Women with polycystic ovary syndrome who have been through the menopause are more than twice as likely to develop ovarian cancer, the largest study of its kind has found.
The findings, presented yesterday at the 39th annual meeting of the European Society of Human Reproduction and Embryology (ESHRE) in Copenhagen, Denmark, and also published the International Journal of Cancer, have led the authors to call for increased awareness when managing the health of these patients.
The overall likelihood of women with polycystic ovary syndrome (PCOS) developing ovarian cancer is low, with the data based on nearly two million women finding the age-adjusted incidence rates were 11.7 per 100 000 person-years and 13.2 per 100,000 person-years for women with and without PCOS, respectively.
However, lead author Dr Clarisssa Frandsen, from the Danish Cancer Society Research Center in Copenhagen, Denmark, said clinical guidelines for managing the long-term health consequences for PCOS patients should include recommendations on their potential ovarian cancer risk.
“Our results and those from previous studies should be taken into account when revising guidelines on how to manage the health of women with PCOS in the long term,” she said.
“Unfortunately, there is no effective screening for early detection of ovarian cancer. Both patients and clinicians will benefit from improved knowledge of the potential long-term health risks associated with PCOS.”
The analysis by the Danish Cancer Research Center and Herlev Hospital in Denmark focused on epithelial ovarian cancer, which accounts for 90% of ovarian tumours.
The study included all 1.7 million women born in Denmark between 1 January 1940 and 31 December 1993, although excluded were those who emigrated, died, were diagnosed with cancer, or had undergone surgery to remove their ovaries and fallopian tubes before the start of the study.
Details on diagnosis of PCOS and cancer and on migration were obtained from national registers. Additional analysis was carried out on women who had reached 51 years, which is the median age in Denmark for menopause.
They found 6,490 women were diagnosed with epithelial ovarian cancer and 2,990 with borderline ovarian tumours during a median follow-up time of 26 years.
Overall, the study authors found the increased risk was not statistically significant for ovarian cancer and borderline ovarian tumours among women with PCOS compared to those without the condition.
However, the risk of developing ovarian cancer was significantly greater among postmenopausal women compared to those without PCOS.
The risk was more than double for serous borderline among PCOS patients – these abnormal cells are not classed as cancer but are not completely benign and studies show they can lead to ovarian cancer.
The authors acknowledge the study included a low number of ovarian cancer cases and the conference abstract says while the data they used were ‘highly valid’, diagnosis of PCOS is challenging, and they were unable ‘to account for changes in diagnostic practices over time’.
Dr Frandsen said they did not examine why postmenopausal women were more likely to develop ovarian cancer.
Frandsen CLB, Svendsen PF, Nøhr B et al. Risk of epithelial ovarian tumors among women with polycystic ovary syndrome: A nationwide population-based cohort study. International Journal of Cancer 26 June 2023; doi: 10.1002/ijc.34574
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