Intrauterine devices and gynaecological malignancies - an umbrella review of systematic reviews and meta-analyses

Abstract

Background and aims: The intrauterine device (IUD) is globally recognised as a safe, cost-effective, and reliable contraceptive. This umbrella review and meta-analysis synthesises current evidence regarding the association between IUD usage and incidence of gynaecological and breast malignancies.

Materials and methods: A comprehensive search of PubMed, Cochrane Library, and Ovid databases was conducted for systematic reviews and meta-analyses examining any type of IUD in relation to gynaecological and breast cancers. The screening and data extraction processes adhered to PRISMA guidelines, and random-effects meta-analysis was employed for data synthesis.

Results: 323 titles and abstracts were screened, leading to the review of 41 full texts and the inclusion of 17 articles. Analyses of these articles and of their 32 primary sources indicated a decreased risk of cervical, endometrial and ovarian cancer for ever-users of IUD (respective OR: 0.63 [95% CI 0.48-0.82], 0.41 [0.31-0.54], and 0.71 [0.59-0.86]; all p < 0.001). Our analysis did not yield any statistically significant association between IUD use and breast cancer risk (OR 1.00 [0.70-1.41], p = 0.99).

Conclusion: IUD use is associated with a reduced risk of ovarian, endometrial, and cervical cancers, while no link was found with breast cancer. These findings can inform patient counselling on the benefits and risks of IUD use.

Keywords: Intrauterine contraception; breast cancer; cervical cancer; endometrial cancer; gynaecological malignancy; ovarian cancer.