Relias Media - Continuing Medical Education Publishing

The trusted source for

healthcare information and

CONTINUING EDUCATION.

  • Sign In
  • Sign Out
  • MyAHC
    • Home
      • Home
      • Newsletters
      • Blogs
      • Archives
      • CME/CE Map
      • Shop
    • Emergency
      • All Products
      • Publications
      • Study Guides
      • Webinars
      • Group Sales
    • Hospital
      • All Products
      • Publications
      • Study Guides
      • Webinars
      • Group Sales
    • Clinical
      • All Products
      • Publications
      • Study Guides
      • Webinars
      • Group Sales
    • All Access
      • Subscribe Now
      • My Subscription
    • My Account
      • My Subscriptions
      • My Content
      • My Orders
      • My CME/CE
      • My Transcript
    Home » Intrauterine Device Use and Ovarian Cancer Risk
    ABSTRACT & COMMENTARY

    Intrauterine Device Use and Ovarian Cancer Risk

    November 1, 2019
    No Comments
    Reprints
    Facebook Twitter Linkedin Share Share

    Related Articles

    Intrauterine Device Use Linked With Decrease in Cervical Cancer Incidence

    Ovarian Cancer Risk in Relation to Estrogen/Progestin Dose and Use Characteristics of Oral Contraceptives

    Risk of Ovarian Cancer Algorithm to Screen for Ovarian Cancer

    Related Products

    Intrauterine device and implant are effective beyond use approved by the FDA

    Options expand for women: FDA approves a new intrauterine device

    Ovarian Cancer Screening: Mortality Results

    Keywords

    contraceptive

    levonorgestrel

    intrauterine

    ovarian

    By Rebecca H. Allen, MD, MPH

    Associate Professor, Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Women and Infants Hospital, Providence, RI

    Dr. Allen reports she receives grant/research support from Bayer and is a consultant for Merck.

    SYNOPSIS: In this systematic review, the odds ratio of ever-use of an intrauterine device and incident ovarian cancer was 0.68 (95% CI 0.62-0.75).

    SOURCE: Wheeler LJ, Desanto K, Teal SB, et al. Intrauterine device use and ovarian cancer risk: A systematic review and meta-analysis. Obstet Gynecol 2019; Sep. 10. doi: 10.1097/AOG.0000000000003463. [Epub ahead of print].

    This was a systematic review and meta-analysis of existing studies that evaluated both the incidence ovarian cancer and ever-use of an intrauterine device (IUD). IUD use in the setting of menopausal hormone therapy was excluded; both case control and cohort studies were included. Data extracted from the studies included geographic location, years of data collection, year of publication, study size, and characteristics of the study population (age, menopausal status, gravidity, history of oral contraceptive use, body mass index, IUD type, method of ovarian cancer diagnosis, and family history of cancer).

    After searching MEDLINE, Embase, Cochrane Library, Web of Science Core Collection, Google Scholar, and ClinicalTrials.gov, and reviewing the results for inclusion, researchers chose 11 trials (nine case-control and two cohort studies) for the analysis. The case-control studies contributed 4,484 cases of ovarian cancer and 9,107 controls, and the cohort studies contributed 649 ovarian cancer patients and 173,928 women without ovarian cancer. All studies took age, parity, and oral contraceptive use into consideration.

    In the meta-analysis, the summary odds ratio between ever-use of an IUD and incidence ovarian cancer was 0.68 (95% confidence interval [CI], 0.62-0.75). This inverse association remained even when the meta-analysis was stratified to include studies that evaluated other confounding factors, such as body mass index, history of bilateral tubal ligation, menopausal status, and family history of cancer.

    COMMENTARY

    The National Cancer Institute estimates there will be 22,530 new cases of ovarian cancer and 13,980 deaths from ovarian cancer in the United States in 2019.1 The five-year survival rate is 47.6%. Ovarian cancer is the second most common cause of gynecologic cancer in the United States, and the median age of diagnosis is 63 years. To date, attempts to develop screening programs for ovarian cancer have not been successful. Factors that are protective against the development of ovarian cancer are critical to elucidate. Other contraceptive methods known to reduce the risk of ovarian cancer include combined oral contraceptives (50% reduction with 10 or more years of use) and tubal ligation. Recently, the introduction of opportunistic salpingectomy at the time of hysterectomy or for permanent contraception has offered another possibility to reduce ovarian cancer risk.

