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Increased risk of serous ovarian cancer following clomifene fertility treatment
- Ellen CG Grant (11 February 2009)
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GnRH or GnHR-Analogues
- Bernd Hinney (16 May 2009)
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Re: GnRH or GnHR-Analogues
- Allan Jensen, Heidi Sharif, Kirsten Frederiksen, and Susanne Krüger Kjær (8 June 2009)
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Ellen CG Grant, physician and medical gynaecologist Kingston-upon-Thames. KT2 7JU, UK
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Jensen and colleagues did find a highly significant increase in the commonest type of ovarian cancer, serous, following use of the commonest fertility drug, clomifene.1 In women with a history of fertility problems, 58% of 156 ovarian cancers were serous. Clomifene had been given to 58/77 (75.3%) of treated cases. The adjusted risk ratio for serous cancer in clomifene users was 1.67 (95% C I: 1.07- 2.61) compared to the risk for women with fertility problems who had not been given fertility drugs. Jensen previously found a significantly increased risk for ovarian cancer in women with infertility problems a stardardized incidence ratio of 1.46, l (CI: 1.24- 1.71) compared to incidence in the general Danish population. The risk of breast cancer also increased with follow-up time. Similar risk patterns were observed for the different histologic types of breast cancer and all non-mucinous types of ovarian cancer. Progestogens and oestrogens given as HRT increase the risk of ovarian cancer. The risk of developing ovarian cancer when ovaries are stimulated artificially by fertility drugs will be underestimated if the relevant information of progestogen/oestrogen use is missing. Is it possible to know how many of the 156 women with a history of fertility problems were current or recent users of hormonal contraceptives or HRT when they were diagnosed with ovarian cancer between the ages of 18 to 81? 1 Jensen A, Sharif H, Frederiksen K, Kjær SK. Use of fertility drugs and risk of ovarian cancer: Danish population based cohort study. BMJ 2009;338:b249. 2 Jensen A, Sharif H, Olsen JH, Kjaer SK. Risk of breast cancer and gynecologic cancers in a large population of nearly 50,000 infertile Danish women. Am J Epidemiol 2008; 168:49-57. Competing interests: None declared |
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Bernd Hinney, Professor for Obstetrics and Gynaecology University Hospital Goettingen 37075 Goettingen
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With interest I read the article on fertility drugs by Allan Jensen et al. However, judging from my experience in the field of reproductive medicine, I find it hard to believe that so many patients suffering from infertility were treated with GnRH in Denmark. For the therapy of infertility, GnRH must be administered every 90 minutes and the use of a computer-controlled pump is necessary. Also, this therapy is only promising in patients who suffer from secondary ovary insufficiency WHO group I. This is a very rare condition. I therefore assume that in the article by Jensen et al., GnRH was mistakenly identified with GnRH-analogues. GnRH-analogues are used (and have been successfully used for many years) in the combined therapy with gondatrophines, as they suppress the unwanted premature LH-peak during a high-dosage gonadotrophine-therapy (before IVF- or ICSI-therapy. Competing interests: None declared |
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Allan Jensen, PhD DK-2100, Heidi Sharif, Kirsten Frederiksen, and Susanne Krüger Kjær
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Sir, As observed by Dr. Hinney, the term "GNRH" in our paper relates to "GNRH-analogues" and not GNRH itself. GNRH-analogues are in Denmark as in other countries used to suppress the unwanted premature LH-peak during high-dosage gonadotrophin therapy as mentioned by Dr. Hinney. Consequently, we agree that it is more appropriate to use the term “GNRH- analogues in the present paper. Competing interests: None declared |
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