Divisions of Gynecologic Oncology and Family Planning, Department of Obstetrics and Gynecology, and the Health Sciences Library, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
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OBJECTIVE:To explore the relationship between intrauterine device (IUD) use and risk of ovarian cancer through systematic review of the literature and meta-analysis.DATA SOURCES:We searched MEDLINE, EMBASE, Cochrane Library, Web of Science Core Collection from inception to June 2018. For the MEDLINE search, we included the MeSH terms “intrauterine devices” AND “ovarian neoplasms,” however also searching “intrauter*,” “ovar*” and “fallopian tube,” as well as “cancer” and “carcinoma” as keywords to include all possible variations. Similar search terms were used in the other databases. We also searched ClinicalTrials.gov.METHODS OF STUDY SELECTION:Case–control and cohort studies that collected individual level data on IUD use and ovarian cancer diagnosis were critically reviewed and data extracted. Review of abstracts from 399 articles through systematic database review and an additional 200 articles through Google Scholar identified a total of 15 studies with individual level data regarding IUD use and incident ovarian cancer. On critical review, 11 of these studies were used for meta-analysis. All case reports and reviews were excluded.TABULATION, INTEGRATION, AND RESULTS:The data were harmonized and weighted and summary odds ratios (ORs) were calculated. Covariates were identified evaluated separately. A random-effects meta-analysis was performed to confirm minimal bias. Harmonization and weighting of the data revealed an OR association between ever use of an IUD and incident ovarian cancer to be 0.68 (95% CI 0.62–0.75). There were no significant differences found between covariates. Heterogeneity among all studies was found to be I2=68%.CONCLUSION:Intrauterine device use is associated with a reduced incidence of ovarian cancer based on a review of existing retrospective data. Unfortunately, prospective investigation into the role of IUDs in ovarian cancer prevention is limited.