    The authors of this study sought to estimate the effect of IUD use on ovarian cancer incidence. They found that IUD use was protective (32% decreased risk) across multiple large, international, case-control and cohort studies, which increased the generalizability. Unfortunately, the investigators were not able to evaluate the risk by type of IUD; therefore, these data represent different copper, stainless steel, and levonorgestrel IUDs combined. The theoretical mechanism of action for the copper IUD or stainless steel varieties used internationally could include alteration in the pH of the reproductive tract or a localized inflammatory response that would destroy malignant cells.2 The levonorgestrel IUD has the additional effects of thickening cervical mucus, inhibition of endometrial proliferation, and also provides occasional ovulation suppression. Both copper and levonorgestrel IUDs are known to reduce the risk of endometrial cancer as well.3

    The study is limited by the risk of biases in the individual studies included in the meta-analysis, which may include recall bias, selection bias, and lost-to-follow-up bias. The investigators also could not evaluate whether duration of IUD use affects risk, nor whether one type of IUD worked better than another. Nevertheless, these are promising data that indicate IUD use could have a future effect of reducing ovarian cancer rates as more women opt for this method of contraception. We can inform patients of this important potential non-contraceptive benefit of IUD use during contraceptive counseling.

    REFERENCES

    1. SEER Cancer Stat Facts: Ovarian Cancer. National Cancer Institute. Bethesda, MD. Available at: https://seer.cancer.gov/statfacts/html/ovary.html. Accessed Oct. 7, 2019.
    2. Rivera R, Yacobson I, Grimes D. The mechanism of action of hormonal contraceptives and intrauterine contraceptive devices. Am J Obstet Gynecol 1999;181:1263-1269.
    3. Bahamondes L, Valeria Bahamondes M, Schulman LP. Non-contraceptive benefits of hormonal and intrauterine reversible contraceptive methods. Hum Reprod Update 2015;21:640-651.

    Post a comment to this article

    Report Abusive Comment

    www.reliasmedia.com

    OB/GYN Clinical Alert

    View PDF
    OB/GYN Clinical Alert (Vol. 36, No. 7) – November 2019
    November 1, 2019

    Table Of Contents

    Sedentary Behavior, Physical Activity, and Nighttime Urinary Symptoms

    Intrauterine Device Use and Ovarian Cancer Risk

    Consensus Position Statement on the Use of Testosterone in Women

    Recommendations for the Use of Testosterone Therapy in Women: A Global Consensus Statement

    Begin Test

    Buy this Issue/Course

    Financial Disclosure: OB/GYN Clinical Alert’s Editor Jeffrey T. Jensen, MD, MPH, reports that he is a consultant for and receives grant/ research support from ObstetRx, Bayer, Merck, and Sebela; he receives grant/research support from AbbVie, Mithra, and Daré Bioscience; and he is a consultant for CooperSurgical and the Population Council. Peer Reviewer Catherine Leclair, MD; Nurse Planner Andrea O’Donnell, RN, FNP; Editorial Group Manager Leslie Coplin; Editor Jason Schneider; and Executive Editor Shelly Mark report no financial relationships relevant to this field of study.

    Shop Now: Search Products

    • Subscription Publications
    • Books & Study Guides
    • Webinars
    • Group & Site
      Licenses
    • State CME/CE
      Requirements

    Webinars And Events

    View All Events
    • Home
      • Home
      • Newsletters
      • Blogs
      • Archives
      • CME/CE Map
      • Shop
    • Emergency
      • All Products
      • Publications
      • Study Guides
      • Webinars
      • Group Sales
    • Hospital
      • All Products
      • Publications
      • Study Guides
      • Webinars
      • Group Sales
    • Clinical
      • All Products
      • Publications
      • Study Guides
      • Webinars
      • Group Sales
    • All Access
      • Subscribe Now
      • My Subscription
    • My Account
      • My Subscriptions
      • My Content
      • My Orders
      • My CME/CE
      • My Transcript
    • Help
    • Search
    • About Us
    • Sign In
    • Register
    Relias Media - Continuing Medical Education Publishing

    The trusted source for

    healthcare information and

    CONTINUING EDUCATION.

    Customer Service

    customerservice@reliasmedia.com

    U.S. and Canada: 1-800-688-2421

    International +1-404-262-5476

    Accounts Receivable

    1-800-370-9210
    ReliasMedia_AR@reliasmedia.com

    Mailing Address

    • 1010 Sync St., Suite 100
      Morrisville, NC 27560-5468
      USA

    © 2020 Relias. All rights reserved.

    Do Not Sell My Personal Information  Privacy Policy  Terms of Use  Contact Us  Reprints  Group Sales

    For DSR inquiries or complaints, please reach out to Wes Vaux, Data Privacy Officer, DPO@relias.com

    Design, CMS, Hosting & Web Development :: ePublishing