title: In vitro fertilization and risk of breast and gynecologic cancers: a retrospective cohort study within the Israeli Maccabi Healthcare Services.
abstract: OBJECTIVE
  To assess long-term cancer risks associated with in vitro fertilization (IVF).
  
  
  METHODS
  Record-linkage study.
  
  
  METHODS
  Health maintenance organization in Israel.
  
  
  METHODS
  A total of 87,403 women evaluated and/or treated for infertility on or after September 25, 1994, who were followed for cancer development through June 22, 2011: 522 breast, 41 endometrial, 45 ovarian, 311 in situ cervical, and 32 invasive cervical cancers were identified.
  
  
  METHODS
  None.
  
  
  METHODS
  Hazard ratios (HRs) for specific cancers.
  
  
  RESULTS
  We found no significant relationships of IVF exposures to the risks of breast, endometrial, or ovarian cancers. However, compared with women with no fertility treatment, the HR for ovarian cancer associated with IVF was 1.58 (95% confidence interval [CI] 0.75-3.29), with higher risk among those receiving four or more cycles (HR 1.78, 95% CI 0.76-4.13). There was also a nonsignificantly elevated risk for endometrial cancer among women who received 1-3 IVF cycles (HR 1.94, 95% CI 0.73-5.12), but additional cycles were associated with less risk. In contrast, the risk of in situ cervical cancer was significantly reduced and invasive cervical cancer nonsignificantly reduced among women receiving IVF as well as other fertility treatments.
  
  
  CONCLUSIONS
  Our results regarding long-term effects were largely reassuring, but women receiving IVF should continue to be monitored given that the procedures involve potent ovulation stimulators and repeated ovarian punctures.
authors: Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD 20852, USA. brinton@nih.gov
authors: Louise A
authors: LA
authors: Brinton
authors: Britton
authors: B
authors: Trabert
authors: Varda
authors: V
authors: Shalev
authors: Eitan
authors: E
authors: Lunenfeld
authors: Tal
authors: T
authors: Sella
authors: Gabriel
authors: G
authors: Chodick
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000453:epidemiology*; D016889:Endometrial Neoplasms / Q000453:epidemiology; D005260:Female; D005307:Fertilization in Vitro / Q000009:adverse effects* / Q000706:statistics & numerical data*; D005500:Follow-Up Studies; D005833:Genital Neoplasms, Female / Q000453:epidemiology*; D006279:Health Maintenance Organizations / Q000706:statistics & numerical data; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000453:epidemiology; D011247:Pregnancy; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013995:Time; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology; D055815:Young Adult
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