Small study suggests contraceptive IUDs may delay womb cancer
Contraceptive intrauterine devices (IUDs) - the coil - may be effective at treating early-stage cancers of the endometrium (womb lining), a small clinical trial performed in Italy suggests.
Endometrial cancer starts in the lining of the womb and is the most common type of womb cancer.
New research, published in the Annals of Oncology, suggests that the coil could be used to delay the progression of the disease, giving women with early endometrial cancer the chance to have a family before undergoing a hysterectomy to permanently remove the cancerous tissue.
At present, the only way to delay hysterectomy in these patients is to give them hormone therapy, which slows down the growth of the cancer but can cause unwanted side-effects.
Scientists at the European Institute of Oncology in Milan carried out a clinical trial to see whether an IUD releasing the progestin hormone levonorgestrel, combined with a monthly injection of gonadotropin-releasing hormone (GnRH) for six months, helped to prevent further cancer growth.
Levonorgestrel prevents growth of the womb lining, while GnRH blocks the production of the hormone oestrogen, which can promote the development of endometrial cancer.
The researchers hoped that, by delivering levonorgestrel directly to the womb rather than in tablet form, the side-effects of the hormone therapy could be reduced.
Henry Scowcroft, Cancer Research UK's science information manager, said: "This is a very small pilot study and there are all sorts of hurdles to be overcome before we can know if this method could be used to treat women with womb cancer. We look forward to seeing the results of larger, more robust trials."
A total of 34 patients were included in their analysis, all of whom were aged 40 or younger and had been diagnosed with a precursor to endometrial cancer (called atypical endometrial hyperplasia or AEH) or the early stages of endometrial cancer that had not yet spread beyond the womb lining.
Participants were fitted with an IUD, which was left in place for a year. At this point, the IUDs were removed from women whose cancer had not continued to grow so that they could try for a pregnancy.
Women were followed up every six months to ensure their cancer had not returned.
Of the 20 patients with a precursor to endometrial cancer, 19 (95 per cent) responded to treatment with the IUD, although four later relapsed and had to be re-treated.
Of the 14 patients with early-stage endometrial cancer, eight (57.1 per cent) responded to treatment with the IUD, with four (28 per cent) showing signs of continued cancer growth. Of those who responded to treatment, two subsequently relapsed.
Eleven pregnancies were recorded in nine women following removal of their IUDs.
Study author Dr Lucas Minig, who is now based at the Hospital Universitario Madrid Sanchinarro, explained: "Using an IUD allows us to deliver a much higher dose of the hormone levonorgestrel to the endometrial surface than would be possible via a pill. It keeps concentrations of the hormone at a low level in the blood serum, thereby avoiding the many side-effects resulting from giving the drug via the systemic route.
"We think that treatment with levonorgestrel-releasing IUDs is ideally suited to young patients who may not want to have children immediately but would like to have the opportunity to have them in the future."
The researcher called for a large-scale clinical trial to verify the findings and determine the best course of treatment for women with endometrial cancers who wish to become pregnant in the future.
- Minig, L., Franchi, D., Boveri, S., Casadio, C., Bocciolone, L., & Sideri, M. (2010). Progestin intrauterine device and GnRH analogue for uterus-sparing treatment of endometrial precancers and well-differentiated early endometrial carcinoma in young women Annals of Oncology DOI: 10.1093/annonc/mdq463