Abstract
PurposeMutations in the genes BRCA1 and BRCA2 represent a significant risk factor for ovarian and breast cancer. With increasing number and success rates, fertility protection and treatment are gaining importance also for BRCA1/2 mutation carriers. However, the effect on primary cancer risk and risk for recurrence remains unclear. This review analyses the published data on fertility treatment and risk of ovarian and breast cancer in BRCA1/2 mutation carriers.MethodsIn this review, we included all relevant articles published in English from 1995 to 2018. Literature was identified through a search on PubMed and Cochrane Library.ResultsWe identified one retrospective cohort and one case–control study regarding the association of fertility treatments and ovarian cancer risk in BRCA mutation carriers. The studies show no increase in ovarian cancer risk. Furthermore, one case–control study on the association between fertility treatment and breast cancer risk in BRCA mutation carriers and one prospective cohort study on the long-term safety of medication used for fertility preservation in women with a history of breast cancer were identified. One of the studies shows a possible adverse effect for gonadotropin-containing medication.ConclusionPossible increases in cancer risk associated with fertility treatments in BRCA1/2 mutation carriers cannot be excluded at this time. Based on the existing studies, BRCA1/2 mutation carriers should not be generally excluded from fertility treatments. However, they have to be informed about limited data and possible increases in cancer risk.
Highlights
In the last decades, the number of fertility treatments is increasing due to postponing family planning to a later age
We found one retrospective cohort study and one case–control study regarding the association of fertility treatments and ovarian cancer risk in BRCA1/2 mutation carriers to include in our review (Table 1)
Perri et al conducted a cohort study with Jewish Israeli women undergoing genetic counseling because of family history of ovarian cancer [11]. They included a total of 718 BRCA1 and 331 BRCA2 mutation carriers. 139 of the BRCA1 and 33 of the BRCA2 mutation carriers were diagnosed with ovarian cancer
Summary
The number of fertility treatments is increasing due to postponing family planning to a later age. More recent studies suggest a negative impact of BRCAmutations on fertility treatment response rates [8] This hypothesis and the possibly occurring psychological urge to fulfill family planning in a certain time in order to schedule risk-reducing surgery procedures contribute to the fact that fertility treatment and cancer risk is of particular interest for the subgroup of BRCA1/2 mutation carriers. This applies especially for BRCA1/2 mutation carriers with a previous history of malignant disease. We analyze the published data on fertility treatments and their association with primary ovarian and breast cancer risk and risk for recurrence in BRCA1/2 mutation carriers
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