Safety of Pregnancy After Primary Breast Carcinoma in Young Women: A Meta-Analysis to Overcome Bias of Healthy Mother Effect Studies

Onkologkliniken Sörmland, Mälarsjukhuset, Central Hospital of Eskilstuna, Eskilstuna, Sweden.
Obstetrical & gynecological survey (Impact Factor: 1.86). 12/2010; 65(12):786-93. DOI: 10.1097/OGX.0b013e31821285bf
Source: PubMed


An increased number of women are expected to conceive after the diagnosis of early breast cancer. Most physicians recommend that pregnancy be delayed by 2 to 3 years after diagnosis of early breast cancer, but this recommendation is based on data from trials with small patient cohorts. Furthermore, a healthy mother effect (HME) selection bias may be operative in most of these studies, because women undergoing childbearing after treatment were healthier when compared with the control group.
To perform a systematic review and meta-analysis of published trials corrected for HME bias so as to assess the effect of pregnancy (at least 10 months after diagnosis) versus no pregnancy on overall survival of primary breast cancer patients less than 45 years.
We searched MEDLINE and Thomson Reuters (ISI) Web of Knowledge for eligible studies. From each study we extracted the relative hazard ratio or, if not provided, all the necessary data to impute it. In cases where the duration from diagnosis to pregnancy was not reported, we extracted relevant data to estimate it.
Our electronic search strategy yielded 1623 hits pertaining to 20 potentially eligible studies involving 49,370 premenopausal breast cancer patients. Ten studies were eligible after considering HME potential bias in matching controls. Among these, 9 studies (pregnant 1089, matched-controls 13051) contained data appropriate for analysis. Overall survival was statistically higher among patients who became pregnant compared to controls: fixed effect model estimated pooled hazard ratio for death 0.51 (95% confidence interval: 0.42-0.62). No study heterogeneity was observed: Q = 10.4, P = 0.17; I(2) = 48%.
The pooled available evidence indicates that in early breast cancer patients, pregnancy that occurs at least 10 months after diagnosis does not jeopardize prognosis and may actually confer significant survival benefit.
Obstetricians & Gynecologists, Family Physicians.
After completing this CME activity, physicians should be better able to assess the effect pregnancy has on long-term survival in primary breast cancer patients under age 45; counsel patients on the safety of pregnancy after breast cancer diagnosis and treatment; and interpret how pregnancy may be associated with improved breast cancer survival.

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    • "In a subgroup analysis, they compared the outcome of women with a history of breast cancer that became pregnant to breast cancer patients who did not get pregnant and did not find a difference in survival between the groups. A separate meta-analysis also controlling for the “healthy mother effect” also found similar results with a survival that was higher among early stage breast cancer patients compared to control (hazard ratio 0.51) for pregnancy that occurred at least 10 months after the diagnosis [62]. "
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