title: Effects of fertility drugs on cancers other than breast and gynecologic malignancies.
abstract: OBJECTIVE
  To examine the relationship of ovulation-stimulating drugs to risk of cancers other than breast and gynecologic malignancies.
  
  
  METHODS
  Retrospective cohort study, with additional follow-up since initial report.
  
  
  METHODS
  Reproductive endocrinology practices.
  
  
  METHODS
  Among a cohort of 12,193 women evaluated for infertility between 1965 and 1988, a total of 9,892 women (81.1% of the eligible population) were followed through 2010, via passive and active (questionnaire) approaches.
  
  
  METHODS
  None.
  
  
  METHODS
  Hazard ratios (HRs) and 95% confidence intervals (CIs) for various fertility treatment parameters for select cancers.
  
  
  RESULTS
  During 30.0 median years of follow-up (285,332 person-years), 91 colorectal cancers, 84 lung cancers, 55 thyroid cancers, and 70 melanomas were diagnosed among study subjects. Clomiphene citrate (CC), used by 38.1% of patients, was not associated with colorectal or lung cancer risks, but was related significantly to melanoma (HR = 1.95; 95% CI: 1.18-3.22), and non-significantly to thyroid cancer risks (HR = 1.57; 95% CI: 0.89-2.75). The highest melanoma risks were seen among those with the lowest drug exposure levels, but thyroid cancer risk was greatest among the heavily exposed patients (HR = 1.96; 95% CI: 0.92-4.17 for those receiving >2,250 mg). Clomiphene citrate-associated risks for thyroid cancer were somewhat higher among nulligravid, compared with gravid, women, but did not differ according to distinct causes of infertility. Gonadotropins, used by only 9.7% of subjects, were not related to risk of any of the assessed cancers.
  
  
  CONCLUSIONS
  Our results provide support for continued monitoring of both melanoma and thyroid cancer risk among patients receiving fertility drugs.
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland. Electronic address: brintonl@mail.nih.gov.
authors.forename: Louise A
authors.initials: LA
authors.lastname: Brinton
authors.affiliation: Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan.
authors.forename: Kamran S
authors.initials: KS
authors.lastname: Moghissi
authors.affiliation: Department of Obstetrics and Gynecology, University of Illinois, Chicago, Illinois.
authors.forename: Bert
authors.initials: B
authors.lastname: Scoccia
authors.affiliation: Stanford University, Stanford, California.
authors.forename: Emmet J
authors.initials: EJ
authors.lastname: Lamb
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland.
authors.forename: Britton
authors.initials: B
authors.lastname: Trabert
authors.affiliation: Westat, Inc., Rockville, Maryland.
authors.forename: Shelley
authors.initials: S
authors.lastname: Niwa
authors.affiliation: IMS, Inc., Rockville, Maryland.
authors.forename: David
authors.initials: D
authors.lastname: Ruggieri
authors.affiliation: Department of Obstetrics and Gynecology, Columbia University, New York, New York.
authors.forename: Carolyn L
authors.initials: CL
authors.lastname: Westhoff
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000453:epidemiology; D015179:Colorectal Neoplasms / Q000453:epidemiology; D005260:Female; D005300:Fertility Agents, Female / Q000494:pharmacology / Q000627:therapeutic use*; D005500:Follow-Up Studies; D005833:Genital Neoplasms, Female / Q000453:epidemiology; D006801:Humans; D007247:Infertility, Female / Q000188:drug therapy / Q000453:epidemiology; D008175:Lung Neoplasms / Q000453:epidemiology; D008545:Melanoma / Q000453:epidemiology; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology*; D011247:Pregnancy; D012189:Retrospective Studies; D013964:Thyroid Neoplasms / Q000453:epidemiology
chemical_list: D005300:Fertility Agents, Female
keywords: Cancer; clomiphene citrate; gonadotropins; infertility; risk