used during ART and a later diagnosis of breast cancer?
While I realize that each diagnosis is unique particularly with respect to contributing factors, I am interested in your general thoughts on former studies that attempted to make a connection b/w medications used during fertility treatment and later cancer diagnosis.
Warm thanks, Amy Demma, Wellesley, Massachusetts
Answer:
Dear Amy,
I welcome the opportunity to respond to your client's question. I know that this theme is a recurring worry among infertility patients, especially IVF patients because of the misinformation that was publicized by the NIH's WHI (Women's Health Initiative) study linking estrogen and breast cancer. It is logical to think that increased estrogen levels in fertility treatments like IVF might increase the chances for breast or ovarian cancer. However, this has been studied over the past 30 years and there has not been any increased incidence of breast or ovarian cancer in infertility or IVF patients. In fact, a Swedish study published in Human Reproduction in 2007 (Hum Reprod 2007 22(2): 421-426) showed a decreased incidence of breast and ovarian cancer in women delivering after IVF. Also, for your reference, O Magazine previously published an inaccurate article in February 2004 linking ovarian and breast cancer to infertility based on anectodal stories, which ASRM (American Society of Reproductive Medicine) responded to. ASRM strongly criticized the article for misinformation.
This is the link:http://bit.ly/aKORPJ .
Scientific studies, done over the past 30 years, have not shown any increased cancer risk. It is true that most breast cancers are estrogen receptor positive, which means that increased estrogen, including one's natural estrogen, will cause the cancer cells to grow. However, this stimulation has to be consistent over a long period of time. The short durations of stimulation with IVF, even with multiple attempts, is only days long. It is not of sufficient duration to stimulate growth of the cells. Even if we assumed that it did, how would the cells continue to grow once the stimulation is suddenly removed?
A further incongruity between the association of estrogen and breast cancer is the fact that in the WHI study, there were two arms being evaluated: women taking only estrogen (premarin) because their uterus' had been removed previously and women taking an estrogen/progesterone formulation (prempro) because they had intact uterus'.
What people fail to realized, and the media did not publish, is that there was NO increased breast cancer incidence in the Estrogen-only group. That certainly invalidates the logic between the association of estrogen and breast cancer. Maybe it means that our tendency to associate estrogen and breast cancer is much too simple and the relationship is a lot more complex that it seems.
Please reassure your client that the association she has placed between her multiple IVF treatments and her breast cancer is unfounded. It is completely coincidental. I tell my patients considering hormone replacement therapy that the breast cancer cells have to be there already for the estrogen to cause them to grow. Estrogen will not CAUSE or PRODUCE cancer cells. This is probably true for birth control pill users and infertility patients as well. However, again this assumes that there is an association between estrogen and breast cancer. I don't think one can make that assumption. I think that infertility patients should feel confident that their fertility treatments are not putting them at increased risk of breast or ovarian cancer. That fact, has been shown by many studies over many years.
Thank you very much for reaching out to me for an answer to your client's question.
Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
http://www.montereybayivf.com/
Monterey, California, U.S.A.
Twitter with me at @montereybayivf, and follow me on Facebook at http://bit.ly/9Iw9oV
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