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Levonorgestrel-releasing intrauterine system use is associated with a decreased risk of ovarian and endometrial cancer, without increased risk of breast cancer. Results from the NOWAC Study

Published:February 24, 2018DOI:https://doi.org/10.1016/j.ygyno.2018.02.006

      Highlights

      • We present a population-based prospective cohort study of LNG-IUS users.
      • A mean of 4 years use was associated with 47% reduced ovarian cancer risk.
      • Endometrial cancer risk was reduced by 78%.
      • We found no association between LNG-IUS use and breast cancer.

      Abstract

      Objective

      Women with ovarian cancer have poor survival rates, which have proven difficult to improve; therefore primary prevention is important. The levonorgestrel-releasing intrauterine system (LNG-IUS) prevents endometrial cancer, and recent studies suggested that it may also prevent ovarian cancer, but with a concurrent increased risk of breast cancer. We compared adjusted risks of ovarian, endometrial, and breast cancer in ever users and never users of LNG-IUS.

      Methods

      Our study cohort consisted of 104,318 women from the Norwegian Women and Cancer Study, 9144 of whom were ever users and 95,174 of whom were never users of LNG-IUS. Exposure information was taken from self-administered questionnaires, and cancer cases were identified through linkage to the Cancer Registry of Norway. Relative risks (RRs) with 95% confidence intervals (CIs) were estimated with Poisson regression using robust error estimates.

      Results

      Median age at inclusion was 52 years and mean follow-up time was 12.5 (standard deviation 3.7) years, for a total of 1,305,435 person-years. Among ever users of LNG-IUS there were 18 cases of epithelial ovarian cancer, 15 cases of endometrial cancer, and 297 cases of breast cancer. When ever users were compared to never users of LNG-IUS, the multivariable RR of ovarian, endometrial, and breast cancer was 0.53 (95% CI: 0.32, 0.88), 0.22 (0.13, 0.40), and 1.03 (0.91, 1.17), respectively.

      Conclusion

      In this population-based prospective cohort study, ever users of LNG-IUS had a strongly reduced risk of ovarian and endometrial cancer compared to never users, with no increased risk of breast cancer.

      Abbreviations:

      BMI (body mass index), CI (confidence interval), ICD (International Classification of Diseases), LNG-IUS (levonorgestrel-releasing intrauterine system), NOWAC (Norwegian Women and Cancer), OC (oral contraceptives), PY (person-years), RR (relative risk), SD (standard deviation), SIR (standardized incidence ratio)

      Keywords

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