Chien-Tien Hsu Memorial Lecture. Fertility and gynaecologic malignancies

Area of Science:

• Gynecologic Oncology
• Reproductive Endocrinology
• Cancer Epidemiology

Background:

• The relationship between fertility and gynecological malignancies is significant, with inverse correlations observed between family size and ovarian/endometrial cancer incidence.
• Hormonal contraceptive use impacts the risk of various gynecological cancers, with a notable, time-dependent association with breast cancer risk.

Discussion:

• Oral contraceptives (OCs) are associated with reduced risks of ovarian and endometrial cancers, though a slight, transient increase in breast cancer risk is noted, particularly in younger users.
• While OCs may increase cervical cancer risk, its multifactorial etiology is crucial to consider. Protective effects against ovarian cancer are suggested for tubal ligation and breastfeeding.
• Cancer therapies can affect fertility, but advancements like fertility-sparing surgeries (e.g., radical trachelectomy) and successful pregnancies post-chemotherapy demonstrate preserved reproductive potential.

Key Insights:

• Oral contraceptive use shows a complex relationship with gynecological cancers, decreasing some risks while potentially increasing others transiently.
• Fertility-sparing surgical techniques are increasingly viable for young women with early-stage gynecological cancers, including ovarian and cervical malignancies.
• Managing gynecological cancers during pregnancy requires individualized treatment, with varying prognoses depending on the cancer type.

Outlook:

• Further research into the long-term effects of hormonal contraceptives on cancer risk and fertility is warranted.
• Continued development and refinement of fertility-sparing treatments will improve reproductive outcomes for young cancer survivors.
• Optimizing the management of gynecological cancers in pregnancy remains a critical area for clinical advancement.