January 21, 2020
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Use of intrauterine devices may decrease risk for ovarian cancer

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About 14,000 women each year die of ovarian cancer, making it one of the deadliest gynecologic cancers.

Moreover, 80% of ovarian cancer diagnoses occur only after the disease has progressed to a late stage. The Ovarian Cancer Research Alliance estimated 22,530 new cases in 2019 alone.

Previous studies have linked the use of intrauterine devices (IUDs) to reduced risk for cervical and uterine cancer. Based on these findings, Saketh R. Guntupalli, MD, associate professor and director of the division of gynecologic oncology at University of Colorado School of Medicine, and colleagues examined the possible correlation between IUD use and risk for ovarian cancer.

“We wondered whether anyone had looked at the effects of IUDs on the deadliest of women’s cancers, which is ovarian,” Guntupalli said in an interview with Healio. “Nobody had, and we thought we’d do a similar study. We were very pleasantly surprised to see that women who used IUDs had a rather substantially decreased risk for the development of ovarian cancer.”

Harmonization and weighting of data from 11 studies in the meta-analysis showed an OR association between any IUD use and incident ovarian cancer of 0.68 (95% CI, 0.62-0.75).

Guntupalli spoke with Healio about the possible mechanisms of this association and its implications for the future of ovarian cancer prevention.

Question: What do you think is the mechanism behind this correlation?

Answer: We think it’s twofold. The progestins in an IUD have an antiestrogenic effect, and less estrogen is associated with a protective effect against developing ovarian cancer. The IUD itself has a local anti-inflammatory response because it is a foreign body within the uterus and brings in those immune cells. We know that the immune surveillance and immune cells are far more involved in the prevention and destruction of cancer than previously thought. Those are the two working theories we have now.

Q: How much of a reduction in risk did you find among women who used IUDs?

A: It was 32% reduced risk.

Q: Would you recommend that women use IUDs to lower their risk for ovarian cancer?

A: All women need to talk to their physicians about what contraceptive therapy is right for them. IUDs are not right for everyone, but they’re right for most women, and they have an outstanding contraceptive effect. If they have secondary benefits, that’s more of a reason to consider using them.

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Q: Would IUDs confer this benefit for postmenopausal women?

A: Probably not as much; we’re not sure. We couldn’t say, for example, that there would be a greater effect in a woman who used an IUD for 10 years as opposed to 10 months. We theorize that there is a temporal benefit, that the longer you use the IUD, the more benefit you have, but we don’t know for sure. However, we theorize that the benefit is mainly for reproductive-aged women.

Q: Do you think this provides hope for ovarian cancer prevention?

A: Absolutely. Anything we can do to decrease the risk for a very deadly disease is good thing, especially a disease for which we have no good screening test. We need to approach all studies with some degree of caution. We were unable to establish a temporal relationship, so we don’t know the magnitude of the protection based on how long the patient has had the IUD. All we know is that in our study, the women who had IUDs had a decreased risk for ovarian cancer. – by Jennifer Byrne

References:

Wheeler LJ, et al. Obstet Gynecol. 2019;doi:10.1097/AOG.0000000000003463.

Ovarian Cancer Research Alliance. What is Ovarian Cancer? ocrahope.org/patients/about-ovarian-cancer/. Accessed Dec. 16, 2019.

For more information:

Saketh R. Guntupalli, MD, MS, can be reached at 1665 Aurora Court, Aurora, CO 80045.

Disclosures: Guntupalli reports no relevant financial disclosures.