Pregnancy after breast cancer: population based study  

Oleh:

Ives, Angela ; Saunders, Christobel ; Bulsara, Max ; Semmens, James

Jenis: Article from Journal - ilmiah internasional
Dalam koleksi: British Medical Journal (keterangan: ada di Proquest) vol. 334 no. 7586 (Jan. 2007), page 194.

Ketersediaan

Perpustakaan FK Nomor Panggil: B16.K.2007.04 Non-tandon: 1 (dapat dipinjam: 0) Tandon: tidak ada

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ABSTRACT Objectives To identify women who survived breast cancer and subsequently conceived and to determine the rate of pregnancy (proportion), management, outcome of the cancer, and outcome ofthe first subsequent pregnancy. Design Population based descriptive study with cases identified from the Western Australian data linkage system and validated by review of medical charts. Supplementary data obtained from hospital and clinician records. Setting Western Australia, 1982-2003. Participants Women aged <45 with a diagnosis of breast cancer who subsequently conceived. Main outcome measures Pregnancy outcome and rate, survival, time from diagnosis to pregnancy. Results Sixty two (54%) women with a diagnosis of breast cancer who subsequently conceived did so less than two years after their diagnosis: 29 of them had an abortion, 27 had a live birth, and six miscarried. Within a proportional hazards regression model subsequent pregnancy was associated with improved overall survival (hazard ratio 0.59,95% confidence interval 0.37 to 0.95). When the model was stratified by time from diagnosis subsequent pregnancy was associated with improved overall survival in women who waited at least 24 months to conceive (0.48, 0.27 to 0.83) and a non-significant protective effect was seen for women who waited at least six months to become pregnant. Conclusions Our study does not support the current medical advice given to premenopausal women with a diagnosis of breast cancer to wait two years before attempting to conceive. This recommendation may be valid for women who are receiving treatment or have systemic disease at diagnosis, but for women with localised disease early conception, six months after completing treatment, is unlikely to reduce survival. '. least equivalent, if not better, survival than similar women matched for age and stage of cancer who do not subsequently conceive. 1-7 This may be due to selection bias called the "healthy mother" effect; women with a diagnosis of breast cancer who subse¬quently conceive are a self selecting group of women with better prognosis.8 We identified women who survived breast cancer and subsequently conceived in the Western Australian population in 1982-2003 and determined the preg¬nancy rate (proportion), management, and outcomes of the breast cancer and first subsequent pregnancy. METHODS We used the Western Australian data linkage system9 to identify women with breast cancer who conceived at least once after their diagnosis of cancer (see bmj. com for details). We identified potential cases in two stages. Firstly, the linkage system identified women who were dis¬charged from hospital with an international classifi¬cation of diseases (I CD) code or a cancer or death registration for breast cancer from 1 January 1982 to 31 December 2000. Age at diagnosis was restricted to 15-44 years. Secondly, we used ICD diagnostic or procedure codes, or both, to identify women with a pregnancy subsequent to their diagnosis of breast cancer but before 31 December 2003. The outcome of the pregnancy could be abortion, miscarriage, ectopic, stillbirth, or live birth. We used pathology reports in the Western Austra¬lian cancer registry and hospital and clinician records to validate cases. A researcher reviewed these records to obtain additional data including demographics, breast symptoms, method of diagnosis, management details, characteristics of the tumour, management and outcome of subsequent pregnancy (including dates oflast menstrual period,gestational age, and time from diagnosis of breast cancer to the estimated date of the last menstrual period)

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