Risk Management
Chemoprevention and ovarian cancer
Overview
Chemoprevention is the use of medication to reduce risk or prevent diseases such as cancer in healthy people. Some chemoprevention medications may reduce the risk for ovarian cancer. Just how well these drugs perform in high-risk women depends on each woman’s individual level of risk. Because some chemoprevention research may not apply to every person with hereditary cancer risk, when considering your best risk management options, it is important to have a clear a sense of your own risk, as well as the potential benefits and side effects of these medications. A health care team with expertise in managing high-risk patients can help you get a clearer idea of your risk for cancer so you can choose a risk management option that is right for you. Please visit our clinical trials section for information on studies to lower the risk for ovarian cancer.
Oral contraceptives
Oral contraceptives are medications used for birth control in women. Studies of women in the general population show use of oral contraceptives lowers the risk for ovarian cancer. One 2004 study of oral contraceptives looked at 451 women with BRCA mutations. Women who took the contraceptives for at least 1 year reduced their risk for ovarian cancer by about 15%, compared with women who didn’t take use the medication. Women who used oral contraceptives for 6 or more years had a 38% reduction in risk for ovarian cancer. Another older study showed an even larger risk reduction in ovarian cancer risk in BRCA1 and BRCA2 carriers who used oral contraceptives. However, a study of ovarian cancer risk in BRCA carriers with one of the three common mutations found in people of Jewish ancestry did not show any risk reduction in women who took oral contraceptives.
Oral contraceptives can have side effects, including a slightly increased risk for blood clots. In addition, one study showed women with BRCA1 mutations who first used oral contraceptives before 1975, before age 30, or who used them for 5 or more years had an increased risk of early-onset breast cancer compared to BRCA 1 carriers who never used the medications. In this study, no increased risk for breast cancer was found in women who carried a BRCA2 mutation. Another study did not find an increased risk for breast cancer with use of more modern low-dose oral contraceptives.
These studies are limited by their small size and the fact they are observational studies only. Their conclusions are noteworthy, but do not prove that taking oral contraceptives actually decreased ovarian cancer risk or increased breast cancer risk. More research is needed in order to understand contraceptive use and cancer risk in BRCA carriers. Oral contraceptives may not be appropriate for all women with BRCA mutations who want to reduce their risk for ovarian cancer. Anyone considering taking oral contraceptives to lower their cancer risk should discuss the benefits, risks and limitations with their health care team and experts in managing high-risk women.
Analgesics
Analgesics are medications used for pain relief. They include many common over-the-counter painkillers called Non-steroidal Anti-inflammatories (NSAIDs), such as aspirin and ibuprofen (Advil, Motrin) and acetaminophen (Tylenol). Research to determine whether these medications decrease ovarian cancer risk produced conflicting results. One study showed a 25% reduction in ovarian cancer risk in women who took aspirin on a regular basis and a 50% ovarian cancer risk reduction in women who took acetaminophen on a regular basis compared to women who did not take either drug. A more recent study showed a similar risk reduction for ovarian cancer in women who took acetaminophen on a regular basis but not women who took aspirin. A third study showed no reduction in ovarian cancer risk in women who took acetaminophen. The Nurses Health Study, a large research effort following 76,821 nurses, found a risk reduction associated with NSAIDs in general but not with aspirin use. None of these studies specifically reviewed ovarian cancer risk in women with BRCA mutations. Because these studies were only observational, they do not prove taking analgesics actually lowered cancer risk.
Certain analgesics in the NSAID category may increase the risk for death from heart disease. A recent clinical trial studying whether Celebrex might reduce the risk for colon polyps was discontinued due to an increase in heart disease and heart-disease related deaths in people who took the medication compared to people who took a placebo. The risk was still low for death by heart disease: about 3% for people who were on the highest dose, and 2% risk for people on the lower dose. However, in that particular study, the benefits of Celebrex were not believed to outweigh the risks.
Clearly more research is needed in order to better understand analgesic use and the risk for ovarian cancer, particularly in BRCA carriers. For more information on research studies see our section on clinical trials and research. Anyone considering analgesics to decrease their risk for cancer should discuss the benefits, risks and limitations with their health care team and experts in managing high-risk women.
Fenretinide
Fenretinide is a medication related to Vitamin A. Research studies suggest Fenretinide might reduce the risk of several types of cancers. One small study looked at ovarian cancer risk in breast cancer survivors who took this medication to prevent recurrence of their breast cancer. The study found Fenretinide reduced ovarian cancer risk during the 5 years women took it, compared to women who did not take it. The risk-lowering effect did not continue when the medication was stopped. The study also suggested this protective effect against ovarian cancer may be stronger in women with BRCA mutations than women with sporadic breast cancer.
