Women's Cancers

Written by Don S. Dizon, MD, FACP

To new readers, let me introduce myself. My name is Don S. Dizon and I am a medical women's cancers specialist. I am training in Internal Medicine and Medical Oncology, but focused my career on the care and research of women's cancers specifically. As such, my patient population primarily consists of women diagnosed with breast or gynecologic cancers and I am actively involved in research on new treatment strategies, as well as survivorship concerns of this population of women cancer survivors.

This blog will focus on news as it relates to women's cancers, and will cover news making its way nationally and on the Web, as well as updates that come out of our national meetings in cancer care. There is a lot of work going on in the realm of both breast and gynecologic cancers and it is an exiciting time to be an oncologist, particularly since our patients will be direct beneficiaries of this ongoing effort to improve the outcomes of women with cancer. Given the scope of this task, I will be working with my friend and colleague, Rochelle Strenger, MD—a renown and respected oncologist, with a primary interest in breast cancer.

This past weekend was the Annual Meeting of the Society of Gynecologic Oncologists, held in San Antonio, TX. Among the biggest stories that caught my eye was the results out of Holland seeking to address the question of whether there is an increased risk of ovarian cancer in women who undergo in vitro fertilization. The team lead by Dr. Curt Burger had followed 18,970 women treated with IVF between 1983 and 1995 and over 7,500 women with fertility issues evaluated between 1980 and 1995, but had not undergone IVF or ovarian stimulation. With 15 years of follow-up, there were more cases of ovarian malignancies in women undergoing IVF versus what was expected, 61 versus 38 cases, respectively. This same risk was not seen in women with fertility issues, whose risk of ovarian cancer mimicked that of the general population. However, of note, the increase in ovarian malignancies appeared driven by an increase in tumors of low malignant potential, or borderline tumors, but not from an increased risk of invasive cancers. Their analysis also suggested that development of borderline versus invasive tumors of the ovary peaked at different times, with the risk of the former manifest in the first 9 years and invasive tumors developing after 15 years. Still, the overall incidence of ovarian tumors was less than 1% in women treated with IVF, at 0.74%, which was still slightly elevated compared to normal population, where it is reported at 0.45%.

So, what does this tell me? Well, the overall incidence remains very low, at less than 1%, and the increase risk is associated with more borderline tumors, which by definition are not invasive, and hence more likely curable at diagnosis. Should this sway women against proceeding with IVF? I don't think so. However, this knowledge may be useful in women who have undergone IVF, to watch for symptoms of ovarian cancer, and hopefully may lead to earlier diagnosis.

The Gynecologic Cancer Foundation has published on the early warning signs of ovarian cancer, which while non-specific, should be paid closer attention to in women who have undergone IVF. Specific symptoms include new symptoms of bloating, pelvic, or abdominal pain, difficulty with eating or getting full fast, as well as urinary complaints (pain with urination, for example) which persist and occur with regularity.

Sources:

Burger C, et al. The risk of borderline and invasive ovarian tumors after ovarian stimulation for in vitro fertilization in a large Dutch cohort after 15 years of follow-up. Gyn Onc 2009; 112(S1): Abstr 6.