Liz Tilberis, British-born editor of Harper’s Bazaar, didn’t have the agony or the luxury of such a choice. Tilberis, now 47, took fertility drugs in her 30s; they didn’t work, and she and her husband adopted two boys, now 13 and 9. Last year she learned she had ovarian cancer, diag-nosed at a moderately advanced stage. Now, after aggressive chemotherapy, Tilberis says her doctors have pronounced her cured. It was a narrow escape: the survival rate for ovarian cancer is just over 41 percent, primarily because no test reliably detects it at an early, curable stage. Tilberis, who wrote in Harper’s Bazaar about a suspected link between the disease and fertility drugs a month before the NEJM study appeared, has received more than 200 heartfelt letters from readers.
The lifetime risk of ovarian cancer is less than 2 percent, compared with 12 percent for breast cancer. A family history of the disease greatly increases the risk; a diet high in saturated fat may also play a role. For reasons not entirely clear, frequency of ovulation also seems to encourage malignantics. Clomiphene, like several other fertility drugs, is prescribed to stimulate ovulation; pregnancies and birth-control pills both suppress it, lowering the odds.
Other studies have suggested an association between clomiphene and ovarian cancer without demonstrating a firm causal relationship. According to Dr. Noel Weiss, an epidemiologist at Seattle’s University of Washington School of Public Health and a coauthor of the new report, its findings “move the ball quite a bit forward in establishing a causal link.” Women who took clomiphene for more than 12 menstrual cycles, he says, had a risk of ovarian cancer 11 times higher than usual. The drug’s manufacturers recommend only three cycles; the American Fertility Society advises no more than six.
To some women, the possible risk of the drugs simply doesn’t matter. “It’s not my priority,” declares Susan Cahn, 30, a Newton, Mass., retail manager who has just completed her 10th cycle of clomiphene. “Getting pregnant is my priority.” She does, however, plan to pay extra attention to having her ovaries examined if she takes any more clomiphene. Judy Sachs Sullivan, 37, a museum educator from Belmont, Mass., took seven cycles of clomiphene even though there’s a history of ovarian cancer in her family and she knew the medication might put her at still further risk. She had her ovaries examined with ultrasound (which does not necessarily detect early tumors) and took the new CA 125 blood test, which measures a protein often present in ovarian cancer but fails to detect many tumors. “You need to educate yourself about the drugs,” Sullivan says, “but the risk can be worth it to have a baby.”
Clomiphene is still being prescribed, sometimes with new caution. “Now there are enough studies to warrant this kind of attention,” says Dr. Mark Sauer, a director of the University of Southern California’s in vitro fertilization program. “But people shouldn’t panic.” Sauer believes the drug is safe to use for up to a year. One reason: there’s been almost no increase in ovarian cancer cases since U.S. women–more than 2 million by now–began taking domiphene and similar drugs in the late 1960s.
Writing again in the October Harper’s Bazaar, Tilberis acknowledges that “we have no answers to the big questions that surround ovarian cancer”–including the proposed link with fertility drugs. “All I want is for women to ask the questions,” she told NEWSWEEK–and to get thorough, regular gynecological examinations. Infertile women who have chosen to adopt a child may particularly need reminding, she warns. “They may put gynecological care on the back burner, probably because they’re cross with those parts of their bodies that failed them.” Beseareh on diseases affecting women has also long been on the hack burner, but that’s finally changing. One of several new women’s health studies funded by the National Institutes of Health will examine which fertility drugs are most hazardous and who is most at risk. For infertile women, that may eliminate at least one frightening uncertainty.
PHOTO: Tiberis; Urging women to ‘ask the right questions’
Ovarian cancer is Pare; breast cancer strikes seven times as many women. But it’s particularly deadly, with an overall survival rate of 41 percent. These are the known risk factors for ovarian cancer:
A woman whose close maternal or paternal relatives have had colon, breast or gynecological cancer is three times more likely to develop ovarian cancer.
A woman who’s never been pregnant or taken birth-control pills, which both suppress ovulation, is at increased risk.
A new study suggests that foods high in saturated fat may contribute to ovarian cancer.
Taking drugs to stimulate ovulation may increase ovarian malignancies.