More research is needed. Current clinical trials are studying whether Fenretinide can lower ovarian cancer risk in high-risk women with BRCA mutations. Results from this research will not be available for several years. To enroll or learn more about clinical trials for chemoprevention, visit our clinical trials section.
Clinical trials
ClinicalTrials.gov
This
site, produced by the U.S. National Library of Medicine (NLM), provides patients,
family members, and members of the public easy and free access to information
on clinical studies for a wide range of diseases and conditions.
Phase II Randomized Study of Levonorgestrel in Patients at High Risk for Ovarian Cancer
Further reading - articles (advanced reading)
Oral
contraceptive use and risk of early-onset breast cancer in carriers and
noncarriers of BRCA1 and BRCA2 mutations
Roger L. Milne, Julia A. Knight,
Esther M. John, Gillian S. Dite, Ronald Balbuena, Argyrios Ziogas, Irene
L. Andrulis, Dee W. West, Frederick P. Li, Melissa C. Southey, Graham G.
Giles, Margaret R.E. McCredie, John L. Hopper and Alice S. Whittemore for
the Breast Cancer Family Registry. Cancer Epidemiology
Biomarkers & Prevention.
Vol. 14, Number 2, p. 350-356, February 2005.
Oral
contraceptive use and ovarian cancer risk among carriers of BRCA1 or BRCA2
mutations
A S Whittemore, R R Balise, P D P Pharoah, R A DiCioccio,
Kathleen Cuningham Foundation Consortium for Research into Familial Breast
Cancer (kConFab), I Oakley-Girvan, S J Ramus, M Daly, M B Usinowicz, K
Garlinghouse-Jones, B A J Ponder, S Buys, R Senie, I Andrulis, E John,
J L Hopper and M S Piver. British Journal of
Cancer. Volume 91, Number
11, p. 1911-1915, November 2004.
Oral
contraceptives and the risk of breast cancer in BRCA1 and BRCA2 mutation
carriers
Steven A. Narod, Marie-Pierre Dubé, Jan Klijn, Jan
Lubinski, Henry T. Lynch, Parviz Ghadirian, Diane Provencher, Ketil Heimdal,
Pal Moller, Mark Robson, Kenneth Offit, Claudine Isaacs, Barbara Weber,
Eitan Friedman, Ruth Gershoni-Baruch, Gad Rennert, Barbara Pasini, Theresa
Wagner, Mary Daly, Judy E. Garber, Susan L. Neuhausen, Peter Ainsworth,
Hakan Olsson, Gareth Evans, Michael Osborne, Fergus Couch, William D. Foulkes,
Ellen Warner, Charmaine Kim-Sing, Olufunmilayo Olopade, Nadine Tung, Howard
M. Saal, Jeffrey Weitzel, Sofia Merajver, Marion Gauthier-Villars, Helena
Jernstrom, Ping Sun, Jean-Sebastien Brunet. Journal
of the National Cancer Institute. Volume 94, Number 23: p. 1773-1779, December 2002.
Aspirin,
other NSAIDs, and ovarian cancer risk
Kathleen M. Fairfield, David
J. Hunter, Charles S. Fuchs, Graham A. Colditz, and Susan E. Hankinson.
Cancer Causes and Control. Volume 13, Number 6: p. 535-542, August 2002.
Effect of fenretinide on ovarian carcinoma occurrence Giuseppe De Palo, Luigi Mariani, Tiziana Camerini, Ettore Marubini, Franca Formelli, Barbara Pasini, Andrea Decensi and Umberto Veronesi. Gynecologic Oncology. Volume 86, Issue 1: p 24-27, July 2002.
Parity,
oral contraceptives, and the risk of ovarian cancer among carriers and
noncarriers of a BRCA1 or BRCA2 mutation
Baruch Modan, Hartge, P.,
Hirsh-Yechezkel, G., Chetrit, A., Lubin, F., Beller, U., Ben-Baruch, G.,
Fishman,A., Menczer, J., Struewing, J., Tucker, M., Ebbers, S., Friedman,
E., Piura, B., Wacholder, S., for the National Israel Ovarian Cancer Study
Group. New England Journal of Medicine. Volume 345, Number 4: p. 235-240,
July 2001.
Oral contraceptives
and the risk of hereditary ovarian cancer
Steven A. Narod, M.D., Harvey
Risch, M.D., Ph.D., Roxana Moslehi, M.Sc., Anne Dørum, M.D., Susan
Neuhausen, Ph.D., Hakan Olsson, M.D., Diane Provencher, M.D., Paolo Radice,
Ph.D., Gareth Evans, M.D., Susan Bishop, M.Sc., Jean-Sébastien Brunet,
M.Sc., Bruce A.J. Ponder, M.D., Ph.D., Jan G.M. Klijn, M.D., for The Hereditary
Ovarian Cancer Clinical Study Group. New England
Journal of Medicine. Volume
339: p. 424-428, August 1998.