As soon as Giuliana Rancic, 37 year old E! News host and star of the reality show Giuliana & Bill, announced that she had breast cancer, the speculation began. Was her cancer caused by her fertility treatment (she was gearing up for her third round of IVF)? Other high profile women, such as Elizabeth Edward (author and political wife); Gilda Radner (comedienne); and Liz Tilberis (the late editor-in-chief of Harper’s Bazaar), have also had breast or ovarian cancer after multiple rounds of IVF.
The topic of the long term health impacts of ovulation stimulation and in vitro fertilization is troublesome for many of us who care deeply about the infertile. For many, having a child is the most important thing in their life regardless of the potential dangers. I get that. Totally. It was for me too.
First, let me be perfectly clear: the research on the connection between IVF and cancer is uncertain at best. Older women are more likely to be undergoing IVF, and older women are more likely to have breast and ovarian cancer. This does not mean that the first causes the second.
Some doctors and researchers believe there is no connection between fertility treatment and cancer. “There’s no evidence for a link between breast cancer and infertility treatment,” says Dr. Eric Widra, who chairs the Society for Assisted Reproductive Technology. “A 2005 study looked at a possibility but the study authors concluded a link to breast or ovarian cancer had not been found.”
There is even some evidence that IVF may even lower the risk. “The evidence is that IVF has no effect or lowers incidence, said Adrian V. Lee, a professor of pharmacology and chemical biology and director of the Women’s Cancer Research Center at the University of Pittsburgh’s Magee-Womens Research Institute. “The largest study in Sweden [I was unable to find the date] — of 25,000 women who had IVF compared to 1.4 million without — showed a 25 percent reduction in breast cancer and a 40 percent reduction in cervical cancer in those who had IVF.”
However, one of the largest, most recent, and best designed study, published in October 2011, found that women who underwent at least one vitro fertilization cycle were almost twice as likely to develop ovarian cancer as women who experienced infertility but did not have IVF. The study at the Netherlands Cancer Institute tracked 19,000 infertile women who had IVF and 6,000 women who did not for 15 years. The researchers found that those who had undergone IVF were over four times more likely to develop borderline ovarian tumors. Researchers also found the link grew stronger the longer the women were followed. Among women who were tracked for 15 years or more after their first cycle of IVF, rates of invasive ovarian cancer were over three times higher than invasive ovarian cancer rates in the group that did not have IVF.
So where does that leave the infertile women whose only hope of getting pregnant is IVF? Talk about the ultimate Faustian Choice! What you want most in life might harm your life. In truth, I suspect most folks with no family history of ovarian or breast cancer would willingly run the risk given the current state of research on the cancer risks, at least for the first round or two of IVF. After the first couple of rounds, it’s worthwhile to realistically assess the odds of success with the risk, however small, of cancer. I hope fertility doctors will by willing to help with this assessment. I also think these risks should inform how many cycles egg donors should be allowed.
The good news is that Rancic’s cancer was discovered because her fertility doctor insisted that she have a mammogram before he would start her third IVF cycle; however, mammograms are not a part of routine fertility treatment regardless of what cycle you are on. Routine mammography on younger infertile women without a family history of breast cancer is not without risks as well due to radiation exposure. Talk with your doctor about balancing all the competing risks against your odds of success.
Giuliana Rancic is recovering from a double mastectomy and reconstruction on Dec. 13 and plans to start trying again as soon as her body heals.
Image credit: Us Magazine