Patients with polycystic ovary syndrome may not have a higher risk of ovarian cancer than those without the condition; however, postmenopausal patients with polycystic ovary syndrome may have twofold the risk of developing ovarian cancer, according to recent findings presented by Frandsen et al at the European Society of Human Reproduction and Embryology (ESHRE) 2023 Annual Meeting (Abstract O-012) and simultaneously published in the International Journal of Cancer.
Background
Ovarian cancer is not as prevalent as breast cancer, but the disease is three times more deadly. Epithelial ovarian cancer starts on the surface of the ovaries and accounts for about 90% of ovarian tumors. Polycystic ovary syndrome affects about 10% of women.
“[Polycystic ovary syndrome] is a common but complex condition that represents a serious public health issue. It can affect a [patient’s] chance of becoming pregnant and increase the odds of other diseases,” explained Cristina Magli, MSc, former Chair of the ESHRE and Laboratory Director at the Italian Society for the Study of Reproductive Medicine, who was not involved in the study. “The odds of [patients] with [polycystic ovary syndrome] being diagnosed with ovarian cancer are very low. But the more that is known about the risks, the better [physicians] are able to monitor patients, especially those [who are] postmenopausal,” she added.
“Unfortunately, there [are] no effective screenings for early detection of ovarian cancer. Both patients and clinicians will benefit from improved knowledge of the potential long-term health risks associated with polycystic ovary syndrome,” emphasized lead study author Clarissa Frandsen, MD, a PhD student in the Lifestyle, Reproduction, and Cancer Group at the Danish Cancer Society Research Center as well as a researcher in the Department of Obstetrics and Gynecology at the University Hospital of Herlev and Gentofte.
Study Methods and Results
In the recent study, researchers included 1.7 million patients born between January 1, 1940, and December 31, 1993, in Denmark, excluding those who emigrated, died, were diagnosed with cancer, or had undergone surgery to remove their ovaries and fallopian tubes prior to the study period. Data on the diagnosis of polycystic ovary syndrome and cancer were obtained from national registers, and additional analysis was carried out on patients aged 51 years and older—which is the median age of menopause in Denmark.
After a median follow-up of 26 years, the researchers identified 6,490 patients who had been diagnosed with epithelial ovarian cancer and 2,990 who had borderline ovarian tumors.
The researchers found no significant statistical differences in the increased risk of developing ovarian cancer and borderline ovarian tumors among patients with and without polycystic ovary syndrome. They noted that the age-adjusted incidence rates of ovarian cancer were 11.7 per 100,000 person-years and 13.2 per 100,000 person-years for patients with and without polycystic ovary syndrome, respectively.
Other factors that could potentially affect the risk of ovarian cancer—such as obesity and highest level of education—were taken into account. However, the risk of developing ovarian cancer was significantly higher among postmenopausal patients compared with those without polycystic ovary syndrome.
In addition, the risk of developing ovarian cancer was more than twofold for patients with serous borderline ovarian tumors who had polycystic ovary syndrome. Despite not being classified as cancer, serous borderline ovarian tumors are not completely benign, and previous studies have shown they can lead to ovarian cancer later on.
Conclusions
The researchers emphasized that increased awareness may be needed when managing the health of patients with polycystic ovary syndrome. Although the overall likelihood of patients with the condition developing ovarian cancer was low, clinical guidelines for managing the long-term health consequences for these patients should include recommendations on their potential ovarian cancer risk.
The researchers did not examine why postmenopausal patients were more likely to develop ovarian cancer—but long-term exposure to potential cancer-causing factors could be behind the increased risk.
“Our results and those from previous studies should be taken into account when revising guidelines on how to manage the health of [patients] with polycystic ovary syndrome in the long term,” concluded Dr. Frandsen.
Disclosure: For full disclosures of the study authors, visit onlinelibrary.wiley.com.
