August 12, 2009

Young Ovarian Cancer Patients Can Preserve Fertility

Young women with early-stage ovarian cancer can preserve fertility by keeping at least one ovary or the uterus without increasing the risk of dying from the disease, a new study finds.

Although ovarian cancer occurs most often in older women, up to 17 percent of ovarian tumors occur in women age 40 or younger, many of whom have early stage disease. Surgery for ovarian cancer usually involves hysterectomy -- complete removal of the uterus and ovaries -- which not only results in the loss of fertility, but also subjects young women to long-term consequences of estrogen deprivation.

Researchers led by Jason Wright, M.D., of Columbia University College of Physicians and Surgeons in New York City conducted a study to examine the safety of fertility-conserving surgery in premenopausal women with ovarian cancer. This type of surgery conserves at least one ovary or the uterus.

The investigators analyzed data from women 50 years of age or younger who were diagnosed with early stage ovarian cancer between 1988 and 2004 and who were registered in the National Cancer Institute's Surveillance, Epidemiology and End Results database, a registry that includes approximately 26 percent of the U.S. population. Patients who had both ovaries removed were compared with those who had only the cancerous ovary removed. A second analysis examined uterine conservation vs. hysterectomy.

Of the 1,186 ovarian cancer patients identified in the first analysis, about one in three, or 36 percent, had one ovary conserved. The researchers found those in whom one ovary was saved had similar survival for up to at least five years.

In the second analysis, researchers studied 2,911 women to investigate the effect of uterine preservation. Of these women, about one in four, or 23 percent, had uterine preservation. Uterine preservation also had no effect on survival.

Women who were younger, who were diagnosed in more recent years, and who resided in the eastern or western United States were more likely to undergo ovarian or uterine conservation. These results are promising for the many young women who are diagnosed with ovarian cancer each year.

An estimated 21,650 women in the United States were diagnosed with the disease in 2008. The study's authors were quoted as saying, "Given the potential reproductive and non-reproductive benefits of ovarian and uterine preservation, the benefits of conservative surgical management should be considered in young women with ovarian cancer."

SOURCE: Cancer, September 15, 2009