In the largest study of its kind, University of Pittsburgh researchers say women who undergo fertility treatments are not at a higher risk of contracting ovarian cancer, the fifth most common cancer in adult women. The study could put to an end the long-held suspicion that fertility drugs can cause ovarian cancer, scientists said. "This could be a powerful study that could put the speculation to rest," said Jeff Boyd, director of the gynecology and breast research laboratory at Memorial Sloan-Ketterring Cancer Center in New York, who was not involved with the Pitt research that will be published in the Feb. 1 issue of the American Journal of Epidemiology. The study found any increased risk of ovarian cancer is caused by infertility, itself, rather than the drugs used to treat it, said Dr. Roberta Ness, the study's principal investigator and a professor of epidemiology at Pitt's Graduate School of Public Health. "Women undergoing fertility treatments have been terrified of getting cancer," said Ness. "I really do think this study seriously begins to lay a rest to that concern." Doctors for years have battled concerns that fertility drugs, because they promote ovulation and increase hormone levels, also promote cancer. The study pointed to two underlying causes of infertility — endometriosis and a condition called unknown infertility, where the cause is not known — as the major risks for ovarian cancer. Endometriosis is a condition in which cells that line the uterus wander off into the abdominal cavity and start growing. That sometimes results in painful adhesions, cysts and blockages. At the same time, the researchers said their analysis showed no link between ovarian cancer and other causes of infertility, such as ovulation or menstrual problems, ovarian cysts or blocked tubes. See This Related Graphic A look at ovarian cancer (136K) Signs and symptoms You will need the Adobe Acrobat reader to view this file. Download the free reader here . Researchers analyzed data on infertility and fertility drug use from nearly 13,000 women, the largest analysis to date on the topic. They collected data from eight studies conducted between 1989 and 1999 in the United States, Denmark, Canada and Australia. Researchers, after analyzing data from 5,027 women with ovarian cancer and 7,705 women without ovarian cancer, found that women who spent more than five years trying to get pregnant, regardless of whether they took fertility drugs, were at a 2.7-fold higher risk for ovarian cancer. Women who had used fertility drugs were not more likely to develop ovarian cancer than those who had never used fertility drugs. Researchers did not exclude any fertility drug from the study, and it focused one section on women who took the two most common medications — chlomiphene and pergonal. The debate about the link between cancer and fertility drugs has been so fierce, some are still skeptical of the study's results. Karen Bowers of Ross Township said she had taken the fertility drug clomid when she was diagnosed with cervical cancer in June 1998. Although there is a history of cancer in her family, she suspects the drug played a role in the development of her cancer. "I would be leery of the study," said Bowers, 47, adding that when she started fertility treatments doctors gave her a list of risks that included ovarian cancer. "I personally think there's logic in thinking they (drugs) do contribute to cancer." Since developing cancer, Bowers has become president of the Pittsburgh chapter of the National Ovarian Cancer Coalition. She said she recommends that women who take fertility drugs be aware of symptoms of ovarian cancer, which sometimes are hard to recognize. Boyd understands why some would be doubtful about the study because the strongest known risk factor for ovarian cancer is increased ovulation. "That's why we've known for years that oral contraceptives reduce the risk of ovarian cancer, because they decrease ovulatory cycles," he said. An estimated 27,000 women in the U.S. will be diagnosed with ovarian cancer this year, and 14,000 will die from the disease, according to the American Cancer Society. Surgery and drug therapy are effective treatments against the disease, but since the overwhelming majority of tumors are detected late, the prognosis for most patients is poor. Boyd, who studies the genetics of ovarian cancer, said the new findings are promising, and suggest that the mechanism of cancer in the ovary is more complicated. "It suggests it's not as simple as we think," he said. Nancy Reilly of Aspinwall had her twins, a boy and a girl, in December 1999. She had taken fertility drugs for about a year before becoming pregnant. A former oncology nurse, she said she knew data about a possible link between fertility drugs and cancer was contradicting, but having children outweighed a risk of cancer, even though her family had a history of breast cancer. "Wanting to be a mother, that was more important than getting ovarian cancer down the line," she said. The Pitt study should provide some peace of mind to those concerned about cancer links, she said. "I certainly think it is a relief to people, and it certainly sounds like the biggest study that has been done," she said.

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