Seung-Ah Choe

Fertility treatment and risk of non-gynecological cancer: a systematic review

Dienogest use and the risk of breast and gynecologic cancers: A nationwide population‐based study

Abstract Objective To evaluate whether dienogest exposure is associated with the risk of breast, endometrial, or tubo‐ovarian cancer in women with endometriosis. Methods In this nationwide retrospective cohort study (January 2012 to December 2023), we used the Korean National Health Insurance Review & Assessment Service database. Women aged 20–49 years with endometriosis who received dienogest for at least 6 months were compared with an active control group treated with gonadotropin‐releasing hormone (GnRH) agonists, with cohorts balanced by inverse probability of treatment weighting. Incident breast, endometrial, and tubo‐ovarian cancers were ascertained, and adjusted hazard ratios (aHR) were estimated using Cox proportional hazards models. Results Among 1 887 957 women with endometriosis, 14 647 dienogest users and 181 587 GnRH agonist users met the eligibility criteria for the breast cancer cohort; sample sizes were similar for endometrial and tubo‐ovarian analyses. Compared with GnRH agonists, dienogest use was not associated with increased risk of breast cancer (aHR 1.01, 95% confidence interval [CI] 0.75–1.37), endometrial cancer (aHR 0.84, 95% CI 0.40–1.77), or tubo‐ovarian cancer (aHR 0.92, 95% CI 0.30–2.80). Use of dienogest for 0.5–1.5 years was associated with a reduced breast cancer risk (aHR 0.72, 95% CI 0.53–0.99), whereas associations for longer durations were inconsistent. Conclusion Dienogest use in women with endometriosis was not associated with higher or lower risks of breast, endometrial, or tubo‐ovarian cancer compared with GnRH agonists, supporting its oncologic safety. Further longer‐term studies are warranted to clarify duration‐specific effects.

Income-based disparities in the risk of distant-stage cervical cancer and 5-year mortality after the introduction of a National Cancer Screening Program in Korea

OBJECTIVES: This study assessed the socioeconomic gradient in the risk of distant-stage cervical cancer (CC) at presentation and 5-year mortality for new CC patients after the introduction of a national Cancer Screening Program (NCSP) in Korea.METHODS: All new CC cases from 2007 to 2017 were retrieved from the Korea Central Cancer Registry database linked with the National Health Information Database of the National Health Insurance Service. The age-standardized cumulative incidence of CC, adjusted odds ratios (ORs) of distant metastasis at presentation, and adjusted all-cause mortality hazard ratios (HRs) within 5 years post-diagnosis were assessed according to the income gradient.RESULTS: The 11-year age-standardized cumulative incidence of CC ranged from 48.9 to 381.5 per 100,000 women, with the richest quintile having the highest incidence. Of 31,391 new cases, 8.6% had distant metastasis on presentation, which was most frequent among Medical Aid beneficiaries (9.9%). Distant-stage CC was more likely when the income level was lower (OR, 1.46; 95% confidence interval [CI]), 1.28 to 1.67 for the lowest compared to the richest) and among Medical Aid beneficiaries (OR, 1.50; 95% CI, 1.24 to 1.82). The 5-year mortality was greater in the lower-income quintiles and Medical Aid beneficiaries than in the richest quintile.CONCLUSIONS: The incidence of CC was higher in the richest quintile than in the lower income quintiles, while the risk of distant-stage CC and mortality was higher for women in lower income quintiles in the context of the NCSP. A more focused approach is needed to further alleviate disparities in the timely diagnosis and treatment of CC.